Creative Education
2012. Vol.3, No.6, 721-728
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.36107
Copyright © 2012 SciR e s . 721
Effectiveness of Salsa, Sabor y Salud Program and the Impact of a
Salsa, Sabor y Salud Maintenance Program on Outcome Measures
Stephanie R. Fox, Virginia A. Bennett
Central Washington University, Ellensburg, USA
Received August 2nd, 2012; r evised September 5th, 2012; accepted September 20th, 2012
Chronic diseases in the United States are disproportionately higher in the Hispanic population. A signifi-
cant factor in the high prevalence of chronic disease in Hispanics may be their overweight or obese status.
Intervention strategies are imperative if this trend is to be reversed. Researchers have found that culturally
sensitive health programs for the Hispanic population have a higher success rate, but very few of these
programs are available. One culturally sensitive health program in particular that has had a lot of positive
feedback is the Salsa, Sabor y Salud (SSS) program. Although research has shown that SSS is a success-
ful program, SSS has not had a maintenance program to date. Health maintenance programs are essential
for people to retain information and to continue the practice of skills needed to live healthy lifestyles. Re-
search has shown that health program participants will revert to their old behaviors within five years time.
Recent studies suggest that these reversions can be avoided with a health maintenance program. The ob-
jective of this pilot study was to evaluate the effectiveness of the SSS program and the impact of a Salsa,
Sabor y Salud Maintenance (SSSM) program on outcome measures. In both the SSS and SSSM program
the participants increased nutrient dense food consumption and chose lower fat options for food. The par-
ticipants in both programs had a significant increase in overall knowledge of nutritious eating habits and
the benefits of physical activity as well. With the addition of the SSSM program participants reported an
increase in fruit and vegetable intake, and food label reading when shopping, which was not seen in the
SSS program alone. This study further confirms the SSS program improves healthy lifestyle choices
based on measured outcomes, but it also provides evidence that the SSSM program significantly enhances
positive health outcomes.
Keywords: Cultural Competency; Salsa Sabor y Salud; Maintenance Program
Introduction
In the past few decades there has been a major increase in the
number of overweight and obese i ndividuals in the United St at es
(USA) (Wang, Beydoun, Liang, Caballero, & Kumany ika, 2008).
According to data from the National Health and Nutrition Ex-
amination Survey (NHANES) in 2007-2008 the prevalence of
overweight and obese adults was 68% and 33.8% respectively.
Within the Hispanic population in the USA 77.9% were over-
weight and 38.7% were obese (Flegal, Carroll, Curtin, & Ogden,
2010).
Childhood obesity is also a growing problem in the USA. In
2008, 34% children and adolescents of all ethnic groups were
considered overweight with a body mass index (BMI) above
the 85th percentile and 17% were obese with a BMI above the
95th percentile (Centrella-Nigro, 2009). BMI is an estimation
of body fat based on the calculation using the height and weight
of a person (Bennett & Sundsmo-Switzer, 2011). There is an
increased risk for Hispanic children and adolescents to become
overweight or obese (Centrella-Nigro, 2009). The NHANES 2008
survey revealed that 38.2% of Hispanic children and adoles-
cents were overweight and 20.9% were considered obese. This
is a profound concern because the majority of overweight and
obese chi ldren and a dolescen ts will co ntinue to m aintain t h is status
later in life, which can lead to life-threatening chronic diseases
(Ogden, Carroll, Curtin, Lamb, & Flegal, 2010).
Chronic disea ses in the USA occur at disproportiona tely hi gh er
rates in the Hispanic population (Lopez-Quintero, Berry, & Neu-
mark, 2009). There are numerous Hispanic immigrants who c om e
to the USA with healthy diets and levels of high physical activ-
ity, but there is evidence that through acculturation there is a
negative impact on their nutrition and exercise (Ayala, Baquero,
& Klinger, 2008). Health care providers have had difficulty
conveying the importance of nutrition and physical activity to
the Hispanic population (Lopez-Quintero et al., 2009). Researchers
have found that if the health information is presented to His-
panic participants in a culturally sensitive manner they will
have a higher success rate in their health programs, such as
diabetes education programs (Brown, Kouzekanani, Garcia, &
Hanis, 2002; Gilmer, Philis-Tsimikas, & Walker, 2005; Gordon,
2004). For the current pilot intervention, in Ellensburg WA, US A,
was selected because there are currently no culturally specific
healthy lifestyle classes offered to this population and 53% of
Hispanics in Kittitas County are at or below 184% of the fed-
eral poverty level, making them at risk for poor he alth outcome s
(Wilkerson, 2008).
