Manuela Ortiz (a fictitious name to protect subject confidentiality) never knew she was a diabetic and never thought she would give up her rice fried in lard for lettuce and apple salads. Mrs. Ortiz’s life changed when she joined with about 20 other members of her small community in Alamo, Texas to take part in a unique research initiative designed to turn the community into a proactive health coalition to address the severe health problems it faces.

“I knew something had to give when I went to the health fair and found out my sugar was off the charts, that I was a diabetic,” said Mr. Ortiz. “But changing old habits was hard.”

For Mrs. Ortiz and the more than a million Hispanics living in the Lower Rio Grand Valley (LRGV) of south Texas, the old habits are a diet with a lot of fat but few fruits and vegetables, and a lifestyle devoid of regular exercise. The devastating consequences are why they wanted to change. 52% are obese, 30% are diabetic, and their rates for heart disease, strokes and other consequences of their life style are three to four times the national average.

In this and many similar communities across the country, change is being led by the National Center on Minority Health and Health Disparities (NCMHD).  “This is exactly the kind of high need, low access public health situation that NCMHD is especially equipped to help address”, said Dr, Nathaniel Stinson, acting director of scientific programs at NCMHD. The agent of change in south Texas is Elena Bastida, Ph.D., a young sociologist at the University of Texas Pan American’s Center on Aging and Health. She and her colleagues designed the research initiative in collaboration with the community they wanted to study.

“We took well accepted Community Based Participatory Research protocols and adapted them to this community,” said Bastida. “Our goal was to culturally and ecologically imbed the program into the reality of people’s lives; to take principles from the clinic to the community.”

The program is called SABOR which is Spanish for flavor. It was designed to reduce the major risk factors for obesity and diabetes. Six outcomes are targeted through various delivery strategies:  1) reduction or control of BMI; 2) reduction in the consumption of animal fats and refined carbohydrates; 3) reduction in the consumption of soda and other sugared beverages; 4) increase in consumption of fiber; 5) increase in water intake and 6) increase in physical activity. 

Within these broad outcomes, Sabor targets reasonable objectives, for example, the program encourages reduction in the consumption of white flour tortillas and promotes consumption of corn tortillas. It encourages the substitution once or twice a week of Mexican rice (which is fried) with a green salad. Sabor stresses moderation in portion size and a balanced diet. Finally Sabor stresses physical activity within a family context whether it is dancing or regular family walks.

This community has few resources. It has the highest unemployment rate and lowest median annual income in Texas and more than half of the population live in so called Colonias; unfinished residential developments, outside city limits, lacking basic infrastructure, such as indoor plumbing and electricity.

Sabor began with a series of extensive focus group meetings. Data from this informed the intervention and gave the community a stake in its success. Feedback from the participants revealed dietary habits, behaviors, favorite recipes, levels of physical activity and identified modifiable behaviors, while examining contextual factors that could facilitate or impede their modification. 

The 12 week intervention consisted of a weekly two hour health education program disguised as a cooking and salsa dance class. Each session began with short presentation on the topic of the week, such as good eating habits. That is followed by an hour cooking demonstration and tasting; here socializing is stressed since they encourage each other to try different dishes.
The last 40 minutes is a Salsa dance class.

The results as shown in Table 1 indicate moderate effect for the biomedical markers but a large effect for the modifiable behaviors.

Table 1: Sabor Pilot: Selected Primary and Secondary Outcomes

One result of the intervention is that many of the participants are acting as health promotion advocates in their larger communities,” said Bastida. To help them researchers at U.T. Pan American have instituted computer classes to increase their computer and health literacy skills.

Mrs. Ortiz says she’s not only learned how to live better, but is proud she’s played a role in helping her community as well.