Your Heart, Your Life: A Lay Health Educator’s Manual for the Hispanic Community

Full text

Originally published by the National Heart, Lung, and Blood Institute (NIH Publication No. 08-3674). U.S. government work, public domain. Reproduced as archived reference, not current guidance.

Your Heart, Your Life

A Community Health Worker’s Manual for the Hispanic Community

NIH Publication No. 08-3674 Originally Printed 1999 Revised May 2008

You Are Unique in This World

Dedicated to Community Health Workers

Almost prancing, joyful and dancing You walk our streets observing, yearning to know, eager to share. Dreaming to see in the light of the dawn, your dream come true: Our world better off. You are unique in this world, and you don’t even know it.

To the neighborhood and family you surrender your heart. No one at all is beyond the reach of your hands. With heartfelt voice proclaiming, you offer hope, courage, and health. You are unique in this world, and you don’t even know it.

Heart health is the key, and you now know it well. “Let’s better your health!” is your battle cry. You are our hero, our neighborhood inspiration. You are unique in this world, and you don’t even know it.

You know how hard it is to change your ways. The way we used to sit around. The use of too much salt and lard. Those now belong to days gone by. You are our leader, your family and neighborhood salute you. You are unique in this world, and you don’t even know it.

You are a great listener. You are the one who knows how we feel and understands our pain. You are the one who has courage to challenge for change in our world. Today is the day! I’m telling you now! You are unique in this world, and I want you to know it.

Poem written by Gloria Ortiz, National Heart, Lung, and Blood Institute English translation by Ariela C. Rodriguez, Ph.D., A.C.S.W.

Table o f Contents

Dear Community Health Worker Letter......................................................................... v

introduction

The Role of the Community Health Worker................................................................. vi

Acknowledgments......................................................................................................... xi

About the “Your Heart, Your Life” Manual................................................................. xv

How To Use This Manual.......................................................................................... xvii

session 1

Are You at Risk for Heart Disease?............................................................................... 1

session 2

Act in Time to Heart Attack Signs............................................................................... 19

session 3

Take Heart: Say YES to Physical Activity.................................................................. 43

session 4

Help Your Heart: Control Your High Blood Pressure................................................ 73

session 5

Be Heart Smart: Keep Your Cholesterol in Check....................................................111

session 6

Keep Your Heart in Mind: Aim for a Healthy Weight.............................................. 155

session 7

Protect Your Heart: Take Good Care of Your Diabetes for Life.............................. 189

Your Heart, Your Life: A Community Health Worker’s Manual

session 8

Make Heart Healthy Eating a Family Affair.............................................................. 233

session 9

Eat in a Heart Healthy Way—Even When Time or Money Is Tight......................... 263

session 10

Enjoy Living Smoke Free.......................................................................................... 285

session 11

Review and Graduation.............................................................................................. 315

session 12

Use Evaluation To Track Your Progress (Especially for Promotores)...................... 343

appendix

Activities for Training Community Health Workers................................................. 401

for more information..................................................................................... 441

Your Heart, Your Life: A Community Health Worker’s Manual

Dear Community Health Worker:

Cardiovascular disease (CVD) is the #1 killer of all Americans, including Latinos. Sadly, nearly one out of four Latinos dies of heart disease. High blood pressure, high blood cholesterol, obesity, smoking, physical inactivity, and diabetes are all factors that increase a person’s risk of CVD. The good news is that people can lower their risk by making some lifestyle changes, and community health workers (promotores de salud) like you can help. The “Your Heart, Your Life” manual can guide you as you begin this journey.

“Your Heart, Your Life” is a heart health manual created especially for Latino communities by the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH), U.S. Department of Health and Human Services (DHHS). The manual is taught by community health workers and focuses on helping people build skills to make practical, lasting changes to help fight heart disease and to improve their health.

The “Your Heart, Your Life” manual provides all the information you need to put this heart health project into action in your community. This manual can be used to train community health workers as well as to educate members of the Latino community, or it can serve as the basis for other community activities.

“Your Heart, Your Life” is dedicated to community health workers like you who devote time and energy to help others improve their health and live longer. Thank you for making a difference.

Much success,

Robinson Fulwood, Ph.D., M.S.P.H. Chief Enhanced Dissemination and Utilization Branch Division for the Application of Research Discoveries National Heart, Lung, and Blood Institute

Introduction v

The Role of the Community Health Worker

Community health workers (promotores) play a key role in promoting better health in Latino communities. They help people learn about health issues and show them ways to live healthier lives. Without them, many Latinos might not receive such vital information.

Successful community health workers have special qualities. They know their communities well. They are dedicated to improving the health of their communities. They enjoy teaching others, feel comfortable in front of a group, and know how to work with a group. They are also:

• Confident • Willing to try new ways

to improve their own health

Let’s Hear From You!

We thank you for your interest and efforts to help Latinos take steps to protect their hearts. We invite you to give us your feedback on how you are using the manual in your community. To share the Your Heart, Your Life activities, please register at the Web site at http://www.nhlbi.nih.gov/health/prof/heart/latino/lat_mnl.htm.

Your feedback will help promote the expansion of the project in the United States and abroad and contribute to the growth of the Salud para su Corazón network. Establishing a large network is important to keep the project going strong!

vi Your Heart, Your Life: A Community Health Worker’s Manual

You may also send your feedback to:

Salud para su Corazón Initiative NHLBI Division for the Application of Research Discoveries Building 31, Room 4A10 31 Center Drive, MSC 2480 Bethesda, MD 20892-2480

Or you may e-mail your feedback to Matilde Alvarado, R.N., M.S.N., at alvaradm@nhlbi.nih.gov.

“Your Heart, Your Life” Helps Communities: Testimonials From Community Health Workers

“The manual helps me give my community the information they need about heart health. I can give them the information in the language they understand where they can hear, see, touch, and taste to learn better and act upon what they learn.”

Esperanza Vásquez Promotora with 10 years of experience Centro San Vicente El Paso, TX

“I find that the ‘Your Heart, Your Life’ manual is a simple and practical tool that allows participants to make heart healthy lifestyle changes.”

Odelinda Hughes Promotora with 14 years of experience Centro San Vicente El Paso, TX

“In our community there is lack of information or there is misinformation. It is awesome to have one tool to bring promotores in for training and to join other programs across the country that impart the same information. Personally, it has helped me. I lost 20 pounds and have kept them off for the last 4 years.”

Sandra Varela CalWORKs Resource Specialist San Joaquin Delta College Stockton, CA

Introduction vii

“I value the manual as a gift of life.”

Otíla García Promotora with 13 years of experience Gateway Community Health Center Laredo, TX

“The manual made me become the promotora I want to be. I am more confident when I work with the community and present the sessions.”

Marta Garcia Promotora with 3 years of experience North County Health Services San Marcos, CA

“These instructional materials and the promotores are significant factors in families’ participation in their own health.”

Mary Luna Hollen, Ph.D., R.D. Director of Promotores Program School of Public Health University of North Texas Health Science Center Fort Worth, TX

“The ‘Your Heart, Your Life’ manual is an inspiration to lay health workers, to our Latino/Hispanic families; it is an example of cultural competence that goes beyond adequate scientific information delivery. It is a philosophy of prevention; it is about enjoying a healthy lifestyle for our hearts.”

Hector Balcazar, Ph.D. Regional Dean and Professor Health Promotion and Behavioral Sciences University of Texas School of Public Health at Houston El Paso Regional Campus El Paso, TX

viii Your Heart, Your Life: A Community Health Worker’s Manual

Organizations

The following organizations support and recommend the use of this manual:

• Latino Caucus of the American Public Health Association

• Lay Health Workers/Promotores National Network, Inc.

• National Council of La Raza

• National Hispanic Council on Aging

• National Hispanic Medical Association

• New Mexico Community Health Workers Association

• Regional Center for Border Health, Inc.

• United States-Mexico Border Health Commission

• Visión y Compromiso Network of Promotoras

• The Way of the Heart: The Promotora Institute

Salud para su Corazón Network

The following partners implemented pilot projects using the “Your Heart, Your Life” manual in various U.S. Latino communities:

• Center for Hispanic Policy and Advocacy, Providence, RI

• Centro San Bonifacio, Chicago, IL

• Centro San Vicente, El Paso, TX

• El Concilio—Council for the Spanish-speaking, Stockton, CA

• Gateway Community Health Center, Laredo, TX

• Hands Across Cultures Corporation, Espanola, NM

Introduction ix

• Mariposa Community Health Center, Nogales, AZ

• Migrant Health Promotion, Progreso, TX

• Neighborhood Healthcare, Escondido, CA

• North County Health Services, San Marcos, CA

• University of North Texas Health Science Center at Fort Worth, School of Public

Health, Fort Worth, TX

These pilot projects confirmed that the “Your Heart, Your Life” manual effectively helps people to improve their heart health. The projects also showed that the manual can be implemented using the following community strategies:

1. Training lay health educators.
2. Conducting educational heart health activities in the community.
3. Educating patients about how they can improve their control of risk factors for heart disease and helping patients make changes for healthy lifestyles.

The results of the pilot projects revealed the need to add an evaluation component to the manual, which is found in Session 12, on pages 343–400. Many of the modifications to this manual resulted from the implementation and evaluation of pilot projects.

x Your Heart, Your Life: A Community Health Worker’s Manual

Acknowledgments

The “Your Heart, Your Life” manual was first published in 1999. This updated 2008 version involved the dedication of many people. NHLBI gratefully acknowledges the contributions of promotores, families, groups, and organizations to the success of the “Your Heart, Your Life” manual.

Special Recognition

NHLBI extends special recognition to the following:

• The promotores de salud for their insight, deep commitment, and full

endorsement. Their community work has made a difference in people’s lives.

• The community-based organizations, community health centers, and other users

for their critical role in demonstrating the value of the manual in a variety of settings, and for different audiences. These groups have shared a wealth of knowledge and have provided valuable direction in the enhancement of the manual.

• Amanda Aguirre, M.A., R.D., Executive Director of the Regional Center for

Border Health, Inc.; Tuly Medina and Mariajose Almazan, Coordinators of the National Promotores Conference; and the Lay Health Workers Promotores National Network, Inc., for providing a “meeting ground” for using the manual to train promotores at nine annual National Community Health Workers/Promotores Conferences. Their guidance and support served to continually promote and expand the project nationwide and internationally.

May the enhanced version of the “Your Heart, Your Life” manual lead to a new cycle of action that will strengthen and sustain heart health in the Latino community.

Introduction xi

Reviewers

NHLBI recognizes the contributions of the following reviewers:

Cecilia Ahumada-Navarro Assistant Coordinator Mariposa Community Health Center Nogales, AZ

Teresa Andrews, M.S. Promotores Health Literacy and Leadership Training Specialist Rural Community Assistance Corporation West Sacramento, CA

Hector Balcazar, Ph.D. Assistant Dean and Professor Health Promotion and Behavioral Sciences University of Texas School of Public Health at Houston El Paso Regional Campus El Paso, TX

Maria Banuelos Cardiovascular Program North County Health Center San Marcos, CA

Jeri Beaumont, R.D. Senior Nutrition Program Director Division on Aging, Union County Elizabeth, NJ

xii

Gladys Cate Public Health Analyst Office of Minority and Special Populations Bureau of Primary Health Care Health Resources and Services Administration Rockville, MD

Yanira Cruz President and CEO National Hispanic Council on Aging Washington, DC

Gail DeKovessey Bergen County Division of Community Development Hackensack, NJ

Carmen Dorio NJCEED Program Community Medical Center— Community Health Services Toms River, NJ

Susan Fountain Rutgers Cooperative Research and Extension in Mercer County New Brunswick, NJ

Your Heart, Your Life: A Community Health Worker’s Manual

Judith Fradkin, M.D. Director Diabetes, Endocrinology, and Metabolic Diseases Division National Institute of Diabetes and Digestive and Kidney Diseases Bethesda, MD

Joanne M. Gallivan, M.S., R.D. Director National Diabetes Education Program National Institute of Diabetes and Digestive and Kidney Diseases Bethesda, MD

Marta Garcia Promotora Cardiovascular Program North County Health Center San Marcos, CA

Otíla García Promotora Coordinator Gateway Community Health Center Laredo, TX

Odelinda Hughes Promotora Educator Centro San Vicente El Paso, TX

Jann Keenan, Ed.S. President The Keenan Group, Inc. Experts in Health Literacy Ellicott City, MD

Sue Lachenmayr, M.P.H., CHES Older Adult Health and Wellness Division of Aging and Community Services New Jersey Department of Health and Senior Services Trenton, NJ

Janet Lucero Certified Diabetes Educator Las Clinicas del Norte Ojo Caliente, NM

Eva Moya, L.M.S.W. Consultant, Health and Human Services/Affairs El Paso, TX

Maria Gómez Murphy, M.A.I.A. President and CEO The Way of the Heart: The Promotora Institute Nogales, AZ

Rosie Piper Health Promotion Manager Mariposa Community Health Center Nogales, AZ

Lourdes Rangel Director, Special Projects Gateway Community Health Center Laredo, TX

Rosalba Ruíz, M.D. Coordinator United States-Mexico Diabetes Project Pan American Health Organization U.S.-Mexico Border Field Office El Paso, TX

Introduction xiii

Sandra Gómez Varela CalWORKs Resource Specialist San Joaquin Delta College Stockton, CA

Esperanza Vásquez Promotora Educator Centro San Vicente El Paso, TX

NHLBI Salud para su Corazón Team

Matilde Alvarado, R.N., M.S.N. Coordinator Minority Health Education and Outreach Activities Division for the Application of Research Discoveries Bethesda, MD

Robinson Fulwood, Ph.D., M.S.P.H. Chief Enhanced Dissemination and Utilization Branch Division for the Application of Research Discoveries Bethesda, MD

Janet de Jesus, M.S., R.D. Nutrition Education Specialist Division for the Application of Research Discoveries Bethesda, MD

xiv

Gloria Ortiz International Program Officer Division for the Application of Research Discoveries Bethesda, MD

Victor R. Olano, M.P.H. Public Health Advisor Division for the Application of Research Discoveries Bethesda, MD

Laina P. Ransom, M.B.A. Publication Production Manager Division for the Application of Research Discoveries Bethesda, MD

Madeleine Wallace, Ph.D. Public Health Analyst Division for the Application of Research Discoveries Bethesda, MD

Terri Williams, M.S.A. Publication Production Manager Division for the Application of Research Discoveries Bethesda, MD

Contributors

Amalia Cabib Professional Translator of Original Manual Bethesda, MD

IQ Solutions, Inc. Rockville, MD

Your Heart, Your Life: A Community Health Worker’s Manual

About the “Your Heart, Your Life” Manual

“Any training that does not include the emotions, mind, and body is incomplete; knowledge fades without feelings.”—Anonymous

To teach the “Your Heart, Your Life” sessions, the following materials are needed:

• “Your Heart, Your Life” manual. Spanish version is NIH Publication No.

08-4087. English version is NIH Publication No. 08-3674.

• “Your Heart, Your Life” picture cards. NIH Publication No. 08-3275.

• The Ramírez family fotonovelas, five brief stories on how to prevent heart

disease, found in the Appendix on pages 411–421.

• A video series of 60-second heart health dramas (telenovelas), available in

Spanish only. NIH Publication No. 55-886.

• “Act in Time to Heart Attack Signs” video in Spanish, for Session 2. NIH

Publication No. 56-078N. English version is NIH Publication No. 56-042N.

The “Your Heart, Your Life” manual is part of the Salud para su Corazón initiative sponsored by NHLBI. Salud para su Corazón develops the tools and strategies to promote heart health among Latino individuals, families, and communities.

Other Salud para su Corazón materials include:

• “Bringing Heart Health to Latinos: A Guide for Building Community

Programs.” A guide for health planners and community-based programs to establish a successful heart health promotion project for a Latino community. NIH Publication No. 98-3796.

• “From Heart to Heart: A Bilingual Group Discussion Kit.” A how-to guide for

conducting discussion groups (charlas) on heart health at churches, community centers, and other sites. The guide comes with a video of two educational programs in Spanish (“Por amor al corazón [For the Love of Your Heart]” and “Cocinar con su corazón en mente [Cooking With Your Heart in Mind]”). NIH Publication No. KT-018.

Introduction xv

• “Delicious Heart Healthy Latino Recipes.” A bilingual cookbook that gives

heart healthy versions of traditional Latino dishes. NIH Publication No. 08-4049.

• “Healthy Home, Healthy Heart Series.” Six easy-to-read bilingual booklets on

heart healthy living:

Are You at Risk for Heart Disease? NIH Publication No. 08-6351

Keep the Beat: Control Your High

Ordering information for these materials appears in the Appendix.

xvi Your Heart, Your Life: A Community Health Worker’s Manual

How To Use This Manual

Community Health Workers

This manual is for you! The “Your Heart, Your Life” manual can be used to train community health workers. After you’ve been trained, you can conduct your own trainings and teach others how to be community health workers.

The “Your Heart, Your Life” manual consists of 12 sessions that include step-by-step instructions on how to teach 11 fun and educational sessions to community residents or patients. Each session is taught in motivational and interactive ways to keep the attention of the group members. Each session helps people learn about what they can do to prevent heart disease. The manual includes worksheets and handouts for project participants (group members) to take home to read and share with their family and friends.

It also includes a special session for community health workers on how to evaluate completed projects. This session helps community health workers determine how successful they have

“Your Heart, Your Life” Sessions

1. Are You at Risk for Heart Disease?
2. Act in Time to Heart Attack Signs
3. Take Heart: Say YES to Physical Activity
4. Help Your Heart: Control Your High Blood Pressure
5. Be Heart Smart: Keep Your Cholesterol in Check
6. Keep Your Heart in Mind: Aim for a Healthy Weight
7. Protect Your Heart: Take Good Care of Your Diabetes for Life
8. Make Heart Healthy Eating a Family Affair
9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight
10. Enjoy Living Smoke Free
11. Review and Graduation
12. Use Evaluation To Track Your Progress (Especially for Promotores)

been in implementing their training and educational activities and helping community residents adopt heart healthy habits. The Appendix features special training activities and teaching tips and explains how to start a project in your community. (See pages 401–410.)

Introduction xvii

About the Sessions

Each session covers a different topic related to heart health. The sessions generally follow the same structure, which will be explained next. Each session also includes “More Information” boxes, which have additional facts on selected health topics to help you answer questions from group members.

Length of Sessions

Most sessions last about 2 hours. Session 5, “Be Heart Smart: Keep Your Cholesterol in Check,” and Session 7, “Protect Your Heart: Take Good Care of Your Diabetes for Life,” last a little longer.

Based on requests from promotores and other users of the previous manual, two new sessions have been added: Session 7 (referenced above) and Session 12, “Use Evaluation To Track Your Progress.”

Evaluation

Session 12, “Use Evaluation To Track Your Progress (Especially for Promotores),” is designed to guide promotores and project evaluators in the planning, implementation, and evaluation of the project. The purpose of the session is to provide ideas for tracking project activities and tools for measuring changes in participants’ behaviors and clinical values. You can use the ideas and tools to: (1) improve the quality of the project, (2) show that your activities work, and (3) provide information to institutions that support your project through funding, referrals, and in-kind contributions.

Supermarket Visits

You may want to take your group on a grocery store tour between Sessions 9 and 10. Call your local clinic, local medical center, or the American Heart Association. Ask if they have a registered dietitian who conducts tours on shopping for a healthy diet. You can also check with the manager at your local grocery store or call the grocery store offices to see if there are registered dietitians on staff who offer store tours.

Glossary

Community health workers may find it helpful to have a glossary of terms or more information on cardiovascular topics covered in this manual. The NHLBI Diseases and Conditions Index, http://www.nhlbi.nih.gov/health/dci/index.html, contains information on diseases, conditions, and procedures related to heart disease.

xviii Your Heart, Your Life: A Community Health Worker’s Manual

Session Outline

Each session begins with a summary page that explains:

• What you want group members to do or learn
• Materials and supplies that you will need
• Worksheets and materials that you will hand out
• The session outline

Each session also includes five major parts:

PaRT 1—Introducing the Session

• Welcome the group members.
• Review the information from the last session.
• Ask the group members to talk about their pledges. (See the Weekly Pledge section under this outline.)
• Explain what you will talk about in today’s session.

PaRT 2—Conducting the Session

• Present new information.
• Lead the group in fun and educational activities.
• Ask the group members questions.
• Let the group members ask questions about what they have heard.

PaRT 3—Review of Today’s Key Points

• Ask questions to help the group members review what they just learned.
• Emphasize the important points.

Introduction xix

PaRT 4—Weekly Pledge

• Help group members come up with a pledge to make a healthy lifestyle change that relates to the information they have learned during the session.
• Give several examples of pledges that are specific and realistic.
• Share the personal value. The value helps encourage participants to keep their pledges and gain confidence so they can make lasting lifestyle changes.

PaRT 5—Closing

• Tell the group members that you enjoyed the session, and wish them luck in meeting their pledges.
• Thank the group members for attending the session.
• Ask the group members what they thought of the session.

Symbols

The following symbols are used throughout the manual to let you know quickly what comes next:

Do an activity.

Use a picture card.

Give out a handout.

Help group members create a pledge for heart health.

xx Your Heart, Your Life: A Community Health Worker’s Manual

Give out a recipe.

RECIPE

Do a training activity.

Picture Cards

The “Your Heart, Your Life” picture cards can be used with the manual to help you present information for each session. When you see the picture card symbol in the manual, you will know to show a picture that relates to the information you will be talking about. On the back of each picture card is a script in English and Spanish that you can read aloud while you show the picture card.

Breaks and Refreshments

You should take a short break about halfway through each session. You may want to use the time to do some easy stretches (see the “Stretching Activities” handout on page 69). Another option is to serve a small healthy snack with water during the break. Snack ideas include light yogurt; baked, unsalted tortilla chips; and fruit or vegetables with low-fat dip. Or you can prepare a dish from one of the recipes in this manual and have group members taste it.

Getting Started

at Least 6 Weeks in advance

1. Find a location. Find a place to teach the Your Heart, Your Life sessions in your area that people can get to easily. Call local clinics, schools, churches, and community centers. Reserve a room for a time when community members can attend.
2. Tell people about the project. Let community leaders and others know that you are offering the course. Ask clinic personnel, clergy, and caseworkers to recommend it.

Introduction xxi

These are some of the benefits of the course:

• The course can help participants and their families find out their own risk for

heart disease and learn how to lead healthier lives.

• Participants will learn low-cost cooking techniques as well as how to eat

healthy foods, prevent heart disease, become more physically active, keep a healthy weight, take care of diabetes, and quit smoking.

• The course is also for participants who have risk factors for heart disease

or are under the care of a doctor because of heart disease. This course will guide participants to take steps to protect and improve their heart health.

• Participants will learn that, whatever your age or current health status, it is

never too late to take steps to protect your heart.

1. advertise the sessions. Post flyers at health fairs and in community sites, such as clinics, grocery stores, churches, and other places in your community. (See the sample flyer on page xxvi.) Place course announcements in local media outlets.
2. Class size. A small group of about 10 to 12 people is best. Try to get about 20 people to sign up, because some may not show up for the class, and others may drop out.

at Least 1 Week Before Each Session

1. Read through the sessions, picture cards, and handouts. Read through these materials two or three times to be prepared.
2. Carefully read the information that you will present to the group members. Practice what you will say in front of a mirror or to a friend or family member. Be sure to use the picture cards. Also practice making a few healthy changes in your own life.
3. Review the instructions for each activity. Make a list of things you need to do before the session, such as making a food display or getting a VCR and TV monitor. For some sessions, you will need to create lists of places where people can get their blood pressure, blood glucose (test for diabetes), or blood cholesterol checked.

xxii Your Heart, Your Life: A Community Health Worker’s Manual

1. Pay attention to the “More Information” boxes. This extra information will help you answer questions from the group.
2. ask a health educator, registered dietitian, nurse, or doctor to explain any information you do not understand. Contact these health professionals at your local hospital or neighborhood clinic.
3. Review the list of handouts, materials, and supplies you will need for each session.

• Make enough copies of the handouts for all group members.

• Gather all the materials and supplies needed to conduct the session.

The Day of the Session

1. Review the list of materials, supplies, and handouts. Make sure that you have everything.
2. arrive 30 to 60 minutes ahead of time. This will allow you to set up the room, VCR, and TV monitor.
3. Tell group members when sessions will meet and how often.

Working With Your Group

Leading the Group

• Get to know the members of your group. They may have different backgrounds, interests, and needs.
• Use words and terms that are familiar to the people in your group. A banana is known as a “plátano” to some and as a “guineo” to others. Oranges may be called “naranjas” or “chinas.” Strawberries may be known as “fresas” or “frutillas.”
• Encourage group members to ask questions. Asking questions helps group members apply the information to their own lives and remember what they have learned.

Introduction xxiii

• Keep the sessions flowing smoothly so everyone is interested and involved.

• Be ready to deal with people who talk too much. Thank these people

for sharing their opinions. Then quickly ask if anyone else has something to share.

• Help members who do not read or write well in a way that will not bring

attention to them.

• Offer help, but do not force anyone to accept help.

• Change the activity to a group discussion.

• Be observant. Watch for clues from group members who do not understand and try to give the information in a different way if you see these clues:

• Puzzled looks

• Wrinkled foreheads

• Looking away from you

• Being quiet

Motivating Group Members

• Praise or reward group members’ efforts in order to keep them motivated.

• Give praise when it is deserved. This gives more meaning to what you are

teaching.

• Praise people in front of others. This can help them stay committed.

• Encourage group members to share their opinions.

• Show interest in group members and what they have to say.

• Be patient. Some people may not speak because they have never been asked

to share their opinions in a group setting.

• Try to involve everyone in the discussion and activities, but do not

force anyone to speak. People will speak up when they become used to the group.

xxiv Your Heart, Your Life: A Community Health Worker’s Manual

• Encourage participants to take small steps toward change.

• People are more likely to develop new habits if you promote small changes

slowly. This brings more success.

Getting People To Come

• Remind the group members that it is important to come to all the sessions. Tell them that they will:

• Learn something new at each session.

• Help family members.

• Socialize and meet people.

• ask people to team up and call one another as a reminder to attend the sessions. This encourages people to attend.
• Remind them about the meeting time and length of classes.

answering Hard Questions

Remember that it’s okay not to know all the answers! Say that you will have the correct answer by the next session. Call a local health educator, registered dietitian, or nurse to find out the correct information.

Keeping People on Track

Give the group the correct information when a group member gives incorrect or incomplete information. Give the person credit for any part of his or her answer that is correct. Say that people often hear incorrect information and believe it to be true. Tell the group members that this is one important reason why they are taking the course— to get correct information.

and Finally . . .

Have a good time. You are doing an important service for yourself and your community. Thank you!

Introduction xxv

Did You Know…

Nearly one out of four Latino deaths is due to heart disease. But you can do something about it!

In the Your Heart, Your Life project, you will:

Learn how to keep your heart and your family’s hearts healthy.

Find ways to increase your physical activity, eat in a heart healthy way, keep a healthy weight, and not smoke.

Learn how to talk to your family, neighbors, and friends about heart disease.

Enjoy videos, games, role playing, and other activities that make learning fun.

Get take-home materials you can share with others.

Classes meet once a week for 11 weeks.

Sponsored by: _________________________________________________________

Location: _____________________________________________________________

Day/time: ____________________________________________________________

Classes begin on: ______________________________________________________

For more information or to register, contact: _________________________________

an Ounce of Prevention Is Worth a Pound of Cure!

The course is free.

Everyone who completes the course will receive a certificate.

xxvi

Begin With a Heart

Use this shape to cut out the heart. You will need these heart shapes in session 1. (See page 3.)

Introduction xxvii

s essi o n

Are You at Risk for Heart Disease?

Objectives

By the end of this session, group members will:

• Know about the Your Heart, Your Life project.
• Know how the heart works and its importance.
• Know that heart disease can be prevented.
• Be able to name six risk factors for heart disease that can be prevented.
• Know other group members.

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Name tags
• Hearts cut from red felt (try to get the kind that has a sticky backing) or red construction paper. Use the shape on page xxvii to cut out the heart.
• Safety pins (if not using felt with sticky backing)
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Clear container that is filled with 4 cups of water

Session 1. Are You at Risk for Heart Disease? 1

Handouts

Give each group member these handouts during this session:

• “Are You at Risk for Heart Disease?” (page 16)
• “A Day With the Ramírez Family” (page 17–18)

Session Outline

Introducing the Session

1. Welcome
2. Project Overview
3. Class Rules

Conducting the Session

1. Getting To Know Each Other
2. Getting To Know the Secrets of the Heart

A. How the Heart Works

B. The Heart’s Structure

1. Facts About Heart Disease
2. Risk Factor Activity
3. A Day With the Ramírez Family

Review of Today’s Key Points

Closing

Note: Read the “More Information” chart on pages 9–10 to be ready to answer

questions from group members.

2 Your Heart, Your Life: A Community Health Worker’s Manual

Introducing the Session

1. Welcome

• Introduce yourself as people walk in.
• Ask each person his or her name. Write it on a name tag. Give each person a name tag and a felt or paper heart.
• Ask group members to wear the name tags on their shirts. Ask them to place the felt or paper hearts where their own hearts are found.
• Welcome group members to the session. Tell them that you are very happy to see them.

2. Project Overview

Heart disease is the #1 reason why people die in this country. The National Heart, Lung, and Blood Institute, part of the National Institutes of Health, created the Salud para su Corazón initiative to help Latinos prevent heart disease.

Together, we will learn about the risk factors for heart disease. We will also learn things you and your family can do to have healthy hearts.

The “Your Heart, Your Life” manual is part of the Salud para su Corazón initiative. This heart health education manual has 12 sessions and an optional grocery store tour. Session 12 explains evaluation and is only for promotores.

• Show the names of the sessions on the blackboard or on a large piece of paper taped to the wall.

1. “Are You at Risk for Heart Disease?”
2. “Act in Time to Heart Attack Signs”

Session 1. Are You at Risk for Heart Disease? 3

1. “Take Heart: Say YES to Physical Activity”
2. “Help Your Heart: Control Your High Blood Pressure”
3. “Be Heart Smart: Keep Your Cholesterol in Check”
4. “Keep Your Heart in Mind: Aim for a Healthy Weight”
5. “Protect Your Heart: Take Good Care of Your Diabetes for Life”
6. “Make Heart Healthy Eating a Family Affair”
7. “Eat in a Heart Healthy Way—Even When Time or Money Is Tight”
8. “Enjoy Living Smoke Free”
9. “Review and Graduation”
10. “Use Evaluation To Track Your Progress (Especially for Promotores)”

Please come to all of the sessions. I will lead the sessions, but I need each of you to participate. This will help you learn the information and enjoy the sessions more. Please feel free to ask questions. Your questions also help others to learn.

3. Class Rules

Note: This section will help group members feel like a team. It also will make it easier

for you to lead the sessions.

Everyone will feel more at ease if they know what to expect from the training. Before we begin, let’s talk about the best way to run the sessions. Let’s agree as a group on a few basic rules.

This course takes effort and time from each group member. It is important for you to attend each session and to arrive on time. Each of the sessions is about 2 hours long.

4 Your Heart, Your Life: A Community Health Worker’s Manual

• (Optional, if you are able to make changes) Ask:

• How often do you want to meet (once a week, twice a week, etc.)?

• Is this a good time to meet?

Note: If not, set a meeting time that is best for most of the group.

• Ask:

Is this a good place to meet?

Note: If not, decide on a location that is best for most of the group.

Here are some things you can do to help you learn the most from the sessions.

1. Feel free to ask questions.
2. Share your personal experiences. This will make the program mean more to all of us.
3. Try to stay on the subject. We have a lot of information to talk about in a short time.
4. (Optional) Call me at [telephone number] if you have questions or concerns about this course. I am here to help you in any way that I can.

Because you will share your experiences and opinions, we need to agree on a few things.

• Ask:

• Do you agree to keep other group members’ comments to yourself?

• Do you agree not to judge others?

• Do you agree to try to come to all of the sessions?

• Ask:

• Do you have other rules that you would like to talk about?

Session 1. Are You at Risk for Heart Disease? 5

Note: Allow a moment for group members to respond.

Conducting the Session

1. Getting To Know Each Other

We’ll begin today’s session by introducing ourselves and getting to know each other a little better.

• Ask group members to:

• Give their names and tell one or two things about themselves.

• Tell why they came to this course and what they hope to learn.

Note: Start this activity by going first. Tell the group why you are interested in heart

health. Be honest, and talk about your own personal experience. Give each group member a chance to answer.

You can help your family and friends by being a good example, sharing with them what you learn, and encouraging them to live healthier lives. Thank you for making this effort.

2. Getting To Know the Secrets of the Heart

Now that we know a little bit about each other, let’s get to know a few facts about the heart.

A. How the Heart Works

The heart is an amazing part of the body. It pumps approximately 5 liters of blood every minute. It beats about 100,000 times a day.

6 Your Heart, Your Life: A Community Health Worker’s Manual

Note: Hold up a clear container that has 1 liter (about 4 cups) of water in it. Remind

the group that the heart pumps five times this amount of blood each minute.

The heart sends blood to the lungs to pick up oxygen. Then it delivers oxygen to all the cells in the body.

You can feel the beat of your heart by taking your pulse. To find your pulse, gently place the index and middle finger of one hand on the inside wrist of your other hand. Slide your two fingers toward the thumb side of your wrist until you feel a slight beating.

• Show group members how to do this.

B. The Heart’s Structure

• Show picture card 1.1.

The heart is a hollow, muscular, cone-shaped organ, about the size of a fist.

• Hold up your fist for the group members to see.
• Point out each part of the heart on the picture card.

• The heart has two upper chambers and two lower chambers.

• The upper chambers (right atrium and left atrium) receive blood.

• The lower chambers (right ventricle and left ventricle) pump blood.

• Show picture card 1.2.

Session 1. Are You at Risk for Heart Disease? 7

• The heart is located in the middle of the chest. Did you place your felt or

paper heart in the correct spot?

• The heart is one of three main components of the circulatory system. The

others are blood vessels and the blood.

• The circulatory system is very important for sustaining life. It is made of all

the vessels that carry the blood throughout the body.

• Blood vessels are long, hollow tubes of tissue, much like drinking straws.

There are various kinds of blood vessels. The main ones are called arteries (shown in red), veins (shown in blue), and capillaries (not shown).

• The circulatory system delivers oxygen and nutrients to cells in your body

and removes carbon dioxide and other waste products.

• Show picture card 1.3.

Note: Point to each artery and vein. Describe the following two steps while pointing to pictures 1 and 2.

• Say: Let’s go over the major veins and arteries.

1. Blood (with little oxygen) enters the right top chamber of the heart through the largest veins in your body. These veins are called the superior and inferior vena cava.
2. Blood then flows down to the right lower chamber so it can be pumped out to the lungs through the pulmonary arteries. In the lungs, waste (carbon dioxide) is removed from the blood. The blood then gathers more oxygen.

• Show picture card 1.4.

Note: Describe the two steps while pointing to pictures 3 and 4.

