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Steps to a HealthierUS logo Salud! Salinas Steps to Health

The Steps to a HealthierUS five-year cooperative agreement program aims to help Americans live longer, better, and healthier lives by reducing the burden of diabetes, overweight, obesity, and asthma and addressing three related risk factors—physical inactivity, poor nutrition, and tobacco use.

For FY 2003, this U.S. Department of Health and Human Services (HHS) program allocated $13.6 million to fund 23 communities, including the city of Salinas in Monterey County, California, to implement community action plans to reduce health disparities and promote quality health care and prevention services.

Project Area

City of Salinas in Monterey County, California, (population 415,800); federally classified Health Professional Shortage and Medically Underserved Area.

Target Population for Steps Interventions

Elementary, middle, and high school students, parents, teachers, school administrators, and school boards; low-income Latino and white children and adults; agricultural employers; fast-food restaurant customers, focusing on children; adults > 60 years (especially Latino seniors), and adults and children who speak both Spanish and English.

Proposed Interventions

All programs will involve input from community residents and be guided by evidence-based and cost- effective strategies tailored to the health literacy, linguistic, and cultural needs of Latinos and other groups in the community.


  • Use bilingual media and information technology to educate people about chronic disease prevention and control by expanding the Monterey County Health Department Web site; developing programs; and producing public service announcements and articles for television, radio, newspapers, and community newsletters.
  • Policy

  • Eliminate soft drink sales on school campuses and at school-related events.
  • Eliminate fast-food sales on school campuses.
  • Open school playgrounds and outdoor sports fields to the public during nonschool hours.
  • Encourage low-fat, healthy food choices at church-related events.
  • School-Based

  • Increase asthma education, healthy food options, and physical activity opportunities for elementary school students.
  • Increase healthy food options, physical activity opportunities, and tobacco-use cessation for middle and high school students (including high-risk independent study and continuation high school students).
  • Community-Based

  • Partner with fast-food franchises to offer and promote healthy food choices, initiate a chronic disease awareness program for customers, offer on-site diabetes and risk assessments, and introduce toys that promote physical activity.
  • Introduce healthy food choices and physical activity programs; expand diabetes screening, referral, and education; and work with social service agencies to offer on-site enrollment for health insurance coverage and food assistance programs in senior centers.
  • Integrate health behavior themes with spiritual messages in church activities. Accompany themes with diabetes screenings, referrals, and health risk appraisals and healthy food and physical activity interventions.
  • Implement intensive interventions in a 25-block area in East Salinas where residents have a particularly high risk for obesity, diabetes, and asthma. Train neighborhood leaders as health promoters; conduct a needs assessment; convene a town hall meeting; and use the Spectrum of Prevention framework to work with family, community, and health provider groups to expand programs to increase physical activity and healthy food choices and improve screening, referral, and self-management of asthma, diabetes, and obesity.
  • Workplace

  • Expand healthy food choices in cafeterias, vending machines, and field catering trucks; expand diabetes screenings and referrals; initiate smoking cessation programs; and improve health insurance coverage for agricultural workers.
  • Health Care

  • Work with community health care systems to establish patient and physician reminder practices that follow current standards of care for obesity, diabetes, and asthma and expand self-management education (individual or group sessions) and case management systems.
  • Improve medical care access for patients who are asthmatic, diabetic, and/or obese.
  • Evaluation

    HHS will provide training and technical assistance to help each Steps community develop measurable program objectives and specific indicators of progress and use relevant data to support ongoing program improvement. HHS also will conduct a national evaluation of the overall program. Existing data sources, such as the Behavioral Risk Factor Surveillance System and the Youth Risk Behavior Surveillance System, will be used to identify and measure program outcomes and assess progress toward program goals.

    Community Consortium

    American Lung Association, Central Coast Alliance for Health, Clinica de Salud del Valle de Salinas, Monterey County Area Agency on Aging, Monterey County Office of Education, Monterey County Health Consortium, Natividad Medical Center, California State University Monterey Bay, Regional Diabetes Collaborative of the Central Coast, Nutrition and Fitness Coalition of the Central Coast, Coalition for a Tobacco-Free Monterey County, Salinas Ministerial Association, Agricultural Growers and Shippers, Spanish Television Media, American Cancer Society, American Heart Association, Salinas Valley Memorial Healthcare System, Tellus/Diganos Center for Community Research, Monterey County Ministerial Association, Monterey County Insurance Group, and Agriculture Growers/Shippers Association.

    Salinas Steps contact

    John P. Snider, MPH, MPA
    Director, Community Health Division
    Monterey County Health Department
    1270 Natividad Road
    Salinas, CA 93906
    (831) 755-4529
    (831) 751-9015 fax

    Note: Steps communities have until May 2004 to finalize their community action plans. Proposed interventions may change accordingly.

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