With the high rate of Hispanic overweight or obesity, it is
clear that there is a need for an effective and culturally appro-
priate healthy lifestyle program. One program in particular that
has had a lot of positive feedback is the culturally sensitive
Hispanic healthy lifestyle program called Salsa, Sabor y Salud
(SSS) that was created by National Latino Children’s Institute
(Ayala et al., 2008). There has been one study that measured

S. R. FOX, V. A. BENNETT
objective outcomes of this program and found statistically sig-
nificant positive health indicators upon completion, which in-
cluded dietary changes, weight, body mass index, waist circum-
ference, blood pressure, heart rate, reported physical activity,
and healthy lifestyle scores (Bennett et al., 2011). Health main-
tenance programs are essential for people to retain information
and to continue the practice of skills needed to live healthy
lifestyles (Wilfley et al., 2007; Carels et al., 2008; Lean, 2011).
Many studies suggest that participants will revert back to their
old behaviors within five years time, but it can be avoided with
a health maintenance program ((Anderson et al., 2001; Franz et
al., 2007; Harvey-Berino, Pintauro, Buzzell, DiGiulio, Gold,
Moldovan, & Ramirez, 2002; Collins et al., 2010). To date, th er e
has not been a maintenance component available for the Salsa,
Sabor y Salud program.
The purpose of this pilot research was to determine the effec-
tiveness of the SSS program and the impact of a Salsa, Sabor y
Salud Maintenance (SSSM) progra m on outcome mea sure s.
Participants and Methods
Participants
The SSS healthy lifestyles program was offered to Hispanic
families living in Kittitas County during the winter of 2011, fol-
lowed by the SSSM program that was offere d in the of summer
2011. Participation in the winter program was open to Hispan-
ics living in the immediate area. Participants were eligible to
join the SSSM if they had participate d in the SSS program held
in the winter of 2011 and attended 3 or more sessions. Demo-
graphics were assessed using the Washington State University
Demographics Questionnaire (Blackburn, Townsend, Kaiser,
Martin, West, Turner, & Joy, 2006), which helped determine if
the participants were of Hispanic ethnicity and the race they
considered themselves to be. It qualified age as 18 - 59 or 60
plus. They were also asked if they were receiving government
assistance. This question helped identify the socioeconomic
status of the participants in the study.
The SSS and SSSM programs seek to improve the health of
the whole family due to the close family relationships in the
Hispanic culture, but for this study, only data was collected for
the adults. The programs were held at a catholic church imme-
diately after the Spanish mass. This study was open to either
sex and the only exclusions to pa rticipation were obvious ph ysi -
cal or mental limitations that impaired the subject to participate
in the physical or mental aspects of the program. This study
was conducted in Ellensburg because, based on our research of
the surrounding area, there were currently no culturally specific
healthy lifestyle classes offered to this population.
Recruitment for the SSS and SSSM program were done with
radio announcements, announcements made at the church, and
flyers about the program one month prior to the classes starting.
Those who were interested were enrolled. When recruiting for
the SSSM program participants in the winter SSS program were
notified and announcements were made at the church.
There were a total of 17 participants enrolled for the winter
SSS program. From this SSS program, 15 participants were
enrolled in the summer SSSM program. Participants who had
missing data or didn’t meet the attendance standards (three or
more sessions during the winter SSS program and two or more
sessions during the summer SSSM program) were not included
in the study.
Study Desi gn
This study was approved by the Central Washington Univer-
sity Human Subjects Review Committee. Participants were gi ven
materials in either Spanish or English based on their preference.
A written consent and explanation of the study was given to all
adult participants. If an adult did not want to be part of the re-
search study, they were still able to participate in the SSS and
SSSM programs.
This was a quasi experimental design, in which the partici-
pant volunteered to be a part of the study. The same pre- and
post-testing was used for both the SSS and SSSM program. Pre-
and post-testing was used to assess changes in nutrition and ph y s i -
cal activity knowledge, and dietary habits. All participants who
were included in the data analysis pilot study had to complete
both the pre- and post-measurements.