1. The blood, rich with oxygen, returns to the heart and enters the upper left chamber through the pulmonary vein.

8 Your Heart, Your Life: A Community Health Worker’s Manual

More information

Heart Disease Risk Factors You Can Do Something About

Risk FACtoRs High blood pressure High blood pressure, or hypertension, is

FACts You NeeD to kNow When your blood pressure is high, your heart works harder than it should to move blood to all parts of the body. If not treated, high blood pressure can lead to stroke (brain attack), heart attack, eye and kidney problems, and death.

called the silent Check your blood pressure numbers (mmHg*): killer. It often has no symptoms, yet Level systolic Diastolic it can cause very serious illness. Normal Less than 120 Less than 80 prehypertension 120–139 80–89

High Blood pressure 140 or higher 90 or higher

• Millimeters of mercury

Check your total cholesterol number (mg/dL*): High blood cholesterol Cholesterol in Desirable Less than 200 your arteries is like rust in a Borderline High 200–239 pipe. Low-density High 240 or higher lipoprotein (LDL) is known as the “bad” cholesterol. † Check your LDL cholesterol number (mg/dL*): Too much LDL cholesterol can clog your arteries, Desirable Less than 100 which increases the risk of heart Near Desirable/ disease and Above Desirable 100–129 stroke. High- Borderline High 130–159 density lipoprotein (HDL) is known High 160 or higher as the “good” cholesterol. HDL carries cholesterol * Milligrams per deciliter away from your

†

arteries. The goal for LDL cholesterol is different for everyone. Your

doctor can help you set your LDL goal.

HDL levels of 60 mg/dL or higher help lower your risk for heart disease. HDL levels below 40 mg/dL are a major risk factor for heart disease. Check your triglyceride level (mg/dL): A normal triglyceride level is below 150.

tAke tHese steps to pReveNt HeARt DiseAse

• Check your blood pressure

once a year. Check it more often if you have high blood pressure.

• Aim for a healthy weight.
• Be physically active.
• Choose and prepare foods with

less salt and sodium.

• Eat more fruits, vegetables, and

low-fat milk products.

• If you drink alcohol, do so in

moderation.

• If your doctor gives you blood

pressure medicine, take it the way the doctor tells you.

• Get a blood test called a lipid

profile at your doctor’s office. This test measures all your cholesterol levels (total, LDL, and HDL) and triglycerides.

• Get your blood cholesterol levels

checked every 5 years if you are age 20 or older.

• Learn what your cholesterol

numbers mean. If they are high, ask your doctor how you can lower them.

• Choose foods that are lower

in saturated fat, trans fat, and cholesterol.

• Aim for a healthy weight.
• Be physically active.

Take these other steps to control triglycerides:

• Limit candy, sweets, regular

soda, juice, and other beverages high in added sugar.

• Avoid smoking and alcohol.

Smoking raises triglycerides and lowers HDL cholesterol. Excess alcohol also raises triglycerides.

Session 1. Are You at Risk for Heart Disease?

More information

Heart Disease Risk Factors You Can Do Something About

Risk FACtoRs overweight and obesity Overweight occurs when

FACts You NeeD to kNow Check your body mass index (BMi) and waist measure:

extra fat is stored in your Level BMi body. It increases your risk of developing high Normal 18.5–24.9 blood pressure, high blood cholesterol, heart disease, overweight 25–29.9 stroke, and diabetes. obese 30 or greater

• A waist measurement of more than

35 inches for a woman and more than 40 inches for a man increases the risk of heart disease.

Diabetes When the sugar in the blood is high, your body cannot use the food you eat for energy.

• Diabetes is serious. You may not know you have it. It can lead to heart attack, stroke, blindness, amputations, and kidney disease.

• Nearly 1 out of every 10 adult Latinos

has diabetes.

• Being overweight is a major risk factor

for diabetes.

Not being physically active • Adults should do at least 30 minutes

Being inactive can double your chances of heart disease and take away years from your life.

of moderate physical activity on most days, preferably daily. • Some adults need up to 60 minutes of moderate (medium-level) to vigorous

(high-level) activity on most days to prevent unhealthy weight gain.

• Adults who used to be overweight need

60 to 90 minutes of moderate physical activity every day to avoid regaining weight.

• Children and adolescents need at least

60 minutes of moderate to vigorous physical activity on most days.

smoking

• Cigarette smoking is addictive. It

You put your health and your family’s health at risk when you smoke.

harms your heart and lungs. It can raise your blood pressure and blood cholesterol.

10 Your Heart, Your Life: A Community Health Worker’s Manual

tAke tHese steps to pReveNt HeARt DiseAse

• Get your BMI and waist

measured every 2 years, or more often if your doctor recommends it.

• Aim for a healthy weight.

Try not to gain extra weight.

• If you are overweight, try to

lose weight slowly. Lose 1 to 2 pounds a week.

• Eat smaller portions and be

physically active for at least 60 minutes daily.

• Find out if you have diabetes.
• Get your blood glucose (blood

sugar) level checked at least every 3 years, beginning at the age of 45. You should be tested at a younger age and more often if you are at risk for diabetes.

• Stay active. You can build up

to 60 minutes of exercise each day by being active for 20 minutes three times a day.

• Try walking, dancing, or

playing soccer.

• Stop smoking now, or cut back

gradually.

• If you can’t quit the first time,

keep trying.

• If you don’t smoke, don’t start.

1. The blood then flows down to the lower left chamber and is pumped out of the aorta to the rest of your body. Your left and right coronary arteries carry oxygen-rich blood to all parts of your heart.

Heart disease is a condition that affects the heart muscle, heart valves, or blood vessels of the heart. The major form of heart disease is coronary heart disease. Because the heart is such an important organ, you want to keep it free from heart disease. When the heart stops, life stops. So when you take care of your heart, you take care of your life.

3. Facts About Heart Disease

Note: Before the session, read the “More Information” chart on pages 9–10. This chart lists the risk factors for heart disease that you can do something about. It gives you steps you can take to prevent or lower those risk factors.

Now that we know how important the heart is, let’s talk about heart disease and what we can do to protect our hearts.

• Ask:

Do you know someone who has heart disease?

Note: Allow about 2 minutes for group members to respond.

• Show picture card 1.5.

Heart disease is a serious health problem for Latinos.

• It is the #1 cause of death for Latinos in the United States. One out of four

deaths among Latinos is due to heart disease.

• Many Latinos believe that a heart attack or stroke happens suddenly because

of a scary experience, getting bad news, stress caused by work, family problems, worries, or having strong feelings, such as anger.

Session 1. Are You at Risk for Heart Disease? 11

• A heart attack or stroke may seem sudden, but the truth is that heart

disease happens over many years. Often it starts when you are very young.

• Taking steps to prevent heart disease is important at any age. Taking these

steps is like performing regular service on a car, such as changing the oil and checking the fluids and tires. Car maintenance helps keep the engine running smoothly so that the car won’t break down on the road. In the same way, you need to take steps to care for your body so you can lower your chances of getting heart disease.

• This course will show the steps you and your family can take to have

healthier hearts.

• Show picture card 1.6.

In every session, you will hear about something called “risk factors.” Risk factors are traits or habits that make a person more likely to get heart disease. Some risk factors—such as age, family history, and being a man or woman—are things you cannot change. But the good news is that you can do something about some risk factors:

• High blood pressure

• High blood cholesterol

• Cigarette smoking

• Diabetes

• Overweight

• Not being physically active

4. Risk Factor Activity

ACTIVITY

• Give each group member the “Are You at Risk for Heart Disease?” handout (page 16). Read aloud each risk factor. As you read each one, ask group members to check off the risk factors they have.

12 Your Heart, Your Life: A Community Health Worker’s Manual

The more risk factors you have checked, the greater your risk for heart disease and stroke. Talk to your doctor about your risk.

This session will explain how these risk factors affect the health of the heart. It will also teach you how you and your family can prevent or control those risk factors. You will learn how to:

• Lose weight if you are overweight. • Take prescribed medications as

your doctor tells you.

• Be physically active. • Quit smoking. • Cut down on salt and sodium. • Get your blood pressure, blood • Eat foods that are lower in cholesterol, and blood glucose

saturated fat and trans fat. (blood sugar) levels checked.

• Eat more fruits and vegetables and

low-fat milk and milk products.

(Optional) Note: You can share information on The Heart Truth campaign described in the Appendix on page 423.

5. A Day With the Ramírez Family

• Ask:

How did you feel when you learned that you or your loved ones have risk factors for heart disease?

Note: Allow 3 minutes for group members to answer.

• Give each group member the “A Day With the Ramírez Family” handout (pages 17–18).

Session 1. Are You at Risk for Heart Disease? 13

People act in different ways when they learn that they must make changes in their habits to lower their risk for heart disease. Let’s read the examples from the “A Day With the Ramírez Family” handout. This activity will help us learn how ready we are to make healthy lifestyle changes.

• Ask a volunteer to read the handout.

Note: You can make puppets to represent each member of the Ramírez family from

socks or paper bags. Use glue, markers, and other craft scraps to give your puppets features and costumes.

• Ask:

• Which family member do you identify with the most?

• What reasons do you have to improve your health?

• What barriers keep you from making daily changes?

• What can you do to reduce these barriers?

Review of Today’s Key Points

• Ask:

What are the risk factors for heart disease that we can prevent or control?

• Add these answers if they are not mentioned:

• Overweight and obesity

• Not being physically active

• High blood pressure • High blood cholesterol • Diabetes • Smoking

14 Your Heart, Your Life: A Community Health Worker’s Manual

It can be hard to change old unhealthy habits and learn new healthy ones. This program will teach you what you need to know and how to make these changes slowly. Seeing you make healthy changes may make others want to make these changes, too.

Closing

• Ask:

Do you have any questions about the project?

Note: Give group members a moment to respond.

• (Optional) Ask:

How many of you want to go on a grocery store tour? During week 9 or 10, a nutritionist can lead us through a grocery store and help us learn how to shop for our hearts.

Note: If enough group members are interested, call the grocery store in your area and

set up a date for a tour. See page xviii.

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

In the next session, we are going to discuss the warning signs of a heart attack.

Note: Think about today’s session. What worked and what didn’t? Has the session

helped group members learn about their risk for heart disease?

Session 1. Are You at Risk for Heart Disease? 15

Are You at Risk for Heart Disease?

Name: ________________________________________________________________

Risk factors are traits or habits that make a person more likely to develop heart disease. Read this list of risk factors for heart disease. Check the ones you have.

Heart disease risk factors you can do something about:

Check the ones that you have.

r Being overweight r High blood pressure r High blood cholesterol r Diabetes

r Not sure r Not sure r Not sure r Not sure r Not being physically active r Cigarette smoking

Heart disease risk factors you cannot control:

Check the ones that you have.

r Age (45 years or older for men and 55 years or older for women)

r Family history—

• Father or brother with heart disease before age 55

• Mother or sister with heart disease before age 65

The more risk factors you have checked, the greater your risk for heart disease. Talk to your doctor about your risk.

16 HAnDOuT—SESSiOn 1

A Day With the Ramírez Family

People act in different ways when they learn that they need to make lifestyle changes to lower their chances of getting heart disease. Let’s see how the Ramírez family acts when they get the news about their risk.

Mariano: “I don’t really care.” Mariano learns that he is at risk for heart disease, but he is not concerned about it. He gets upset when reminded about changing his unhealthy habits. He has no intention of making changes for better health. “Whatever will be, will be,” claims Mariano.

Carmencita: “I am stuck.” Carmencita is worried and depressed because she is aware of her chances of getting heart disease. She thinks about making changes but cannot get started. She feels trapped and is not motivated to take steps for better health. “You can bring a horse to water, but you can’t make it drink,” ponders Carmencita.

Virginia: “I am making plans.” Virginia learns that she is at risk for heart disease and thinks that she should get ready to make changes. Instead of just saying “I will start to make changes tomorrow,” she talks to her friends about the plan she has in mind. “Walking the walk is harder than talking the talk,” says Virginia.

Doña Fela: “I am taking action.” Doña Fela learns that she is at risk for heart disease and quickly starts doing something about it. She goes to classes to learn how to improve her health. She practices what she learns. She feels confident and cheerful. Doña Fela makes simple changes and helps others to do the same. “An ounce of prevention is better than a pound of cure,” says Doña Fela.

Néstor: “I stay on the healthy path.” Néstor is making changes and is motivated to stay on track to improve his health. He knows that it is easy to fall back to old habits. He makes plans to prevent setbacks and learns to start again if he needs to. He is positive toward life. He asks for help and does not give up. “Time is gold, and health is priceless,” says Néstor.

HAnDOuT—SESSiOn 1 17

A Day With the Ramírez Family (continued)

Now, please answer these questions:

1. With which family member do you identify the most?
2. What reasons do you have to make changes for better health?
3. What are the barriers that keep you from making changes to improve your health?
4. What can you do to overcome these barriers?

18 HAnDOuT—SESSiOn 1

s essi o n

Act in Time to Heart Attack Signs

Objectives

By the end of this session, group members will learn:

• What a heart attack is
• Why it is important to seek treatment quickly if a heart attack happens
• The warning signs of a heart attack
• Why people delay in seeking help for a heart attack
• The benefits of calling emergency medical services
• How to plan ahead

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Blackboard and chalk or several large pieces of paper, markers, and tape
• VCR or DVD and TV monitor
• “Act in Time to Heart Attack Signs” video

(Optional) Note: Arrange for a health professional to come to the session to discuss cardiopulmonary resuscitation (CPR).

Session 2. Act in Time to Heart Attack Signs 19

Handouts

Give group members these handouts during this session:

• “Learn What a Heart Attack Feels Like” (page 36)
• “Fast Action Saves Lives” (page 37)
• “Fast Action Saves Lives: Role Plays” (pages 38–40)
• “My Emergency Card” (page 41)
• “Tender Care for a Happy Heart” (page 42)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. The Facts Don’t Lie
2. What Is a Heart Attack?
3. Importance of Rapid Treatment for a Heart Attack
4. What Are the Warning Signs of a Heart Attack?
5. Delay Can Be Deadly
6. The Role of Emergency Medical Services
7. How To Plan Ahead
8. Tender Care for a Happy Heart

20 Your Heart, Your Life: A Community Health Worker’s Manual

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about the risk factors for heart disease.

• Ask:

Who remembers the risk factors that we can prevent or control?

Note: Allow about 3 minutes for group members to respond.

• Add the following risk factors if they are not said:
• Overweight and obesity
• Not being physically active
• High blood pressure
• High blood cholesterol
• Diabetes
• Smoking
• Ask:

Would any of you like to share what you are doing to improve your heart health?

Session 2. Act in Time to Heart Attack Signs 21

Note: Allow about 2 minutes for group members to respond.

3. About This Session

Heart disease develops over many years. Sometimes, despite our best efforts, heart disease can result in a heart attack. That is why it is important to know the warning signs of a heart attack and what to do if you experience them. In today’s session, we will discuss these warning signs and the importance of taking quick action if you experience warning signs. By the end of this session, you will know:

• How the heart functions

• What a heart attack is

• The importance of fast treatment for a heart attack

• The warning signs of a heart attack

• Why people delay in seeking help for a heart attack

• The benefits of calling 9–1–1

• Steps you can take now to help you survive a heart attack

• How to prepare your emergency card

Conducting the Session

1. The Facts Don’t Lie

• Each year about 1.2 million people in the United States will have a heart

attack, and about half of these people will die.

22 Your Heart, Your Life: A Community Health Worker’s Manual

• About half of the people who die of a heart attack will die before they reach

the hospital.

To begin our session today, I would like to show a video about the importance of paying attention to heart attack warning signs.

• Show the “Act in Time to Heart Attack Signs” video (14 minutes).

Now that we have seen the video, let’s talk about it.

• Ask:

• What did you see in the video?

• What did you hear in the video?

• How did the video make you feel?

Note: Allow about 5 minutes for group members to respond.

2. What Is a Heart Attack?

In the video, you heard facts about heart attacks. Now let’s talk about what a heart attack is and how one happens.

• Show picture card 2.1.

A normal artery allows blood to flow freely. A heart attack occurs when the blood supply going to a portion of the heart through one of the coronary arteries is blocked. Here’s how this happens.

• Heart disease, which can lead to a heart attack, develops over time. Fatty

deposits build up on the inside of the coronary arteries. When this happens, the arteries become narrow, and not enough blood, oxygen, and nutrients get through to meet the needs of the heart.

Session 2. Act in Time to Heart Attack Signs 23

• The coronary arteries can become blocked, usually by a clot. When this

happens, the blood flow is closed off and a heart attack begins.

• If the blockage continues, part of the heart muscle will start to die.

• When a heart attack occurs, medical treatment can restore the blood flow to

the heart. This keeps the heart muscle from dying.

• Treatments work best if given as soon as possible, within 1 hour after

warning signs of a heart attack begin.

• When a part of the heart muscle dies, nothing can be done to restore it.

• Ask:

Are there any questions about what happens during a heart attack?

Note: Allow about 5 minutes for group members to answer.

3. Importance of Rapid Treatment for a Heart Attack

• Treatments for heart attacks have improved over the years. Twenty years

ago, not much could be done to stop a heart attack.

• Today there are treatments that can open up the heart’s arteries and restore

blood flow.

• “Clot-busting” medicines and other artery-opening treatments can break up

the clots and quickly restore blood flow to the heart.

• Show picture card 2.2.

• There is also a treatment called angioplasty. A balloon is placed in the

coronary artery and inflated to open the artery. This restores the blood flow.

24 Your Heart, Your Life: A Community Health Worker’s Manual

• Sometimes with angioplasty, doctors will insert a stent. A stent is a wire

mesh tube that is used to open the artery.

• The stent stays in the artery and keeps it open to improve blood flow to

the heart.

• These treatments should be given as soon as possible, within 1 hour after

warning signs of a heart attack start.

• The more heart muscle that is saved, the better chance a heart attack patient

has of surviving and returning to a normal life.

4. What Are the Warning Signs of a Heart Attack?

It is important to know how to recognize a heart attack. This activity should help you learn the warning signs of a heart attack.

• Ask:

What warning signs would make you think someone is having a heart attack?

Note: Write group members’ responses on a blackboard or on a large piece of paper taped to the wall.

• Give each group member the “Learn What a Heart Attack Feels Like” handout (page 36).
• Show picture card 2.3, and review the handout.

These are the warning signs most commonly reported by heart attack patients, both women and men.

• Discomfort in the center of the chest that lasts more than a few minutes. It

can feel like uncomfortable pressure, squeezing, fullness, or pain.

Session 2. Act in Time to Heart Attack Signs 25

• Discomfort in one or both arms or the back, neck, jaw, or stomach

• Shortness of breath, with or without chest discomfort

• Cold sweat

• Feeling light-headed

• Nausea or feeling sick to their stomach

The most common heart attack warning sign for men and women is chest pain or discomfort.

• Men and women do not need to have all of the warning signs to be having a

heart attack.

• The warning signs mentioned are the most common ones, and most people

experience more than one of them. Some signs can occur together. For example, chest discomfort often occurs with shortness of breath. Also, arm pain, sweating, and nausea may occur together.

• Many people think that all heart attacks happen the way you see in soap

operas or the movies—a person has crushing chest pain and falls to the floor. This is a myth. The reality is that not all heart attacks happen this way. Many heart attacks start slowly, with signs gradually getting stronger.

• A heart attack often is not a sudden, deadly event. A variety of warning signs

may signal that someone is in danger.

• Sometimes the pain or discomfort is mild, and the signs may come and go.

• Ask:

What do you think are other reasons why people do not recognize when they are having a heart attack?

26 Your Heart, Your Life: A Community Health Worker’s Manual

Note: Allow about 5 minutes for group members to call out answers.

• Add the following reasons if they are not mentioned.

• People may confuse the warning signs of a heart attack with the symptoms of

other diseases, such as asthma.

• People may confuse heart attack signs with symptoms of a pulled muscle,

indigestion, or the flu.

• Some people do not believe they are at risk for having a heart attack. When

they have warning signs, they ignore them or wait to see if the signs get worse before they call for help.

5. Delay Can Be Deadly

People often wait too long before they seek medical care for the warning signs of a heart attack.

• Some people wait 2 to 4 hours, or even a day or more, before getting help.

• If you think a heart attack is happening, the most important thing to remember

is this: Call 9–1–1 in 5 minutes or less.

When people having heart attacks decide to seek help, they often do not call 9–1–1. Only half of all heart attack patients arrive at the hospital by ambulance.

• Give each group member the “Fast Action Saves Lives” handout (page 37).

Let’s go over how to take fast action when you think a heart attack is happening.

• Ask a volunteer to read the handout aloud.

Session 2. Act in Time to Heart Attack Signs 27

• Ask:

Think about yourself and your family—what might prevent you from calling 9–1–1 quickly if you think you are having a heart attack?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these reasons if they are not mentioned.

• They did not think their symptoms were severe enough.

• They were unaware that calling 9–1–1 has many lifesaving advantages.

• They thought driving themselves to the hospital would be faster.

• They were concerned about being embarrassed when an emergency

vehicle—ambulance or fire engine—showed up at their door.

• They were concerned about the cost of the ambulance and medical care.

• They were afraid of being embarrassed if the symptoms were a false alarm.

If you are having a heart attack and you or someone else cannot call 9–1–1, have someone drive you to the hospital at once. Never drive yourself. You may pass out along the way, putting yourself and others in danger.

It is easy to talk about what to do when a heart attack happens, but it is not so easy to take the right action if you or someone you know is actually having symptoms. Let’s take time to act out different scenarios to prepare you for a real situation.

Note: Ask for volunteers in the group to form three teams of two people each. Give each team one of the three different role plays in the “Fast Action Saves Lives: Role Plays” handout (pages 38–40).

Note: Ask the teams to take a few minutes to read the role play, decide who will play the characters, and think about what they will say. Then ask each team in turn to present their “drama” to the group.

28 Your Heart, Your Life: A Community Health Worker’s Manual

• Ask:

Now that you have seen the three scenarios, what do you think is the main action you must take when someone is having the warning signs of a heart attack?

Note: Allow a moment for group members to call out the answer. If no one gives the

correct answer, say:

The answer is to call 9–1–1 in 5 minutes or less.

6. The Role of Emergency Medical Services

Our actors did a great job of showing us why it is important to call 9–1–1 right away. Calling 9–1–1 is like bringing the hospital emergency department to your door.

• Ask:

What are the benefits of calling emergency medical services?

Note: Allow 3 minutes for group members to respond.

• Add these answers if they are not mentioned.

• Emergency personnel arrive fast and can start treatment right away. They

may carry oxygen, heart medicine, pain relief medicine, aspirin, or other medications that can help in case of a heart attack.

• In many locations, emergency personnel are linked to the hospital. They can

send information about a patient’s condition to the emergency department before the patient arrives at the hospital.

• Heart attack patients who are brought by ambulance receive faster treatment

than patients who have someone drive them to the hospital.

• Your heart may stop beating during a heart attack. Emergency personnel

carry equipment to restart the heart if that happens.

Session 2. Act in Time to Heart Attack Signs 29

Note: Most communities have the 9–1–1 system. However, if your community does not,

say:

The best way to get the care you need is to call the local emergency medical number. In our community, that number is _____________________.

It is a good idea to plan ahead for who will take care of your family in an emergency. Emergency personnel will usually contact a relative or friend to make arrangements, if necessary.

• Ask:

What would you plan to do if you suddenly had to go to the hospital in an ambulance?

Note: Allow about 5 minutes for group members to discuss their answers.

7. How To Plan Ahead

We have learned a lot today about heart attacks and what to do if one happens. Here’s the good news: Planning ahead with your family can help you survive a heart attack. Here are things you can do now to prepare for a possible heart attack.

• Show picture card 2.4.

You now know the warning signs for a heart attack. Talk to your family and friends about these signs and the importance of calling 9–1–1 right away.

• Show picture card 2.5.

You and other adults in your family should talk to your doctor about your risk of a heart attack and how to lower it.

30 Your Heart, Your Life: A Community Health Worker’s Manual

• Show picture card 2.6, and give each group member the “My Emergency Card” handout (page 41).

You and your family should have a plan of action in case of an emergency. This plan should include an emergency card. This card gives health care providers the information they need to know about you in case of an emergency.

Let’s look at your emergency card. The emergency card includes the following information:

• Name, relationship, and phone number of emergency contacts who should be

called if you have to go to the hospital

• Emergency numbers in your area

• Name and phone number of your doctor or clinic

• Your health conditions

• Current medicines

• Known allergies

• Any other important information

Make a copy for all adults in your family and encourage them to fill it out.

• Ask for volunteers to tell you how they would explain the importance of making a survival plan to their family members.
• Ask group members to tell you how they would make sure that all of their family members (such as a grandparent, spouse, or uncle) know what to do in case of a heart attack.

Note: Allow 2 or 3 minutes for group members to respond.

Session 2. Act in Time to Heart Attack Signs 31

More Information

Aspirin: Take With Caution

A person who is thinking about using aspirin to treat or prevent heart problems should talk to a doctor first. If the doctor thinks that aspirin is a good choice, it is important to take the correct dose.

If a person has had a heart attack or stroke, aspirin can help lower the risk of a second one. It can also help keep arteries open in persons who have had heart surgery. It has also been shown that healthy women who take a low dose of aspirin every other day may prevent a first stroke. Aspirin may also prevent a first heart attack in women over the age of 65.

8. Tender Care for a Happy Heart

After you finish preparing your emergency card, try some of these actions to lift up your heart.

• Give group members the “Tender Care for a Happy Heart” handout (page 42).

Note: Allow 2 to 3 minutes for group members to read the handout.

• Ask:

Which of these things would you like to do first?

Note: Allow about 3 minutes for group members to answer.

Choose one or two action items from this handout that you would like to do during each week of the training. Then, write down the date that you complete each action.

32 Your Heart, Your Life: A Community Health Worker’s Manual

Review of Today’s Key Points

Let’s review the main points that we learned today.

What is a heart attack?

• A heart attack occurs when a coronary artery becomes blocked and blood

flow is closed off.

• If the blood flow is stopped, parts of the heart muscle start to die.

What stops a heart attack?

• Quick action and medical treatment restore blood flow and save

heart muscle.

Why is it important to get treatment quickly?

• Quick treatment can prevent the heart muscle from dying.

• It is best to receive treatment within 1 hour after warning signs start. This

will improve chances of survival and will help save the heart muscle.

• “Clot-busting” and other medicines open up the artery and restore

blood flow.

• Angioplasty opens the artery and restores blood flow.

What are the warning signs of a heart attack?

• Your chest may hurt or feel squeezed.

• One or both of your arms, your back, or your stomach may hurt.

• You may feel pain in your neck or jaw.

• You may feel like you cannot breathe.

• You may feel light-headed or break out in a cold sweat.

• You may feel sick to your stomach.

Session 2. Act in Time to Heart Attack Signs 33

What should you do if you experience these warning signs?

• Call 9–1–1 in 5 minutes or less, even if you are not sure you are

having a heart attack. Calling 9–1–1 gets you treated more quickly.

• Do not drive yourself to the hospital.

Weekly Pledge

You have learned a lot today about how to be prepared if a heart attack happens. Now let’s think about how you can practice what you have learned. Please think of one change you can make. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• Within the next week, I will think about what to do if a heart attack happens

at home, at work, in the middle of the night, or in other situations.

• I will talk with family and friends within the next week about the heart attack

warning signs and the need to call 9–1–1 right away.

• I will make an appointment within the next month to talk to my doctor about

my heart attack risk.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

34 Your Heart, Your Life: A Community Health Worker’s Manual

• (Optional) Say:

A personal value is a quality that you consider valuable or important. Personal values can help you make changes in your everyday life to improve your health.

Today, the value is serenity. Serenity helps you stay calm, even when you face problems or worries. It can help you manage stress and anger, which are two things that can bring about a heart attack.

Note: Ask the group members to share how serenity, or another personal value, can help them keep their pledge. Allow 3 minutes for group members to share their ideas.

We will talk about how you did with your pledge at the next session.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

The next session is about physical activity. Please wear comfortable clothing and walking shoes.

Session 2. Act in Time to Heart Attack Signs 35

Learn What a Heart Attack Feels Like

Act fast. Call 9–1–1. It could save your life.

Clot-busting medicines and other treatments can stop a heart attack as it is happening. These treatments work best if given within 1 hour of when heart attack signs begin. If you think you are having a heart attack, call 9–1–1 right away.

KnOW THE HEART ATTACK WARnIng SIgnS:

Your chest may You may feel discomfort You may feel discomfort in feel pressure. in one or both arms, or the your neck or jaw. back or stomach.

You may feel like You may feel light-headed or You may feel sick you can’t breathe. break out in a cold sweat. to your stomach.

36 HAnDOuT—SESSIOn 2

Fast Action Saves Lives

YOu MAY nOT BE SuRE IT IS A HEART ATTACK. A heart attack may not be sudden or very painful. You may not be sure what is wrong. But it is important to check it out right away.

ACT FAST. CALL 9–1–1.

Call 9–1–1 in 5 minutes or less. When you call 9–1–1, an emergency vehicle arrives Do not drive yourself to the hospital. right away. Medicines can be given at once.

TO HELP SuRvIvE A HEART ATTACK, TAKE THESE STEPS:

• Learn the warning signs of a heart attack, and act fast if you feel them.
• Talk with family and friends about the warning signs and the need to call 9–1–1 right away.
• Ask your doctor about your heart attack risk and how to lower it.
• Complete the “My Emergency Card” handout (page 41).

HAnDOuT—SESSIOn 2 37

Fast Action Saves Lives: Role Plays (continued)

Role Play 1: At Home

Actor 1 You are at home having breakfast with your spouse. You tell your spouse that you woke up not feeling well. You have a variety of warning signs, including the following:

• You feel some pressure and discomfort in your chest.
• Your arm hurts.
• You feel short of breath.
• You feel a little light-headed.

Actor 2 You look worried—you are not sure what is wrong, but your spouse looks sick. You tell your spouse you have recently heard about the signs of a heart attack and are worried that this may be the problem. You say that maybe it is best if you call 9–1–1.

Actor 1 You insist it is nothing, probably just indigestion. It will pass; you will be fine.

Actor 2 You reply by telling your spouse why it is important to call 9–1–1 right away:

• Even if you are not sure it is a heart attack, it is best to check it out.
• If it is a heart attack, fast treatment can prevent damage to the heart.
• Getting to the hospital quickly means that treatment can start right away and maybe save your life.

You call 9–1–1.

38 HAnDOuT—SESSIOn 2

Fast Action Saves Lives: Role Plays (continued)

Role Play 2: At Work

Actor 1 You are at work one afternoon, and you see that your coworker does not look well. You ask if anything is wrong.

Actor 2 You reply that you came to work this morning not feeling quite right. You describe the warning signs:

• A heavy feeling in the center of the chest
• Difficulty catching your breath
• Feeling sick to your stomach
• Feeling light-headed
• Some pain going down the left arm

Actor 1 You say you have heard that these signs may mean a heart attack. If so, it is best to get it checked out right away at the hospital. You offer to call 9–1–1.

Actor 2 You give your coworker many reasons why this is not necessary.

• You ate a big lunch, and it’s just indigestion, nothing serious.
• You don’t want to cause a scene at work and get everybody worried.
• You want to wait and see if the pain goes away in a little while.
• If you went to the hospital, no one would be there to pick up your grandson from daycare.

Actor 1 You tell your coworker why it is important to call 9–1–1 right away. You make the call.

HAnDOuT—SESSIOn 2 39

Fast Action Saves Lives: Role Plays (continued)

Role Play 3: At Night

Actor 1 You are at home one night reading a magazine when you suddenly start to feel very sick. You call your neighbor on the phone to say you are not feeling well. You describe the signs.

• You suddenly feel a very bad pain in the center of your chest.
• You are out of breath, and you are breaking out in a cold sweat.

You feel it is something bad, and you think you should drive yourself to the hospital. Will your neighbor go with you?

Actor 2 You tell your neighbor you are worried because these symptoms sound like the warning signs of a heart attack. You say in this case it is best to call 9–1–1, not to drive yourself, so you will get to the hospital safely and be treated right away.

Actor 1 You protest that you don’t want to wake up the neighborhood and cause a big scene with the siren and all the lights; it’s easier to drive.

Actor 2 You tell your neighbor why it is better to call the emergency service.

• Emergency personnel can start medical care right away.
• If your heart stops beating, emergency personnel can revive you.
• Heart attack patients who arrive by ambulance tend to receive faster treatment when they get to the hospital.

Actor 1 You agree that this makes sense. You ask your neighbor to call 9–1–1 for you right away and then come over to be with you.

40 HAnDOuT—SESSIOn 2

My Emergency Card

" "

Other ____________________________Diabetes _______________________High Blood Pressure ______________Previous Heart Attack _____________Heart Disease ___________________Do you have any of the following conditions?

Phone

Relationship q q q q YesYesYesYes

My Emergency Card

q q q q No No No No

Name Name: ______________________________________________Date of Birth: _____________ Home Phone: ________________Emergency Contacts:

(fold 2) ________________________________________________________________________________________________________Other Information: _____________________________________Known Allergies: ______________________________________Current Medications: ___________________________________

Family Doctor: _____________________________________Phone: ___________________________________________Local Clinic/Hospital: ________________________________Phone: ___________________________________________Emergency numbersFire Department: ___________________________________Local Police Department: ____________________________

Cut along dotted lines. Fold card in half and paste with a glue stick (Fold 1).Fold in half again to make your own personal wallet card (Fold 2).

" (fold 1) "

HAnDOuT—SESSIOn 2 41

Tender Care for a Happy Heart

Choose one or two action items from this handout that you would like to do during each week of the training. Then, write down the date that you completed each action.

Action

q Say something nice, positive, or uplifting to someone.

q Allow additional time to do things and get to places without rushing.

q Try a new hobby such as arts and crafts.

q Look for an activity that will allow you to make new friends.

q Show gratitude to at least five people.

q Tell your loved ones that you love them.

q Do something nice for someone.

q Think about three things that make you happy.

q Value what you have, and try to see the positive side of things.

q Do something special for yourself.

q Laugh and be positive. If you like jokes, tell one.

Date Action Date

q Call a friend you have not seen for a long time.

q Look at yourself in the mirror and say, “I am special and unique.”

q Write down how you feel.

q At the end of the day, think about the things that were good and the things you can improve.

q Rest. Go to bed 1 hour earlier than usual.

q Listen to soft music to relax.

q Help someone in need.

q Plant a garden.

q Be thankful for your family.

q Seek support in your faith community.

q Speak calmly. Do not yell or scream.

q Take 15 minutes to breathe deeply and relax.

q Be kind to someone with whom you have differences.

HAnDOuT—SESSIOn 2

s essi o n

Take Heart: Say YES to Physical Activity

Objectives

By the end of this session, group members will learn that:

• Physical activity is good for the heart and overall health.
• Adults should be physically active for 30 to 60 minutes on most days.
• Children and adolescents should be physically active for about 60 minutes on most days, preferably daily.
• Brisk walking is a simple activity nearly everyone can do.
• There are ways to fit more activity into a busy schedule.

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• (Optional) Index cards for physical activity guessing game*
• (Optional) VCR or DVD and TV
• Prepare before the session.

