Tu Salud Si Cuenta Media Campaign
Condition: Obesity; Diabetes
MeSH terms: Obesity
Study type: Interventional

Summary: 
      The Tu Salud, Si Cuenta (TSSC) media campaign uses behavioral journalism, community outreach
      and environmental changes to promote physical activity and nutritional changes among
      disadvantaged Mexican-Americans living along the U.S./Mexico border. This intervention posits
      that increased physical activity and increased fruit and vegetable consumption with smaller
      portion sizes will result in a decrease in obesity prevalence and diabetes incidence in this
      population.
    

Detailed description: 
      The TSSC campaign relies on behavioral journalism which includes the use of Spanish language,
      attractive and influential role models to illustrate healthy physical activity and
      nutritional habits through television, radio, and print media, to convey healthy physical
      activity and nutritional messages to the target population. This intervention method will be
      coupled with community outreach and environmental changes in the host community to further
      promote these changes. Community outreach includes the use of local, lay community workers to
      provide information and health screenings. Environmental changes focus on creating a positive
      built environment that promotes physical activity through well-lit streets, walking trails
      and safe recreational areas and healthy nutritional behaviors through increased access to
      markets and centers where affordable produce can be purchased and nutritional knowledge on
      healthy foods preparation and use can be disseminated.

      As part of this intervention, a promoter-led community weight-loss challenge will be
      comprised of participants from the City of Brownsville's sixteen week weight-loss challenge.
      The location and site of the weigh-ins for this challenge occur at City Parks and Recreation
      facility on designated dates. Community members who select to participate in the city's
      weight loss challenge will be exposed to the Tu Salud Si Cuenta campaign. These individuals
      will have the same access to promoter-led exercise classes and nutrition education sessions,
      similar to CCHC participants. Recruited participants will also have the same access to
      information provided by promoters about health, physical activity and healthful food choices
      using motivational interviewing strategies. Participants of the weight-loss challenge are
      asked to weigh-in at least two times during the challenge and have their height, blood
      pressure and hip and waist circumference assessed.

      We are proposing to evaluate the efficacy of this weight loss challenge more stringently and
      answer two important questions. The firs is what timing and types of support via text
      messages is appropriate for supporting weight loss in a community based weight loss
      challenge? The second question is what is the long term weight loss maintenance of
      participants in the 16 week weight loss challenge?

      To answer the first question we will recruit and enroll Individuals who participate in the
      weight-loss challenge in a randomized behavioral intervention trial examining exposure to
      text messages and weight loss outcomes. Prior research has shown that making a change in
      behavior and weight loss can be dependent upon the type of messages provided to an individual
      (Rothman AJ, Salovey P, Antone C, et al, 1993; Patrick K, Raab F, Adams MA, 2009). We will
      test whether different content delivered via text messages impacts weight loss outcomes.

      For this study, we will enroll up to 200 weight-loss challenge participants to receive text
      messages on their personal mobile phones throughout the 16 week challenge. Consent and
      enrollment in the trial will take place at registration for the weight-loss community
      challenge in the language of their choice. Recruited participants will be randomly assigned
      to a group after consenting to the study and the timing and content of text messages will
      vary according to group assignment (Groups A - D).

      Group A will receive weekly reminders for upcoming weigh-in events. Group B will receive the
      same weekly reminders but will also receive one-way messages every two weeks providing the
      participant motivational messages/topics and weight loss health tips. Group C will receive
      the same text messages as Group B but will also receive weekly prompts to self-monitor weight
      status. The final group, Group D will receive the same text messages as Group C plus daily
      prompts that will act as a guide for the participant to monitor his or her behavior changes.

      Participants will be asked to complete a short questionnaire about fruit and vegetable
      consumption, physical activity and social support for weight loss at the initial and final
      weigh in. (See attachment) We will also conduct a brief qualitative interview with 10 people
      per group about their opinions regarding the texting content and frequency. Finally, they
      will also consent for the research team to access their weight loss measures at initial and
      final weigh in and use in the research project to assess weight status changes. For those
      participants who do not attend final weigh in, the research team will contact the participant
      to obtain a final weight. At the time of enrollment into the behavioral intervention trial,
      participants will receive a $5 incentive. They will also receive an additional $10 incentive
      at the final weigh-in with their completed measures.

      To answer the second research question of what is the long term weight loss maintenance of
      participants in the 16 week weight loss challenge we are proposing a follow-up feasibility
      study. We will enroll and consent Biggest Loser Challenge participants in a study that will
      follow them beyond the 16 week challenge one time at three months. At the registration of the
      weight-loss challenge participants will be consented in the language of their choice.

      This study will enroll up to 150 consenting participants. Participants will have their
      height, weight, blood pressure and hip and waist circumference measures at initial, final
      weigh-in and 3 months post using the same protocols as all other Biggest Loser Challenge
      Participants. Weight will be taken using a calibrated Tanita scale and hip and waist
      circumference will be measured with a tape measure following protocols used in our CCHC
      (described below). Trained individual will take all measurements. A special number will be
      used to identify the participant in the study and only the investigator will know their name.
      These study participants however will also complete a short questionnaire about fruit and
      vegetable consumption, physical activity and social support for weight loss. (see attachment-
      this is the same instrument being used in the behavioral intervention trial examining text
      messaging)

      For Biggest Loser Challenge participants who do not complete the final weigh-in measure but
      who have enrolled in this study, staff will contact the participants and schedule a time and
      location to obtain the final weigh in measures. The measures will need to be obtained within
      three weeks of the scheduled final weigh in challenge date. For the three month follow-up
      contact again we will contact the participant and schedule a time and location to obtain
      follow-up measures. Following all measurements (during the challenge and follow-up period),
      participants will have the opportunity to discuss their results with a community health
      worker trained to discuss these issues.

      Individuals who complete the additional measures beyond the challenge period will receive
      incentives for their time associated with participating in the research study. Participants
      will receive an item valued at $5.00 for completing the three month post measurements.
    

Intervention name(s): TSSC; TSSC Randomized Behavioral Intervention for weight loss
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The intervention community is exposed to the media messages of the TSSC campaign. Residents of this community also receive the lay health worker visits as well as benefit from the positive built environment changes.; We will enroll up to 200 weight-loss challenge participants to receive text messages on personal mobile phones throughout the challenge. Consent and enrollment in the trial will take place at registration for the weight-loss community challenge in the language of their choice. Recruited participants will be randomly assigned to a group after consenting to the study and the timing and content of text messages will vary according to group assignment (Groups A - D).
Group A will receive weekly reminders for upcoming weigh-in events. Group B will receive the same weekly reminders but will also receive one-way messages every two weeks providing the participant motivational messages/topics and weight loss health tips. Group C will receive the same text messages as Group B but will also receive weekly prompts to self-monitor weight status. Group D will receive the same text messages as Group C plus daily prompts that will act as a guide for the participant to monitor behavior changes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Behavioral Journalism; Mexican-Americans; Obesity; Nutrition; Physical Activity; Border Health