The SSS program is a culturally sensitive program that was
created for educating Hispanic families on how to make healthy
lifestyle choices. It was designed to include eight sessions at 90
minutes, but is a flexible program that can be adjusted to meet
the needs of the organization that is coordinating it. There are
different themes for each session that are intended to educate
regarding the importance of nutrition and physical activity.
A novel maintenance program designed to complement the
SSS program was developed for this pilot study. The curricu-
lum was set up similarly to the actual SSS program. It included
four 90 minute sessions and can be changed to fit the needs of
any organization. It consists of four new sessions with cultur-
ally sensitive themes that educates the families on nutrition and
physical activity, but all the lessons are more advanced versions
of the previous learning objectives in the SSS program.
Procedure
CWU undergraduate nutrition students taught the sessions in
Spanish. The CWU undergraduate nutrition stude nts chosen were
bilingual, bicultural, and trained by the national SSS program
trainers. At least one registered dietitian and one graduate nutri-
tion student from CWU attended every session for both the SSS
and SSSM programs to help with any questions related to nutri-
tion and physical activity. All pre- and post-measurements were
administered and described by the CWU undergraduate nutri-
tion students, a registered dietitian, and/or a graduate nutrition
student from CWU.
Participants were assigned a numerical identifier when they
filled out all pre- and post-forms. A list of participants with
matching coded identifier was kept in a secure cabinet apart
from the data and used only by the principal investigators. Par-
ticipants were given their ID numbers as part of their docu-
mentation and asked to use them in subsequent data collection.
In this manner, no names were linked to data. The list with
names linking coded identifiers was destroyed upon completion
of data collection.
Both photographs and videos were taken of classroom activi-
ties, but limited to those participants who agreed to being pho-
tographed or video recorded on a signed consent form. While
these photos could identify the participants, personal data was
not connected to the photos. The photographs and/or video were
archived for future use in an annual presentation to dietitians
describing the educational program and its benefits as well as
part of the graduate student’s oral defense. These photos are stored
in the principal investigator’s locked office inside a locked file
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S. R. FOX, V. A. BENNETT
cabinet, with all data collect coded with numbers instead of par-
ticipants names.
Due to time constraints, the winter SSS program was modi-
fied as to the number of sessions and the amount of time pre-
sented. As mentioned before, the curriculum was designed for
eight sessions at 90 minutes, but adjustments can be made to
the program to adhere to the group’s time frames. Six weekly
sessions for the SSS program were offered in the winter con-
sisting of 120 minutes each. For the first 75 minutes there were
lectures and activities. In the remaining 45 minutes there was
SSS physical activities and review of the session. At the first
session there was a debriefing about the program and the study.
During this time written consents were explained. The pre-mea-
surements were taken in session one during the first 30 minutes
and in session 6 the post-measurements were taken the last 30
minutes. For each session the learning objectives were clearly
defined and reinforced throughout the six week program. At the
last session there was a review of the whole program and par-
ticipants were able to sign up for the SSSM program.
For the SSSM program there were four weekly sessions that
were 120 minutes each. The SSSM had the same structure as t he
six week SSS winter program, but included different themed
activities. For the first 75 minutes there were lecture and activi-
ties. In the remaining 45 minutes there were SSS physical ac-
tivities and review of the session. At the first session there was
a debriefing about the program and the study. The pre-measu-
rements were taken in session one during the first 30 minutes
and in session four the post-measurements were taken the last
30 minutes. For each session the learning objectives were c le a rly
defined and reinforced throughout the four week program. At
the last session there was a review of the whole program and
participants were given a SSSM program tips packet to help
them maintain their nutrition and physical activity knowledge
after the program completion.
Measurements
Pre- and post-testing was used to assess healthy lifestyle cha-
nges in nutrition and phy sical activity knowledge with two s hort
questionnaires. One of the questionnaires, Salsa, Sabor y Salud
Healthy Lifestyle Test, obtained from the National Latino Chil-
dren’s Institute (Bennett et al., 2011; Barrera et al., 2002), was
used to assess knowledge, beliefs, and attitudes surrounding nu-
trition and physical activity. The other questionnaire, Washing-
ton State University (WSU) Food Behavior Checklist (Black-
burn et al., 2006; Murphy, Kaiser, Townsend, & Allen, 2001;
Townsend, Kaiser, Allen, Joy, & Murphy , 2003; Townsend, Sy l -
va, Martin, Metz, & Wooten-Swanson, 2008), is a multiple choice
questionnaire assessing food group preference, food frequency,
food label knowledge, food security, and physical activity.