Session 3. Take Heart: Say YES to Physical Activity 43

• (Optional) “The New Health Machine: Exercise” telenovela or fotonovela (pages 412 and 413)

Note: The telenovela is available in Spanish only.

• Cool drinking water and cups
• (Optional) Music for walking activity and tape player or CD player

Handouts

Give group members these handouts during this session:

• “Getting Started With Physical Activity” (page 65)
• “Getting Started With Physical Activity: Doña Fela’s Answers” (page 66)
• “Take Heart—Say Yes to Physical Activity” (pages 67–68)
• “Stretching Activities” (page 69)
• “How To Be Physically Active” (page 70)
• “Make Physical Activity a Habit—My Personal Record” (page 71)
• “Sample Walking Program” (page 72)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

44 Your Heart, Your Life: A Community Health Worker’s Manual

Conducting the Session

1. Facts About Physical Activity
2. (Optional) “The New Health Machine: Exercise” Telenovela or Fotonovela (pages 412–413)
3. Benefits of Physical Activity
4. Types of Physical Activity

(Optional) Physical Activity Guessing Game

1. Getting Started: Important Things To Know
2. Finding Time To Be Physically Active
3. Walking: An Activity for Almost Everyone*

A. Discussion and Stretching

B. Walking Activity

Review of Today’s Key Points

Weekly Pledge

Closing

Note: If you have time, include a 30-minute activity, such as walking, at the beginning or end of the remaining sessions.

• Prepare for the walking activity by reading the box with tips on page 58.

Session 3. Take Heart: Say YES to Physical Activity 45

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session we talked about the heart attack warning signs. Who remembers the warning signs of a heart attack?

Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these signs if they are not mentioned:

• Your chest may hurt or feel squeezed.

• You may feel pain in your neck or jaw.

• One or both of your arms, your back, or your stomach may hurt.

• You may feel like you can’t breathe.

• You may break out in a cold sweat.

• You may feel sick to your stomach.

• You may feel light-headed.

• Ask:

Who remembers what you should do if you feel these symptoms?

46 Your Heart, Your Life: A Community Health Worker’s Manual

The answers are:

• Call 9–1–1 in 5 minutes or less, even if you are not sure you are having a

heart attack. Calling 9–1–1 gets you treated more quickly.

• Do not drive yourself to the hospital.

At the end of the session, we pledged to do one thing to be prepared if a heart attack happens. Please share with the group what you did.

Note: Allow 2 to 3 minutes for group members to respond.

3. About This Session

During today’s session, we will discuss physical activity and how important it is to your heart health. When the session ends, you will know:

• How physical activity can help you and your family

• What kind of activities are good for you and for your heart

• How much activity you should do

• How you can find time to be active

Note: “Physical activity” and “exercise” mean the same thing.

Session 3. Take Heart: Say YES to Physical Activity 47

Conducting the Session

1. Facts About Physical Activity

Not getting enough physical activity is a major health risk for people today.

• Being physically inactive puts you at risk for heart disease. The good news

is that you can do something about this risk factor.

• Latinos, especially women and children, are not getting enough physical

activity.

• As a person gets older, having little or no physical activity can lead to health

problems.

2. (Optional) “The New Health Machine: Exercise”

Telenovela or Fotonovela

• If you choose, show the telenovela on physical activity, “The New Health Machine: Exercise,” or have volunteers read the fotonovela (pages 412–413).

Note: The telenovela is available in Spanish only.

3. Benefits of Physical Activity

• Ask:

How do you think physical activity can help you?

Note: Allow about 5 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Show picture card 3.1.

48 Your Heart, Your Life: A Community Health Worker’s Manual

Physical activity can help you:

• Strengthen your heart and lungs. • Feel better about yourself.

• Build and maintain healthy bones, • Lower your stress.

muscles, and joints.

• Reduce feelings of depression • Control your weight. and anxiety.

• Have more energy. • Sleep better.

• Show picture card 3.2.

Physical activity can also help you:

• Lower your blood pressure.

• Control your blood cholesterol.

• Lower your risk of getting heart disease, diabetes, and some cancers.

• Show picture card 3.3.

People feel better when they are active. Physical activity may help you lose weight.

4. Types of Physical Activity

• Ask:

What do you do to be physically active?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Session 3. Take Heart: Say YES to Physical Activity 49

There are different types of physical activity. Physical activity includes some of the things that you probably do each day, like walking, climbing stairs, or doing household chores.

• Show picture card 3.4.

You may want to start with moderate (medium-level) activities. Moderate activities should require you to make some physical effort, but you should be able to have a conversation comfortably while doing them. Examples of moderate activities include:

• Walking at a brisk pace • Scrubbing floors and washing

windows

• Gardening (mowing, raking) • Weightlifting • Dancing (salsa, merengue) • Playing softball • Making home repairs (painting) • Doing floor exercises • Washing and waxing a car

(pushups, situps)

• Show picture card 3.5.

After a while, you will be able to do more vigorous (high-level) activities. Vigorous activities require hard physical effort and make your heart rate and breathing much faster. You usually can’t carry on a conversation comfortably while you are doing vigorous activities. Vigorous activities that you might enjoy include:

• Playing soccer, basketball, or baseball • Swimming laps

• Running or jogging
• Bicycling fast or uphill
• Doing aerobics
• Jumping rope
• Skating
• Performing heavy construction

work

50 Your Heart, Your Life: A Community Health Worker’s Manual

A. (Optional) Physical Activity Guessing Game

Note: You can play a physical activity guessing game. Ahead of time, write the names of the 8 medium-level physical activities on index cards of one color and the 10 high-level activities on index cards of a different color (listed on page 68).

• Divide participants into two groups, and give each person a card.
• Ask the medium-level activity group to go first. One by one, each person will act out the physical activity on his or her card. Ask the rest of the participants to guess the activity.
• Follow the same process for the high-level activity group.

All types of physical activity are good for you. Aerobic activities, such as brisk walking that speeds your heart rate and breathing, help your heart. Other activities such as weightlifting and stretching can help improve strength and flexibility.

Start slowly. Then move on to higher-level activities. For example, when you are comfortable walking, gradually begin to jog. You’ll feel great!

• Ask:

How much physical activity do you think you need to do each day to improve your health?

• Adults should have at least 30 minutes of moderate physical activity daily to

lower their chances of getting heart disease.

• Some adults need up to 60 minutes of moderate physical activity on most

days to prevent unhealthy weight gain.

• Adults who used to be overweight need 60 to 90 minutes of moderate

physical activity every day to avoid regaining weight.

• Children and adolescents need at least 60 minutes of moderate to vigorous

physical activity on most days, preferably daily.

Session 3. Take Heart: Say YES to Physical Activity 51

• Show picture card 3.6.

If you can’t set aside 30 or 60 minutes at one time to be active, you can break your activity into shorter periods of 10 minutes or longer. It’s the total time of physical activity that is important. Just make sure that the total time adds up to 30 or 60 minutes on most days.

For example, if you can only do 30 minutes of physical activity a day:

• Ride your stationary bike for 10 minutes before you go to work.............+10

• Take a 10-minute walk with your kids after work....................................+10

• Do aerobic exercises for 10 minutes later in the day................................+10

30 minutes

• Show picture card 3.7.

If you have more time, you can build up to 60 minutes a day with activities like these:

• Use your stationary bike for 10 minutes before you go to work..............+10

• Take a 15-minute walk with coworkers during your lunch break. ...........+15

• Lift weights (dumbbells) while dinner is baking ......................................+10

• Dance with your family to your favorite music........................................+15

• Do aerobic exercises for 10 minutes later in the day................................+10

60 minutes

52 Your Heart, Your Life: A Community Health Worker’s Manual

More Information

Just Move It

• Physical activity is important in weight control.
• Try to be physically active for 30 to 60 minutes on most days.

Here are some examples of how many calories you can burn from various activities for 30 minutes.

Activity Calories burned per 30 minutes*

• These calories are for a healthy 154-pound person. A lighter person burns fewer calories; a heavier person burns more.

Source: “The Compendium of Physical Activities Tracking Guide,” University of South Carolina, 2000

Session 3. Take Heart: Say YES to Physical Activity 53

5. Getting Started: Important Things To Know

Note: This session gives information for people who are just starting to be active. It also helps people add more activity to what they already do.

There are a few things you should know before starting to be physically active.

• Give each group member the “Getting Started With Physical Activity” handout (page 65).

It’s very important to know when to talk with a doctor before starting a physical activity program. In the list on your handout, check which people should see a doctor before they begin physical activity.

• Read the passages below while the participants check off the boxes.

Carlos is 65 years old and had a heart attack 10 years ago, but he is fully recovered.

Maria is 32 years old and had a healthy baby 8 months ago.

Arturo is 38 years old and has diabetes, but he controls his condition very well with medication.

Carmen is 35 years old and wants to start being more physically active to lower her high blood pressure and help herself to quit smoking.

Gloria is 27 years old and in good health, and she wants to start running.

Hector is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day but wants to start jogging.

Note: Allow a few minutes for group members to discuss.

• Give each group member the “Getting Started With Physical Activity: Doña Fela’s Answers” handout (page 66).

54 Your Heart, Your Life: A Community Health Worker’s Manual

Let’s look at the handout to see what Doña Fela has to say about this.

Note: Go over the answers with the group.

These are Doña Fela’s answers:

Carlos should see a doctor before starting a physical activity program, because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.

Maria does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.

Arturo should see a doctor before starting a physical activity program, because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.

Carmen should see a doctor before starting a physical activity program because she has two risk factors: high blood pressure and smoking.

Gloria does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young and in good health.

Hector should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first, because he wants to start a harder physical activity program, and he is more than 45 years old.

Here are some other things you should know before starting a physical activity program:

1. Start slowly. Build up the time and effort that you put into any activity. You should not be tired the next day.

Session 3. Take Heart: Say YES to Physical Activity 55

1. Drink plenty of fluids before, during, and after physical activity, even if you are not thirsty. Drink water. Water has no calories and will prevent you from becoming dehydrated. Special sports drinks are not needed.
2. Wear shoes and socks that give your feet support. Shoes with thick soles will cushion your feet and absorb shock.
3. Wear comfortable clothing. You do not need to buy fancy outfits.
4. Never wrap your body in plastic or wear clothing that is too heavy. This will not help you lose fat, but it can:

• Make you sweat too much.

• Make your body temperature rise.

• Make your heart beat too fast.

• Make you sick to your stomach.

• Cause you to pass out.

• Cause damage to your organs.

You should also know that some people who are very overweight may face special challenges in trying to be physically active, but they too have good options.

Start with these activities:

• Weight-bearing activities, such as walking, involve lifting or pushing your

own body weight.

• Nonweight-bearing activities, such as swimming and water workouts,

put less stress on your joints because you do not have to lift or push your own weight. If your feet or joints hurt when you stand, nonweight-bearing activities may be best for you.

• Lifestyle activities, such as gardening, do not have to be planned.

56 Your Heart, Your Life: A Community Health Worker’s Manual

Note: For more information on being active at any size, visit the Weight-control Information Network at http://win.niddk.nih.gov or call 1–877–946–4627 (toll free).

• Ask:

Does anyone have any questions?

Note: Allow 2 or 3 minutes for questions.

6. Finding Time To Be Physically Active

I know that all of you have busy lives. You may be wondering how you will ever find time to be physically active. Let’s look at some ways.

• Give each group member the “Take Heart—Say Yes to Physical Activity” handout (pages 67–68). Read the handout aloud.
• Ask:

What are some other ways to become more active even when you don’t have time?

Note: Allow about 5 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these ways if group members do not mention them.

• Take a 15- to 20-minute walk during your lunch break at work or after dinner

with your family.

• Jump rope a few minutes each day. Work up to jumping for 10 minutes.

• Dance with your children. You’ll burn calories and have fun together.

Spend more time being active, and cut back on watching TV, videos, or DVDs; using the computer; or playing video games.

Session 3. Take Heart: Say YES to Physical Activity 57

7. Walking: An Activity for Almost Everyone

Tips for Preparing for the Walking Activity

Before the start of this session:

• Review the “Stretching Activities” handout (page 69).
• Practice until you know each part well enough to teach it to the group members.
• Practice a brisk walk. Take long strides, and swing your arms.

When leading this activity, remember:

• Music can get people in the mood for being active. Use a lively song for the warmup exercises, a faster beat for the walking, and a relaxing song for the cooldown period. Make sure that no one objects to the music.
• Be enthusiastic. Group members will pick up on your enthusiasm and feel good about exercising.
• Lead the walk in a circle if you have to do the walking indoors or if space is limited.
• Have plenty of cool drinking water available before and after the activity.

A. Discussion and Stretching

Brisk walking is an excellent form of physical activity. It’s easy to do, and you do not need special equipment. All you need are shoes for support and socks for cushioning.

58 Your Heart, Your Life: A Community Health Worker’s Manual

Walking can be done outdoors or indoors. If you do not feel safe walking in your neighborhood, a school or churchyard may be a safer place to walk. Walk in well-lit areas at night. Many shopping malls let people walk inside the mall before the stores open. Some malls even have walking clubs that meet every day.

It’s important to spend time warming up and cooling down each time you are physically active. Although the risk of injury from walking is low, the warmup gets your leg muscles ready for the activity. The cooldown lets your heart rate slowly return to normal. This also keeps your leg muscles from getting stiff.

Note: Ask the group members to stand up and spread out, with at least 3 feet between them and other group members.

• Start the music.

It is important to warm up your muscles and stretch before you begin physical activity. First, we will warm up our muscles, and then we will stretch. Let’s walk in place slowly for 3 minutes.

Now, I am going to show you some stretching activities. Watch me, and then try doing them yourselves. Some are easier to do than others. With time and practice, you will be able to do them all. If you have a bit of trouble at first, just do your best. You will get a handout that tells you how to do these stretching activities. Use the handout to help you do them at home.

B. Walking Activity

• After the stretching activities, lead the group members on a 15- to ACTIVITY 20- minute walk. Walk slowly for the first 5 minutes. Then show them how to do a brisk walk for 5 to 10 minutes.
• During the last 5 minutes, slow your pace.

Session 3. Take Heart: Say YES to Physical Activity 59

We are slowing down now so that our bodies can gradually relax. This important part is called the cooldown period. It’s usually recommended that you gradually slow your pace during the last 5 minutes of an activity. Doing a few stretching exercises to loosen the muscles should also be part of your cooldown.

For example, runners or joggers may cool down by walking for a few minutes and then stretching their leg muscles before they stop entirely.

• Ask:

How do you feel? Do you think you could continue to walk like this? Why or why not?

Note: Allow 3 to 5 minutes for group members to answer.

If you already walk three or more times a week, add other activities to become more fit. Try running, jumping rope, or doing aerobics.

One of the hardest parts of being more active is staying motivated. Many people find that having a partner helps them stay active. A partner can be a family member, neighbor, or friend. The benefits of having a partner are:

• You can motivate each other. You can set goals together and help each other

meet them.

• It makes the time go by faster. You focus on talking rather than on the

activity.

Walking clubs are a great way to enjoy physical activity and make friends.

60 Your Heart, Your Life: A Community Health Worker’s Manual

Note: See page 424 for tips on how to organize a walking club, so you can share the tips with group members.

• Ask:

• What would help you stay motivated to continue being physically active?

• Where are some safe places in your neighborhood to be active?

Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Give each group member the following handouts: “Stretching Activities” (page 69), “How To Be Physically Active” (page 70), “Make Physical Activity a Habit—My Personal Record” (page 71), and “Sample Walking Program” (page 72).

Use the “Make Physical Activity a Habit—My Personal Record” handout to track your daily progress.

Review of Today’s Key Points

Let’s review what we have learned today.

What are some of the benefits of regular physical activity?

• Regular physical activity can:

• Strengthen your heart and lungs.
• Build and maintain healthy bones, muscles, and joints.
• Help you lose excess weight and prevent weight gain.
• Control blood cholesterol and lower blood pressure.

Session 3. Take Heart: Say YES to Physical Activity 61

• Help you sleep better, reduce stress, increase energy, and reduce feelings of depression.
• Lower your chance for heart disease, diabetes, and cancer.

What is an activity that just about everyone can do?

• Brisk walking

What are simple ways to become more active throughout the day?

• Take a walk.

• Get off the bus early and walk.

• Dance to your favorite music.

What is the minimum amount of physical activity recommended for you to do every day?

• Adults need at least 30 minutes, and children and adolescents need at least

60 minutes daily.

Weekly Pledge

You have learned a lot today about how you can become more physically active. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to increase your level of physical activity. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Examples include:

• I will talk to family members and friends this weekend about taking regular

walks together.

62 Your Heart, Your Life: A Community Health Worker’s Manual

• I will start walking for at least 20 minutes during my lunch break at work,

starting tomorrow.

Write your pledge on the “Take Heart—Say Yes to Physical Activity” handout on page 68. Keep this handout in a special place so you can review your pledges and keep your goal in mind.

Note: Allow 5 minutes for group members to think of a pledge and write it down.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

• (Optional) Say:

Keeping a personal value in mind can help you make changes in your everyday life to become more physically active. Remember that a personal value is a quality that you consider important.

Today the value is perseverance. Perseverance helps you have the willpower to keep your pledge, even if it means starting again after a slip. It helps you set a routine to keep you focused on your goal to improve your health.

• Ask:

How could you use perseverance or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will talk about how you did with your pledge at the next session. Remember to keep working on your pledge to be prepared if a heart attack happens.

Session 3. Take Heart: Say YES to Physical Activity 63

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about how to cut back on salt and sodium to prevent and control high blood pressure.

Note: Think about today’s class. What worked? What didn’t work? Have you made any changes in your own life that were covered in today’s session?

64 Your Heart, Your Life: A Community Health Worker’s Manual

Getting Started With Physical Activity

It’s very important to know when to talk with a doctor before starting a physical activity program.

In the list below, check which people should see a doctor before they begin a physical activity program.

Carlos is 65 years old and had a heart attack 10 years ago, but he is fully recovered.

Maria is 32 years old and had a healthy baby 8 months ago.

Arturo is 38 years old and has diabetes, but he controls his condition very well with medication.

Carmen is 35 years old and wants to start being more physically active to lower her high blood pressure and help her to quit smoking.

Gloria is 27 years old and in good health, and she wants to start running.

Hector is 57 years old and broke his leg 2 years ago, but it healed very well. He walks every day, but wants to start jogging.

HANDOuT—SESSION 3 65

Getting Started With Physical Activity: Doña Fela’s Answers

Carlos should see a doctor before starting a physical activity program because he has had a heart attack. Even though he is fully recovered, he should still check with his doctor.

Maria does not need to see a doctor before starting a physical activity program. Having a baby is not a risk factor, and she is young.

Arturo should see a doctor before starting a physical activity program, because he has diabetes. Even though he is young and he controls his condition very well with medication, he should still check with his doctor.

Carmen should see a doctor before starting a physical activity program, because she has two risk factors: high blood pressure and smoking.

Gloria does not need to see a doctor before starting a physical activity program. Even though she wants to start a harder activity, such as running, she is young and in good health.

Hector should see a doctor before starting a physical activity program. His broken leg is not a factor, but he should check with the doctor first, because he wants to start a harder physical activity program, and he is more than 45 years old.

66 HANDOuT—SESSION 3

Take Heart—Say Yes to Physical Activity

Regular physical activity can help your heart and lungs work better; lower your blood pressure, blood cholesterol, and blood glucose (blood sugar); and help you control your weight. It can also help you relax, feel less tense, sleep better, have more energy, and feel better about yourself. Physical activity can also reduce your risk for diabetes and some types of cancer.

Make staying active a lifelong habit.

Doña Fela has learned that the more physical activity you do, the easier it gets.

I do not wait until the end of the day when I am too tired to do any physical activity. I am active throughout the day. I take the stairs instead of the elevators and walk everywhere I can. Now I am up to walking 60 minutes a day with Leticia, my neighbor. It helps to like what you do and to do it with a friend. We are so busy talking, we walk even longer.

HANDOuT—SESSION 3 67

Take Heart—Say Yes to Physical Activity

Keep moving. Start slowly, and work your way up!

Strive to do at least 30 minutes of activity every day. If you’re short on time, try three or more 10-minute periods.

Start with light activities

• Slow walking
• Watering the lawn or garden
• Vacuuming

Move to moderate activities

• Walking at a brisk pace
• Gardening (mowing, raking)
• Dancing
• Doing home repairs
• Washing and waxing a car
• Washing windows and scrubbing floors
• Playing softball
• Weightlifting

Increase to vigorous activities

• Playing soccer
• Playing basketball
• Playing baseball
• Running or jogging
• Bicycling fast or uphill
• Doing aerobics
• Swimming laps
• Jumping rope
• Skating
• Doing heavy construction work

Other things to do to help you and your family get started:

• Leave a pair of walking shoes in your car.
• Set a date and time with a coworker to begin walking.

Carmencita, Virginia, and Néstor Ramírez have all increased their physical activity. They now dance and use their stationary bike almost every day. And Mariano Ramírez jogs in place each day.

Make your personal pledge to exercise like the Ramírez family does!

Look at these examples:

Morning

Park the car a few blocks away and walk for 10 minutes.

Noon

During lunch, take a walk with a coworker.

Evening

After dinner, take a walk with your family.

Write the changes you will make this week.

Your health and your family’s health are priceless. Make an investment in it!

HANDOuT—SESSION 3

Stretching Activities

Do these stretches gently and slowly. Do not bounce.

1. Deep breathing

Arms up, breathe in. Arms down, breathe out. Two times each.

1. Waist Stretches

Side to side three times in each direction.

1. Leg Stretch 1

Hold onto ankle, four times on each side.

1. Neck Stretching 3. Shoulder Stretches 4. Side Stretches

Side to side two times. Up and down five times Up and down five times on each side. in each direction.

1. Twists 7. Back and Leg 8. Back Stretch Side to side three times Stretches Arms through legs six

in each direction. Down and up five times. times.

1. Leg Stretch 2 11. Leg Stretch 3

Down and up five times. Move heels up and down six times.

Developed by the California Diabetes Program, California Department of Health Services.

HANDOuT—SESSION 3 69

How To Be Physically Active

Walk slowly for 5 minutes. Then do stretching exercises. (See handout on

1. 2. Walk briskly for 20 minutes.

stretching exercises.)

3. Walk slowly for 5 minutes. 4. Relax!

70 HANDOuT—SESSION 3

Make Physical Activity a Habit—My Personal Record

Name: _____________________________________________

Track your progress every day. Start out slowly.

Aim to reach 60 minutes or more each day!

Write down the number of minutes you are active each day.

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Example 5 min. 5 10 10 15 15 15

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

HANDOuT—SESSION 3 71

Sample Walking Program*

Warm Up

Week 1 Walk slowly

5 minutes

Week 2 Walk slowly

5 minutes

Week 3 Walk slowly

5 minutes

Week 4 Walk slowly

5 minutes

Week 5 Walk slowly

5 minutes

Week 6 Walk slowly

5 minutes

Week 7 Walk slowly

5 minutes

Week 8 Walk slowly

5 minutes

• Walk every day of the week.

Walk Cool Down Total Time

Walk briskly Walk slowly 15 minutes 5 minutes 5 minutes

Walk briskly Walk slowly 20 minutes 10 minutes 5 minutes

Walk briskly Walk slowly 25 minutes 15 minutes 5 minutes

Walk briskly Walk slowly 30 minutes 20 minutes 5 minutes

Walk briskly Walk slowly 35 minutes 25 minutes 5 minutes

Walk briskly Walk slowly 40 minutes 30 minutes 5 minutes

Walk briskly Walk slowly 45 minutes 35 minutes 5 minutes

Walk briskly Walk slowly 50 minutes 40 minutes 5 minutes

HANDOuT—SESSION 3

s essi o n

Help Your Heart: Control Your High Blood Pressure

Objectives

By the end of this session, group members will learn:

n What blood pressure is n That it is best to have a blood pressure below 120/80 mmHg (millimeters of mercury)

n That blood pressure between 120/80 and 139/89 mmHg is prehypertension n That a blood pressure of 140/90 mmHg or greater is high n What a stroke is and what the warning signs are n That eating less salt and sodium can lower the risk of developing high blood pressure n That they can take steps to lower the amount of salt and sodium in their diet

Materials and Supplies

To conduct this session, you will need:

n “Your Heart, Your Life” manual and picture cards n Blackboard and chalk or several large pieces of paper, a marker, and tape n Measuring spoons (1 teaspoon)

n Small amount of salt

Session 4. Help Your Heart: Control Your High Blood Pressure 73

n Colored plate or plastic test tube n Doña Fela’s Seasoning Mixture (page 105). Prepare enough to give a small sample to each group member in a plastic bag or cup.

n (Optional) The “They’ll Learn To Like Him” and “An Unsettling Surprise: Prevent High Blood Pressure” telenovelas. The “An Unsettling Surprise: Prevent High Blood Pressure” fotonovela can be found on pages 414–415.

Note: The telenovela is available in Spanish only.

n (Optional) VCR or DVD and TV monitor

(Optional) Note: Arrange for a health professional to come to the session to take blood pressure readings.

Handouts

Give these handouts to each group member during this session:

n List of places where group members can get their blood pressure checked* n “Know the Stroke Signs. Act Quickly.” (page 98)

n “My Healthy Heart Wallet Card” (page 99)

n “Take Steps—Healthy Habits To Lower High Blood Pressure!” (page 100)

n “Read the Food Label for Sodium!” (page 101)

n “Mariano’s Food Choices” (pages 102–103)

n “Sodium in Foods” (page 104)

n “Keep Your Heart in Mind: Eat Less Salt and Sodium” (pages 105–106)

n “Tips for Taking Medicine for High Blood Pressure” (page 107)

• Prepare this list before the session. You may find information at your local health department, a hospital, or a clinic.

74 Your Heart, Your Life: A Community Health Worker’s Manual

n “Turkey Meatloaf Recipe” (page 108)

n “Use Herbs and Spices Instead of Salt” (page 109)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. The Facts Don’t Lie
2. (Optional) “An Unsettling Surprise: Prevent High Blood Pressure” Telenovela or Fotonovela
3. Facts About Blood Pressure and Stroke
4. Lowering High Blood Pressure
5. (Optional) “They’ll Learn To Like Him” Telenovela
6. Salt and Sodium—How Much Do We Need?
7. Food Label Activity—Sodium
8. Shake the Salt and Sodium Habit
9. Easy on the Alcohol
10. Manage Your High Blood Pressure With Medicine
11. Turkey Meatloaf Recipe

Review of Today’s Key Points

Weekly Pledge

Session 4. Help Your Heart: Control Your High Blood Pressure 75

(Optional) Blood Pressure Check

Closing

Introducing the Session

1. Welcome

n Welcome group members to the session.

2. Review of Last Week’s Session

n Say:

Last week, we talked about why you should be physically active. What do you remember about the benefits of being physically active?

Note: Allow about 3 minutes for group members to answer. Write responses on the blackboard or on a large piece of paper taped to the wall.

n Add the following benefits if they are not mentioned. Physical activity:

• Strengthens your heart and lungs.

• Builds and maintains healthy bones, muscles, and joints.

• Helps you feel better about yourself.

• Helps you control your weight.

• Helps you lower your high blood pressure.

• Helps you control your blood cholesterol.

• Helps you sleep better.

• Helps you reduce stress and feelings of depression and anxiety.

76 Your Heart, Your Life: A Community Health Worker’s Manual

• Helps you have more energy.

• Helps lower your chances of developing diabetes (high blood sugar), heart

disease, and some cancers.

n Say:

At the end of our last session, everyone made a pledge to be more active.

Note: Share with the group what you did and what barriers you faced.

n Ask:

Would any of you like to share with the group what you did? What problems did you face (such as not having time or not getting family support)? How did you solve them?

Note: Allow about 5 minutes for responses.

3. About This Session

n Say:

Today’s session is about blood pressure and the steps you can take to lower your blood pressure or keep it from rising.

Conducting the Session

1. The Facts Don’t Lie

n Say:

• More than 65 million people (one in three) in the United States have high

blood pressure, which is also called hypertension. Nearly a third of these people don’t know they have high blood pressure.

Session 4. Help Your Heart: Control Your High Blood Pressure 77

• Another 59 million Americans have prehypertension, which means they are

at risk for developing high blood pressure.

• Nearly one in five Latinos has high blood pressure.

• Only one in five Mexican Americans with high blood pressure have their

blood pressure under control.

2. (Optional) “An Unsettling Surprise” Telenovela or Fotonovela

n Show the telenovela, “An Unsettling Surprise: Prevent High Blood Pressure,” or have volunteers read the fotonovela (pages 414–415).

3. Facts About Blood Pressure and Stroke

n Show picture card 4.1.

n Say:

Blood pressure is the force of blood against the walls of your arteries. Blood pressure is needed to move the blood through your body.

n Show picture card 4.2.

n Say:

Blood pressure is recorded as two numbers––the systolic pressure (as the heart beats) over the diastolic pressure (as the heart relaxes between beats).

n Say:

The measurement is written one above the other, with the systolic number on top and the diastolic number on the bottom. For example, a blood pressure measurement of 120/80 mmHg is expressed verbally as “120 over 80.”

78 Your Heart, Your Life: A Community Health Worker’s Manual

n Say:

It is important to keep track of your blood pressure numbers. Write down your numbers every time you have your blood pressure checked.

n Ask:

Do you know your blood pressure numbers?

Note: Allow about 2 minutes for responses.

Note: Copy this chart on the blackboard or on a large piece of paper taped to the wall.

Your Blood Pressure Numbers

Level First number Second number Results (mmHg) (mmHg)

Normal Below 120 Below 80 Good for you!

Prehypertension 120–139 80–89 Keep an eye on your blood pressure.

It is time to make changes in your eating and physical activity habits. Visit the doctor if you have diabetes.

High blood 140 or greater 90 or greater Ask your doctor or nurse how to pressure control it.

n Say:

A normal blood pressure is less than 120/80 mmHg. Blood pressure of 120/80 to 139/89 mmHg is prehypertension. This means that you don’t have high blood pressure yet, but are likely to develop it in the future, unless you make changes in your health habits. Blood pressure is high when it is 140/90 mmHg or greater.

n Show picture card 4.3.

Session 4. Help Your Heart: Control Your High Blood Pressure 79

n Say:

If you have high blood pressure, or hypertension, it means your heart has to pump harder than it should to get blood to all parts of your body. High blood pressure raises your chances of having a stroke, heart attack, or kidney problems or becoming blind.

n Say:

High blood pressure is known as the “silent killer” because it often has no symptoms. Most people who have it don’t feel sick until they have a stroke, heart attack, or some other problem caused by high blood pressure.

n Say:

High blood pressure is a major risk factor for stroke. Other risk factors that increase your chances of having a stroke include heart disease, smoking, diabetes, and high blood cholesterol.

n Ask:

Do you know anyone who has had a stroke?

Note: Allow a few minutes for group members to answer.

n Give group members the “Know the Stroke Signs. Act Quickly.” handout (page 98).

n Show picture card 4.4.

n Say:

A stroke is also called a brain attack. A stroke happens when blood suddenly stops going to the brain and brain cells die. A stroke is very serious and can lead to disability and death.

80 Your Heart, Your Life: A Community Health Worker’s Manual

n Say:

The warning signs of a stroke happen suddenly. A person may have one or more warning signs. The warning signs of a stroke include:

• Numbness of the face, arm, or leg (especially on one side of the body)

• Confusion, trouble talking, and difficulty understanding others

• Trouble seeing in one or both eyes

• Trouble walking, dizziness, and loss of balance or coordination

• Severe headache

n Say:

Ministrokes—or transient ischemic attacks (TIAs)—have the same symptoms as a stroke, but they do not last as long and usually do not cause brain damage. A ministroke is a warning that a stroke may happen in the future.

n Say:

Ministrokes may last a few seconds or an entire day and then go away. These signs should not be ignored. As with a heart attack, act immediately if you or someone you know has stroke symptoms. Calling 9–1–1 right away will help prevent serious problems.

n Show picture card 4.5.

n Say:

Measuring blood pressure is easy and does not hurt. The best way to find out if you have high blood pressure is to have it checked at least once a year. Check it more often if you already have high blood pressure.

n Give group members:

• A list of places (such as clinics and hospitals) to get blood pressure checked

• The “My Healthy Heart Wallet Card” handout (page 99)

Session 4. Help Your Heart: Control Your High Blood Pressure 81

n Say:

Ask for your numbers each time you have your blood pressure checked. Keep a record of each reading on the wallet card.

4. Lowering High Blood Pressure

n Ask group members to raise their hands if someone in their families has high blood pressure.

n Say:

If a member of your family has high blood pressure, you are at greater risk for getting it, too. Even if you do not have high blood pressure now, you are still at greater risk if a family member has it.

n Say:

The good news is that you can take steps now to lower your blood pressure or keep it from rising. Let’s find out how.

n Give each group member the “Take Steps—Healthy Habits To Lower High Blood Pressure!” handout (page 100).

n Read aloud the steps to lower high blood pressure or keep it from rising.

n Ask:

Which steps could you and your family take to prevent or lower high blood pressure?

Note: Allow 3 minutes for group members to respond.

82 Your Heart, Your Life: A Community Health Worker’s Manual

5. (Optional) “They’ll Learn To Like Him” Telenovela

n Say:

Let’s see what the Ramírez family has to say about eating less salt and sodium.

n Show the “They’ll Learn To Like Him” telenovela.

6. Salt and Sodium—How Much Do We Need?

Note: For this activity, you will need a /4 teaspoon measuring spoon, a 1 teaspoon measuring spoon, and some salt. Use a colored plate or a plastic test tube to show the sodium levels.

n Say:

Eating less salt and sodium can help you prevent or lower high blood pressure. You probably know what salt is, but you may wonder what sodium is. Sodium is a part of salt. It is also part of mixtures used to flavor and preserve foods.

n Say:

You should cut back the amount of sodium you get from all foods and beverages to less than 2,300 milligrams of sodium, or about 1 teaspoon of salt per day.

Note: Now show 1 teaspoon of salt.

n Say:

Most people in the United States eat about 4,000 to 6,000 milligrams of sodium each day, or about 2½ teaspoons.

Note: Now show 2½ teaspoons of salt.

Session 4. Help Your Heart: Control Your High Blood Pressure 83

n Say:

This is about 8 to 12 times more sodium than the body needs. Eating this much salt and sodium may lead to high blood pressure.

n Show picture card 4.6.

n Say:

Let’s talk about what foods are high in sodium.

• Most of the sodium that we eat comes from packaged foods, and from

restaurants and fast foods. Examples of packaged foods are regular canned soups, canned vegetables, frozen dinners, salty chips, and meats high in sodium such as hotdogs.

• When you eat out, most of the food will be high in sodium. If you have high

blood pressure, you should eat out less often.

• Sodium also comes from salt added during cooking or at the table.

