Together We STRIDE (Strategizing Together Relevant Interventions for Diet and Exercise)

Childhood obesity rates in the Lower Yakima Valley of Washington State are alarming: 34% of
youth are obese compared to the state average of 23%. A large proportion of those children
are Hispanic; Hispanics represent 47% of the population in Yakima County and 67% of the
population in the Lower Yakima Valley. In January 2013, the investigators study received a
planning grant from the National Institute of Minority Health and Health Disparities to build
and enhance community capacity and infrastructure on childhood obesity initiatives in the
Lower Yakima Valley. This project began with the community as they expressed concern at the
high incidence of obesity among Hispanic children in the Valley. In the ensuing two and a
half years, the investigators and the community used community-based participatory research
(CBPR) to 1) form a community advisory board (CAB); 2) build a Steering Committee; 3) conduct
a comprehensive multi-level needs assessment; 4) develop and institute a pilot study; and 5)
evaluate our activities. In response to RFA MD-15-010, the investigators and the community
are now prepared to implement the intervention activities that were successful in our pilot
study into a large-scale quasi-experimental intervention trial. The multi-level interventions
will include activities at the individual level, family level, school level, and community
level. Activities include distributing comic books to students about healthy eating and
physical activity, a multi-generational level family intervention that teaches families about
healthy eating and cooking skills as well as physical activity, a variety of school events to
teach children about the food industry as well as encourage them to be physically activity at
small intervals in the classroom, and community activities to foster the idea of the
community being a healthy place for kids. The overall goal of this project is to continue to
use a CBPR approach; in so doing, test the effectiveness of the comprehensive, multi-level
intervention on reducing children's BMI z-scores, the primary endpoint. BMI z scores will be
assessed by taking height and weight measures of the children at baseline, 12 months, and 24
months. This study will recruit and enroll a total of 900 Hispanic children in grades 3rd to
5th (ages 8-12 years) who attend the four elementary schools in the intervention community
and the four elementary schools in the comparison community. Schools in both communities will
be matched based on student standardized test scores, percent of students eligible to receive
free or reduced-price lunch, and school size. Secondary outcomes include dietary patterns and
accelerometer data of physical activity in a subgroup of 180 Hispanic children. Community
participation in this project has been extraordinary and our letters of support indicate the
communities' enthusiasm for this project.

Inclusion Criteria:

- Hispanic children in grade levels 3rd-5th (ages 8-12 years) who attend elementary
schools in these two communities will be eligible to participate in the study.

Exclusion Criteria:

- Exclusion criteria include children with clinically-diagnosed dementia, terminal (<5
years) illness, major psychiatric illness, severe hearing impairment, and inability to
move, which will be assessed during the distribution of the study recruitment packets
to parents.