As done in the previous SSS study by Bennett et al., dietary
habits were also recorded at pre- and post-interventions, and
assessed with a 24-hour diet recall form (2011). The 24-hour
diet recall form included all foods and beve rages consumed du r-
ing the 24 hours proceeding the day of the interview from mid-
night to midnight. Overall foo d consumption was a nalyzed b a se d
on the amount of servings from MyPlat e.gov website. Fo od groups
were based on the SSS healthy plate model, a culturally sensi-
tive visual that depicts all of the food groups. The food groups
include a vegetable group; fruit group; grain group; legumes,
nuts, meat, fish, poultry, and eggs group; dairy group; and a s ep a-
rate category of f at , oils, and sweets.
Statistical Analysis
There were a total of six ways the SSS program and SSSM
program were examined which include:
 Demographics.
 Attendance.
 Knowledge, beliefs, and attitudes surrounding nutrition and
physical activity via the Salsa, Sabor y Salud.
 Eating behaviors and food security via the WSU Food Be-
havior Checklist.
 24 Hour Recall.
 Program Satisfaction and Recommendation.
The pre- and post-testing included the mean likert scale re-
sults of the Salsa, Sabor y Salud Healthy Lifestyle Test and
WSU Food Behavior Checklist. For the WSU Food Behavior
Checklist there were three different likert scales that described
results which included: 1 represented never to 4 represented
always when referring to how often they do something; 1 rep-
resented don’t drink juice to 4 represented 16oz or more when
referring to the amount of juice they drink daily, and 1 repre-
senting never to 5 representing 3 cups or more when referring
to fruit and vegetable portions. For the Salsa, Sabor y Salud
Healthy Lifestyle Test, and the program satisfaction and rec-
ommend a t i on an a lysi s th e l i k ert s c a l e w a s: 1 r e pres e nte d strongly
disagrees to 5 represented strongly agree.
Mean scores on these items were compared using dependent
t test. The mean 24 hours recall food group servings were all
compared with dependent t test as well. For WSU Food Be-
havior Checklist, Salsa, Sabor y Salud Healthy Lifestyle Test,
and 24 hour recall the following measurements were compared:
 Pre- and Post-SSS Program.
 Between the Programs.
 Pre- and Post-SSSM Program.
 Both Programs Combined.
Data were analyzed using Microsoft Excel Data Analysis
(version 2007). Statistical significance was set at p < .05.
Results
Demographics
All participants were Hispanic and reported their race as white.
Both women (75%) and men (25%) participated in the adult
group with an age range between 18 - 59 years old. A total of
75% of the participants reported receiving government assis-
tance. The total included in the analysis were: eight in the SSS
program analysis, five in the analysis between programs, five in
the analysis of the SSSM program, seven in the analysis of com-
bined programs, and seven in the program satisfaction and rec-
ommendation analysis (Figure 1).
Attendance
The SSS sessions participants had an average attendance of
72.92% or 4.375 out of the 6 sessions. For the SSSM sessions
the participants’ average attendance was 75% or 3 out of 4 of
the sessions. With SSS and SSSM combined, the participants’
average attendance was 73.75% or 7.375 out of 10 of the ses-
sions.
WSU Food Behavior Checklist
Salsa, Sabor y Salud Program: There was a significant in-
crease in participant’s consumption of more than 1 type of fruit
Copyright © 2012 SciRe s . 723

S. R. FOX, V. A. BENNETT
Copyright © 2012 SciRe s .
724
Combined Programs: When comparing the pre-SSS to post-
SSSM, there was an increase in the use of fruits and vegetables
as a snack from 2.14 fruit snacks per day/week to 2.86 per
day/week (p < .047). Another significant result was the increase
in use of low fat or non-fat dairy products 2.29 cu ps/ se r vi ng s/ day
to 3.43 cups/servings/day (p < .047). There was an increase in
having more than 1 type of fruit per day from 1.71 to 2.86 (p
< .030). Also, there was a trend in having more than one type of
vegetable per day from 2.00 types to 2.86 types of vegetables
per day (p < .078). Label reading also improved substantially in
the group, increasing from 1.29 labels read on average to 2.57
(p < .022). There was a significant increase in servings of vege-
table and fruit portions, from 2.14 to 3.14 for vegetables and
from 2.14 to 3.29 for fruits (p < .038 and p < .015, respectively)
(see Table 1).
and vegetables per day. Mean likert scale results increased from
1.63 to 2.50 for fruit and from 2.25 to 2.75 for vegetables (p
< .021 and p < .033, respectively). Use of low fat or non-fat
dairy products significantly increased fro m 2.38 to 3.38 ( p < .033)
(Table 1).