7. Food Label Activity—Sodium

n Show picture card 4.7.

n Say:

The food label found on packaged foods is one of the best tools we have for choosing foods for a healthy diet. In this session, we will learn how to use the food label to choose foods that are lower in sodium.

n Give group members the “Read the Food Label for Sodium!” handout (page 101).

n Say:

84 Your Heart, Your Life: A Community Health Worker’s Manual

The food label lists the serving size and number of servings in the container. It also gives the amount of calories, sodium, saturated fat, trans fat, cholesterol, and sugar in one serving of the food. We will talk about calories, saturated fat, trans fat, and cholesterol in the next two sessions. Today we will concentrate on sodium.

n Point to where the Percent Daily Value is located on the food label.

n Say:

The Percent Daily Value helps you compare products. It tells you if a food is high or low in various nutrients. Remember—it is easy to take in more than 2,300 milligrams of sodium. Choose foods with a lower Percent Daily Value for sodium. A Percent Daily Value of 5 or less is low, and a Percent Daily Value of 20 or more is high. Once you get into the habit of looking at food labels, it will be easy.

n Say:

Let’s take a close look at the Nutrition Facts on an actual label to find the amount of sodium. Let’s go back to the “Read the Food Label for Sodium!” handout.

n Point again to picture card 4.7.

n Say:

The Percent Daily Value for sodium in a packaged noodle soup is circled on the food label.

n Say:

The sodium content of the same food can vary, depending on how it is packaged or what brand it is. Compare food labels to choose foods that are lower in sodium.

n Say:

Look at the bottom of the handout. Look at the Percent Daily Value for lowsodium soup and for packaged noodle soup. Which soup is lower in sodium?

n Say:

Session 4. Help Your Heart: Control Your High Blood Pressure 85

Low-sodium soup is lower in sodium. One serving of low-sodium soup has only 9 percent of the Daily Value for sodium. One serving of packaged noodle soup has 34 percent of the Daily Value for sodium. The oriental soup has four times more sodium than low-sodium soup.

n Say:

n Say:

More Information: Potassium, Calcium, and Magnesium

The latest research shows that foods rich in potassium are important in protecting against high blood pressure. Foods rich in calcium and magnesium may help, too. Eat foods that are a good source of these nutrients:

• Potassium: bananas, plantains, tomatoes, potatoes, oranges, prunes, spinach,

and dry beans

• Calcium: low-fat milk; low-fat, reduced-sodium cheese; low-fat yogurt;

calcium-fortified orange juice; leafy greens; and fresh or rinsed canned fish

• Magnesium: whole-grain breads and cereals, beans, nuts, seeds, okra, and

spinach

86 Your Heart, Your Life: A Community Health Worker’s Manual

More Information: The DASH Eating Plan To Lower Your Blood Pressure

One eating plan that can lower blood pressure is Dietary Approaches to Stop Hypertension (DASH). By using the DASH plan, you can lower blood pressure by eating:

• Lots of fruits and vegetables • Fat-free or low-fat milk products • Whole-grain products • Fish, poultry, and lean meats • Nuts, seeds, and dry beans

The DASH eating plan also includes:

• Less salt and sodium • Small amounts of fats and oils • Small amounts of sweets and beverages that are high in added sugar

People with high blood pressure will get extra benefits from following the DASH eating plan and eating foods low in salt and sodium. This combination also is heart healthy for people who don’t have high blood pressure.

Choosing and preparing foods that are lower in salt and sodium may help prevent or lower high blood pressure. Eating more fruits and vegetables, wholegrain breads and cereals, and fat-free or low-fat milk products also may help lower blood pressure.

n Say:

Let’s try an activity that will help us choose foods that are low in salt and sodium. First, I am going to describe a situation that may apply to you or to a member of your family. Then, using food labels, we are going to learn how to choose lower-sodium foods.

ACTIVITY

n Give each group member the “Mariano’s Food Choices” handout (pages 102–103). Read or ask a volunteer to read the story below.

Session 4. Help Your Heart: Control Your High Blood Pressure 87

n Say:

Let’s go over some questions. Use the food labels to choose the food

Mariano’s Food Choices

Mariano’s blood pressure was slightly higher the last time he visited his doctor. The doctor told Mariano to cut back on the amount of sodium he eats. Use the food labels to help his wife Virginia choose foods that will help Mariano follow his doctor’s advice.

that is lower in sodium.

n Ask these questions. Give the correct answer after group members guess.

8. Shake the Salt and Sodium Habit

Questions Correct Answers

When buying juice, should Virginia choose tomato juice Orange juice or orange juice?

Should she serve corn tortillas or flour tortillas? Corn tortillas

Is there less sodium in canned chicken or Roasted chicken roasted chicken?

To cut back on sodium, should Mariano Baked tortilla chips eat thin pretzels or baked tortilla chips?

88 Your Heart, Your Life: A Community Health Worker’s Manual

Note: Prepare Do ˜na Fela’s Seasoning Mixture (page 105) before the session.

n Give group members the “Sodium in Foods” handout (page 104).

n Ask:

Does anyone see a food on the right side of the page that you eat often?

n Ask the person to name a lower-sodium food on the left side that he or she could eat instead.

n Say:

Let’s now review some practical tips that will help you cut back on salt and sodium.

n Give each group member a copy of the “Keep Your Heart in Mind: Eat Less Salt and Sodium” handout (pages 105–106). Review the tips on how to cut back on salt and sodium when you are shopping, cooking, and eating.

n Say:

Here is a sample of Doña Fela’s secret recipe from the bottom of the “Keep Your Heart in Mind” handout. Fill an empty saltshaker with the seasoning mixture, and put it on your table. Tell your family to try this instead of salt.

n Give each group member a sample of Doña Fela’s seasoning mixture.

n Ask:

Why is it hard for you to cut back on salt and sodium?

Note: Write their responses on the blackboard or on a large piece of paper taped to the wall. Then write down some possible solutions. See the “Examples” box for some problems and solutions.

9. Easy on the Alcohol

Session 4. Help Your Heart: Control Your High Blood Pressure 89

Examples

Problems You May Encounter Solutions

The food has no flavor. Use herbs or spices to add flavor to foods. See the “Use Herbs and Spices Instead of Salt” handout (page 109).

Family members will get upset. Cut back on salt slowly. Use less salt each time you cook, so family members can get used to the taste.

Adding salt is a habit that is hard Give yourself time to get used to using to break. less salt. Choose brands that are lower in salt. Take the saltshaker off the table.

n Say:

Drinking too much alcohol can raise your blood pressure. It can also harm the liver, brain, and heart. Alcoholic drinks also contain calories. The extra calories can make it hard to control your weight.

If you don’t drink alcohol, don’t start. If you drink alcohol, drink only a moderate amount. That means:

• Men should have no more than two drinks a day.

• Women should have no more than one drink a day.

• Pregnant women should not drink any alcohol.

n Ask:

What do you think counts as one drink?

Note: Allow a few minutes for group members to respond.

n Say:

90 Your Heart, Your Life: A Community Health Worker’s Manual

One drink is:

• 12 ounces of beer (regular—150 calories; light—100 calories)

• 5 ounces of wine (100 calories)

• 1½ ounces of liquor (100 calories)

Manage Your Blood Pressure With Medicine

ink is: edr On

5 ounces 12 ounces of of wine beer

n

Say:

10.

If you have high blood pressure, making the lifestyle changes we just discussed may not be enough to lower your blood pressure. Medications are available to lower blood pressure. They work in different ways.

n Give group members the “Tips for Taking Medicine for High Blood Pressure” handout (page 107).

n Ask:

Do any of you take medicine for high blood pressure?

n Ask:

Session 4. Help Your Heart: Control Your High Blood Pressure 91

If you are taking medication for high blood pressure, what are some things you can do to help your medicines work better?

Note: Allow a few minutes for group members to respond.

n Add the following suggestions if they are not mentioned:

• Ask your doctor the name of your medicine and how to take it.

• Take your medicine the way the doctor tells you.

• Tell your doctor the names of all other medicines, home remedies, herbs, or

supplements you take.

• Tell your doctor if the medicine makes you feel strange or sick.

• Refill your prescription before you run out of medicine.

• Have your blood pressure checked to see if the medicine is working for you.

• Keep taking the medicine as your doctor tells you, even if your blood

pressure is okay.

Turkey Meatloaf Recipe

More Information: Medicine for High Blood Pressure

• Many people with high blood pressure may take more than one medicine to keep

their blood pressure low.

• Some medicines can cause side effects or reactions. If this happens, talk to

your doctor.

• Eating more fruits and vegetables, cutting back on salt and sodium, losing weight,

and being physically active can help your medicines work better.

92 Your Heart, Your Life: A Community Health Worker’s Manual

11.n Give group members the “Use Herbs and Spices Instead of Salt” handout (page

109). Ask them to use some of the herbs and spices in place of salt when they cook this week.

n Give group members the “Turkey Meatloaf Recipe” handout (page 108). Ask them to prepare it during the coming week. Tell them that using this recipe will give them a chance to practice some of the ideas from the session.

RECIPE

Review of Today’s Key Points

n Say:

Let’s review what we learned today.

What is blood pressure?

• Blood pressure is the force of blood against the walls of your arteries. Blood

pressure is needed to move blood through your body.

What is a normal blood pressure?

• A normal blood pressure is below 120/80 mmHg.

What is prehypertension?

• Blood pressure of 120/80 to 139/89 mmHg is prehypertension. This means

that you don’t have high blood pressure yet, but you’re likely to develop it in the future unless you make changes in your health habits.

What is high blood pressure?

• High blood pressure is 140/90 mmHg or greater. Have your blood pressure

checked. If it is 140/90 mmHg or greater, see your doctor.

Why is high blood pressure dangerous?

Session 4. Help Your Heart: Control Your High Blood Pressure 93

• High blood pressure can lead to a heart attack, stroke, kidney problems, eye

problems, and death.

What can you do to help make your blood pressure medicine work better?

• Eat more fruits and vegetables, cut back on salt and sodium, lose weight,

and be more physically active. Take your medicine as your doctor tells you. Talk to your doctor about side effects.

Why should you cut back on salt and sodium in your food?

• You should cut back on salt and sodium to help prevent or lower high blood

pressure.

What are some ways to cut back on salt and sodium?

• Use herbs and spices to season foods. Be careful! Some seasonings such as

garlic salt and onion salt are high in sodium. Check the food label to choose foods lower in sodium. Eat more fruits and vegetables for snacks instead of salty snacks such as nuts, pretzels, or chips.

How can drinking alcohol affect your blood pressure?

• Drinking too much alcohol can raise blood pressure.

What is a stroke?

• A stroke happens when blood suddenly stops going to the brain. This can

happen for different reasons. One example is that a blood vessel bursts. Another way is that a clot blocks the arteries. Either way, the result is the same: blood stops going to the brain, and brain cells die. Both types of stroke are very serious and can lead to disability and death.

What is another name for a stroke?

• A stroke is also called a brain attack.

94 Your Heart, Your Life: A Community Health Worker’s Manual

Weekly Pledge

n Say:

You have learned a lot today about how to prevent and control high blood pressure. You also learned how to cut back on salt and sodium. Now let’s think about how you can practice what you have learned. Please think of one change you can make in your everyday life. This will be your pledge for the week.

n Say:

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will get my blood pressure checked within the next month.

• I will read food labels the next time I go to the store to help me choose

canned soups that are lower in sodium, or I will prepare homemade soup without adding salt.

• I will rinse canned foods with water before I cook or eat them, starting

tomorrow.

• I will take the saltshaker off the table, starting tomorrow.

n Say:

Write your pledge on the back of the “Keep Your Heart in Mind: Eat Less Salt and Sodium” handout on page 106. Keep this handout in a special place so you can review your pledge and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge and write it down.

n Say:

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

Session 4. Help Your Heart: Control Your High Blood Pressure 95

n (Optional) Say:

Keeping a personal value in mind can help you make changes in your everyday life to prevent and control high blood pressure. Remember that a personal value is a quality that you consider important.

Today’s value is openness. Being open means you are willing to consider making changes to improve your health, such as cutting back on foods high in salt and sodium.

n Ask:

How can you enlist the quality of openness, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

n Say:

We will talk about how you did with your pledge at the next session. Remember to keep working on your pledge to be more physically active.

Blood Pressure Check

(Optional—Try to get a health professional to come to your session.)

n Tell group members that a health professional will now check everyone’s blood pressure.

n Ask group members to write their blood pressure numbers on the “My Healthy Heart Wallet Card” handout.

96 Your Heart, Your Life: A Community Health Worker’s Manual

Closing

n Say:

Thank you for coming today. What did you think of today’s session?

Note: Wait to see if group members have a response.

n Say:

I am looking forward to seeing you at the next session. The next session will be about how to prevent and control high blood cholesterol.

Note: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own life based on what was covered in today’s session?

Session 4. Help Your Heart: Control Your High Blood Pressure 97

Know the Stroke Signs. Act Quickly.

A stroke happens when blood suddenly stops going to the brain and brain cells die. A stroke is very Brain Eyes serious and can lead to disability and death.

Face

Signs of a stroke:

Arm

n Numbness of the face, arm, or leg (especially on one side of the body)

n Confusion, trouble talking, and difficulty understanding others n Trouble seeing in one or both eyes

Leg

n Trouble walking, dizziness, and loss of balance or coordination n Severe headache

A Stroke Is Serious. Every Second Counts.

• Learn the stroke signs and teach them to your family and friends.

• Call 9–1–1 immediately if you have any of these stroke warning signs.

• Treatment can reduce the risk of damage from a stroke. You must get help

within 3 hours of your first symptoms.

Adapted from the American Stroke Association, “Let’s Talk About Risk Factors for Stroke.” 1999–2003. A division of the American Heart Association.

98 HANDOUT—SESSION 4

My Healthy Heart Wallet Card

Talk to your doctor about what these numbers mean!7% or lessA1CLess than 100Blood glucoseBlood tests to check sugar in the blood for diabetesWomen—35 inches or lessMen—40 inches or lessWaist measureWeight

(fasting)

ResultDateResultDate ResultDateResultDate

Check your:

blood pressure, blood cholesterol, weight, waist measure, and blood glucose

Name: ___________________________

Take Care of Your Heart

Less than 150 mg/dLTriglycerides40 mg/dL or moreHDLLess than 130 mg/dL—nearLess than 100 mg/dL—idealLDLLess than 200 mg/dLTotal CholesterolLess than 120/80 mmHgBlood Pressure ideal

(fold 2)

Blood tests to measure fats in the blood

ResultDateResultDate ResultDateResultDate ResultDate

fat, cholesterol, and sodium trans

fruits, vegetables, whole grains, and fat-free or low-fatmilk productsphysical activityweight and waist measure

Fold the card in half and paste with a glue stick (fold 1).++– calories, saturated and–0 cigarettes= a healthy heart

Cut along dotted lines.Fold in half again to make your own personal wallet card (fold 2).Try these tips for a healthy heart!MoreLessNone

(fold 1)

HANDOUT—SESSION 4 99

Take Steps— Healthy Habits To Lower High Blood Pressure!

To prevent high blood pressure:

1. Maintain a healthy weight.

Try not to gain extra weight. Lose weight if you are overweight. Try losing weight slowly, about 1 to 2 pounds each week until you reach a healthy weight.

1. Be active every day for at least 30 minutes.

You can walk, dance, play sports, or do any activity you enjoy.

1. Eat less salt and sodium.

Buy foods marked “sodium free,” “low sodium,” or “reduced sodium.” Take the saltshaker off the table.

1. Eat more fruits and vegetables, whole-grain breads and cereals, and fat-free or low-fat milk products.
2. Cut back on alcohol.

Men who drink should have no more than one or two drinks each day. Women who drink should have no more than one drink a day. Pregnant women should not drink any alcohol.

To lower high blood pressure:

1. Practice these steps:

• Maintain a healthy weight. • Be active every day for at least

30 minutes.

• Eat fewer foods high in salt

and sodium.

• Eat more fruits and vegetables,

whole-grain breads and cereals, and fat-free or low-fat milk products.

• Cut back on alcoholic beverages.

1. Take your medicine the way your doctor tells you.
2. Have your blood pressure checked often.

HANDOUT—SESSION 4

Read the Food Label for Sodium!

Food labels tell you what you need to know about choosing foods that are lower in sodium. Here’s a food label for packaged noodle soup.

Packaged Noodle Soup

Nutrition Facts

Serving Size 1/2 block Servings Per Container 2

Amount Per Serving

Amount Per Serving

Calories190 Calories from Fat 70

The nutrient amounts are for

% Daily Value*

one serving. So, if you eat the

Serving Size and Number of Servings

The serving size is ½ of the block of noodles. The package contains two servings. Remember, the numbers on the label are for one serving, not the whole package.

% %

you need to double the nutrient Trans Fat 0g

Percent Daily Value

The Percent Daily Value

%

helps you compare products

%

and quickly tells you if

%

the food is high or low in

% Sugars 1g

Listed are the amounts of

Protein 5g

sodium in one serving. These amounts are listed in Vitamin A 2% • Vitamin C 2% milligrams (mg). Calcium 2% • Iron 6%

The Choice Is Yours— Calories

90 Calories from Fat 0

Compare! % Daily Value*

Total Fat 0g 0%

Which one would you

Saturated Fat 0g 0%

choose? Trans Fat 0g

Cholesterol 0mg 0%

Low-sodium soup is lower in

Sodium 210mg 9%

sodium than packaged soup. Read the food labels, and choose

Calories 180 Calories from Fat 0

foods that are lower in sodium to

% Daily Value*

help keep your heart strong. Total Fat 1.5g 12%

Saturated Fat 4g 0%

TransFat 0g

Cholesterol 0mg 0%

Sodium 820mg 34%

sodium. Choose products with the lowest Percent Daily Value for sodium: 5 percent or less is low, and 20 percent or more is high.

Low-Sodium Soup One serving (1 cup) of lowsodium soup, has 210 mg of sodium and 9 percent of the Daily Value for sodium.

Packaged Noodle Soup One serving, ½ block of the packaged noodle soup, has 820 mg of sodium and 34 percent of the Daily Value for sodium. This is nearly four times the amount of sodium in a serving of lowsodium soup.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDOUT—SESSION 4

Mariano’s Food Choices

1 – Tomato Juice

Mariano’s blood pressure was

Nutrition Facts

slightly higher Serving Size 8 fl oz (240mL)

Servings Per Container 8

the last time he visited his Amount Per Serving doctor.

Calories 50 Calories from Fat 0

The doctor

% Daily Value*

told Mariano

Total Fat 0g 0%

to cut back on Saturated Fat 0g 0% the amount of Trans Fat 0g sodium he eats. Cholesterol 0mg 0%

Sodium 750mg 31%

Use the food Total Carbohydrate 10g 3% labels to help Dietary Fiber 1g 4% his wife Virginia Sugars 6g choose foods Protein 2g that will help

Vitamin A 10% • Vitamin C 120%

Mariano follow Calcium 2% • Iron 5% his doctor’s advice.

3 – Corn Tortillas

Write the

number of your Nutrition Facts

Serving Size 2, 6-inch (48g)

choice for each

Servings Per Container 5

pair in the space

Amount Per Serving

between the

Calories 110 Calories from Fat 10

labels.

% Daily Value*

Total Fat 1.5g 2% Saturated Fat 0g 0% Trans Fat 0g

Sugars 0g Protein 3g

Vitamin A 0% • Vitamin C 0% Calcium 8% • Iron 4%

2 – Orange Juice

Nutrition Facts

Serving Size 8 fl oz (240mL) Servings Per Container 8

Amount Per Serving

Calories 110 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 5mg 0% Lower Total Carbohydrate 25g 8% sodium Dietary Fiber 1g 4% Sugars 20g choice Protein 1g

___

Vitamin A 0% • Vitamin C 143% Calcium 0% • Iron 8%

4 – Flour Tortillas

Nutrition Facts

Serving Size 2, 6-inch (48g) Servings Per Container 5

Amount Per Serving

Calories160 Calories from Fat 30

% Daily Value*

Total Fat 3g 5% Saturated Fat 0.5g 3% Trans Fat 0g Cholesterol 0mg 0% Lower Sodium 230mg 10% sodium Total Carbohydrate 27g 9% choice Dietary Fiber 1g 4% Sugars 1g ______ Protein 4g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 8%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

102 HANDOUT

Mariano’s Food Choices

5 – Canned Chicken

Nutrition Facts

Serving Size 1 can (88g) Servings Per Container 1

Amount Per Serving

Calories 90 Calories from Fat 15

% Daily Value*

Total Fat 1.5g 2% Saturated Fat 0g 0% Trans Fat 0g

Sugars 0g Protein 20g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 8%

7 – Thin Pretzels

Nutrition Facts

Serving Size 1 oz (28g/about 10 pretzels) Servings Per Container 2

Amount Per Serving

Calories100 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 1g Protein 2g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 2%

6 – Roasted Chicken (Boneless, Skinless Breasts)

Nutrition Facts

Serving Size 3 oz (85g) Servings Per Container 4

Amount Per Serving

Calories 110 Calories from Fat 10

% Daily Value*

Total Fat 1g 2% Saturated Fat 0g 0% Trans Fat 0g

Lower Dietary Fiber 0g 0% sodium Sugars 0g Protein 25g choice

Vitamin A 0% • Vitamin C 0%

___

Calcium 0% • Iron 4%

8 – Baked Tortilla Chips

Nutrition Facts

Serving Size 1 oz (28g/about 8 chips) Servings Per Container 8

Amount Per Serving

Calories120 Calories from Fat 15

% Daily Value*

Total Fat 1.5g 2% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 170mg 7% Lower Total Carbohydrate 23g 8% sodium Dietary Fiber 1g 4% choice Sugars 0g Protein 2g ___

Vitamin A 0% • Vitamin C 0% Calcium 4% • Iron 4%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

• SESSION 4 103

HANDOUT

Sodium in Foods

Choose MORE Often

Foods LOWER in Sodium

• Chicken and turkey (with skin

removed)

• Fresh fish or

rinsed canned fish such as tuna* or sardines

• Canned foods packed in water

• Low-sodium or reduced-sodium

cheeses

• Low-salt chips, nuts,

and pretzels

• Plain rice, noodles, or pasta

• Homemade, low-sodium, or reduced-

sodium soups

• Fresh, frozen, “no salt added,” or

rinsed canned† vegetables

• Spices, herbs, and

flavorings such as cilantro, parsley, garlic powder, onion powder, vinegar, and chili powder

Choose LESS Often

Foods HIGHER in Sodium

• Smoked and cured meats such as

bacon, ham, sausage, hotdogs, and bologna

• Canned fish such as tuna* and

sardines (that are not rinsed) and salted/dried codfish (bacalao seco y salado)*

• Canned foods packed

in broth or salt†

• Most cheeses

• Salty chips, crackers, nuts, and

pretzels

• Quick-cooking rice and boxes of

mixed rice, potatoes, or noodles

• Regular canned and instant soups

• Regular canned

vegetables, pickles, olives, and pickled vegetables†

• Condiments and seasonings

such as soy sauce, ketchup, garlic salt, seasoning salt, bouillon cubes, meat tenderizer, and monosodium glutamate (MSG)

Pregnant and nursing mothers: Talk to your health care provider to find out the types of fish you can eat that are lower in mercury. † Rinse canned foods to reduce the sodium.

HANDOUT

Keep Your Heart in Mind: Eat Less Salt and Sodium

Do you know your blood pressure numbers?

• A normal blood pressure is below 120/80 mmHg. • If your blood pressure is 120/80 to 139/89 mmHg, you have prehypertension. This

means that you don’t have high blood pressure yet, but you’re likely to develop it if you don’t change your health habits.

• If your blood pressure is 140/90 mmHg or higher, you have hypertension or high blood

pressure. High blood pressure does not go away by itself. Ask your doctor for help in lowering it.

• Ask your doctor what your blood pressure number is. Keep track of each reading on

your wallet card.

Write down your blood pressure reading here:

Normal! Below

80 ______/_____

Spice it up!

Discover how much flavor you can add by using spices and herbs.

Doña Fela has learned that it’s To make food taste good

without salt, I use cilantro,

not hard to get your family to cumin, fresh garlic, parsley,

onion, green pepper,

eat less salt and sodium.

oregano, and even a dash of hot pepper when I

To break your family’s habit cook. Everyone in

my family got

of using the saltshaker at the used to the taste

of foods with

table, try Doña Fela’s secret less salt. recipe!

Look for other salt-free seasonings in the

Doña Fela's ¼ cup chili powder

grocery store. Seasoning Mixture 2 tablespoons paprika

Fill the saltshaker with these herbs and spices, and use it instead of salt to

2 teaspoons oregano ½ teaspoon dry mustard 1 teaspoon garlic powder 1 teaspoon black pepper

½ teaspoon red pepper

flavor foods.

HANDOUT—SESSION 4 105

Take the lead and try these simple changes:

When Shopping

1. Buy fresh, frozen, or no-salt-

added canned vegetables. Choose food packed in water instead of in broth or salt.

2. Buy fresh garlic

or garlic powder instead of garlic salt.

3. Choose foods labeled “low

sodium,” “sodium free,” or “no salt added.”

When Cooking

1. Slowly cut back on the amount

of salt added when cooking until you don’t use any.

2. Add no salt to the water when

cooking beans, rice, pasta, and vegetables.

3. Cut back on meats high in

sodium, such as bologna, ham, hotdogs, and sausage.

4. Rinse all canned products to

reduce the amount of sodium.

When Eating

1. Fill the saltshaker

with a mixture of herbs and spices.

2. Slowly cut back on

the amount of salt added at the table until you don’t use any.

3. Choose fruits and vegetables

instead of salty snacks like chips, fries, and pork rinds.

Mariano has learned to control his high blood pressure. He takes his blood pressure pills with breakfast every morning to make sure that he doesn’t forget to take them. He walks daily, has stopped smoking, and has found that food can still taste good with less salt and sodium.

Make your personal pledge to do what Mariano has done! Look at these examples:

Breakfast

Cook oatmeal with fat-free or low-fat (1%) milk, raisins, cinnamon, and no salt.

Lunch

Use leftover roasted chicken to make a sandwich instead of using luncheon meats.

Dinner

Make your own soup with vegetables and half the usual amount of salt.

Snack

Eat an orange (without salt) instead of salty chips.

Write the changes you will make this week:

Your health and your family’s health are priceless. Make an investment in it!

HANDOUT—SESSION 4

Tips for Taking Medicine for High Blood Pressure

1. Make sure you take medicine as your doctor tells you, not only on the days when you do not feel well.
2. Tell the doctor the names of all other medicines, home remedies, herbs, or supplements you take. Bring everything with you when you have a doctor’s appointment.
3. Tell the doctor right away if the medicine makes you feel strange or sick. Ask the doctor about changing the dosage or switching to another type of medicine.
4. Refill your prescription before you run out of medicine.
5. Have your blood pressure checked often to see if the medicine is working for you.
6. Don’t stop taking your medicine if your blood pressure is okay. That means the medicine is working.

Questions to ask the doctor:

When the doctor gives you medicine for high blood pressure, ask:

Name of medicine(s): _______________________________________________

Amount of medicine to take: _________________________________________

When to take it: ____________________________________________________

What to eat or drink with it: __________________________________________

If your other medicines can be taken safely at the same time: _______________

_________________________________

If problems occur, call this number immediately: _________________________

HANDOUT—SESSION 4 107

Turkey Meatloaf Recipe

Here is a healthier version of an old dinner favorite.

1 pound lean turkey, ground 1. ½ cup regular oats, dry 1 large egg 2.

1 tablespoon ¼ cup 2 2 ½

onion, dehydrated ketchup celery stalks, chopped garlic cloves, minced green pepper, diced 3.

Quick Fact

This healthy version of an old dinner favorite is prepared with low-fat ground turkey.

108 HANDOUT—SESSION 4

Combine all ingredients and mix well.

Bake in loaf pan at 350 °F for 25 minutes, or until the internal temperature reaches 165 °F.

Cut into five slices and serve.

Yield: 5 servings Serving size: 1 slice (3 oz) Each serving yields: Calories: 197 Total fat: 7 g Saturated fat: 2 g Cholesterol: 103 mg Sodium: 218 mg Total fiber: 2 g Protein: 23 g Carbohydrates: 11 g Potassium: 336 mg

Use Herbs and Spices Instead of Salt

Basil: Use in soups, salads, vegetables, fish, and meats.

Chili Powder: Use in soups, salads, vegetables, and fish.

Cilantro: Use in meats, sauces, stews, and rice.

Cinnamon: Use in salads, vegetables, breads, and snacks.

Clove: Use in soups, salads, and vegetables.

Dill Weed and Dill Seed: Use in fish, soups, salads, and vegetables.

Ginger: Use in soups, salads, vegetables, and meats.

Marjoram: Use in soups, salads, vegetables, beef, fish, and chicken.

Nutmeg: Use in vegetables and meats.

Onion Powder: Use in meats, poultry, soups, and salads.

Oregano: Use in soups, salads, vegetables, meats, and chicken.

Parsley: Use in salads, vegetables, fish, and meats.

Rosemary: Use in salads, vegetables, fish, and meats.

Sage: Use in soups, salads, vegetables, meats, and chicken.

Thyme: Use in salads, vegetables, fish, and chicken.

Note: To start, use small amounts of these herbs and spices to see if you like them.

HANDOUT—SESSION 4 109

s essi o n

Be Heart Smart: Keep Your Cholesterol in Check

Objectives

By the end of this session, group members will:

• Know what cholesterol is and how it affects the body.
• Know what healthy cholesterol levels are.
• Learn the steps they can take to lower their blood cholesterol levels.

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Blackboard and chalk or several large pieces of paper, markers, and tape
• How To Make an Artery Model (page 125)
• How To Explain the Artery Model (page 126)
• One empty paper towel roll
• Scissors
• Red construction paper and tape or red felt with sticky backing
• Red and yellow modeling clay

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 111

• (Optional) VCR or DVD and TV monitor
• (Optional) “The Crossword Puzzle: Lower Cholesterol” telenovela or fotonovela (pages 416–417)

Note: The telenovela is available in Spanish only.

• Six paper plates
• Set of measuring spoons
• Can of shortening or lard
• Bottle of vegetable oil*
• Choice of three of the following foods:*

• Cooked beans

• Beef hotdog

• Orange

• Sour cream

• Cheddar cheese

• Fried chicken

• Snack cakes (packaged cupcakes)

Handouts

Give each group member these handouts during this session:

• List of places where group members can get their cholesterol levels checked†
• “Take Action To Control Your Cholesterol” (pages 142–143)
• You can use pictures of these foods. † Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

112 Your Heart, Your Life: A Community Health Worker’s Manual

• “Fats and Oils To Choose” (page 144)
• “Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol” (page 145)
• “Virginia’s Breakfast Choices” (pages 146–149)
• “Guess the Fat Activity” (page 150)
• “Cooking With Less Saturated Fat” (pages 151–152)
• “Chicken Stew Recipe” (page 153)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Facts About Blood Cholesterol
2. (Optional) “The Crossword Puzzle: Lower Cholesterol” Telenovela or Fotonovela
3. Cholesterol and Heart Disease
4. What Are Your Numbers?

A. What Are Triglycerides?

B. Metabolic Syndrome and Your Health

1. Healthy Arteries Activity
2. Facts About Saturated Fat, Trans Fat, Cholesterol, and Fiber
3. Food Label Activity—Fats

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 113

1. Guess the Fat Activity
2. Cooking With Less Saturated Fat Activity
3. Reduced-Fat Chicken Stew Recipe Activity

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about salt and sodium.

• Ask the questions below, and give the correct answers if group members do not.

Q: Who remembers why you should try to limit the amount of salt and sodium in your diet?

A: You should cut back on salt and sodium to help prevent or lower high blood pressure.

Q: Does anyone remember some ways to reduce the amount of salt that you eat?

A: To cut back on salt and sodium, you can:

• Check the food label to choose foods lower in sodium.

• Use herbs and spices instead of salt to season foods.

114 Your Heart, Your Life: A Community Health Worker’s Manual

• Eat more fruits, vegetables, and fat-free or low-fat milk products

for snacks.

• Choose low-sodium or unsalted nuts, pretzels, and popcorn.

At the end of our last session, you made a pledge to choose foods lower in salt and sodium. Share with the group what you did. What problems did you have? How did you solve them?

Note: Allow 5 minutes for group members to respond.

3. About This Session

Today we are going to talk about high blood cholesterol as a risk factor for heart disease. You will learn what you can do to keep your blood cholesterol levels low. We will also do some group activities that show how much saturated fat is in some foods and how to cook with less saturated fat. We will also learn how to keep trans fat and cholesterol intake low.

Conducting the Session

1. Facts About Blood Cholesterol

If a person’s blood cholesterol level is too high, he or she is more likely to get heart disease. Here are some facts about blood cholesterol:

• About one in five Latinos has high total blood cholesterol. Only half know

that they have high blood cholesterol.

• Adult Latinos are less likely than most ethnic groups to have their blood

cholesterol checked.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 115

2. (Optional) “The Crossword Puzzle” Telenovela or

Fotonovela

• Show the telenovela “The Crossword Puzzle: Lower Cholesterol,” or ask volunteers to read the fotonovela (pages 416–417).

Note: The telenovela is available in Spanish only.

3. Cholesterol and Heart Disease

Note: This section explains what cholesterol is, why the body needs cholesterol, how much cholesterol the body needs, and where cholesterol comes from.

Cholesterol is a soft, waxy, fat-like substance found in the body. Your body uses cholesterol to produce hormones and some vitamins.

• Show picture card 5.1.

Cholesterol comes from two sources:

• Your liver makes all the cholesterol your body needs to keep you healthy.

When cholesterol is produced, it goes into the bloodstream. The cholesterol that travels in your bloodstream is called blood cholesterol.

• Cholesterol also comes from the food you eat. Foods that come from

animals have cholesterol. The cholesterol from foods you eat is called dietary cholesterol. Other types of fat in foods that raise cholesterol are saturated fat and trans fat. Today we will learn how to lower your intake of these fats.

When too much cholesterol is in the blood, it increases the risk of a heart attack, stroke, and other health problems.

116 Your Heart, Your Life: A Community Health Worker’s Manual

• Ask:

Do any of you know someone who has high blood cholesterol?

Note: Allow about 2 minutes for group members to respond.

Several things affect your blood cholesterol level. You cannot change some of these things, such as your age, whether you are a man or a woman, or your family history (having family members with high blood cholesterol). But you can change the types of food you eat, the amount of physical activity you do, and your weight.

You can help prevent or lower high blood cholesterol by taking the following measures:

• Eating a heart healthy diet low in saturated fat, trans fat, and cholesterol • Being active every day • Maintaining a healthy weight

• Show picture card 5.2.

Let’s look at how cholesterol travels through the blood:

• Cholesterol travels through the bloodstream in the form of packages called

“lipoproteins.” These packages are made of fat and protein.

• Low-density lipoproteins (or LDL) carry the cholesterol to your blood

vessels, clogging them like rust in a pipe. This is why LDL cholesterol is often called the “bad” cholesterol.

• Cholesterol also travels in the blood in high-density lipoproteins (or HDL).

HDL helps to remove cholesterol from your body. This is why HDL cholesterol is often called the “good” cholesterol. Picture it this way:

• The LDL person in the car (bad blood cholesterol) throws fat and cholesterol into the street (blood vessels).

