Tu Salud Si Cuenta Media Campaign

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.

Inclusion Criteria:

- To be included in the evaluation survey study the participants must be living in
Cameron park or Laredo TX at the time of the study, Hispanic men or women aged 20 -
75. The participants must speak Spanish.

- To be included in the observational study of physical activity the participants must
be visiting the observational study site (park, exercise facility, walking trail) at
the time of observation. No other criteria for inclusion exists for this study.

- To be included in the Randomized Behavioral Intervention, the participants must be
participants in the weight-loss challenge and 18 years or older.

Exclusion Criteria:

- Participants who will be excluded from the evaluation survey study include those who
are not Hispanic, not living in Cameron Park or Laredo TX, unable to speak Spanish
and are either older than 55 or younger than 20.

- Participants excluded from the Randomized Behavioral Intervention are those younger
than 18 and not participants of the weight loss challenge.