Salsa, Sabor y Salud Maintenance Program: There was a de-
crease in sugary drink consu mption from 2.40 to 1.60 (p < .016).
There was a strong trend in reading food labels when shopping
with an increase in from 1.60 to 3.00 (p < .052). Also, there was
a significant decrease from 3.00 to 2.00 for 100% juice con-
sumption (p < .034) (Table 1).
Salsa, Sabor y Salud Healthy Lifestyle Test
Salsa, Sabor y Salud Program: There was an increase from
4.25 to 4.88 in knowing that eating healthy foods increases en-
ergy levels (p < .049). There was strong trend in the particip ants
knowledge of what food groups should be included in daily m eals ,
with the mean likert scale results increasing from 3.25 to 4.38
(p < .051) (Table 2).
Salsa, Sabor y Salud Maintenance Program: There was no
significant difference found for the SSS Healthy Lifestyle Test
between the SSSM pre-testing and SSSM post-testing meas-
urements taken (Table 2).
Combined Programs: With the two programs combined, there
was a significant increase in consumption of healthy foods in
general, with the mean likert scale results increasing from 3.71
to 4.57 (p < .045). Healthy foods in general were defined as low
fat, high fiber, low sugar, and high mineral and/or vitamin con-
tent. Also, the results illustrated a trend in importance to bal-
ance the type and amount of food eaten with daily level of physical
activity, with the mean likert scale results increasing from 3.57
to 4.71 (p < .084) (see Table 2).
Figure 1.
Participants included in the study.
Table 1.
Pre-intervention a nd post-intervention for WSU Food Behavio r Checklist for an average day.
SSS Program SSSM Program Combined Programs
Variable n
Pre-
Intervention Post- Intervention p ValuenPre- Intervention Post- Intervention p ValuenPre- SSS Post- SSSM p Value
Intake of Sweetened
Drinksa 8 2 .13 ± .84 2.50 ± .54 .197 52.40 ± .551.60 ± .55.016* 71.86 ± .38 1.57 ± .54.172
Fruits and Vegetables as
a Snacka 8 2.25 ± .71 2.38 ± .74 .685 52.80 ± .843.20 ± .84.374 72.14 ± .69 2.86 ± 1.07.047*
Intake of 100% Fruit
Juiceb 8 3.00 ± .93 2.75 ± .89 .170 53.00 ± 1.002.00 ± .71.034* 72.71 ± 1.25 2.00 ± .58.140
Intake of Vege tables
Portionsc 8 2.38 ± .74 2.8 8± .84 .275 52.60 ± .553.20 ± .84.208 72.14 ± .69 3.14 ± .90.038*
Intake of Fruit Portionsc 8 2.38 ± .74 3.00 ± .7 7 .180 52.80 ± .843.40 ± .55.208 72.14 ± .69 3.29 ± .76.015*
1 or More Types of
Fruita 8 1.63 ± .74 2.50 ± .54 .021*52.80 ± .842.80 ± .841.000 71.71 ± .76 2.86 ± .90.030*
1 or More Types of
Vegetablesa 8 2.25 ± .4 6 2.75 ± .46 .033*52.20 ± .4 52.80 ± .84.208 72.00 ± .78 2.86 ± .90.078+
Low or Non-F at Dairya 8 2.38 ± .74 3.38 ± 1.19 .033*53.00 ± 1.003.40 ± .55.477 72.29 ± .76 3.43 ± .54.005*
Reading Fo od Labels a 8 1.38 ± .52 2.00 ± 1.07 .180 51.60 ± .553.00 ± 1.23.051+ 71.29 ± .76 2.57 ± 1.27.022*
Note: aLikert scale: 1 = never, 2 = yes, sometimes, 3 = yes, often, & 4 = always; bLikert scale: 1 = Don’t D rink Juice, 2 = 8 oz, 3 = 12 oz, & 4 = 16 oz o r more; cLikert scale:
1 = None, 2 = 1/2 cup, 3 = 1 cup, 4 = 2 cups, & 5 = 3 cups or more; *Significance p < .05; +Trend p < .1.