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 117

• The HDL person (good blood cholesterol) cleans up fat and cholesterol deposited by the LDL and puts it in the trash.
• Just remember, the “L” in LDL is for Lousy, and the Lower it is, the better. The “H” in HDL is for Healthy, and the Higher it is, the better.

4. What Are Your Numbers?

• Show picture card 5.3.
• Ask:

How do you find out if you have high blood cholesterol levels or too much fat in your blood?

Your blood cholesterol levels are measured with a blood test. The test can be done at a doctor’s office or at a cholesterol screening (for example, at a health fair).

• A lipid profile is the blood test done at the doctor’s office. It is a complete

test to measure the levels of each type of fat in the blood. It measures total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. (We will talk about triglycerides later.) You have to fast for 12 hours before this test. This test is recommended for adults aged 20 and older.

• Screening sites may only test total cholesterol and sometimes HDL

cholesterol. If you are an adult aged 20 or older, you may need to follow up with the doctor for a complete lipid profile.

• Ask:

Have you ever had your blood cholesterol checked? If you have, do you remember your levels?

• Give group members the “Take Action To Control Your Cholesterol” handout (pages 142–143). Review the cholesterol levels.

118 Your Heart, Your Life: A Community Health Worker’s Manual

Note: If participants should ask, explain that cholesterol is measured in milligrams per deciliter (mg/dL).

• Show picture card 5.4.

Here are what the total cholesterol numbers (mg/dL) mean:

Less than 200 Desirable—Keep up the good work.

200–239 Borderline high

• Depending on your other risk factors, you may be at a higher risk for heart disease.
• It is time to change your eating habits, increase your physical activity, and lose weight if overweight.

240 or more High

• You are at a higher risk for clogged arteries and a heart attack.
• Ask your doctor what your risk is for heart disease.

Here is what your HDL and LDL cholesterol numbers (mg/dL) mean:

LDL (bad) cholesterol: Keep it low!

HDL (good) cholesterol: The higher the better!

Keep it 40 mg/dL or higher.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 119

More Information

Heart Disease Risk and Your LDL Level

The goal for the LDL (bad cholesterol) level is different for each person. It depends on the risk factors you have. The number of risk factors—such as high blood pressure, low HDL, family history of heart disease, age and gender, and smoking—affects your LDL goal. The higher your LDL level and the more risk factors you have, the greater your chances of developing heart disease or having a heart attack. Your doctor can help you set a goal for your LDL level.

A. What Are Triglycerides?

Have any of you heard of triglycerides?

Note: Allow 2 minutes for group members to answer.

Triglycerides are another type of fat in the blood. When you eat too many calories, drink alcohol, or smoke, your body makes more triglycerides. When your triglycerides are high, it puts you at increased risk for heart disease.

A healthy triglyceride level is less than 150 mg/dL.

People with high triglycerides often have low HDL cholesterol (good cholesterol). People with diabetes can also have high triglycerides and low HDL cholesterol.

120 Your Heart, Your Life: A Community Health Worker’s Manual

To have a healthy triglyceride level:

• Maintain a healthy weight or lose weight if you are overweight.

• Be physically active on all or most days of the week.

• Eat a heart healthy diet that is low in saturated fat, trans fat, and cholesterol.

• Limit candy, sweets, desserts, regular soda, juice, and other food and drinks

high in added sugar.

• Avoid smoking cigarettes and drinking alcohol. Smoking raises triglycerides

and lowers HDL cholesterol. Excess alcohol also raises triglycerides.

More Information

Here is what your triglyceride number (mg/dL) means:

Less than 150 Normal

150–199 Borderline high You may be at an increased risk for heart disease. To lower your level, aim for a healthy weight, and be more physically active.

200–499 High Weight control and physical activity are very important to lower your level. Watch out for other heart disease risk factors such as overweight and obesity, diabetes, low HDL, and high blood pressure.

500 or More Very high See your doctor immediately! This level requires attention to prevent severe problems with your pancreas.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 121

• Ask:

Do you know what your triglyceride level is?

Note: Allow a few minutes for group members to respond.

• Encourage group members to make an appointment to have their cholesterol and triglycerides checked.

• Tell them to be sure to ask for their results and to write them on their

wallet cards.

• Give group members a list of clinics and hospitals where they can get low-

cost or free blood cholesterol testing.

B. Metabolic Syndrome and Your Health

• Today we’re going to learn about metabolic syndrome. This disorder is made

up of a group of five factors that affect heart health.

• Many people have this health problem and don’t know they have it. • Metabolic syndrome is more common in Latinos than in members of other

ethnic groups.

While I name the five factors that make up metabolic syndrome, hold up your fist. Raise one finger for each risk factor that you have.

• Show picture card 5.5.

The five factors that make up metabolic syndrome are:

1. A low HDL (good) cholesterol level of below 50 for women and below 40 for men
2. A triglyceride level of 150 mg/dL or more

122 Your Heart, Your Life: A Community Health Worker’s Manual

1. A blood pressure of 130/80* or more (either number that is high counts as a risk)
2. A waist measurement of greater than 35 inches (89 cm) for women and greater than 40 inches (102 cm) for men
3. Higher than normal fasting blood glucose (blood sugar) levels of 100 or more

• Ask:

How many fingers (risk factors) do you have raised?

• If you have at least three of these factors, you have metabolic syndrome. • Metabolic syndrome raises your chances of developing heart disease,

diabetes, or stroke.

• People with metabolic syndrome should lose weight and become

physically active.

If you think you have metabolic syndrome, talk to your doctor.

5. Healthy Arteries Activity

Note: This section uses the picture cards and an artery model to show how cholesterol can collect on the walls of the arteries and slow down and block the flow of blood. Blocked arteries can cause a heart attack or stroke.

• Show picture card 5.6.

Blood flows freely to all cells of the body when arteries are normal and healthy.

• The blood pressure level considered a factor for metabolic syndrome is 130/80. This level is different from the level that defines high blood pressure, 140/90.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 123

When your LDL cholesterol is too high, cholesterol may become trapped in the walls of the arteries, causing them to harden. The opening of the arteries can become clogged and narrowed.

• Show the artery model.

Note: See the next two pages to help you explain the artery model.

• Pass the artery model around so that group members can look at it closely.
• Ask:

Have you ever seen someone fry food with lard and dump the hot lard down the sink?

• Allow a moment for group members to answer. Then ask them why they should not do this.

It is because the lard will clog the pipes. Foods high in saturated fat and trans fat will clog your pipes (arteries). So we want to treat our bodies just as well as we treat our pipes.

124 Your Heart, Your Life: A Community Health Worker’s Manual

How To Make an Artery Model

What you will need:

one empty paper towel roll scissors

red construction paper and tape or red felt with sticky backing

yellow modeling clay

What you need to do:

1. Cut construction paper or felt to fit around the outside of the roll.
2. Tape construction paper or stick felt around the outside of the roll.
3. Roll out thin pieces of yellow and red clay into doughnut-shaped figures.
4. Make one small round ball of the red clay.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check

How To Explain the Artery Model

1. Place the doughnut-shaped pieces of red clay on the outside edge of both ends of the roll.

Say: This is a healthy artery. The blood can flow through the opening easily.

1. Add pieces of the yellow clay to the inside edge of the red clay on one end of the roll.

Say: This is the beginning of a clogged artery. Cholesterol is starting to build up.

1. Continue to add pieces of yellow clay to this end of the roll. Add pieces until you almost fill in the opening completely.

Say: The opening of the clogged artery is getting smaller. Blood cannot flow through easily.

1. Put a red ball in the small opening that is left at the end of the roll.

Say: When the inside of an artery becomes narrowed, a blood clot may block an artery going to the heart. This may cause a heart attack. If the blood clot blocks an artery going to the brain, it may cause a stroke, or “brain attack.” Other problems caused by narrowed arteries are angina (chest pain) and poor blood circulation.

126 Your Heart, Your Life: A Community Health Worker’s Manual

6. Facts About Saturated Fat, Trans Fat, Cholesterol, and Fiber

Today, we will talk about the different types of fat and how they affect heart health.

• There are two main types of fat—saturated fat and unsaturated fat. Most

foods contain some of both types. The total fat found in food is its saturated fat plus its unsaturated fat.

• Saturated fat is found in foods that come from animals, such as high-fat

meat, cheese, milk, and butter.

• A type of unsaturated fat called trans fat also raises cholesterol. Trans fat is

found in a variety of baked goods (such as cookies, pies, and crackers), fried foods, stick margarine, and vegetable shortening. Choose light margarine (soft tub) instead of stick (hard) margarine, and look for trans-fat-free spreads in the grocery store.

• Eating too much saturated fat and trans fat will raise your blood cholesterol

level more than anything else you eat. This will raise your chances of developing heart disease.

It is important to limit the saturated fat and trans fat you eat, but you need some dietary fat to be healthy. Fats are necessary because they are used by the body to:

• Store and provide energy.

• Help carry vitamins A, D, E, and K throughout the body.

• Ask:

What types of fat do you use to cook your food?

Note: Allow about 3 minutes for group members to answer. Write responses on the blackboard or on a large piece of paper taped to the wall.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 127

• Show group members a stick of butter (or a can of lard).

• Butter, shortening, and lard are examples of foods high in saturated fat.

• Saturated fat is usually solid at room temperature.

• Saturated fat is usually found in foods from animals.

• Show picture card 5.7.

Here are foods that are high in saturated fat:

• Whole milk and products made • Shortening

from whole milk (regular cheeses Lard

and sour cream) •

Oils such as coconut, palm, and

• Ice cream and whipped cream •

palm kernel

• Fatty cuts of meat, such as chuck,

Doughnuts and pastries

regular ground beef, ribs, bacon, •

and sausage

• Tortillas and other bread made

with lard, butter, or shortening

• Skin of chicken, turkey, and pig

• Butter

• Show picture card 5.8.

Here are foods that are lower in saturated fat:

• Lean meats such as loin, round,

and extra lean ground beef

• Fish
• Poultry without the skin
• Fat-free and low-fat milk, cheese,

and yogurt

• Vegetable oil
• Corn tortillas and bread (made without fat)

• Beans

128 Your Heart, Your Life: A Community Health Worker’s Manual

• Rice • Fruits and vegetables

• Tub margarine

You want to limit the amount of saturated fat in your diet.

• Show group members a bottle of vegetable oil.

Unsaturated fats are usually liquid at room temperature. As mentioned before, a few oils (coconut, palm, and palm kernel) are high in saturated fat.

• (Optional) Say:

The types of unsaturated fats are polyunsaturated and monounsaturated.

More Information

Polyunsaturated fat is found in:

• Vegetable oils
• Safflower oil
• Corn oil
• Sunflower oil
• Soybean oil
• Some types of fish

Monounsaturated fat is found in:

• Vegetable oils
• Canola oil
• Olive oil
• Peanut oil
• Avocados
• Nuts
• Give group members the “Fats and Oils To Choose” handout (page 144).

The graph will quickly show you which products have the least amount of saturated fat.

• Ask:

What three oils have the least amount of saturated fat?

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 129

Canola oil, safflower oil, and sunflower oil have the least amount of saturated fat.

Although polyunsaturated and monounsaturated fats are better for our health than saturated fat, we need to eat less of all types of fat. Fats are high in calories, and all fats have the same number of calories. Cutting back on calories helps us lose weight. We will talk about this in the next session.

• Show picture card 5.9.

Foods high in cholesterol can also raise your blood cholesterol and increase your risk of heart disease. Dietary cholesterol is found only in foods that come from animals. Foods that are highest in cholesterol are:

• Egg yolks

• Organ meats such as liver, kidneys, brains, tripe, heart, and tongue

• Show picture card 5.10.

Foods that come from plants do not contain cholesterol. Foods that do not contain cholesterol include:

• Fruits, such as bananas, pineapples, mangos, and apples

• Vegetables, such as tomatoes, green peppers, lettuce, and corn

• Beans

• Rice, such as brown rice

• Grains, such as those contained in corn tortillas and whole-grain bread

• Cereals, such as oatmeal

130 Your Heart, Your Life: A Community Health Worker’s Manual

Plant foods that are prepared with an animal product (for example, flour tortillas made with lard) have cholesterol.

Plant foods are generally lower in saturated fat and don’t have cholesterol. They also contain a type of dietary fiber (soluble) that is beneficial for lowering cholesterol.

• Show picture card 5.11.

Soluble fiber is found in foods such as oats, barley, fruits, vegetables, and cooked dry beans and peas. So this gives you one more reason to eat a variety of fruits and vegetables in addition to some whole-grain cereals.

Fruits and vegetables that are a good source of soluble fiber are citrus fruits (oranges and grapefruit), pears, apples, peaches, bananas, brussels sprouts, green beans, artichokes, and carrots. For great sources of soluble fiber, try to include a variety of cooked dry beans. Avoid canned beans that contain high amounts of salt and sodium. Prepare beans at home, flavoring them with celery, garlic, and spices instead of salt.

7. Food Label Activity—Fats

• Give group members the following handouts: “Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol!” (page 145) and “Virginia’s Breakfast Choices” (pages 146–149).
• Point out on the food label where to find saturated fat, trans fat, and cholesterol.
• Show picture card 5.12.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 131

For a healthier heart, use the Nutrition Facts labels to choose foods with a lower Percent Daily Value for saturated fat and cholesterol. If you have high cholesterol, you may need to aim for a lower percent for saturated fat and cholesterol. Try to keep trans fat as low as possible. A doctor or registered dietitian can help you with this.

• Show group members where the Percent Daily Value is found on the food label for whole milk.

Look at the bottom of the “Read the Food Label To Choose Foods Lower in Saturated Fat, Trans Fat, and Cholesterol” handout. Look at the Percent Daily Value for whole milk and fat-free milk. Which is lower in saturated fat?

Fat-free milk is lower in saturated fat. One cup of fat-free milk has none of the Percent Daily Value of saturated fat. One cup of whole milk has 25 percent or ¼ of the Percent Daily Value of saturated fat.

Trans fat is now listed on all food labels. It is listed on a line below saturated fat, as seen here. Compare labels to choose the food lowest in saturated fat, trans fat, and cholesterol.

132 Your Heart, Your Life: A Community Health Worker’s Manual

Virginia’s Problem

Virginia has little time in the morning to prepare breakfast. She often has a cinnamon roll or a doughnut. Look at the food labels. Help Virginia select some breakfast foods that are lower in saturated fat than her usual choices. It is also important to compare labels for trans fat and cholesterol amounts.

Note: The correct answer is underlined.

• A cinnamon roll or a plain bagel?

• A doughnut or an english muffin?

• A fruit danish or a banana?

• Toast with butter or toast with light, soft margarine?

• Chorizo or lean pork?

• Refried beans or cooked beans?

• Low-fat cheddar cheese or regular cheddar cheese?

Now look at “Virginia’s Breakfast Choices.” We are going to use the food label to practice choosing foods that are lower in fat. First, I am going to tell you about a problem for many busy people. Then we will use food labels to find some solutions.

• Ask for a volunteer to describe:

• What he or she usually eats for breakfast

• Which foods are higher in fat

• What lower-fat foods can be chosen to replace them

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 133

Write the answers on the blackboard or on a large piece of paper taped to the wall. Help the volunteer select some substitutes, if needed.

8. Guess the Fat Activity

Before the session

Buy a can of shortening or a stick of margarine. Also buy paper plates and three foods from this list (or use pictures of the food).

• 2 ounces cheddar cheese (about

the size of a 9-volt battery)

• 2 tablespoons sour cream

(about the size of a ping-pong ball)

• 2 pieces of fried chicken

Foods

2 ounces cheddar cheese (about the size of a 9-volt battery)

2 tablespoons sour cream (about the size of a ping-pong ball)

2 pieces of fried chicken

2 snack cakes (1 package)

1 beef hotdog (1.5 ounces)

1 cup cooked beans

1 orange

• 2 snack cakes (1 package of

cupcakes)

• 1 beef hotdog

• 1 cup cooked beans

• 1 orange

• 6 paper plates

Teaspoons of Fat (Grams of Fat)

About 5 teaspoons (20 grams)

About 1¼ teaspoons (5 grams)

About 8½ teaspoons (34 grams)

About 4½ teaspoons (18 grams)

About 4 teaspoons (16 grams)

About ¼ teaspoon (1 gram)

None

Your Heart, Your Life: A Community Health Worker’s Manual

1. Write the name of each food you bought on a separate plate.
2. Look at the following chart. Find the amount of fat for each food you bought.

Note: You do not have to use all the food in the chart. Choose the foods that are eaten most often in your community.

1. Using the can of shortening, spoon the amount of fat listed in the chart onto the plate labeled for that food.
2. Take the remaining plates, and place each food item (or picture of food) on the separate plates.
3. Put all the plates away until you are ready to do the activity.

Group activity

We are going to play a guessing game that will help you learn about the total fat content of several foods. Learning which foods are higher in fat and how to replace them with foods that contain less fat will help you make healthier choices. Decreasing your total fat intake can help you reduce your saturated fat, trans fat, and calorie intake.

• Give group members the “Guess the Fat Activity” handout (page 150).
• Show group members the plates of foods (or pictures of food) you prepared ahead of time.

Guess the number of teaspoons of fat that are found in one serving of each of these foods. Write your guess on the “Guess the Fat Activity” handout.

Note: Ask group members to tell you the amount of fat they guessed for the first food item. After group members have shared the amount they guessed, tell them the actual number of teaspoons of fat the food contains. Tell them to write this amount on their handout, too. Bring out the plate of fat you made ahead of time for that food to show them how much it is. Then do this for the other foods.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 135

As you can see, it is easy to go over the limit for fat when we eat foods higher in fat such as fried foods, some fast foods, hotdogs, chips, and ice cream. Eating foods lower in total fat will also help you reduce your saturated fat, trans fat, and cholesterol intake. To make it easier to cut back on fat, eat more foods that are lower in fat, such as fruits, vegetables, rice, whole-grain cereals and breads, beans, and fat-free or low-fat milk products.

• Ask:

How do you feel about the true amount of fat in the foods you guessed?

Foods

Cheese

Whole milk

Sour cream

Tortilla chips

Beef hotdog

Lower-Fat Substitutions

Fat-free or low-fat cheese

Fat-free or low-fat milk

Fat-free or low-fat sour cream or plain yogurt

Baked tortilla chips

Low-fat hotdog

Note: Allow 3 to 5 minutes for group members to talk about their reactions.

There are lower-fat substitutes for some of the higher-fat foods we often eat.

• Review the following list.

You can also reduce the amount of fat you eat by simply eating foods higher in fat less often or in smaller amounts.

136 Your Heart, Your Life: A Community Health Worker’s Manual

9. Cooking With Less Saturated Fat Activity

Note: This section gives information to help group members cut back on the amount of saturated fat in their diets. This activity will help them understand that they can cut back on the fat in their diets without giving up their traditional foods.

• Ask:

Before we do the next activity, can you tell me what you can do to cook with less saturated fat?

Note: Allow 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

The next activity shows how to prepare foods with less saturated fat.

• Give group members the “Cooking With Less Saturated Fat” handout (pages 151–152). Review each of the dishes listed. Ask volunteers to read each recipe out loud.
• Ask:

Why are the recipes on the handout lower in saturated fat?

Note: Allow a few minutes for group members to respond.

• Add the following reasons if they are not mentioned:

• Beans are naturally low in fat, and no fat (lard, shortening, or oil) is added.

• Boiled rice is naturally low in fat, and no fat is added.

• The potatoes or yuca are baked, not fried.

• The Mexican quesadillas are made with corn tortillas, and no fat is added.

Low-fat cheese is used instead of full-fat cheese.

• The fat is drained from the cooked ground beef.

• The fruit shake is made with fat-free milk instead of whole milk.

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 137

10. Reduced-Fat Chicken Stew Recipe Activity

RECIPE

• Give group members the “Chicken Stew Recipe” handout (page 153).
• Ask:

How has saturated fat been reduced in this recipe?

• Allow a moment for group members to respond. Add the following answers if they are not mentioned:

• The dish is made with chicken without the skin.

• No fat is added.

• It is flavored with vegetables and herb seasonings instead of fat.
• It is cooked slowly in water (moist heat) instead of fat.

Remember that foods lower in fat still contain calories. Check the portion size. If you eat these foods in large quantities, you may gain weight.

Note: Ask if there are any questions. Encourage group members to try this recipe at home this week.

Review of Today’s Key Points

Let’s review what you’ve learned today.

What may cause your arteries to become clogged?

• Cholesterol buildup will clog the arteries.

138 Your Heart, Your Life: A Community Health Worker’s Manual

What is considered a desirable total blood cholesterol level?

• Less than 200 mg/dL

What steps can you take to keep your cholesterol level low?

• Eat foods lower in saturated fat, trans fat, and cholesterol.

• Maintain a healthy weight.

• Stay physically active.

• Eat a variety of whole grains, fruits, and vegetables.

Can you name some foods that are high in saturated fat?

• Fatty meat, poultry with skin, whole milk and cheese, butter, lard, and

shortening

What are some things you can do to make foods lower in fat?

• Trim the fat from meat before cooking.

• Take the skin off poultry and do not eat it.

• Bake, boil, broil, or grill food instead of frying it.

• Skim the fat off soups before serving.

Can you name some foods that are high in soluble fiber?

• Oats, cooked dry beans, and peas

• Fruits and vegetables such as citrus fruits (oranges and grapefruit), pears,

apples, peaches, bananas, broccoli, and carrots

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 139

Weekly Pledge

You have learned a lot today about preventing high blood cholesterol and how to eat less saturated fat, trans fat, and cholesterol. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to keep your blood cholesterol in check. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will take the skin off the chicken, and I will throw the skin away. • I will bake the fish instead of frying it in lard or grease. • I will try low-fat milk or low-fat, lactose-free products, starting this week.

Write your pledge on the “Take Action To Control Your Cholesterol” handout (page 143). Keep this handout in a special place, so you can review your pledges and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

• (Optional) Say:

Keeping a personal value in mind can help you make changes in your everyday life to prevent and control high blood cholesterol. Remember that a personal value is a quality that you consider important.

140 Your Heart, Your Life: A Community Health Worker’s Manual

Today the value is moderation. Moderation increases your ability to make healthy choices and to take responsibility for the habits you need to change. Moderation also helps you improve your eating habits. For example, it can help you limit portion sizes and stop yourself from going back for second servings.

• Ask:

How could you use moderation, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Remember to continue to work on your pledge to be physically active and to reduce salt and sodium in your diet.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Wait to see if group members have a response.

I am looking forward to seeing you at the next session. The next session will be about maintaining a healthy weight.

Note: Think about today’s session. What worked and what didn’t work? Have you decided to make any changes in your own life based on what was covered in today’s session?

Session 5. Be Heart Smart: Keep Your Cholesterol in Check 141

Take Action To Control Your Cholesterol

Do you know your cholesterol numbers?

Get Checked Take Action

• A lipid profile is a blood test that measures your • Eating foods lower in saturated fat, trans

cholesterol and triglyceride levels. fat, and cholesterol can help you reduce

• Adults aged 20 and older should have a lipid profile your blood cholesterol level, reduce your

test at the doctor’s office. weight, and prevent heart disease.

Here is what your cholesterol numbers mean.

Total cholesterol

Less than Desirable. Good for you! Keep up the good work! 200 mg/dL

200–239 mg/dL Borderline high. Depending on your other risk factors, you may be at a higher risk for heart disease. It is time to change your eating habits, increase your physcal activity, and lose weight if overweight. Ask your doctor what your risk is for heart disease.

240 mg/dL or High. You are at a higher risk for clogged arteries and a heart attack. higher Ask your doctor what your risk is for heart disease.

LDL (lousy, bad) cholesterol: Keep it low!

Less than 100 mg/dL Optimal Write Your Numbers Here

100–129 mg/dL Near optimal

Total: ____________________

130–159 mg/dL Borderline high

LDL: ____________________

160 mg/dL or more High

HDL: ____________________

HDL (healthy, good) cholesterol (mg/dL): Triglycerides: _____________ The higher the better! Keep it 40 mg/dL or more.

Triglycerides: Keep your triglycerides below 150 mg/dL.

How I switched my family from whole milk to fat-free milk

I slowly changed the milk my Doña Fela has family drinks from whole milk learned that it’s

to fat-free milk. The first month

not difficult to get

I served reduced-fat (2%) milk.

one’s family to

During the next month I served

low-fat (1%) milk. Finally, I made the switch to fat-free milk. The change was so slow that they couldn’t even taste

eat foods lower in saturated fat, trans fat, and cholesterol. the difference.

142 HANDOuT—SESSION 5

Try some of these simple changes

When Shopping

Buy fat-free or low-fat (1%)

1.

milk and cheese.

Buy vegetable oil spray. Spray

2.

it on baking pans and skillets instead of using a lot of fat to grease pans.

3. Use the food label to help you

choose foods lower in saturated fat, trans fat, and cholesterol.

When Cooking

Trim the fat from meat, and

1.

remove the skin and fat from chicken and turkey before cooking.

Cook ground meat, drain the

2.

fat, and rinse with hot tap water. This removes half the fat.

Cool soups, and remove

3.

the layer of fat that rises to the top.

When Eating

Use fat-free or low-fat

1.

salad dressing, mayonnaise, or sour cream.

Use small amounts of tub

2.

margarine instead of butter.

Choose fruits and vegetables

3.

instead of high-fat foods like chips or fries.

Virginia has learned that eating foods high in saturated fat can raise her blood cholesterol level. So she’s modified her favorite pie recipe by using soft margarine, fat-free milk, and low-fat cream cheese. Now the pie is lower in saturated fat, trans fat, and cholesterol, and it still tastes great.

Make your personal pledge to do what Virginia has done! Look at these examples.

Breakfast

Use fat-free or low-fat milk in coffee or on cereal.

Lunch

Use leftover roasted chicken to make a sandwich. Eat it with some raw carrots and a banana for dessert.

Dinner

Bake chicken with lime juice, cilantro, and tomatoes. Remove and throw away the skin before cooking.

Snack

Eat an apple instead of tortilla chips that are high in fat.

Write the changes you will make this week:

The health of you and your family is priceless. Make an investment in it!

HANDOuT—SESSION 5

Fats and Oils To Choose

When you do use fats and oils, choose those with less saturated fat.

Lower in Saturated Fat— Choose More Often

Canola, corn, olive, safflower, soybean, and sunflower oils

Tub margarine (especially light margarine)

Higher in Saturated Fat— Choose Less Often

• Butter
• Solid shortening
• Lard
• Fatback
• Stick margarine

Read the Food Label To Choose Foods

Lower in Saturated Fat,

Trans Fat, and Cholesterol!

Percent of Saturated Fat

Use this handy graph to help you choose products with the least amount of saturated fat. Look for the ♥.

Source: Adapted from the Canola Council of Canada. “Canola Oil Dietary Fat.” ( council.org/PDF/dietarychart.pdf#zoom=100) July 19, 2007.

HANDOuT—SESSION 5

Read the Food Label To Choose Foods Lower in Fat, and Cholesterol

Food labels tell you what you need to know about choosing foods

Whole

trans

Milk

food label for a carton of whole milk. The label tells you:

Whole Milk

Nutrition Facts

Serving Size 1 cup (fl. oz)

Amount Per Serving

Servings Per Container 8

The nutrient amounts are for one serving. So, if you have Amount Per Serving more than one serving, you

Serving Size and Number of Servings The serving size is 8 fluid ounces (1 cup).

Calories from Fat 70

need to add the corresponding nutrient amounts. For

There are eight servings in

% Daily Value*

example, if you drink

Total Fat 8g

2 cups of whole milk, you are

Saturated Fat 5 g

drinking two servings. You

Trans Fat 0g

would need to double the

Cholesterol 35mg

amount of calories, saturated

Sodium 125mg

fat, trans fat, and cholesterol.

Total Carbohydrate 12g

cholesterol in one serving.

this carton.

12%

25% Percent Daily Value The Percent Daily Value

cholesterol. If you have high blood cholesterol, you should eat less saturated fat,

Vitamin C 4%

trans fat, and cholesterol. A

Vitamin D 25%

Nutrition Facts

milligrams (mg).

doctor or registered dietitian

Serving Size 1 cup (8 fl. oz.) Servings Per Container 8

Amount Per Serving

can help you with this.

Whole Milk

Calories from Fat 70

Compare!

One cup of whole milk has 25

% Daily Value*

Total Fat 8g Saturated Fat 5g

Which one would you choose? Nutrition Facts

Trans Fat 0g

Serving Size 1 cup (8 fl. oz.)

Servings Per Container 8Cholesterol35mg

Except for calories and saturated fat, Sodium 125mg

Amount Per Serving

percent of the Daily Value of

12%

25% saturated fat. This is one-fourth of the total amount of saturated

12%

fat that you should have in 1

5% 12g

fat-free milk has all the nutrients of

CaloriesDietary Fiber 0g90

0%

Calories from Fat 0

whole milk, including the calcium. Sugars 11g

Protein 8g

Fat-Free Milk

% Daily Value*

That makes fat-free milk a better

Total Fat 0g

choice! Read food labels, and choose Vitam in A 6%

Calcium 30%Saturated Fat 0gIron0%

products to keep your heart strong. Trans Fat 0g

Cholesterol 5mg Sodium 125mg

One cup of fat-free milk has

0%

Vitamin C 4%

Vitamin D 25%0% no saturated fat. You can learn a lot from a food label.

2% 5% 12g

• Percent Daily Values Dietary Fiber 0g

4% 0% are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Sugars 11g Protein 8g

HANDOuT—SESSION 5

Vitamin A 10%

Vitamin C 0% 145

Vitamin D 25%

Virginia’s Breakfast Choices

1 – Cinnamon Roll

Virginia has Nutrition Facts

little time in Serving Size 1 roll (85g)

Servings Per Container 15

the morning to prepare Amount Per Serving breakfast. Calories 320 Calories from Fat 130 She often has a

% Daily Value*

cinnamon roll or Lower

Total Fat 14g 22% saturated

a doughnut.

Saturated Fat 3.5g 18% fat Trans Fat 1.5g choice

Look at the food

Cholesterol 50mg 17%

labels. Help Sodium 280mg 12% ______ Virginia select Total Carbohydrate 44g 15% some breakfast Dietary Fiber 2g 8% foods that are Sugars 19g

Protein 5g

lower in saturated fat than her usual

Vitamin A 0% • Vitamin C 0%

choices. Calcium 10% • Iron 4%

Which should she choose? Write 3 – Doughnut the number of

Nutrition Facts

your choice for

Serving Size 1 doughnut (54g)

each pair in the Servings Per Container 5 space between

Amount Per Serving

the labels.

Calories 290 Calories from Fat 170

% Daily Value*

Lower Total Fat 19g 29% saturated Saturated Fat 6g 30% fat Trans Fat 2g choice Cholesterol 10mg 3% Sodium 240mg 10% ___ Total Carbohydrate 27g 9% Dietary Fiber 1g 0% Sugars 15g Protein 3g

Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 8%

2 – Plain Bagel

Nutrition Facts

Serving Size 1 bagel (75g) Servings Per Container 6

Amount Per Serving

Calories 210 Calories from Fat 5

% Daily Value*

Total Fat 1g 2% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 390mg 16% Total Carbohydrate 43g 14% Dietary Fiber 2g 8% Sugars 2g Protein 8g

Vitamin A 0% • Vitamin C 0% Calcium 6% • Iron 15%

4 – English Muffin

Nutrition Facts

Serving Size 1 muffin (57g) Servings Per Container 6

Amount Per Serving

Calories 130 Calories from Fat 10

% Daily Value*

Total Fat 1g 2% Saturated Fat 0g 0% Trans Fat 0g

Sugars 4g Protein 4g

Vitamin A 0% • Vitamin C 0% Calcium 15% • Iron 8%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

146 HANDOuT—SESSION 5

Virginia’s Breakfast Choices

5 – Fruit Danish

Nutrition Facts

Serving Size 1/8 package (57g) Servings Per Container 8

Amount Per Serving

Calories 160 Calories from Fat 7

% Daily Value*

Total Fat 8g 12% Saturated Fat 1.5g 8% Trans Fat 1g

Sugars 13g Protein 2g

Vitamin A 0% • Vitamin C 4% Calcium 10% • Iron 2%

7 – Butter

Nutrition Facts

Serving Size 1 Tbsp (14g) Servings Per Container 32

Amount Per Serving

Calories 100 Calories from Fat 100

% Daily Value*

Total Fat 11g 17% Saturated Fat 8g 40% Trans Fat 0g

Sugars 0g Protein 0g

Vitamin A 8% • Vitamin C 0% Calcium 0% • Iron 0%

6 – Banana

Nutrition Facts

Serving Size 1 medium (126g) Servings 1

Amount Per Serving

Calories 110 Calories from Fat 0

% Daily Value*

Lower Total Fat 0.5g 1% saturated Saturated Fat 0g 0% fat Trans Fat 0g choice Cholesterol 0mg 0% Sodium 0mg 0% ___ Total Carbohydrate 29g 10% Dietary Fiber 1g 4% Sugars 21g Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

8 – Light Margarine (Soft Tub)

Nutrition Facts

Serving Size 1 Tbsp (14g) Servings Per Container 80

Amount Per Serving

Calories 50 Calories from Fat 50

% Daily Value*

Lower Total Fat 6g 9% saturated Saturated Fat 1.5g 8% fat Trans Fat 0g choice Cholesterol 0mg 0%

Sodium 55mg 2% ___ Total Carbohydrate 0g 0% Dietary Fiber 0g 0% Sugars 0g Protein 0g

Vitamin A 10% • Vitamin C 0% Calcium 0% • Vitamin E 8% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Virginia’s Breakfast Choices

9 – Chorizo

Nutrition Facts

Serving Size 1 link (60g) Servings Per Container 5

Amount Per Serving

Calories 270 Calories from Fat 210

% Daily Value*

Total Fat 23g 35% Saturated Fat 9g 45% Trans Fat 0g

Sugars 0g Protein 15g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 5%

11 – Refried Beans

Nutrition Facts

Serving Size 1/2 cup Servings Per Container 3.5

Amount Per Serving

Calories 200 Calories from Fat 100

% Daily Value*

Total Fat 11g 17% Saturated Fat 3g 15% Trans Fat 0g

Sugars 1g Protein 6g

Vitamin A 0% • Vitamin C 2% Calcium 6% • Iron 10%

10 – Lean Pork

Nutrition Facts

Serving Size 2 oz Servings Per Container 5

Amount Per Serving

Calories 100 Calories from Fat 25

Lower % Daily Value* saturated Total Fat 3g 5% fat Saturated Fat 1g 5% choice Trans Fat 0g Cholesterol 45mg 15% ___

Sugars 0g Protein 16g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 5%

12 – Cooked Beans

Nutrition Facts

Serving Size 1/2 cup Servings Per Container 3

Amount Per Serving

Calories 90 Calories from Fat 5

% Daily Value*

Lower Total Fat 0.5g 1% saturated Saturated Fat 0g 0% fat Trans Fat 0g choice Cholesterol 0mg 0% Sodium 460mg 19% ___ Total Carbohydrate 19g 6% Dietary Fiber 6g 24% Sugars 1g Protein 7g

Vitamin A 0% • Vitamin C 0% Calcium 4% • Iron 10%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDOuT

Virginia’s Breakfast Choices

13 – Low-fat Cheddar Cheese

Nutrition Facts

Serving Size 1 oz Servings Per Container 8

Amount Per Serving

Calories 50 Calories from Fat 15

% Daily Value*

Lower Total Fat 1.5g 2% saturated Saturated Fat 1g 5% fat Trans Fat 0g choice Cholesterol 0mg 0% Sodium 220mg 9% ___ Total Carbohydrate 1g 0% Dietary Fiber 0g 0% Sugars 0g Protein 8g

Vitamin A 4% • Vitamin C 0% Calcium 10% • Iron 0%

14 – Regular Cheddar Cheese

Nutrition Facts

Serving Size 1 oz Servings Per Container 7

Amount Per Serving

Calories 120 Calories from Fat 90

% Daily Value*

Total Fat 10g 15% Saturated Fat 7g 35% Trans Fat 0g

Sugars 0g Protein 6g

Vitamin A 6% • Vitamin C 0% Calcium 20% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HANDOuT—SESSION 5

Guess the Fat Activity

Try to guess the amount of fat (in teaspoons) that is found in each food. Write your answers on the “My Guess” line.