S. R. FOX, V. A. BENNETT
Table 2.
Pre-intervention and post-intervention for Salsa, Sabo r y Salud Testing.
SSS Program SSSM Program Combined Programs
Variable n Pre-
Intervention Post- Intervention p Valuen Pre- Intervention Post- Intervention p Valuen Pre- SSS Post- SSSM p Value
All Food Groups
Should Be in
ily Meala Das 8 3.25 ± .89 4.38 ± .92 .051+ 5 3 .60 ± .894.20 ± 1. 10.374 7 3.86 ± 1.22 4.29 ± .95.200
Eating Healthy
Foods Increase
Energya 8 4.25 ± .7 1 4.88 ± .35 .049* 5 5.00 ± .005.00 ± .00 1.000 7 4.71 ± .49 4.71 ± .76
1.000
I Try to Eat More
Healthy Fo ods a 8 3.88 ± .99 4.25 ± .89 .504 5 4.20 ± 1.104.60 ± .8 9 .374 7 3.71 ± .95 4.57 ± .79.045*
Balance Food
Amounts with
Exercisea 8 3 .75 ± 1.044.50 ± .93 .197 5 5.00 ± .005.00 ± .00 1.000 7 3.57 ± 1.13 4.71 ± .76.084+
Note: aLikert scale: 1 = strongly disagree, 3 = agree, & 5 = strongly agree; *Significance p < . 05; +Trend p < .1.
24 Hours Recall
Salsa, Sabor y Salud Program: There was an increase in se rv-
ings of fruit with, the average number of servings per day in-
creasing from .88 to 1.50 (p < .038). Participants’ results dem-
onstrated a trend in increasing servings of whole grains, with
the average number of servings increasing from 4.48 to 6.75 (p
< .061) (Table 3).
Salsa, Sabor y Salud Maintenance Program: There was a de-
crease in average number of servings from 6.40 to 2.80 for the
intake of whole grains (p < .028). Also, there was a signifi-
cantly reduction in fat, sweets, or oils servings from 2.75 to
1.20 servings per day (p < .001). There was a decrease in the
intake of the food group that included legumes, nuts, meat, fish,
poultry, or eggs servings with the average number of servings
decreasing from 3.80 to 1.90 (p < .025). A trend was observed
in a decrease in consumption of dairy products, with the aver-
age number of servings decreasing from 1.60 to .60 (p < .085)
(Table 3).
Combined Programs: There was no significant difference found
for participants in the 24 hour recall data between the SSS pre-
testing and SSSM post-testing measurements taken (see Table 3).
Between Programs
There was no significant difference found for participants in
all SSS post-testing and SSSM pre-testing measurements ta ken,
suggesting that participants maintained the changes made dur-
ing the SSS program.
Program Satisfaction and Recommendation
At the end of the SSS program 98% of the participants re-
ported being satisfied with this program and 98% would rec-
ommend this program to friends and family. In contrast, at end
of the SSSM program all 100% participants reported being sat is-
fied with the program and 100% would recommend this pro-
gram to friends and family.
Discussion
With the Hispanic population’s rapid increase in morbidity
and mortality rates from chronic disease it is clear there is a
need for a healthy lifestyle program (Caballero et al., 2007).
Also, researchers have found that health programs presented in
a culturally sensitive manner to the Hispanic population will
have a higher success rate (Brown et al., 2002; Gilmer et al.,
2005; Gordon, 2004). Another factor is the importance of a ma i n-
tenance component, which is crucial for participants to retain
information and to continue to practice he skills needed to live
healthy lifestyles (Wilfley et al., 2007; Carels et a l., 2008; Lea n,
2011).
The SSS and SSSM program demonstrate how to overcome
the majority of the barriers for the Hispanic population to have
a healthy lifestyle. This pilot research evaluated the effective-
ness of the SSS program, the SSSM program, and the progra ms
combined on health outcome measures. The programs individu-
ally and combined revealed many significantly positive health
indicator results. Additionally, participant satisfaction was ex-
ceptionally high for both programs.
This study further confirms that the SSS program improves
healthy lifestyle choices based on measured outcomes. A pre-
vious study by Bennett et al regarding the SSS program found
that there was an increase in servings of fruit and vegetables,
but the increase was not significantly significant (2011 ). In co m-
paring findings between this study and a previous one (Bennett
et al., 2011), both studies had a significant increase in partici-
pants’ knowledge that eating healthy foods increases energy.
There was a significant decrease in milk servings in general for
the previous study, but with this study there was an increase in
lower fat milk products. The reduction in milk products in the
previous study may be due to less of an emphasis on lower fat
milk product alternatives. There were no differences in weight
and BMI during this study compared to the previous SSS pro-
gram study, which may be due to the shorter length of time (6
weeks vs 8 weeks). Comparing this study to the study done by
Bennett et al, there was an opposite effect on the grains. During
this study there was an increase during the SSS program and in
the Bennett et al study there was a decrease in grain serving
consumption (2011). This is in agreement with the nutritional
trend that the carbohydrate intake for Hispanics from the 1980s
to the 2000s has increased (Fryar, Wright, Eberhardt, & Dye,
2012).
Scores on the SSS program post-testing and the SSSM pro-
gram pre-testing were compared to determine if there were any
changes between the end of the standard program and the start
up of the maintenance program. There were no differences, w hi ch
Copyright © 2012 SciRe s . 725

S. R. FOX, V. A. BENNETT
Table 3.
Pre-intervention and pos t -intervention for th e 2 4 H o u rs Recall food group servings.
SSS Program SSSM Program Combined Programs
Variable n
Pre-
Intervention Post- Intervention p ValuenPre- Intervention Post- Intervention p ValuenPre- SSS Post- SSSM p Value
Vegetables 8 2.34 ± 1.51 2.66 ± 3.02 .774 51.40 ± 1.953.15 ± 1.27.249 72.29 ± 1.78 3.39 ± 1.12.129
Fruit 8 .88 ± 1.25 1.50 ± 1.63 .038* 51.25 ± 2.541.25 ± 1.751.000 7.57 ± .98 2.04 ± 1.96.203
Grains 8 4.44 ± 2.87 6.75 ± 4.71 .061+ 56.40 ± 4.042.80 ± 1. 79.029* 74.43 ± 2.95 3.71 ± 2.22.537
Dairy 8 .94 ± . 8 6 1.19 ± .95 .663 51.60 ± .95 .60 ± .55 .086+ 7.57 ± .79 .71 ± .76 . 805
Legumes, Nuts, Meat,
Poultry, Fish, Eggs 8 3.47 ± 1.66 3.22 ± 3.18 .861 53.80 ± .84 1.90 ± .95 .004* 72.71 ± 1.89 2.21 ± 1.00.342
Fats, Sweets, Oils 8 1.78 ± 1.54 2.59 ± 1.04 .264 52.75 ± 1.121.20 ± .84 .002* 71.86 ± 1.57 .8 6 ± .90 .197
Note: *Significance p < .05; +Trend p < .1.
we assume to be due to the participants retaining the informa-
tion given during the SSS program. Also, this further confirms
that the SSSM program should focus on advanced concepts of
nutrition and physical activity, given that participants appear to
have learned the more basic SSS information.
There is strong evidence that the SSSM program has signifi-
cant positive health outcome indicators as well. All the infor-
mation from the SSS program was provided in the SSSM pro-
gram in a more advanced manner. The SSS progra m result s w e r e
closely examined to determine which areas to focus on for the
SSSM program and the results of the maintenance program
indicate that the objectives were met. There was a decrease in
sugary drink consumption that can be attributed to the emphasis
of drinking more water, especially during the summer months,
which was when the program was held. The decrease in the
100% juice consumption may be due to the emphasis of eating
more fruit rather than drinking fruit juice during the sessions.
There was a trend in increased food label reading while shop-
ping. Food label reading was reinforced in this program and all
participants were given the opportunity to show that they knew
how to read food labels in Spanish as well as English, even if
they were only fluent in Spanish. This was able to be achieved
because an English and a Spanish food label of the same prod-
uct were shown side by side on a handout to show what the
English words mean and it was given to the participants to use
as a guide with all future grocery shopping.
Due to the increased grain intake during the SSS program,
there was session content that helped participants better under-
stand a serving size of grains, best types of grains, and approxi-
mately how many serving they should have a day. This increase
in specificity may have led to the decrease in servings of grains
during this SSSM program, which was a positive result because
participants were consuming more than the recommended serv-
ings for grains in the SSS program. Both the SSS and SSSM
sessions were further tested to see if there was a difference in
whole grain and refined gain product consumption, but no sig-
nificant difference was found. The SSSM sessions all focused
on choosing lower fat, sugar, and oil options because in both
the SSS programs studies done previously there was not a sig-
nificant decrease, which is a contributing factor in the high obe-
sity rate of the Hispanic population (Flegal et al., 2010).