Teaspoons of Fat

Food My Guess True Amount

2 ounces cheddar cheese

2 tablespoons sour cream

2 pieces fried chicken

2 snack cakes (1 package)

1 beef hotdog

1 cup cooked beans

1 orange

150 HANDOuT—SESSION 5

Cooking With Less Saturated Fat

Beans

DoN’T ADD oil, lARD, oR SHoRTENiNG!

1. Cook beans in water until tender.
2. Season with onion, garlic, cumin, oregano, and, if you wish, ¼ teaspoon of salt.
3. To thicken beans, mash and saute in skillet with a little water (without adding lard or vegetable shortening).

Boiled Rice

1. Bring 2 cups of water to a

+

boil, and add 1 cup of rice.

WATER RiCE

1. Cover well, and cook over low heat for 20 minutes.

DoN’T ADD oil!

Oven-Fried Potatoes (or Yuca)

1. Boil yuca until tender. Peel yuca. If using potatoes, leave the skin on. Do not boil the potatoes.
2. Cut potatoes or yuca in the shape of thick french fries.
3. Arrange on a baking sheet that has been lightly sprayed with vegetable oil spray.
4. Bake at 350 °F for 45 minutes to an hour, or until done.

HANDOuT—SESSION 5 151

Cooking With Less Saturated Fat (continued)

Mexican Quesadillas

1. For each quesadilla, place a corn tortilla on a dry griddle

DoN’T ADD

over medium heat. When oil! soft, put a small slice of low-fat cheese on half of the tortilla, and fold. Heat until the cheese melts.

1. Remove from skillet, open, and add salsa, fresh

SAlSA

tomatoes, and cilantro. Refold before eating.

Ground Beef With Potatoes

1. In a hot skillet, saute garlic and chopped onions in 1 teaspoon of vegetable oil. Add extra lean ground beef, and cook until brown. Pour off fat.
2. Dice unpeeled potatoes, and add to ground beef.
3. Season with a small amount of oregano, powdered cumin, black pepper, and, if you wish, ¼ teaspoon of salt.
4. Cook until potatoes are tender.

Fruit Shake

1. Cut your favorite fruit—such as bananas, oranges, mangos, or strawberries—into chunks.
2. Place in a blender, along with fat-free milk, vanilla, and ice.
3. Blend until smooth.

152 HANDOuT—SESSION 5

Chicken Stew Recipe

8 pieces 1 cup 2 small 1 small

chicken, breasts or legs water garlic cloves, minced onion, chopped

1½ teaspoons salt

½ teaspoon 3 medium 1 teaspoon ¼ cup 2 medium 2 small 2

ground black pepper tomatoes, chopped parsley, chopped celery, finely chopped potatoes, peeled and chopped carrots, chopped bay leaves

Yield: 8 servings

Serving size: 1 piece of chicken

Each serving provides: Calories: 206 Total fat: 6 g Saturated fat: 2 g Cholesterol: 75 mg Sodium: 489 mg Total fiber: 2 g Protein: 28 g Carbohydrates: 10 g Potassium: 493 g

1. Remove the skin and any extra fat from the chicken, and throw it away. In a large skillet, combine chicken, water, garlic, onion, salt (as little as possible), pepper, tomatoes, and parsley. Tightly cover, and cook over low heat for 25 minutes.
2. Add celery, potatoes, carrots, and bay leaves, and continue to cook for 15 more minutes or until chicken and vegetables are tender. Remove bay leaves before serving.

Quick Facts

This recipe is lower in saturated fat and cholesterol because:

• The dish is made with chicken

without the skin, and extra fat is removed.

• No fat is added. The dish is flavored

with vegetables and seasonings, and it is cooked slowly in water (moist heat) instead of fat.

HANDOuT—SESSION 5

s essi o n

Keep Your Heart in Mind: Aim for a Healthy Weight

Objectives

By the end of this session, group members will learn that:

• Being overweight is a risk factor for high blood cholesterol, high blood pressure, diabetes, heart disease, and stroke.
• Healthy weights are given in ranges.
• Losing weight or keeping a healthy weight means making lifelong changes.
• Fad diets usually do not work over the long term and can be harmful.

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Two bathroom scales
• A tape measure you can attach to the wall (to measure height)
• A cloth tape measure (to measure the waist)

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 155

• (Optional) Curling ribbon (to measure the waist)*
• A food label (from a can or package)
• (Optional) “I Don’t Like That Boy At All: Watch Your Weight” telenovela or fotonovela (pages 418–419)

Note: The telenovela is available in Spanish only.

• (Optional) VCR or DVD and TV monitor
• 10 serving dishes
• Four measuring cups
• Five spoons
• One knife
• Food

• A 16-ounce box of cereal

• A 15-ounce can of fruit or vegetables

• A block of cheddar cheese (about ½ pound)

• 3 cups of cooked rice

• A 15-ounce can of beans

Handouts

Give group members these handouts during this session:

• “Body Mass Index (BMI) Chart” (page 177)
• “Do You Need To Lose Weight?” (page 178)
• “Doña Fela’s Healthy Lifestyle” (page 179)
• If you choose to use ribbon instead of measuring tape, cut one ribbon at 35 inches for women and one ribbon at 40 inches for men.

156 Your Heart, Your Life: A Community Health Worker’s Manual

• “Virginia’s Habits and Her Weight” (page 180)
• “Tips To Help You Control Your Weight” (page 181)
• “Serving Sizes” (page 182)
• “Read the Food Label for Calories!” (page 183)
• “Virginia’s Snack Choices” (pages 184–186)
• “Fresh Cabbage and Tomato Salad Recipe” (page 187)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Facts About Overweight and Obesity
2. (Optional) “I Don’t Like That Boy At All: Watch Your Weight” Telenovela or Fotonovela (pages 418–419)
3. Your Weight and Your Health
4. What Is a Healthy Weight? Activity
5. The Healthy Way To Lose Weight
6. Beat Weight-Loss Barriers
7. Serving Size Activity
8. Food Label Activity—Calories
9. Fresh Cabbage and Tomato Salad Recipe

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 157

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Last week, we talked about why it is important to cut back on saturated fat, trans fat, and cholesterol in our diets. Can you list three things you can do to make food lower in fat?

Note: Add these possible answers if not mentioned by group members.

• Trim the fat from meat before cooking.

• Take off the skin from chicken before cooking and throw it away.

• Bake, boil, broil, or grill food instead of frying it.

• Ask:

At the end of the last session, you made a pledge to eat less saturated fat, trans fat, and cholesterol. What went well? Did you have any problems?

Note: Allow 5 minutes for group members to respond.

158 Your Heart, Your Life: A Community Health Worker’s Manual

3. About This Session

Today, we will discuss why keeping a healthy weight is important to heart health.

When the session ends, you will know that:

• Being overweight increases your chances for high blood cholesterol, high

blood pressure, diabetes, heart disease, and stroke.

• To lose weight:

• Cut down on the calories you eat.
• Eat smaller portions.
• Be physically active.

• Fad diets usually do not work over the long term and can be harmful to you.

You will also find out if you need to lose weight by learning your body mass index (BMI) and your waist measure.

Conducting the Session

1. Facts About Overweight and Obesity

• Overweight and obesity increase the risk of heart disease and stroke.
• More than half of Latina women are overweight or obese.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 159

• About two of every three Latino men are overweight or obese.
• About one of every four Latino children is overweight.

2. (Optional) “I Don’t Like That Boy At All: Watch Your Weight” Telenovela or Fotonovela

• Show the telenovela, “I Don’t Like That Boy At All: Watch Your Weight,” or have volunteers read the fotonovela (pages 418–419).

Note: The telenovela is available in Spanish only.

3. Your Weight and Your Health

Being overweight or obese increases your risk of heart disease and stroke. It also can contribute to the development of high blood cholesterol, high blood pressure, and diabetes. These can also cause heart disease.

Being overweight can increase the risk of developing some types of cancer. It can make other health problems worse, such as arthritis and sleep disorders.

Losing a small amount of weight can improve many health problems that come from being overweight.

4. What Is a Healthy Weight? Activity

Note: Before beginning this activity, place the scales where group members can weigh themselves in private. Write the following information on the blackboard or on a large piece of paper taped to the wall.

160 Your Heart, Your Life: A Community Health Worker’s Manual

Mariano weighs 180 pounds (82 kilograms). He is 5 feet, 6 inches (1.68 meters) tall.

Virginia weighs 130 pounds (59 kilograms). She is 5 feet, 2 inches (1.57 meters) tall.

• Give group members the “Body Mass Index (BMI) Chart” handout (page 177).

We are going to do an activity to find out if you have a healthy weight or if you should lose weight.

• Show picture card 6.1.

First, we’re going to work together to find out if Mariano and Virginia have healthy weights. We will use the Body Mass Index chart. The BMI chart lets us measure the weight of a person in relation to his or her height. The chart will help us find the BMI.

Mariano weighs 180 pounds (82 kilograms), and he is 5 feet, 6 inches (1.68 meters) tall. His wife Virginia weighs 130 pounds (59 kilograms), and she is 5 feet, 2 inches (1.57 meters) tall.

Let’s use the BMI chart on the handout that I gave you to find out if Mariano and Virginia have healthy weights.

Look for Mariano’s weight on the top of the chart, and circle it. Put your finger on the circled number, and lower your finger until you find the line that corresponds to Mariano’s height. The shade of the square will tell you if his weight is healthy or if he is overweight or obese.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 161

Note: Allow 2 or 3 minutes for group members to look for the answer on the chart.

Now we will find Virginia’s BMI, following the same steps.

Note: Allow 2 or 3 minutes for group members to look for the answer on the chart.

Mariano’s BMI is 29, which means he is overweight. Virginia’s BMI is 24, so she has a healthy weight.

Now we are going to find out if you have a healthy weight. If you do not know how much you weigh, use the scale to weigh yourself. If you do not know your height, use the wall measure.

Note: Allow 15 minutes for group members to use the scales and wall measure.

• Give group members the “Do You Need To Lose Weight?” handout (page 178).

Now we’re going to take three simple steps to learn if we need to lose weight, and then we’re going to find out what actions we should take.

The first step is to find out our BMI, using the chart on the handout that I gave you. We will follow the same process that we used with Mariano and Virginia.

Find your weight on the top of the chart, and circle it. Put your finger on the circled number, and lower your finger until you find the line that corresponds to your height. The shade of your square will show you if your weight level is healthy, overweight, or obese. You do not have to share your BMI number with the group. Just check off your weight level on the handout.

162 Your Heart, Your Life: A Community Health Worker’s Manual

Please raise your hand if you are having trouble, and I will help you.

The second step is to measure your waist.

• Show picture card 6.2.

Waist Measure

Note: Have group members measure their waists by placing a tape measure around the waist just above the hip bone. Be sure the tape is snug, but not too tight on the stomach. Ask them to relax, exhale, and then measure their waists.

Measuring-Tape Position for Waist Measurement in Adults

• Ask group members to measure their waists using the measuring tape.

(Optional) Note: Some people may be sensitive about measuring their waists with a tape measure. To make this activity friendlier, you can use curling ribbon. Cut 35 inches (88 cm) for women and 40 inches (102 cm) for men, and give the ribbon to group members. Tell them how long the ribbon measures. If the ribbon does not go all the way around group members’ waists, their waist measures are high.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 163

Write down your waist measure, and check off what level your waist measure is: healthy or high. A waist measure greater than 35 inches (88 cm) for women and greater than 40 inches (102 cm) for men is high. A high waist measure increases your risk for heart disease.

In the third step, we will find out if you need to lose weight. Look at your weight and waist measure.

If both are healthy, then you are at a healthy weight and do not need to lose weight. Good for you! Try not to gain weight.

• Copy the text in the “Risk Factors” box onto the blackboard or onto a large piece of paper taped to the wall.

Risk Factors

• High blood pressure
• High LDL cholesterol

(bad cholesterol)

• Low HDL cholesterol

(good cholesterol)

• High triglycerides
• High blood glucose
• Family history of heart disease
• Not being physically active
• Smoking

Let’s review these risk factors.

• Ask:

How many risk factors do you have?

Note: Allow a moment for group members to think about their answers to this question.

164 Your Heart, Your Life: A Community Health Worker’s Manual

If your BMI is in the overweight level, and you have two or more of the risk factors we just listed, you should lose weight. It is important not to gain more weight. You should also lose weight if you are overweight and have a high waist measure.

If your BMI level is obese, you also need to lose weight. It is important to lose weight slowly—about 1 to 2 pounds a week. Ask your doctor or a registered dietitian for help.

Note: Ask group members to look at the handout to see what actions they should take for their weight levels.

Level

Healthy Weight

Overweight

Action

• Good for you! Try not to gain any weight.
• It is important not to gain more weight.

• You need to lose weight if you are overweight

and

• Have two or more heart disease risk factors or
• Have a high waist measurement.

• Ask your doctor or a registered dietitian for

help.

Obese • You need to lose weight. Lose weight

slowly—about 1 to 2 pounds a week.

• Ask your doctor or a registered dietitian for

help.

• Give group members the “Doña Fela’s Healthy Lifestyle” handout (page 179).

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 165

Please review the handout to find out how Doña Fela found success managing her weight.

5. The Healthy Way To Lose Weight

Let’s talk about the healthy way to lose weight.

The measure of energy that the body gets from food is called a calorie. People gain weight when they eat more calories than their body uses for energy.

If you need to lose weight, you must choose foods with fewer calories or become more physically active. It’s best to do both.

To lose weight, you must burn more calories than the calories you eat. Losing 5 to 15 percent of your body weight can make a difference in your health. For example, a person who weighs 200 pounds would need to lose 10 to 30 pounds.

Pregnant women should not try to lose weight.

• Give group members the “Virginia’s Habits and Her Weight” handout (page 180).

This handout is about how decreasing calorie intake and adding small amounts of daily activity can lead to weight loss over time.

• Ask for volunteers to read each scene aloud.

166 Your Heart, Your Life: A Community Health Worker’s Manual

• Show picture card 6.3.

Like Virginia in the third scene, you can lose weight in a healthy way: Eat smaller portions, eat a variety of foods lower in fat and calories, and increase your activity level.

Most people who lose weight and keep it off do so by losing the weight slowly. They learn to make lasting changes. They eat fewer calories and stay physically active. You should try to lose 1 to 2 pounds each week until you reach a healthy weight.

• Give group members the “Tips To Help You Control Your Weight” handout (page 181). Review the tips for losing weight.

6. Beat Weight-Loss Barriers

• Ask:

Have any of you ever tried to lose weight?

• Ask people to share their experience with the group. Ask them to tell what kept them motivated to lose weight.
• Ask:

Why do you think it is difficult for some people to lose weight or keep off the weight they lose?

Note: Write their answers on the blackboard or on a large piece of paper taped to the wall.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 167

• Add some of the following answers if they are not mentioned.

Some people have a hard time losing weight because:

• They lack support from family members or friends.

• They do not know how to cook without fat or how to use a recipe.

• They believe that healthy foods are too expensive.

• Fruits and vegetables cost more than junk food at the local store.

• The neighborhood is too dangerous for people to walk in for physical

activity, because it lacks well-lit areas.

• Working parents are often short on time and energy.

• Changing behavior is difficult and takes time and effort.

• They think that being heavy means that a person is healthy.

• Family activities center around food.

• Friends give the wrong message. For example, “You’re better off with some

extra weight.”

• Ask:

Have you found ways to beat the barriers to losing weight?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add some of the following answers if they are not mentioned.

• Find another person who also wants to lose weight. You can talk with this

person to stay motivated.

• Walk or plan other activities with another person. This makes it more fun,

and the time will pass quickly.

168 Your Heart, Your Life: A Community Health Worker’s Manual

• Find activities that the whole family can enjoy to help others control their

weight, too.

• Look for free or low-cost physical activity facilities at local community

centers or parks and recreation programs.

• Share cooking chores and recipes with your friends. For example, if family

members will not eat lower-calorie dishes, make a dish and share it with a friend. Your friend can make a dish and share it with you.

Ask your doctor or a registered dietitian to help you develop a plan if you have a lot of weight to lose.

• Show picture card 6.4.

Losing weight has become a moneymaking business. You hear about miracle diets that claim to help you lose weight quickly and easily. These products make only one thing lighter—and that’s your wallet. Be careful about ads that promote diets and exercise products using personal testimonies.

Diets that promise quick weight loss rarely work. Many of these diets include only a few foods. People get bored with them quickly. These diets do not provide all the nutrients and energy your body needs. They are not healthy.

7. Serving Size Activity

Let’s look at how big a serving is. In Session 8, “Make Heart Healthy Eating a Family Affair,” we will look at how much you should eat.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 169

Before the session

1. Check the “Serving Sizes” handout (page 182) for the serving size of each food. Measure one serving of each food, and put each in a separate dish or other container.
2. Place the dishes with these premeasured foods out of sight.
3. Place the box of cereal, a large bowl of cooked rice, a bowl of fruit or vegetables, a block of cheddar cheese, and a bowl of beans on a table with five dishes, four serving spoons, and a knife.

• Ask five volunteers to come to the table. Ask each volunteer to do one of the following:

1. Spoon out a serving of cereal and put it on a dish.
2. Spoon out a serving of cooked rice and put it on a dish.
3. Cut a serving of cheese and put it on a dish.
4. Spoon out a serving of the fruit or vegetable and put it on a dish.
5. Spoon out a serving of beans and put it on a dish.

• Bring out the foods you measured before the session. Compare the volunteers’ serving sizes with the true amounts.
• Give group members the “Serving Sizes” handout (page 182). Ask volunteers to read aloud the serving sizes for each. Tell them to use this handout at home.

8. Food Label Activity—Calories

Note: This activity will help group members choose foods that are lower in calories.

170 Your Heart, Your Life: A Community Health Worker’s Manual

We have learned that, to lose weight, a person must eat fewer calories than the body burns for energy. In the last session, you learned how to use the food label to choose foods that are lower in saturated fat, trans fat, and cholesterol. Today, we are going to learn how to use the food label to choose foods that are lower in calories.

• Show picture card 6.5.

Here’s where you can look to find the number of calories in one serving on the food label. This food label shows the number of calories in canned peaches in heavy syrup.

• Give group members the “Read the Food Label for Calories!” handout (page 183).

Look at the food labels for canned peaches (in fruit juice) and canned peaches (in heavy syrup) at the bottom of the handout. Which canned peaches have fewer calories?

Note: Allow 1 to 2 minutes for group members to respond.

Canned peaches in fruit juice have fewer calories. There are 50 calories in one serving, or 1/2 cup, of canned peaches in fruit juice. There are 100 calories in one serving, or 1/2 cup, of canned peaches in heavy syrup—twice as many calories as canned peaches in fruit juice.

“Fat-free” does not mean free of calories. You need to watch calories and fat when comparing food labels.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 171

Here are a few examples:

Calories in reduced-fat food Calories in regular-fat food

Reduced-fat chocolate chip cookies, 118 Regular chocolate chip cookies, 142

Let’s try another group activity. I will tell you about a common problem for families today. Then we will learn how to use food labels to help solve the problem.

• Give group members the “Virginia’s Snack Choices” handout (pages 184–186). Read Virginia’s problem. Ask group members which foods Virginia should serve.

172 Your Heart, Your Life: A Community Health Worker’s Manual

Virginia’s Problem

Virginia and her family like to have snacks when they watch television. Recently, Virginia has noticed that her family members have gained weight. Use the food labels to choose some tasty snacks that are lower in calories. What should Virginia serve? Write the number of your choice for each pair on the line. Then write the number of calories saved by this choice.

Note: The choices that are lower in calories are underlined below. The number of calories saved by making the right choice is given below each choice.

Potato chips or microwave popcorn? Choosing popcorn saves 130 calories.

An apple or shortbread cookies? Choosing an apple saves 70 calories.

Whole milk or fat-free milk? Choosing the fat-free milk saves 60 calories.

Chocolate ice cream or a popsicle? Choosing the popsicle saves 95 calories.

Salsa or jalapeño cheese dip? Choosing the salsa saves 25 calories.

• Ask:

• What is an example of a snack that is higher in calories that your family eats?

• What is an example of a snack that is lower in calories that your family

would enjoy?

Note: Allow a few minutes for group members to respond.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 173

9. Fresh Cabbage and Tomato Salad Recipe

RECIPE

• Give group members the “Fresh Cabbage and Tomato Salad Recipe” handout (page 187).

This salad is easy to make. It has only 41 calories and 1 gram of fat per serving. It’s also low in sodium. Try the salad recipe at home this week.

Review of Today’s Key Points

Let’s review what we learned today.

Why is it important to maintain a healthy weight?

• Being overweight may increase your risk of heart disease, high blood

pressure, high blood cholesterol, diabetes, and some types of cancer.

What is the healthiest way to lose weight?

• Eat smaller portions of a variety of foods lower in fat and calories, and

increase your physical activity.

How can the food label help you if you need to lose weight?

• The food label tells you the serving size and the number of calories per

serving. You can compare calories on different packages to choose foods that are lower in calories.

174 Your Heart, Your Life: A Community Health Worker’s Manual

Weekly Pledge

You have learned a lot today about losing weight the healthy way. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to reach or keep a healthy weight. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will buy vegetable oil spray when I go to the grocery store next week. I

will use the cooking oil spray instead of butter when I make scrambled eggs for breakfast.

• I will walk for 30 minutes for 3 days each week during my lunch break at

work, starting tomorrow.

• I will eat only half of my entree the next time I eat out to cut down on my

food portion. I will take the other half home and save it for another meal.

Write your pledge on the “Doña Fela’s Healthy Lifestyle” handout on page 179. Keep this handout in a special place, so you can review your pledges and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge and write it down.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

Session 6. Keep Your Heart in Mind: Aim for a Healthy Weight 175

• (Optional) Say:

Keeping a personal value in mind can help you make changes in your life to reach and keep a healthy weight. Remember that a personal value is a quality that you consider important.

Today, the value is honesty. Honesty can help you think about what makes you overeat, such as feelings of boredom, stress, or anger, or a lack of time or willpower. Honesty can also free you to talk about your struggles and successes with your friends or loved ones who can support you. Finally, honesty can guide you to choose goals that are realistic for you as you work to change your eating and activity habits for the better.

• Ask:

How can you use honesty, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to continue working on your pledges to be more physically active and to cut back on salt, sodium, saturated fat, trans fat, and cholesterol.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about diabetes and how it relates to heart disease.

Note: Think about today’s session. What worked and didn’t work? Have you made any changes in your own life that were covered in today’s session?

176 Your Heart, Your Life: A Community Health Worker’s Manual

56 54 52 51 49 47 46 44 43 42

250 lbs113 kg

54 52 50 49 47 45 44 43 41 40

240 lbs109 kg

52 50 48 46 45 44 42 41 40 38

230 lbs104 kg

49 48 46 44 43 42 40 39 38 37

220 lbs100 kg

47 45 44 42 41 40 38 37 36 35

95 kg 210 lbs

45 43 42 40 39 38 37 35 34 33

91 kg 200 lbs

43 41 40 38 37 36 35 34 33 32

86 kg 190 lbs

40 39 38 36 35 34 33 32 31 30

82 kg 180 lbs

38 37 36 34 33 32 31 30 29 28

77 kg 170 lbs

36 35 34 32 31 30 29 28 28 27

73 kg 160 lbs

Weight in Pounds (lbs)/Kilograms (kg)

34 33 31 30 29 28 27 27 26 25

150 lbs68 kg

31 30 29 28 27 26 26 25 24 23

63 kg 140 lbs

29 28 27 26 25 25 24 23 22 22

130 lbs59 kg

26 26 25 24 23 23 22 21 21 20

40 39 38 37 36 35 34 33

Obese

39 38 37 35 35 34 33 32

37 36 35 34 33 32 31 30

36 35 34 33 32 31 30 29

34 33 32 31 30 29 28 28

Overweight

32 31 30 30 29 28 27 26

31 30 29 28 27 27 26 25

29 28 27 27 26 25 24 24

27 27 26 25 24 24 23 22

26 25 24 24 23 22 22 21

24 24 23 22 22 21 20 20

23 22 21 21 20 20 19 19

Healthy Weight

21 20 20 19 19

19 19

Body Mass Index (BMI) Chart

54 kg 120 lbs

25 24 23 22 22 21 20 20 19

50 kg 110 lbs

22 22 21 20 20 19

100 lbs45 kg

4’8” 4’9” 4’10” 4’11” 5’0” 5’1” 5’2” 5’3” 5’4” 5’5” 1.46 m1.49 m1.47 m1.50 m1.52 m1.55 m1.57 m1.60 m1.63 m

5’6” 5’7” 5’8” 5’9” 5’10” 5’11” 6’0” 6’1” 1.68 m1.70 m1.73 m1.75 m1.78 m1.80 m1.83 m1.85 m 1.65 m

HAnDOuT—SeSSIOn 6

Height in Feet and Inches/Meters (m)

Do You Need To Lose Weight?

Let’s follow these steps to find out if you need to lose weight.

1. Learn if your weight is healthy. My weight is:

Weigh yourself. Use the BMI chart to find out whether your Healthy weight is in the healthy range for people of your height. Find Overweight your weight on the top of the chart, and circle it. Put your finger on the circled number, and lower your finger until you Obese find the line that corresponds to your height. The shade of your square will show you if your weight level is healthy, overweight, or obese.

2. Measure your waist.

Measure your waist by placing

the measuring tape snugly

Write down your waist measure: _________

Your waist measure is high if:

• Women—Your waist measure is greater than 35 inches. around your waist. A high waist

• Men—Your waist measure is greater than 40 inches.

measure increases your risk for My waist measure is: heart disease.

Healthy High

3. Find out if you need to lose weight.

Check off your weight level below to find out if you need to lose weight.

Level Action

Healthy Weight • Good for you! Try not to gain any weight. Overweight • It is important not to gain more weight. • You need to lose weight if you are overweight and:

• Have two or more heart disease risk factors or
• Have a high waist measurement.

• Ask your doctor or a registered dietitian for help. Obese • You need to lose weight. Lose weight slowly—about 1 to 2 pounds

a week. Ask your doctor or a registered dietitian for help.

178 HAnDOuT—SeSSIOn 6

Doña Fela’s Healthy Lifestyle

Losing weight means making long-term changes.

Here’s how Doña

I have had diabetes for 25 years. I used to weigh 200 pounds. I was able to

Fela found

lose weight by eating smaller portions

success. of the foods I like. I also eat fewer

fatty foods and sweets and more fruits and vegetables. After I lost my first 25 pounds, my back and foot problems left me. Now I stay at a healthy weight and control my diabetes while still enjoying what I eat.

Try these tips to get started.

♥ Eat fewer foods that are high in ♥ Make stews with lean meat saturated fat—such as fried chicken, and vegetables. pork rinds, and sausage. tions ♥ Serve small portions, and Por

l

♥ Cut down on cakes, pastries, candy, eat salad if you are still al

m

and soft drinks. hungry. Don’t skip meals. S

♥ Eat more fruits, vegetables, and whole grains. Make your personal pledge to do

♥ Aim for 60 minutes of physical activity each day. Write the changes you will

what the Ramírez family is doing! make this week.

Look at these examples:

When shopping

Read labels to choose foods lower in calories.

Cooking OilSpray

When cooking

Bake meat instead of frying it. Use vegetable oil spray instead of greasing the pan with oil.

When eating

Have green beans and rice with one piece of chicken instead of three pieces of chicken alone.

Get active

Walk for 10 minutes three times a day. Dance with your family for 20 minutes. Lift weights before work for 10 minutes.

The health of yourself and your family is priceless. Make an investment in it!

HAnDOuT—SeSSIOn 6 179

Virginia’s Habits and Her Weight

Eat big portions.

Eat moderate portions.

Eat small portions.

Be physically inactive. Gain weight.

Be physically active most days. Maintain weight.

Be physically active most days. Lose weight.

HAnDOuT—SeSSIOn 6

Tips To Help You Control Your Weight

1. Choose foods low in fat and low in calories. Try:

♥ Fat-free milk or low-fat (1%) milk

♥ Cheeses labeled “fat free” or “low fat” on the package

♥ Fruits and vegetables without butter or sauce. Fruits and vegetables are low in calories and help you feel fuller.

♥ Rice, beans, cereals, corn tortillas, and whole-grain pasta

♥ Lean cuts of meat and fish and skinless turkey and chicken

♥ Water or low-calorie drinks instead of soft drinks and fruit drinks with added sugar

2. Make foods the healthy way.

♥ Bake, broil, boil, or grill instead of frying foods.

♥ Cook beans and rice without lard, bacon, or fatty meats.

♥ Use less high-fat cheese, cream, and butter when cooking.

♥ Use vegetable oil spray or a little bit of vegetable oil or tub margarine when cooking.

♥ Flavor salads with fat-free or low-fat mayonnaise or salad dressing.

3. Limit your portion size.

♥ Serve smaller portions, and don’t have second helpings. Have a salad if you are still hungry.

♥ Eat smaller meals and snacks throughout the day instead of having one big meal.

♥ When eating out, watch your portion sizes. Many restaurants now serve food portions that are too big. Share an entree, or bring half home.

♥ If you drink fruit juice, make sure it is 100 percent fruit juice. Keep an eye on the portion size. The calories in beverages add up quickly.

4. Get active! Say goodbye to excuses!

♥ Do your favorite physical activity for at least 60 minutes each day.

Try this: If you are pressed for time, walk for 20 minutes three times a day.

5. Aim for a healthy weight.

♥ Try not to gain extra weight. If you are overweight, try to lose weight slowly. Lose about 1 to 2 pounds a week. Losing even 10 pounds can help reduce your chances of developing heart disease.

HAnDOuT—SeSSIOn 6

Serving Sizes

Food Group

Grains*

Vegetables

Fruits

Fat-free or low-fat milk and milk products

Lean meats, poultry, and fish

Nuts, seeds, and legumes

Fats and oils

Sweets and added sugars

SUGAR

Serving Sizes

1 slice bread 1 ounce dry cereal† 1/2 cup cooked rice, pasta, or cereal

1 cup raw leafy vegetable 1/2 cup raw or cooked vegetable, cut up 1/2 cup vegetable juice

1 medium-sized fruit 1/4 cup dried fruit 1/2 cup fresh, frozen, or canned fruit 1/2 cup fruit juice

1 cup of fat-free or low-fat milk or yogurt‡ 11/2 ounces of cheese

1 ounce cooked meat, poultry without the skin, or fish 1 egg§

1/3 cup or 11/2 ounces nuts 2 tablespoons peanut butter 2 tablespoons or 1/2 ounce seeds 1/2 cup cooked legumes (dry beans and peas)

1 teaspoon soft margarine 1 teaspoon vegetable oil 1 tablespoon low-fat or fat-free mayonnaise 2 tablespoons low-fat or fat-free salad dressing

1 tablespoon sugar 1 tablespoon jelly or jam 1/2 cup sorbet, gelatin 1 cup lemonade

Whole grains are recommended for most grain servings as a good source of fiber and nutrients. † Serving sizes vary between 1/2 cup and 11/3 cups, depending on cereal type. Check the product’s Nutrition Facts label. Lactose-free alternatives for people who are lactose intolerant. § Limit the number of egg yolks to four per week.

HAnDOuT—SeSSIOn 6

Read the Food Label for Calories!

Food labels tell you what you need to know about choosing foods that are lower in calories. Here’s a food label for canned peaches in fruit juice. Canned Peaches (in Fruit Juice)

Nutrition Facts

Serving Size 1/2 cup (110g) Servings Per Container 4

Amount Per Serving Amount Per Serving The nutrient amounts are for

Calories 50 Calories from Fat 0

one serving. So, if you eat more than a serving, you need to add % Daily Value* nutrient amounts. For example, Total Fat 0g 0% if you eat 1 cup of peaches, you Saturated Fat 0g 0% are eating two servings. You Trans Fat 0g need to double the amount of Cholesterol 0mg 0% calories on the label. Sodium 10mg 0%

Total Carbohydrate 13g 4%

Calories

Dietary Fiber less than 1g 0%

The amount of calories in one

Sugars 9g

serving is given here.

Protein less than 1g

The Choice Is Yours—

% Daily Value*

Compare!

Total Fat 0g 0%

Saturated Fat 0g 0%

Which one would you

Trans Fat 0g

choose? Cholesterol 0mg 0%

Sodium 10mg 0%

Canned fruits packed in syrup have added calories. Read the food label

Calories 100 Calories from Fat 0

to choose fruits packed in fruit juice for a lower-calorie snack or dessert. % Daily Value*

Total Fat 0g 0%

Saturated Fat 0g 0%

Trans Fat 0g

Cholesterol 0mg 0%

Sodium 10mg 0%

Serving Size and Number of Servings The serving size is 1/2 cup. There are 4 servings in the can.

Sugar The amount of sugar is shown here.

Canned Peaches (in fruit juice) Canned peaches in fruit juice have 50 calories in a1/2-cup serving.

Canned Peaches (in heavy syrup) Canned peaches in syrup have 100 calories in a1/2-cup serving

• twice the calories found in a 1/2-cup serving of canned peaches in fruit juice. This is an important difference when trying to lose weight or to maintain a healthy weight.

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HAnDOuT—SeSSIOn 6

Virginia’s Snack Choices

1 – Potato Chips

Virginia and

her family like Nutrition Facts

Serving Size 1 oz (28g/about 12 chips)

to have snacks

Servings Per Container 20

when they

Amount Per Serving

watch television. Recently, Calories160 Calories from Fat 90 Virginia has

% Daily Value*

noticed that her

Total Fat 10g 15% Lower

family members

Saturated Fat 3g 15% calorie

have gained Trans Fat 1g choice weight. Cholesterol 0mg 0%

___ Sodium 660mg 28%

Use the food Total Carbohydrate 7g 2% labels to choose Dietary Fiber 1g 0%

Number

Sugars 6g

some tasty of calories

Protein 1g

snacks that are saved lower in calories. Vitamin A 0% • Vitamin C 0%

___

What should Calcium 0% • Iron 5% Virginia serve?

3 – Apple

Write the number

of your choice Nutrition Facts

Serving Size 1 medium (154g)

for each pair

Servings Per Container 1

in the space

Amount Per Serving

between the label. Then write Calories 80 Calories from Fat 5 the number of

% Daily Value*

calories saved by

Total Fat 0.5g 1%

Lower

this choice.

Saturated Fat 0g 0%

calorie

Trans Fat 0g

choice

Cholesterol 0mg 0% Sodium 0mg 0% ______ Total Carbohydrate 24g 8% Dietary Fiber 4g 16% Sugars 20g Number

of calories

Protein 0g

saved

Vitamin A 0% • Vitamin C 6%

Calcium 0% ______

• Iron 0%

2 – Microwave Popcorn (Light Butter)

Nutrition Facts

Serving Size 1 cup (11g) Servings Per Container 4

Amount Per Serving

Calories 20 Calories from Fat 10

% Daily Value*

Total Fat 1g 2% Saturated Fat 1g 5% Trans Fat 0g

Sugars 0g Protein 0g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

4 – Shortbread Cookies

Nutrition Facts

Serving Size 4 cookies (29g) Servings Per Container 10

Amount Per Serving

Calories150 Calories from Fat 60

% Daily Value*

Total Fat 7g 11% Saturated Fat 1.5g 8% Trans Fat 0g

Sugars 6g Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 2%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

184 HAnDOuT—SeSSIOn 6

Virginia’s Snack Choices

5 – Whole Milk

Nutrition Facts

Serving Size 1 cup (8 fl oz) Servings Per Container 8

Amount Per Serving

Calories150 Calories from Fat 70

% Daily Value*

Total Fat 8g 12% Lower Saturated Fat 5g 15% calorie Trans Fat 0g choice Cholesterol 35mg 12% Sodium 125mg 5% ______ Total Carbohydrate 12g 4% Dietary Fiber 0g 0%

Number

Sugars 11g

of calories

Protein 8g

saved

Vitamin A 6% • Vitamin C 4%

___

Calcium 30% • Iron 0% • Vitamin D 25%

7 – Chocolate Ice Cream

Nutrition Facts

Serving Size 1/2 cup (66g) Servings Per Container 16

Amount Per Serving

Calories170 Calories from Fat 80

% Daily Value*

Total Fat 9g 14%

Lower

Saturated Fat 6g 30%

calorie

Trans Fat 0g

choice

Cholesterol 20mg 7% Sodium 40mg 2% ______ Total Carbohydrate 21g 7% Dietary Fiber 1g 4% Sugars 17g Number

of calories

Protein 2g

saved

Vitamin A 4% • Vitamin C 0%

Calcium 6% ______

• Iron 0%

6 – Fat-Free Milk

Nutrition Facts

Serving Size 1 cup (8 fl oz) Servings Per Container 8

Amount Per Serving

Calories 90 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 11g Protein 8g

Vitamin A 10% • Vitamin C 0% Calcium 30% • Iron 0% • Vitamin D 25%

8 – Popsicle

Nutrition Facts

Serving Size 1 piece (52ml) Servings Per Container 12

Amount Per Serving

Calories 45 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 11g Protein 0g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HAnDOuT—SeSSIOn 6

Virginia’s Snack Choices

9 – Salsa

Nutrition Facts

Serving Size 2 tbsp Servings Per Container 28

Amount Per Serving

Calories 15 Calories from Fat 0

% Daily Value* Lower

Total Fat 0g 0%

calorie

Saturated Fat 0g 0%

choice

Trans Fat 0g Cholesterol 0mg 0% ______ Sodium 230mg 10% Total Carbohydrate 3g 1% Dietary Fiber 0g 0% Number Sugars 2g of calories

saved

Protein 1g

Vitamin A 2% ______

• Vitamin C 0% Calcium 0% • Iron 0%

(continued)

10 – Jalapeño Cheese Dip

Nutrition Facts

Serving Size 2 tbsp Servings Per Container 15

Amount Per Serving

Calories 40 Calories from Fat 25

% Daily Value*

Total Fat 3g 5% Saturated Fat 1g 5% Trans Fat 1g

Sugars 0g Protein less than 1g

Vitamin A 0% • Vitamin C 0% Calcium 2% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

SeSSIOn 6

Fresh Cabbage and Tomato Salad Recipe

1 small head 2 medium 1 cup ¼ teaspoon 2 teaspoons 2 teaspoons ½ teaspoon ½ teaspoon 2 teaspoons

cabbage, sliced thinly tomatoes, cut in cubes sliced radishes salt olive oil rice vinegar (or lemon juice) black pepper red pepper fresh cilantro, chopped

Yield: 8 servings

Serving size: 1 cup

Each serving provides: Calories: 41 Total fat: 1 g Saturated fat: less than 1 g Cholesterol: 0 mg Sodium: 88 mg Total fiber: 3 g Protein: 2 g Carbohydrates: 7 g Potassium: 331 mg

1. In a large bowl, mix together the cabbage, tomatoes, and radishes.
2. In another bowl, mix together the rest of the ingredients, and pour over the vegetables.

Quick Fact

Your family will love this tasty salad. The small amount of olive oil, rice vinegar, fresh herbs, and spices adds flavor, but few calories.

SeSSIOn 6

s essi o n

Protect Your Heart: Take Good Care of Your Diabetes for Life

Objectives

By the end of this session, group members will learn:

• What diabetes is and how it affects the body
• The symptoms of diabetes
• That diabetes is a major risk factor for heart disease
• The levels of blood glucose (blood sugar) and what they mean
• How to prevent and control diabetes
• The amount of sugar in common beverages

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Two bottles of water*
• Red food coloring*
• Prepare before the session (see page 197).

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 189

• 1 cup of corn syrup*
• A box of sugar cubes*
• Three manila file folders for activity display*
• Pictures of drinks listed on page 208*
• Glue*

(Optional) Note: Arrange for a health professional or a promotor(a) diabetes educator to come to the session to measure group members’ blood glucose levels.

Handouts

Give group members these handouts during this session:

• List of places where group members can get their blood glucose checked†
• “What Is Diabetes?” (page 218)
• “Are You at Risk for Type 2 Diabetes?” (page 219)
• “Symptoms of Diabetes” (page 220)
• “Tender Care for Your Feet” (page 221)
• “Be Smart About Your Heart: Control the ABCs of Diabetes” (page 222)
• “Read the Food Label for Sugar!” (page 223)
• “Ana’s Food Choices” (pages 224–225)
• “Think Before You Drink: Hidden Sugar in Common Beverages” (page 226)
• “How Much Sugar and How Many Calories Are in Your Favorite Drink?” (page 227)
• Prepare before the session (see pages 197 and 208). † Prepare this list before the session. You may find information at your local health department, hospital, or clinic.

190 Your Heart, Your Life: A Community Health Worker’s Manual

• “Staying Healthy With Diabetes: Real-Life Stories” (pages 228–230)
• Strawberry and Pineapple Delight Recipe (page 231)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. The Facts Don’t Lie
2. What Is Diabetes?

What Is Prediabetes?

1. Types of Diabetes
2. Risk Factors for Diabetes
3. Symptoms of Diabetes
4. Blood Glucose Levels

A. Hypoglycemia

B. Hyperglycemia

1. Complications of Diabetes
2. ABCs of Diabetes Control
3. Food Label Activity—Sugar

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 191

1. Think Before You Drink—Hidden Sugar in Drinks Activity
2. Staying Healthy With Diabetes Group Activity
3. Strawberry and Pineapple Delight Recipe

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about aiming for a healthy weight.

• Ask these questions:

Q: Does anyone remember why a healthy weight is important to your heart health?

A: Keeping a healthy weight reduces your risk of heart disease, stroke, high blood pressure, high blood cholesterol, diabetes, and some cancers.

192 Your Heart, Your Life: A Community Health Worker’s Manual

Q: What is the healthiest way to lose weight?

A: The healthiest way to lose weight is to eat smaller portions of a variety of foods lower in fat and calories and increase your physical activity.

Q: How does the food label help people who are trying to lose weight?

A: The food label tells you the serving size and the number of calories in a serving.

At the end of our last session, you made a pledge to do something to help you keep or reach a healthy weight. What problems did you have? How did you deal with any problems?

Note: Allow 2 minutes for group members to respond.

3. About This Session

In today’s session, we will learn what we can do to prevent and control diabetes. If you have diabetes, you will need to work closely with a doctor, a registered dietitian, or a certified diabetes educator to help you monitor and control your blood glucose.

Conducting the Session

1. The Facts Don’t Lie

• Diabetes is a serious problem for Latino families. It affects men, women,

and children.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 193

• Nearly 1 in 10 adult Latinos has diabetes.

• Diabetes is a chronic disease that slowly damages the body. Although it has

no cure, complications can be prevented.

• Diabetes is a major risk factor for heart disease.

• Heart disease is the leading cause of death for people with diabetes. One in

four Latinos aged 35 or older with diabetes also has heart disease.

2. What Is Diabetes?

Now we will talk about what diabetes is and the types of diabetes.

• Give group members the “What Is Diabetes?” handout (page 218).

Diabetes happens when the body does not make enough insulin or cannot use it well, causing glucose to build up in the blood. Too much glucose in the blood is not good for your health. As a result, the body does not function well.

• Show picture card 7.1.

In a healthy body, the food we eat goes to the stomach where it is digested. The food is broken down into blood glucose. Blood glucose is also called blood sugar.

The blood takes the glucose to the cells of your body, where it is turned into the energy needed for daily life. However, glucose cannot enter the cells alone. Insulin, a hormone made in the pancreas, helps glucose enter the cells.

• Show picture card 7.2.

194 Your Heart, Your Life: A Community Health Worker’s Manual

Diabetes happens when the body does not produce enough insulin, or when the cells cannot use the insulin well. This means that glucose cannot enter the cells and builds up in the blood. People who have high levels of glucose in their blood have diabetes.

What Is Prediabetes?

• Ask:

What is prediabetes?

Note: Allow a minute for group members to answer.

• Add these answers if they are not said.

• Prediabetes is a condition in which blood glucose levels are higher than

normal, but not high enough to be diabetes.

• People with prediabetes are more likely to develop diabetes within the next

10 years.

• People with prediabetes are also more likely to have a heart attack or stroke.

3. Types of Diabetes

• Show picture card 7.3.

When a person does not have diabetes, the pancreas produces a healthy amount of insulin, which the body can use. This is shown in the first picture.

There are two main types of diabetes.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 195

Type 1 diabetes:

• Happens when the pancreas no longer produces insulin. This is shown in the

second picture.

• Requires an insulin pump or shots every day.

• Is usually found in children, adolescents, or young adults.

• Affects about 5 to 10 percent of those with diabetes.

Type 2 diabetes:

• Happens when some insulin is produced, but the body cannot use it well.

This is shown in the third picture.

• Happens more often in people who are overweight and physically inactive.

• Is usually treated with diet, pills, or sometimes, insulin shots.

• Can occur at any age, but it is more common after age 40.

• Is increasing among children, especially if they are overweight and Latino.

• Affects 90 to 95 percent of people with diabetes.

Gestational diabetes is a special class of type 2 diabetes.

• Some pregnant women develop this kind of diabetes, but it usually

disappears after the baby is born.

• Overweight women and women who have a family history of diabetes are

also at higher risk for gestational diabetes.

• Women who have had gestational diabetes have a much higher chance of

developing type 2 diabetes later in life. Their children are also at a higher risk for becoming overweight and developing diabetes.

196 Your Heart, Your Life: A Community Health Worker’s Manual

We have talked about healthy living throughout the sessions. Type 2 diabetes can be prevented and controlled by making healthy food choices, being physically active, and taking medication as prescribed by your doctor. If you have diabetes, it is important to be under a doctor’s care and to check your blood glucose as your doctor tells you.

Now we are going to do an activity to better understand what diabetes is. We will see the difference between normal blood and blood with a high glucose level.

Before the session:

Prepare the Blood Glucose Demonstration

1. Put two clear plastic bottles on the table.
2. Add 1 cup of water and 3 drops of red food coloring into one of the bottles. This represents blood with normal blood glucose.
3. Add 1 cup of corn syrup and 3 drops of red food coloring into the other bottle. This represents blood with high blood glucose.

• Show the plain water bottle, and slowly tilt it from side to side to show the smooth movement of the liquid.

Notice how the blood moves easily and freely. This represents the blood of someone with normal blood glucose.

• Show the bottle with corn syrup, and slowly tilt the bottle from side to side to show the slow movement of the liquid.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 197

Notice how slowly the blood moves and how thick it is when the blood glucose level is high. This represents the blood of someone with high blood glucose. The glucose stays in the blood instead of being used by the body’s cells and muscles. This shows high blood glucose.

4. Risk Factors for Diabetes

• Ask:

What are some risk factors that increase your chances of getting diabetes?

Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Show picture card 7.4.
• Give group members the “Are You at Risk for Type 2 Diabetes?” handout (page 219). As you read each risk factor, ask group members to make a checkmark next to the risk factors that they have.

Your chances of getting diabetes increase if you:

• Are overweight, especially if you have extra weight around the waist.

• Have a parent or sibling with diabetes.

• Are Latino, African American, American Indian, Asian American, or Pacific

Islander.

• Have had gestational diabetes or have given birth to at least one baby

weighing more than 9 pounds.

• Have blood pressure that is 140/90 mmHg (millimeters of mercury) or

higher or have been told by a health care provider that you have high blood pressure.

198 Your Heart, Your Life: A Community Health Worker’s Manual

• Have cholesterol levels that are not normal, that is, a level of HDL (high-

density lipoprotein) cholesterol (“good” cholesterol) of 35 mg/dL (milligrams per deciliter) or lower, or a triglyceride level of 250 mg/dL or higher.

• Are fairly inactive (exercise fewer than three times a week).

The good news is that, if you are at risk for diabetes, you can prevent or delay getting diabetes by being physically active and having a healthy weight.

It is important to be physically active for 30 minutes on most days and to lose even a small amount of weight. For example, someone who weighs 200 pounds would benefit from losing 10 to 15 pounds.

5. Symptoms of Diabetes

• Ask:

Does anyone know the signs or symptoms of diabetes?

Note: Allow 3 to 5 minutes for group members to answer.

• Give group members the “Symptoms of Diabetes” handout (page 220).
• Show picture card 7.5.
• Now let’s review the symptoms of diabetes:

• Feeling tired

• Increased thirst

• Frequent urination

• Increased hunger

• Unexplained weight loss

• Sores that don’t heal

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 199

• Very dry skin

• “Pins and needles” feeling in feet

• Blurry vision

• Feeling irritable

Often, people with type 2 diabetes have no symptoms. If you have one or more symptoms, see your doctor right away.

6. Blood Glucose Levels

• Show picture card 7.6.

To find out if you have diabetes, you can take a fasting blood glucose test at the doctor’s office or at a lab.

• A fasting blood glucose level below 100 mg/dL is normal. You are in good

shape.

• A fasting blood glucose level of 100 to 125 mg/dL is prediabetes. This is a

warning that you are at risk for developing type 2 diabetes. It is time to lose weight and be physically active at least 5 days a week.

• A fasting blood glucose level of 126 mg/dL or higher means that you have

diabetes. If you have diabetes, you should work with your doctor and other health care providers to learn to control it. It is important to work with your doctor to learn the ABCs (A1C test, blood pressure, and cholesterol) of controlling diabetes. We will learn about the ABCs of diabetes control later in this session.

200 Your Heart, Your Life: A Community Health Worker’s Manual

• You can also get a nonfasting blood glucose test at health fairs and other

sites in your community. This is done using a glucometer and a small amount of blood. A nonfasting blood glucose level of 200 mg/dL or higher could mean that you have diabetes. See your doctor to get a fasting blood glucose test. You must fast for at least 8 hours before the test.

More Information: Fasting Blood Glucose Levels

Fasting Blood 1–2 Hours Level Glucose After Meals Results

Normal 70–99 mg/dL 70–139 mg/dL Good for you!

Prediabetes 100–125 mg/dL 140–199 mg/dL This is a warning that you are at risk for type 2 diabetes. A blood glucose level in this range is higher than normal, but not high enough to be diabetes. You need to take action to prevent diabetes.

Diabetes 126 mg/dL or 200 mg/dL or You have diabetes. Work with higher higher your doctor and other health care providers to control the ABCs of diabetes (A1C, blood pressure, and cholesterol).

People with diabetes may experience problems if their blood glucose levels get too low or too high.

A. Hypoglycemia

Hypoglycemia is a condition that develops when a person’s blood glucose level is too low. People with diabetes may develop hypoglycemia.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 201

People with diabetes may develop hypoglycemia when they:

• Skip or delay a meal or eat very little.

• Take too much insulin or oral diabetes medicine.

• Do too much physical activity.

• Drink alcohol.

The symptoms of hypoglycemia are:

• Having a headache

• Feeling shaky

• Feeling anxious

• Feeling dizzy

• Feeling weak

• Feeling irritable

People with diabetes should talk to their health care providers to learn what to do for low blood glucose.

People with diabetes may suffer from hypoglycemia. If your blood glucose is below 70 mg/dL, your health care provider may tell you to do one of the following:

• Drink /2 cup of fruit juice.

• Drink 1 cup of milk.

• Take two to three glucose tablets.

• Eat 2 teaspoons of sugar or honey.

202 Your Heart, Your Life: A Community Health Worker’s Manual

B. Hyperglycemia

Hyperglycemia is a condition that occurs when a person’s blood glucose level is too high. People with diabetes may develop hyperglycemia when they:

• Eat too much food.

• Are less active than usual.

• Have not taken their medicine.

• Are sick or feel tension and stress.

The symptoms of hyperglycemia are:

• Increased thirst

• Frequent urination

• Dry skin

• Increased hunger

• Blurry vision

• Feeling tired

• Nausea

• People with diabetes should talk to their health care providers about what to

do if they experience the effects of high blood glucose.

• If your blood glucose is too high, your health care provider may need to

change your medication or eating plan.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 203

7. Complications of Diabetes

Diabetes can cause changes in the body. These changes can cause problems, called complications. Can anyone name any complications of diabetes?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Over time, diabetes can affect the large blood vessels in the brain, heart, legs, and feet. It also can affect the small blood vessels in the kidneys and eyes. Diabetes can lead to:

• Heart attack

• Stroke

• Amputation of the feet or legs—Diabetes can cause nerve damage. The first

sign of nerve damage is to lose sensation in the feet or legs. If you have nerve disease, you may lose feeling or have tingling or pain in the toes, feet, or legs.

• Kidney disease—With diabetes, the excess glucose in the blood damages the

blood vessels inside the kidneys.

• Eye disease—Diabetes can harm your vision or even cause blindness.

People with diabetes need to have their eyes examined by a medical eye doctor once a year.

• Dental problems—An increase in cavities and tooth infections is common in

people with poor diabetes control. To prevent tooth decay, brush and floss your teeth every day. See your dentist every 6 months.

204 Your Heart, Your Life: A Community Health Worker’s Manual

Over time, diabetes can affect all parts of the nervous system. This can lead to:

• Loss of strength in muscles

• Changes in digestion, bladder control, and sexual function

• Loss of feeling in feet—This is why you need to keep your feet clean, dry,

soft, and protected.

• Give out and review the “Tender Care for Your Feet” handout (page 221).

8. ABCs of Diabetes Control

If you have diabetes, controlling your blood glucose levels can help prevent or delay complications.

We’ve learned that people with diabetes have a greater chance of having a heart attack or stroke. Let’s find out how to take care of the heart with the ABCs of diabetes control.

• Give and review the “Be Smart About Your Heart: Control the ABCs of Diabetes” handout (page 222).

Be sure to ask your doctor:

• What are my ABC numbers?

• What should my ABC numbers be?

• What actions should I take to control my ABC numbers?

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 205

Knowing about diabetes can help prevent or delay it. For those who already have diabetes, diabetes education can help reduce the complications the disease can cause.

9. Food Label Activity—Sugar

ACTIVITY

People with diabetes should control their sugar intake, because sugar is high in calories and contributes to weight gain. Eating foods with added sugar can also lead to increased blood glucose levels in those with diabetes.

Examples of food and drinks with added sugar are regular soda, fruit drinks, candy, cakes, cookies, ice cream, and some baked goods.

Now let’s do an activity that will help us use food labels to find foods that have less sugar.

• Give group members the “Read the Food Label for Sugar!” handout (page 223).

This handout shows the amount of added sugar in some drinks and foods. Look at the bottom of the handout. Which drink has fewer grams of sugar—grape juice or unsweetened iced tea?

The iced tea has less sugar. One cup of grape juice has 32 grams of sugar, compared to 0 grams of sugar in 1 cup of unsweetened iced tea.

Note: Unlike other nutrients, sugar does not have a Percent Daily Value on the food label.

Let’s try another activity. Ana needs our help.

206 Your Heart, Your Life: A Community Health Worker’s Manual

• Give group members the “Ana’s Food Choices” handout (pages 224–225).

First, I am going to read about Ana’s problem. Then we will use the food labels to find some solutions.

Ana’s Food Choices

Ana lives with her mother, who has diabetes. Ana is grocery shopping and wants to buy foods that are lower in calories and added sugar to help her mother. Look at the food labels. Help Ana select foods that are lower in added sugar. Which foods should Ana buy? Write the number of your choice for each pair. Then write the number of grams of sugar saved by this choice.

Note: The correct answers to the questions are underlined. The sugar and calories saved by making the right choice are given below the choices.

Whole oat cereal or chocolate puffs cereal

Choosing the oat cereal saves 12 grams of sugar.

Gelatin or sugar-free gelatin

Choosing the sugar-free gelatin saves 19 grams of sugar.

Fat-free, no-sugar-added ice cream or regular ice cream

Choosing the no-sugar-added ice cream saves 13 grams of sugar.

Guava Nectar or Water

Choosing water saves 48 grams of sugar.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 207

10. Think Before You Drink—Hidden Sugar in Drinks Activity

ACTIVITY

Note: Prepare before the session.

1. Look at the box that appears below. Use drawings or empty cans or bottles to represent these drinks.
2. Prepare five separate displays for each of the five drinks.
3. Follow these instructions to prepare each display:

• Cut a file folder in half and fold each part in half to make a card (tent).

• Write the name of the drink on one side. On the other side, write the number

of calories, grams of sugar, and teaspoons of sugar in the drink. Glue the cubes of sugar onto the folder to show the number of teaspoons of sugar in each drink. To find the number of teaspoons, divide the grams of sugar on the nutrition label by four. Examples of the displays are shown on page 429.

1. Hide the displays until it is time to do the activity.

208 Your Heart, Your Life: A Community Health Worker’s Manual

Group Activity

We are going to play a guessing game to learn how much sugar is in some common beverages.

• Give group members the “Think Before You Drink—Hidden Sugar in Common Beverages” handout (page 226).
• Show group members the front of each of the five cards that you prepared before the session, showing them the names of the beverages.

Guess how many teaspoons of sugar are in each drink. Write your answers on the handout I gave you.

Note: Allow 2 minutes for group members to write down their answers.

• Ask group members to share the amounts of sugar that they guessed. After the group members have shared the amounts they guessed, show them the actual number of teaspoons of sugar that are in each drink. Pass around the cards one by one.

During the second part of this activity, you will learn how much sugar and how many calories are in your favorite drink.

• Give group members the “How Much Sugar and How Many Calories Are in Your Favorite Drink?” handout (page 227).

Find your favorite drink on the list. Look to see how much sugar and how many calories are in it. Many drinks have a high amount of sugar and calories.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 209

As you can see, it is easy for people who choose drinks with added sugar to get too many calories. Getting too many calories leads to weight gain. Try to drink more water or unsweetened drinks instead of drinks with added sugar or regular sodas.

11. Staying Healthy With Diabetes Group

ACTIVITY

Activity

Note: This activity will help group members think about ways they can help their relatives and friends with diabetes stay healthy. You may select one or more stories to review.

• Give group members the “Staying Healthy With Diabetes: Real-Life Stories” handout (pages 228–230).
• Divide participants into groups of three to five people and give each group a different story to discuss.

Each group will read the story on the handout and think about ways to solve the problems described. Please choose one member of your group to read the story and the corresponding questions aloud to the group. Write down the group’s answers to each of the questions.

Note: Allow 5 to 7 minutes for group members to do the activity.

I would like one volunteer from each group to read the story and the answers to the questions aloud.

Note: After each volunteer reads the story and answers, ask the entire group if anyone has any other solutions to share.

210 Your Heart, Your Life: A Community Health Worker’s Manual

Staying Healthy With Diabetes: Real-Life Stories

Scene 1: Alberto’s Birthday Party Saturday is Alberto’s birthday. His family is having a big party for him, and many relatives will bring lots of tasty foods and desserts such as cakes, ice cream, and pies. Marta has not been to a potluck meal since her doctor told her she has diabetes. She has worked hard to learn how to eat healthy foods. Now, Marta wonders what she should bring to the birthday party and what foods she should eat while she’s there.

Note: Share the answers to each question if they are not said.

• What can Marta bring to the birthday party?

• Water and diet soft drinks • Vegetables seasoned with lemon, a little bit of olive oil, and some herbs

or spices

• Homemade corn tortillas • Homemade dessert with fat-free and sugar-free ingredients • Fresh fruit salad

• How can Marta have healthy eating habits while she’s at the party?

• Eat smaller portions. • Do not have second helpings of high-calorie foods. Eat salad or fresh

fruit if still hungry.

• Cut back on sweet foods, high-fat foods, white sauces, gravies, and

alcohol.

• What else can Marta do?

• Eat a healthy snack before the party so she is not hungry. • Take a walk after eating. • Check her blood glucose 2 hours after eating to see how her food

choices affected it.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 211

Staying Healthy With Diabetes: Real-Life Stories (continued)

Scene 2: Miguel’s New Shoes Miguel bought a new pair of shoes a week ago. He wore them 2 days in a row because his feet felt fine. When he took off his shoes at the end of the second day, however, Miguel noticed some red spots on both of his feet and blisters on the big toe of his right foot. He wonders what he needs to do about the red spots and blisters on his feet. Miguel is concerned that he did not feel the sores on his feet. He also worries that his diabetes is not under control.

Note: Share the answers to each question if they are not said.

• What can Miguel do about the sores on his feet?

• People with diabetes need to see a health care provider if they see a cut,

blisters, or signs of infection on their feet.

• Miguel should go for a foot screening, which includes inspection, testing for

feeling, and other tests.

• Because he can’t feel sensation in his feet, Miguel needs to practice

personal foot care every day to look for changes and infections.

• What should people with diabetes consider when buying shoes?

• Medicare provides coverage of special shoes for people with diabetes.

Check with your doctor to see if you qualify.

• Buy new shoes carefully. • Choose shoes that fit well and are made of leather or canvas, with laces or

straps, a smooth lining inside, rounded toes, low and firm heels, and soft insoles.

• Have the salesperson measure both feet. Test the shoes by wearing them for

at least 5 minutes in the store.

• If the shoes hurt, don’t buy them. • Break in new shoes slowly by wearing them for only 1 or 2 hours a day.

Check for irritation or redness every time you remove your shoes and socks. Never wear new shoes all day long.

212 Your Heart, Your Life: A Community Health Worker’s Manual

Staying Healthy With Diabetes: Real-Life Stories (continued)

Scene 3: What’s Wrong With Andres? First visit: Andres visits his sister, Isabel, who is a promotora. Andres tells her that he is tired, thirsty, and that he urinates often. He asks if Isabel thinks he has diabetes.

Note: Share the answers to each question if they are not said.

• What can Isabel tell Andres?

• Advise Andres to go to the clinic and have his blood glucose checked. If

he has diabetes, he needs to be treated right away. Isabel cannot make a diagnosis.

• Explain that people are more likely to have diabetes if they are

overweight and inactive. Other risk factors for diabetes include having a parent or other family member with diabetes and being age 40 or older.

Second visit: Andres sees Isabel again and tells her that he went to the doctor. The doctor confirmed that Andres has diabetes. Andres is afraid.

• How can Isabel help Andres overcome his fear of having diabetes?

• Tell Andres that most people with diabetes may feel scared, depressed,

or angry at one time or another.

• Mention that some people with diabetes overcome their fear when they

learn what they can do to control diabetes and stay healthy.

• Encourage Andres to attend classes at the clinic and to join a support

group that helps people with diabetes to stay healthy. It helps to talk with others who are living with diabetes.

• Encourage Andres to ask his doctor to check his blood pressure and

cholesterol. Also encourage Andres to learn ways to lower his chances for heart disease and stroke.

• Advise him to visit the eye doctor to check for eye problems.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 213

12. Strawberry and Pineapple Delight Recipe

RECIPE

• Give group members the “Strawberry and Pineapple Delight Recipe” handout (page 231). Ask them to prepare it during the coming week. Tell them that using the recipe will give them a chance to practice some of the ideas from the session.

Review of Today’s Key Points

Let’s review what we learned today.

What is diabetes?

• Diabetes happens when the body does not make enough insulin or cannot use

it well, causing glucose to build up in the blood. As a result the body does not function well.

What are risk factors for diabetes?

• Overweight

• Family members with diabetes

• Age 40 or older

• Not being physically active

• Being Latino, African American, American Indian, Asian American, or

Pacific Islander, because diabetes occurs more often in people from these groups than in whites

• Having had gestational diabetes or given birth to at least one baby weighing

9 pounds or more

• High blood pressure

214 Your Heart, Your Life: A Community Health Worker’s Manual

• Cholesterol levels are not normal—HDL cholesterol is low, or triglyceride

level is high

How can you prevent or delay type 2 diabetes?

• Be physically active for at least 30 minutes on most days.

• Lose a small amount of weight. For example, losing 10 to 15 pounds is

helpful for someone who weighs 200 pounds.

What are the ABCs of diabetes control?

• A is for the A1C test. If you have diabetes, take the A1C blood test at least

two times every year. This test measures how well a person’s blood glucose level has been controlled over the past 3 months. People who have diabetes should aim for an A1C number that is below seven.

• B is for blood pressure. High blood pressure makes your heart work too

hard. It increases your risk for a heart attack, stroke, or damage to your kidneys and eyes. A person with diabetes should have a blood pressure below 130/80 mmHg.

• C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol

(LDL) can build up and clog your arteries. It can cause a heart attack. People with diabetes need to keep their LDL cholesterol below 100 mg/dL.

How does diabetes affect your body?

• Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can

cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet. This can lead to sores that don’t heal and amputation. Good control of your blood glucose can prevent this damage.

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 215

Weekly Pledge

You have learned a lot today about diabetes prevention and control. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to prevent or control diabetes. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will talk to my doctor about my risk for diabetes and see if I need to get my

blood glucose level checked.

• If I have diabetes, I will check my blood glucose levels as my doctor tells

me.

• I will compare food labels the next time I go to the store to help me choose

packaged foods that are lower in sugar.

• I will drink water with my lunch this week instead of regular sodas or other

drinks with sugar.

Write your pledge on the “Be Smart About Your Heart: Control the ABCs of Diabetes” handout on page 222. Keep this handout in a special place so you can review your pledge and keep your goals in mind.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

216 Your Heart, Your Life: A Community Health Worker’s Manual

• (Optional) Say:

Keeping a personal value in mind can help you reduce your risk for diabetes or control your diabetes if you already have it. Remember that a personal value is a quality that you consider important.

Today, the value is joy. Joy can help you replace boredom, indifference, and depression with a positive outlook. Joy can help you enjoy preparing foods the healthy way. Joy is contagious, and others may follow your example!

• Ask:

How could you use joy, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to continue working on your pledges to be more physically active; to cut back on salt, sodium, saturated fat, trans fat, and cholesterol; and to reach and keep a healthy weight.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be about making heart healthy eating a family affair.

Note: Think about today’s session. What worked? What didn’t work? Have you had changes in your own life as a result of today’s session?

Session 7. Protect Your Heart: Take Good Care of Your Diabetes for Life 217

What Is Diabetes?

Diabetes happens when the body does not make enough insulin or cannot use it well. This causes glucose to build up in the blood. As a result, the body does not function well.

Know your body

Glucose

• The food we eat goes to the stomach, where it is digested. The food is turned The

stomach

into blood glucose in the body. Blood

Insulin

The pancreas makes the digests the food.

glucose is also called blood sugar. The body uses glucose for energy needed for daily life.

• The blood takes the glucose to the cells where it is turned into energy. However, glucose cannot enter the cells alone: it needs help. Insulin helps the glucose enter the cells. Insulin is a hormone that is made in the pancreas.
• If the body does not produce enough insulin, or if the cells cannot use the insulin well, then the glucose cannot enter the cells and it builds up in the blood.
• People who have high levels of glucose in their blood have prediabetes or diabetes.

insulin.

Insulin

Glucose

Cell

HAnDOuT—SeSSIOn 7

Are You at Risk for Type 2 Diabetes?

Name:

Check the risk factors you have. The more risk factors you check, the higher your risk for developing type 2 diabetes. Only your health care provider can determine if you have diabetes. On your next visit, find out for sure.

o I am overweight (especially if I have extra weight around the waist).

o I have a parent, brother, or sister with diabetes.

o My family background is Latino, African American, American Indian, Asian American, or Pacific Islander.

o I have had gestational diabetes, or I gave birth to at least one baby weighing 9 pounds or more.

o My blood pressure is 140/90 mmHg or higher, or I have been told by a health care professional that I have high blood pressure.

o My cholesterol levels are not normal. My HDL cholesterol (“good” cholesterol) is 35 mg/dL or lower, or my triglyceride level is 250 mg/dL or higher.

o I do very little physical activity. I exercise fewer than three times a week.

HAnDOuT—SeSSIOn 7 219

Symptoms of Diabetes

The symptoms of type 2 diabetes develop over time. Some people have symptoms, and others do not. Here are some symptoms of diabetes.

Feeling tired

Increased thirst

Frequent urination

Sores that don’t heal

Very dry skin

“Pins and needles” feeling in the feet

Increased hunger Blurry vision

Unexplained weight loss Feeling irritable

220 HAnDOuT—SeSSIOn 7

Tender Care for Your Feet

Diabetes can cause nerve damage, which reduces sensation in your feet. Diabetes may also affect blood flow in your legs and feet, making it harder for cuts or sores to heal. Small injuries may become infected and can become very serious.

Daily care

• Wash your feet in warm water every day. Dry them carefully, especially between your toes.
• Look at your feet every day to check for cuts, sores, blisters, redness, calluses, or other problems. If you cannot bend over or pull your feet up to check them, use a mirror, or ask someone else to check your feet.
• If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.
• Smooth corns and calluses gently with an emery board or pumice stone. Do this after your bath or shower. Do not use a pocketknife or razor blade that can cut your skin.
• Cut your toenails once a week after a bath.

Periodic foot exam

• Remind the health care provider to check your feet at every visit.
• Get a complete foot exam once a year. If you have problems with your feet, have the health provider check them every 3 to 6 months.

Footwear

• Wear well-cushioned shoes and socks at all times. Do not go barefoot.
• Change your socks every day, and make sure they are clean and soft.
• Buy shoes that are roomy and allow your feet to “breathe.”
• Medicare provides coverage of special shoes for people with diabetes. Check with your doctor to see if you qualify.