Surprisingly, there was a decrease in the food group that in-
cluded legumes, nuts, meat, fish, poultry, and eggs servings.
This was additionally analyzed to determine if one type of pro-
tein group was responsible for the decrease in the servings. No
significant difference was determined. There was a trend in
decreasing dairy products, which may be due to the emphasize
in drinking more water and increasing fruit and vegetable in-
take during this program.
It is important to understand the difference that the combined
programs had from the pre-testing of the SSS program to the
post-testing of the SSSM program. There was an increase in the
use of fruits and vegetables as a snack, which was not shown in
either program alone. After both programs, there was an in-
crease in the use of low fat or non-fat dairy products and daily
fruit portions. Also, there was an increase in types of fruit con-
sumed per day and the trend in more than one type of vegetable
consumed per day with the programs combined. Although these
health behaviors were shown to increase significantly during
the SSS program and not during the SSSM program, it is as-
sumed that participants were encouraged to maintain them through
the maintenance program which resulted in a significant change
when program data was combined.
There was no increase in the use of reading food labels when
shopping with the SSS program but with the SSSM program
there was a trend in this measured outcome. From the begin-
ning of the SSS program to the end of the SSSM program it is
clear that there was a statistically significant increase in food
label reading when shopping. In both programs individually there
was no increase in servings of vegetable portions, but with the
combined programs there was an increase. Other results that w er e
only found in the combined programs were that the participants
were eating more healthy foods in general, and there was a tre nd
that participants understood that it is importance to balance the
type and amount of food they ate with physical activity.
The success of the SSS program and SSSM program can be
attributed to the key concepts that are reinforced in a culturally
sensitive manner throughout all the sessions. Every sessio n rein -
forces four key messages: eat foods from each of the food groups
every day; be sensible about porti ons; be physically active e very
Copyright © 2012 SciRe s .
726

S. R. FOX, V. A. BENNETT
day; and take small steps for success. Also, each session pro-
vides experiences and tips that promote healthier food choices
compatible with the lifestyle and cuisine of Hispanic families.
The programs involve the whole family, which is important for
cultural sensitivity as well. There are fun physical activities for
the entire family and discussions about the concept of “energy
balance.” Finally, at every session there are cultural heritage
and lifestyle connections to wellness (Gordon, 2004).
Conclusion
Although research has shown that SSS is a successful pro-
gram, no health maintenance program was available to support
the skills and behaviors established during the SSS program.
Health maintenance programs are essential for people to retain
information and to continue the practice of skills needed to live
healthy lifestyles. Research has shown that health program par-
ticipants will revert to their old behaviors within five years time.
Many studies suggest that these reversions can be avoided with
a health maintenance program (Anderson et al., 2001; Franz et
al., 2007; Harvey-Berino, Pintauro, Buzzell, DiGiulio, Gold,
Moldovan, & Ramirez, 2002; Collins et al., 2010).
The SSS and the SSSM progra m have both shown to be be ne -
ficial culturally sensitive healthy lifestyle programs. These are
flexible programs that can be adjusted to meet the needs of an
organization. In both the SSS and the SSSM programs, the
participants increased nutrient dense food consumption and chose
lower fat options for food. Furthermore, the participants had an
increased overall knowledge of nutritious eating habits and an
increased awareness about phy sical activity benefits in both p ro-
grams as well. With the addition of the SSSM program partici-
pants reported a significant increase in fruit and vegetable in-
take, and food label reading when shopping, which was not
seen in the SSS program alone. The re were some limitations to
this pilot study which include a small sample size, limited vol-
unteers to teach the program, time conflicts with church activi-
ties, and the classes not being offered throughout the year.
This research evaluated the effectiveness of SSS program
and the impact of a SSSM program on outcome measures. T his
pilot study further confirms the SSS program improves healthy
lifestyle choices based on measured outcomes, but it also pre-
sents new evidence that the results in the SSSM program pro-
vides additional positive health outcomes.
Acknowledgements
The authors would like to thank the staff of St. Andrew’s
Church in Ellensburg, Washington for providing their time and
facility for this project. Also, a special thank you to all the vol-
unteers for their hard work and dedication to both the SSS and
SSSM program.
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