HAnDOuT—SeSSIOn 7 221

Be Smart About Your Heart: Control the ABCs of Diabetes

Some people have prediabetes, which is when blood glucose levels are higher than normal, but not in the diabetes range. People with this condition can reduce the risk of developing diabetes by losing a small amount of weight and increasing their physical activity.

If you have diabetes, controlling your blood glucose levels will help prevent complications.

The ABCs of Diabetes Be sure to ask your doctor:

If you have diabetes, three key steps can ■ What are my ABC numbers? help you lower your risk of heart attack and

your average blood glucose over the

past 3 months. It lets you know if your blood glucose level is under control. Get this test at least twice a year.

Write the changes you will make this week to control your blood glucose, blood pressure, or

cholesterol.

Number to aim for: below 7

• B is for blood pressure. The higher your blood pressure, the harder your heart has to work. Get your blood pressure measured at every doctor’s visit.

Numbers to aim for: below 130/80 mmHg

• C is for cholesterol. Maintain a normal cholesterol level. “Bad” cholesterol, or LDL, builds up and clogs your arteries. Get your LDL cholesterol tested at least once a year.

Number to aim for: below 100 mg/dL

222 HAnDOuT—SeSSIOn 7

Read the Food Label for Sugar!

100%

Food labels tell you what you need to know about choosing foods that

Grape

are lower in calories and sugar. Here is a food label for 100 percent

Juice

grape juice. The label provides lots of useful information. 100% Grape Juice

Amount Per Serving

Nutrition Facts

The nutrient amounts Serving Size 1 cup (8 fl oz) provided on the label are Servings Per Container 15 for one serving. If you

Amount Per Serving

have more than one serving,

Serving Size and Number of Servings The serving size is 1 cup. There are

Calories from Fat 0

and other nutrients. For

eight servings in this container.

% Daily Value*

example, if you drink two

Total Fat 0g

servings (2 cups) of grape

Saturated Fat 0g

juice, you will take in 300

Trans Fat 0g

calories and 64 grams of

Cholesterol 0mg

sugar.

Sodium 15mg Potassium 170mg

Calories and Sugar

Total Carbohydrate 37g

Here are the amounts of

Dietary Fiber 0g

calories and sugar in one

Sugars 32g

serving.

Protein 0g

0%

0% Percent Daily Value The Percent Daily 0% Value helps you 1% compare nutrient 5% amounts in products. 12% There is no Percent 0% Daily Value for calories or sugar. Choose foods with the lowest amount of

Vitamin C 120%

Calcium 2% • Iron 2%

The Choice Is Yours— Calories 150 Calories from Fat 0 Compare! % Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0%

Which one would you

Trans Fat 0g Cholesterol 0mg 0%

choose?

Sodium 15mg 1% Potassium 170mg 5%

The unsweetened iced tea has Total Carbohydrates 37mg 12% fewer calories and no sugar. Dietary Fiber 0g 0%

Sugars 32g

That makes the iced tea a better choice! Read food labels, and 100% Grape Juice choose products to keep your One cup of grape juice heart strong. has 150 calories and 32 grams of sugar.

calories and sugar.

Calories 5 Calories from Fat 0

% Daily Value* Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Dietary Fiber 0g Sugars 0g

Unsweetened Iced Tea One cup of unsweetened iced tea has 5 calories and no sugar. You can learn a lot from a food label.

Percent Daily Values are based on a daily diet of 2,000 calories. Your Daily Values may be higher or lower depending on your calorie needs.

HAnDOuT—SeSSIOn 7

Ana’s Food Choices

1 – Whole Oat Cereal*

Ana lives with her

Nutrition Facts

mother, who has

Serving Size 1 cup

diabetes. Ana is Servings Per Container 19 grocery shopping

Amount Per Serving

and wants to buy

Calories150 Calories from Fat 20

foods that are lower in calories Lower

% Daily Value† sugar

to help her mother.

Total Fat 2g 3%

choice

Saturated Fat 0g 0%

Look at the food

Trans Fat 0g ______

labels. Help Ana

Cholesterol 0mg 0%

select foods that Sodium 280mg 12% are lower in sugar. Total Carbohydrate 23g 8%

Grams

Dietary Fiber 3g 12%

of sugar

Which foods Sugars 1g

saved

should Ana buy? Protein 3g Write the number ______

Vitamin A 30% • Vitamin C 25%

of your choice for Calcium 20%

• Iron 45%

each pair in the

space between 3 – Gelatin

the labels. Then

Nutrition Facts

write the number Serving Size 1/4 cup

Servings Per Container 8

of grams of sugar saved by this Amount Per Serving choice.

Calories 80 Calories from Fat 0

% Daily Value† Lower sugar

Total Fat 0g 0%

choice

Saturated Fat 0g 0% Trans Fat 0g ___

Dietary Fiber 0g 0% Grams Sugars 19g of sugar Protein 2g saved

Vitamin A 0% • Vitamin C 0% ______ Calcium 0% • Iron 0%

2 – Chocolate Puffs Cereal*

Nutrition Facts

Serving Size 3/4 cup Servings Per Container 14

Amount Per Serving

Calories160 Calories from Fat 5

% Daily Value†

Total Fat 0.5g 1% Saturated Fat 0g 0% Trans Fat 0g

Sugars 13g Protein 2g

Vitamin A 20% • Vitamin C 25% Calcium 10% • Iron 10%

4 – Sugar-Free Gelatin

Nutrition Facts

Serving Size 1/4 cup Servings Per Container 8

Amount Per Serving

Calories 10 Calories from Fat 0

% Daily Value†

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g

Sugars 0g Protein 1g

Vitamin A 0% • Vitamin C 0% Calcium 0% • Iron 0%

The serving sizes of the cereals are not the same because cereal serving size is determined by weight (ounces), and some cereals weigh more than others. † Percent Daily Values are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

224 HAnDOuT—SeSSIOn 7

Ana’s Food Choices

5 – Fat-Free, No-Sugar- Added Ice Cream

Nutrition Facts

Serving Size 1/2 cup (66g) Servings Per Container 1

Amount Per Serving

Calories 80 Calories from Fat 0

% Daily Value*

Total Fat 0g 1% Saturated Fat 0g 0% Trans Fat 0g

Sugars 4g Protein 3g

Vitamin A 6% • Vitamin C 0% Calcium 8% • Iron 0%

7 – Guava Nectar

Nutrition Facts

Serving Size 1 can (340mL) Servings Per Container 1

Amount Per Serving

Calories240 Calories from Fat 0

% Daily Value*

Total Fat 0g 0% Saturated Fat 0g 0% Trans Fat 0g Cholesterol 0mg 0% Sodium 25mg 1% Total Carbohydrate 59g 20% Dietary Fiber 2g 8% Sugars 48g Protein 1g

Vitamin A 15% • Vitamin C 100% Calcium 4% • Iron 8%

6 – Regular Ice Cream

Nutrition Facts

Serving Size 1/2 cup (66g) Servings Per Container 16

Amount Per Serving

Calories170 Calories from Fat 80

Lower % Daily Value* sugar

Total Fat 9g 14%

choice

Saturated Fat 6g 30% Trans Fat 0g ___

Grams Dietary Fiber 1g 4% of sugar Sugars 17g saved Protein 2g

______ Vitamin A 4% • Vitamin C 0% Calcium 6% • Iron 4%

8 – Water

Nutrition Facts

Serving Size 8 fl oz (240mL) Servings Per Container 2

Amount Per Serving

Calories 0 Calories from Fat 0

Lower % Daily Value*

sugar Total Fat 0g 0% choice Saturated Fat 0g 0% Trans Fat 0g ___

Grams

Sugars 0g

of sugar

Protein 0g

saved

Vitamin A 0% • Vitamin C 0%

___

Calcium 0% • Iron 0%

are based on a 2,000-calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

HAnDOuT—SeSSIOn 7

Think Before You Drink: Hidden Sugar in Common Beverages

Try to guess the amount of sugar (in teaspoons) that is found in each drink. Write your answers on the “My Guess” line.

Drink Teaspoons of Sugar

My Guess True Amount

Powdered drink with sugar ____________ ____________

Diet Soda Diet soda ____________ ____________

100%

Grape Juice

226 HAnDOuT—SeSSIOn 7

How Much Sugar and How Many Calories Are in Your Favorite Drink?

Drink

Approximate Number

HAnDOuT—SeSSIOn 7

Staying Healthy With Diabetes: Real-Life Stories

What can you do?

Scene 1: Alberto’s Birthday Party

Saturday is Alberto’s birthday. His family is having a big party for him, and many relatives will bring lots of tasty food and desserts such as cakes, ice cream, and pies. Marta has not been to a potluck meal since her doctor told her she has diabetes. She has worked hard to learn how to eat healthy foods. Now, Marta wonders what she should bring to the birthday party and what foods she should eat while she’s there.

What can Marta bring to the birthday party?

How can Marta eat healthy while she’s at the party?

What else can Marta do?

228 HAnDOuT—SeSSIOn 7

Staying Healthy With Diabetes: Real-Life Stories (continued)

What can you do?

Scene 2: Miguel’s new Shoes

Miguel bought a new pair of shoes a week ago. He wore them 2 days in a row because his feet felt fine. When he took off his shoes at the end of the second day, however, Miguel noticed some red spots on both of his feet and blisters on the big toe of his right foot. He wonders what he needs to do about the red spots and blisters. Miguel is concerned that he did not feel the sores on his feet. He also worries that his diabetes is not under control.

What can Miguel do about the sores on his feet?

What should people with diabetes consider when buying shoes?

HAnDOuT—SeSSIOn 7 229

Staying Healthy With Diabetes: Real-Life Stories (continued)

What can you do?

Scene 3: What’s Wrong With Andres?

First visit: Andres visits his sister, Isabel, who is a promotora. Andres tells her that he is tired, thirsty, and that he urinates often. He asks Isabel if she thinks he has diabetes.

What can Isabel tell Andres?

Second visit: Andres sees Isabel again and tells her that he went to the doctor. The doctor confirmed that Andres has diabetes. Andres is afraid.

How can Isabel help Andres overcome his fear of having diabetes?

230 HAnDOuT—SeSSIOn 7

Strawberry and Pineapple Delight Recipe

2 cups 1 package (8-serving size) ½ teaspoon 1 large can (20 ounces) 1 can (11 ounces) 16 large

boiling water sugar-free, low-calorie strawberry gelatin cinnamon powder pineapple chunks in fruit juice, not drained mandarin orange segments in fruit juice, drained ice cubes

1. Pour boiling water in a large bowl. Add the gelatin and cinnamon powder to the water. Stir for at least 2 minutes, making sure the gelatin is completely dissolved.
2. Drain pineapple chunks, and save the juice. Add ice (or cold water) to the leftover juice to measure 1½ cups. Add gelatin. Stir until ice is completely melted.
3. Refrigerate about 45 minutes or until gelatin is slightly thickened (consistency of unbeaten egg white). Yield: 12 servings

Serving size: ½ cup

1. Reserve ¼ cup each of the pineapple and

Each serving provides:

orange. Add the remaining pineapple and orange to gelatin. Pour into a 1½-quart serving bowl.

Calories: 41 Total fat: 0 g Saturated fat: 0 g Cholesterol: 0 g

1. Refrigerate 4 hours or until firm. Garnish with Sodium: 23 g the reserved pineapple and orange segments. Total fiber: 1 g

Protein: 1 g Carbohydrates: 10 g Sugars: 9 g

Quick Fact

Potassium: 94 mg

This refreshing healthy dessert will satisfy any sweet tooth.

HAnDOuT—SeSSIOn 7 231

s essi o n

Make Heart Healthy Eating a Family Affair

Objectives

By the end of this session, group members will learn:

• How to plan and prepare traditional Latino meals in a heart healthy way
• How to choose foods for a heart healthy diet

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Set of measuring cups (1 cup, 1/2 cup, 1/4 cup)
• Blackboard and chalk or several large pieces of paper, a marker, and tape
• Enough pairs of scissors and glue for group members to use during the activity

Handouts

Give group members these handouts during this session:

• (Optional) “Serving Sizes” (from Session 6, page 182)
• “Heart Healthy Eating Plan” (page 253)

Session 8. Make Heart Healthy Eating a Family Affair 233

• “Add Color and Flavor to Your Menu” (pages 254–257)
• “Say Yes to Fruits and Vegetables” (pages 258–259)
• “Cooking With Children” (pages 260–261)
• “Maria’s Veggie Wrap Recipe” (page 262)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Eat a Variety of Heart Healthy Foods
2. The Latino Diet
3. A Heart Healthy Eating Plan for Latino Families

Say Yes to Fruits and Vegetables Activity

1. How To Choose Heart Healthy Foods
2. Cooking With Children
3. Maria’s Veggie Wrap Recipe

Review of Today’s Key Points

Weekly Pledge

Closing

234 Your Heart, Your Life: A Community Health Worker’s Manual

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about what you need to know about diabetes.

• Ask these questions, and review the answers with group members.

What is diabetes?

• Diabetes results when the body does not make enough insulin or cannot

make it well, causing glucose (sugar) to build up in the blood. As a result, the body does not function well.

What are risk factors for diabetes?

• Overweight

• Family members with diabetes

• Aged 40 or older

• Physically inactive lifestyle

• Being Latino, African American, American Indian, Asian American, or

Pacific Islander

• History of gestational diabetes or giving birth to at least one baby weighing

9 pounds or more

• High blood pressure

• Cholesterol levels are not normal: HDL cholesterol is low, or triglycerides

are high

Session 8. Make Heart Healthy Eating a Family Affair 235

What are the ABCs of diabetes?

• A is for the A1C test. This simple lab test reflects a person’s average

blood glucose level over the past 3 months. The A1C number to aim for is below 7.

• B is for blood pressure. The higher your blood pressure, the harder your

heart has to work. High blood pressure increases your risk for a heart attack, stroke, and damage to your kidneys and eyes. Your blood pressure should be below 130/80 mmHg (millimeters of mercury).

• C is for cholesterol. Keep cholesterol at normal levels. Bad cholesterol

or LDL can build up and clog your arteries. It can lead to a heart attack or stroke. People with type 2 diabetes need to keep their LDL cholesterol below 100 mg/dL (milligrams per deciliter).

How does diabetes affect your body?

• Diabetes can cause damage to the heart, brain, kidneys, and eyes. It can

cause nerve damage, which reduces feeling in your feet. Diabetes may also affect blood flow in your legs and feet. This can lead to sores that don’t heal and amputation.

At the end of our last session, you made a pledge to do something to help you prevent or control diabetes. What problems did you have? How did you deal with any problems?

Note: Allow 2 minutes for each group member to respond.

3. About This Session

What you choose to eat can make a difference in your heart health. During this session, you will learn how to:

• Choose a variety of foods for heart health.

• Identify serving sizes and the number of recommended servings for each

food group.

236 Your Heart, Your Life: A Community Health Worker’s Manual

Conducting the Session

1. Eat a Variety of Heart Healthy Foods

• Ask:

Why is it important to eat a variety of heart healthy foods?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add the answers below if the group

members do not say them. • Eating a variety of foods that are lower in saturated fat, trans fat, cholesterol, sodium, added sugar, and calories can

More Information Nutrients in the foods we eat include: Carbohydrates help you have a healthy heart. Protein Fats

• One food cannot give all the nutrients in

Fiber the amounts your body needs. Vitamins Minerals

2. The Latino Diet

Note: This session will help group members think about the foods they eat. Some of their favorite traditional Latino foods are very nutritious. Other dishes can be prepared in more heart healthy ways.

• Ask:

What are some traditional Latino foods?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Session 8. Make Heart Healthy Eating a Family Affair 237

Traditional Latino foods are nutritious for you and your family. These include:

• Bread
• Corn tortillas
• Beans
• Rice
• Fruits
• Meat and poultry
• Milk
• Cheese

• Vegetables

The traditional Latino diet is as varied as the cultural heritage of the Latin American region. Heart healthy foods are part of the rich culinary diversity that is a key to good health.

The traditional healthy Latino diet included:

• Daily preparation of meals in the home, using mostly homegrown foods

• A variety of plant foods, especially maize, root vegetables, cassava, potatoes,

sweet potatoes, grains, rice, cornbread, tortillas, beans, nuts, and seeds

• Plenty of fresh fruits and vegetables, which were eaten during main meals

• Poultry and fish, which were eaten weekly

• Limited intake of oils. Fat intake came from foods such as avocados,

walnuts, cashews, peanuts, and palm oil.

Red meats, sweets, and eggs used to be luxuries consumed only at special meals. In the past, people worked in labor-intensive jobs and were very physically active each day. Today, many of these healthy traditions have been replaced by a lack of physical activity and a high-fat diet. Let’s bring back the tradition of healthy eating and active living so that we can say, “¡Qué viva la tradición!”

238 Your Heart, Your Life: A Community Health Worker’s Manual

Some Latinos have adopted cooking and eating habits that can lead to health problems such as heart disease. What are some examples of these habits?

Note: Allow about 3 minutes for group members to answer.

• Add these habits if they are not mentioned:

• Cooking foods with too much saturated fat, such as lard and shortening

• Eating fried foods often, such as refried beans, french fries, fried chicken,

fried tacos, and fried cheese

• Eating foods higher in saturated fat, such as fatty meats, high-fat cheeses and

creams, whole milk, and flour tortillas made with lard

• Eating foods that are higher in calories, such as pastries, candy, and

chocolate

• Drinking high-calorie beverages such as regular soft drinks

• Eating fewer fruits, vegetables, corn tortillas, and beans

• Eating meats high in saturated fat instead of lean meats

• Eating foods high in trans fat such as cookies, crackers, doughnuts, baked

goods, and french fries

3. A Heart Healthy Eating Plan for Latino Families

We can take steps to improve the way we eat and still enjoy our traditional foods. The first step is to learn which foods we should eat more often. The second step is to learn the amount of these foods that we should eat each day.

• Show picture card 8.1. (Keep it in view throughout this activity.)

Session 8. Make Heart Healthy Eating a Family Affair 239

This heart healthy eating plan is a helpful tool. It shows both the types and amounts of foods we can choose for better health.

• Give group members the “Heart Healthy Eating Plan” handout (page 253).

The food choices you make each day affect your health. We will talk about ways to choose healthy foods from the food groups in the heart healthy eating plan.

Grains (6 to 8 servings a day)

• Make at least half of your grains whole grains. Eat at least three servings of

whole-grain cereals, breads, rice, or pasta every day. Remember, one ounce of grains is a serving. In general, 1 ounce of grains is one slice of bread, about 1 cup of ready-to-eat cereal, or 1/2 cup of cooked rice, cooked pasta, or cooked cereal.

• Look at the food label, and choose grain products that have whole grains as

the first ingredient. Some examples of whole-grain ingredients are whole wheat, whole oats, oatmeal, and whole rye.

• For a change, try brown rice or whole-wheat pasta instead of white rice or

pasta.

• Snack on ready-to-eat, whole-grain cereal such as toasted oat cereal. Also try

popcorn with little or no salt or butter as a snack.

240 Your Heart, Your Life: A Community Health Worker’s Manual

Vegetables (4 to 5 servings a day)

• Eat more dark green vegetables, such as broccoli, spinach, and other dark

leafy greens.

• Eat more orange vegetables, such as carrots and sweet potatoes.

• Stock up on frozen vegetables for quick and easy cooking in the microwave.

• Buy fresh vegetables in season. They cost less and are likely to be at their

peak flavor.

• Plan some meals around a vegetable main dish, such as vegetable stir-fry or

soup.

• Choose no-salt-added canned vegetables.

Fruits (4 to 5 servings a day)

• Choose fresh, frozen, canned, or dried fruit.

• Limit fruit juices, because they contain a lot of calories and added sugar.

Try to choose whole fruit instead of fruit juice most of the time.

• Keep a bowl of whole fruit on the table or counter or in the refrigerator.

Fat-free or low-fat milk and milk products (2 to 3 servings a day)

• Get your calcium-rich foods.

• Choose fat-free or low-fat milk, yogurt, and other milk products.

• If you usually use whole milk, switch gradually to fat-free milk. Try

reduced-fat (2%) milk, then low-fat (1%) milk, then fat-free milk.

Session 8. Make Heart Healthy Eating a Family Affair 241

• Have a fat-free or low-fat yogurt for a snack.

• If you are lactose intolerant, try lactose-free products, such as yogurt, cheese,

or lactose-free milk.

Lean meats, poultry, and fish (2 or fewer 3-ounce servings a day)

• Choose low-fat or lean meats and poultry. Select meat cuts that are low in

fat and ground beef that is extra lean.

• Eat a variety of foods with protein. Choose fish more often.

• Choose lean turkey, roast beef, or ham, instead of fatty lunch meats such as

regular bologna or salami.

• Bake, broil, or grill meat.

Nuts, seeds, and legumes (4 to 5 servings a week)

• Choose cooked and dry beans, nuts, seeds, and peas for rich sources of

protein and fiber.

Fats and oils

• Get most of your fat from food sources such as fish, nuts, and vegetable oils.

• Limit solid fats such as butter, stick margarine, shortening, and lard, as well

as foods that contain these fats.

Sweets and added sugars (5 or fewer servings a week)

• Choose foods and beverages that are low in calories and added sugar. Use

242 Your Heart, Your Life: A Community Health Worker’s Manual

the Nutrition Facts label to compare the calorie and sugar content of foods and beverages.

• Choose water, fat-free milk, or other unsweetened beverages most often.

• Select unsweetened cereal and add fruit.

• Ask these questions, and hold up the correct measuring cup for each answer.

What is one serving of a cooked vegetable?

• ½ cup

How much milk or yogurt is considered one serving?

• 1 cup

How much cheese is considered one serving?

• 1.5 to 2 ounces

Can you give an example of a 1-ounce serving from the grains group?

• 1-ounce servings from the grains group include:

• One slice of bread
• About 1 cup of ready-to-eat cereal or ½ cup of cooked cereal, such as oatmeal
• ½ cup of cooked rice or pasta

What counts as one serving of fruit?

• One medium apple, banana, or orange

• ½ cup of raw or canned fruit or 100 percent fruit juice

• ¼ cup of dried fruit

What is a serving of cooked beans?

• ½ cup

Session 8. Make Heart Healthy Eating a Family Affair 243

Say Yes to Fruits and Vegetables Activity

ACTIVITY

• Divide participants into small groups of three to four people.
• Give every small group the “Add Color and Flavor to Your Menu” handout (pages 254–257) and the “Say Yes to Fruits and Vegetables” handout (pages 258–259).
• Give each group a pair of scissors and a glue stick, so that they can cut out and paste the pictures.

Now let’s do the “Say Yes to Fruits and Vegetables” activity to learn how to add fruits and vegetables to your meals.

For this activity, cut out the pictures of fruits and vegetables on the handout that I gave you. Cut out the fruits and vegetables that you want to add to your breakfast, lunch, dinner, and snack. Then, paste your fruit and vegetable choices in the correct spaces on each menu.

Note: Allow 10 minutes for group members to complete their meals.

• Ask each group to say what fruits and vegetables they added to their meals.
• Then, ask the rest of the group members if they have any other suggestions.

Great job! Now you know how easy and fun it can be to add fruits and vegetables to your meals.

4. How To Choose Heart Healthy Foods

We are going to do another group activity. During this activity, we

ACTIVITY

will learn how to make better food choices.

244 Your Heart, Your Life: A Community Health Worker’s Manual

Write Virginia’s breakfast on the blackboard or on a large piece of paper taped to the wall. Fill in the Virginia’s Breakfast and Portion Size

columns. Leave the Food ) Repeat the game with the lunch and dinner meals.

• Ask:

To which food group does each food belong? What changes would make Virginia’s breakfast more heart healthy?

BREAkFAST

Virginia’s Food Group(s) Portion Breakfast (leave blank for activity) Size

guava paste and cream cheese

Butter Fats 1 teaspoon

Orange juice Fruit /2 cup

Coffee with whole Milk 1 cup of coffee milk 1 tablespoon of milk

Better Choices

(leave blank for activity)

Boiled or poached egg, 1/2 cup egg substitute, or 2 egg whites. Scramble eggs with vegetable oil spray instead of using fat.

Lean turkey sausage

Whole-grain toast with lowfat tub margarine and an orange

1 teaspoon of low-fat tub margarine or jam with no added sugar

One orange

Coffee with fat-free milk (or 1 tablespoon of evaporated fat-free milk)

the suggestions beside the foods they are replacing on the blackboard or the correct answers for any items not mentioned by group members.

Session 8. Make Heart Healthy Eating a Family Affair

• (Optional meals: lunch and dinner)

LuNCH

fries serving of fries

Large soft drink Sweets 1 large soft drink

DINNER

vegetables 2 flour tortillas 2 tbsp. cheddar cheese 1 plum tomato

Better Choices

(leave blank for activity)

Small hamburger or grilled chicken sandwich with mustard or ketchup

Small order of fries or a side salad with reducedcalorie salad dressing

Water, diet soft drink, or fat-free milk

Better Choices

(leave blank for activity)

Use skinless chicken breast, corn tortilla, low-fat and low-sodium cheese, and fat-free vegetable oil spray. Bake instead of frying. 2 oz. mushrooms

Refried beans Nuts, seeds, and legumes; /2 cup beans fats

Vanilla shake made Milk, sweets 1 cup with whole milk

Flan Fats, sweets, milk, meats 1 small bowl (eggs)

246 Your Heart, Your Life: A Community Health Worker’s Manual

Use cooked dry beans or rinsed canned beans, and saute beans with a small amount of oil in a nonstick pan.

Homemade shake with fat-free milk, ice, vanilla, and sugar substitute

Fresh fruit cup or low-fat frozen yogurt

• Ask:

What are some ways to eat less saturated fat, trans fat, cholesterol, sodium, and calories?

• Add the following answers if they are not mentioned:

• When shopping:

• Choose a variety of whole grains, fruits, and vegetables.
• Choose low-fat or fat-free milk products, salad dressings, and mayonnaise.
• Choose lean cuts of meat. Trim away extra fat.
• Use food labels to choose foods lower in saturated fat, trans fat, cholesterol, sodium, sugar, and calories.

• When cooking:

• Use vegetable oil or soft tub margarine instead of butter or lard.
• Cook with low-fat methods, such as baking, broiling, or boiling (without added fat), rather than frying.

• When eating:

• Eat foods that are low in saturated fat, trans fat, and added sugars.
• Remove skin from poultry. Throw away the skin, and do not eat it.
• Choose low-fat or fat-free milk products, salad dressings, and mayonnaise.
• Eat no more than four egg yolks each week.
• Eat fewer high-calorie foods with little added nutrition value, such as high-fat lunch meats, pies, cakes, cookies, crackers, and chips. Drink fewer sodas.
• Eat smaller portion sizes.

Session 8. Make Heart Healthy Eating a Family Affair 247

Put the “Heart Healthy Eating Plan” handout on your refrigerator to remind you to eat in a heart healthy way.

Thank you for participating in this activity! You did great! Now you can make healthier choices for you and your family.

5. Cooking With Children

• Give group members the “Cooking With Children” handout (pages 260–261).
• Ask volunteers to read the handout out loud.

As parents, you can teach your children healthy eating habits that will last a lifetime.

For good health and proper growth, children need to eat a variety of different foods every day. When children are offered a balanced diet every day, they will develop good eating habits.

• Ask:

Can you think of other ways to get children involved in helping to prepare healthy meals?

• Write group members’ suggestions on the blackboard or on a large piece of paper taped to the wall.

248 Your Heart, Your Life: A Community Health Worker’s Manual

More Information

We Can! (Ways to Enhance Children’s Activity and Nutrition) is an education program to help children aged 8 to 13 to maintain a healthy weight. The program includes tips for parents on healthy food choices and physical activity. Visit http://wecan.nhlbi.nih.gov.

6. Maria’s Veggie Wrap Recipe

Note: This recipe will give group members a chance to try a heart healthy RECIPE dish at home.

• Give group members the “Maria’s Veggie Wrap Recipe” handout (page 262).

This dish contains beans and tasty vegetables, and it’s high in protein and fiber. Try to prepare it at home this week.

Review of Today’s Key Points

Let’s review what we learned today.

What is heart healthy about the traditional Latino diet?

• The traditional Latino diet can provide a variety of foods that are lower in

fat and sodium, such as bread, corn tortillas, beans, rice, vegetables, fruits, poultry, fish, and milk products.

Session 8. Make Heart Healthy Eating a Family Affair 249

What are some foods that we should eat less often?

• We should limit foods that are high in saturated fat, trans fat, sodium, added

sugar, and calories, including:

• High-fat foods, such as refried beans, fried chicken, fatty meats, and highfat cheeses
• Salty foods, such as potato chips and taco chips
• Foods that are high in saturated fat and added sugar, such as pastries, cookies, and chocolate
• Foods with added sugar, such as candy and soft drinks

How can the heart healthy eating plan be used to choose heart healthy foods?

• Use the heart healthy eating plan to choose foods that are lower in saturated

fat, trans fat, cholesterol, sodium, and added sugar from each of the five food groups. The eating plan also shows you the number of servings that you need from each group every day.

Why is it helpful to know how much you need to eat from each food group each day?

• When you know the amount of food you need to eat every day, it can help

you get the right amount of calories you need.

Weekly Pledge

You have learned a lot today about how to make your favorite dishes in a heart healthy way. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to eat in a heart healthy way with your family. This will be your pledge for the week.

250 Your Heart, Your Life: A Community Health Worker’s Manual

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will make baked chicken instead of fried chicken for the next family meal.

• I will eat one more vegetable and one more fruit each day, starting tomorrow.

Note: Allow 5 minutes for group members to think of a pledge.

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

• (Optional) Say:

Keeping a personal value in mind can help you make heart healthy eating a part of your family life. Remember that a personal value is a quality that you consider important.

Today’s value is fun. Fun can help you stay positive in your efforts to improve your health and the health of your family. It can help you overcome challenges, allowing you to laugh when you want to cry. Fun can also motivate you to turn your pledges into permanent habits.

• Ask:

How could you use fun or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to work on your pledges to be more physically active; to cut back on salt, sodium, saturated fat, trans fat, and cholesterol; to reach and keep a healthy weight; and to prevent or control diabetes.

Session 8. Make Heart Healthy Eating a Family Affair 251

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you again at the next session. We will talk about eating in a heart healthy way—even when time or money is tight.

Note: Think about today’s session. What worked and what didn’t work? Have you made any changes in your own life that were covered in today’s session?

252 Your Heart, Your Life: A Community Health Worker’s Manual

Heart Healthy Eating Plan

Grains

Bread, cereal, rice, and pasta (6 to 8 servings a day)*

Vegetable

(without added fat) (4 to 5 servings a day)*

Fruit

(4 to 5 servings a day)*

Fat-free or low-fat milk and milk products

Milk, yogurt, and cheese (choose fat-free or low-fat more often) (2 to 3 servings a day)*

Lean meats, poultry, and fish

Meat, poultry, fish, and eggs (2 or fewer servings a day)*

Nuts, seeds, and legumes

(4 to 5 servings a week)*

Fats and oils

(2 to 3 servings a day)*

Sweets and added sugars

(5 or fewer servings a week)*

♥ Plain corn or fat-free whole wheat tortillas ♥ Sliced bread (such as wheat, rye, or white), sandwich buns, dinner rolls, pita bread, english muffins, and bagels ♥ Unsalted low-fat crackers (such as graham crackers), unsalted pretzels, and plain popcorn ♥ Cooked hot cereals (not instant) and whole-grain cold cereals ♥ Pasta (such as whole-grain noodles, spaghetti, and macaroni) and rice

♥ Fresh, frozen, or no-salt-added canned vegetables (such as green beans, carrots, cabbage, tomatoes, yuca, squash, broccoli, potatoes, and corn)

♥ Fresh, frozen, canned (packed in fruit juice), or dried fruits (such as oranges, papaya, grapefruit, bananas, apples, mangoes, pineapple, watermelon, peaches, fruit cocktail, and raisins) ♥ Fresh, frozen, or canned fruit juices

♥ Fat-free or low-fat (1%) milk ♥ Fat-free or low-fat yogurt ♥ Cheeses lower in fat and sodium

♥ Chicken or turkey without the skin ♥ Fish ♥ Lean cuts of meat Beef: round, sirloin, chuck, loin, extra lean ground beef Pork: leg, shoulder, tenderloin, lean ham ♥ Eggs (no more than four yolks a week)

♥ Nuts and seeds ♥ Dry beans and peas (black beans, pink beans, kidney beans, navy beans, chick peas, lentils, and split peas)

♥ Margarine (liquid, soft-tub, or reduced-calorie) ♥ Oils (canola, corn, safflower, olive, peanut, or sesame)

♥ Frozen treats (such as frozen juice pops, or low-fat frozen yogurt or ice cream) ♥ Low-fat cake and cookies (such as angelfood cake, fig bar cookies, gingersnaps, animal crackers, vanilla wafers, and graham crackers)

The amount of food from each food group that is right for you depends on how many calories you need. This is based on your age and gender and how physically active you are.

HANDOuT—SESSION 8 253

Add Color and Flavor to Your Menu

BREAkFAST

Omelet

Whole-grain toast

Coffee with fat-free milk

____________

Vegetable

____________

Fruit

Add fruits and vegetables to these meals.

254 HANDOuT—SESSION 8

Add Color and Flavor to Your Menu

LuNCH

Chicken soup

Corn tortilla

____________

Vegetable

____________

Vegetable

____________

Fruit

Add fruits and vegetables to these meals.

HANDOuT—SESSION 8 255

Add Color and Flavor to Your Menu

DINNER

Baked pork

Brown rice

____________

Vegetable

____________

Vegetable

____________

Fruit

Add fruits and vegetables to these meals.

256 HANDOuT—SESSION 8

Add Color and Flavor to Your Menu

SNACk

____________

Vegetable

____________

Fruit

Add fruits and vegetables to these meals.

HANDOuT—SESSION 8 257

Say Yes to Fruits and Vegetables

Vegetables

Cut out these foods, and use them for the activity.

258 HANDOuT—SESSION 8

Say Yes to Fruits and Vegetables (continued)

Fruits

Cut out these foods, and use them for the activity.

HANDOuT—SESSION 8 259

Cooking With Children

Get Them Interested

Cooking with your children is a good way to help them develop healthy eating habits. Most children enjoy helping in the kitchen. While they help you prepare a meal, you can talk to them about healthy foods. Children like to eat the food they make. This is also a good way to get them to try new healthy foods.

Let Them Help

You can show your children how to help you make meals. Here are ways that children of different ages can help in the kitchen:

2-year-olds can:

• Wipe tabletops.
• Scrub and rinse fruits and vegetables.
• Tear lettuce or greens.
• Break cauliflower.
• Bring ingredients from one place

to another.

3-year-olds can:

• Wrap potatoes in foil for baking.
• Knead and shape dough.
• Mix ingredients.
• Shake liquids in a covered container.
• Apply soft spreads.
• Put things in the trash.
• Pour liquids.

4-year-olds can:

• Peel oranges or hardboiled eggs. • Mash bananas or cooked

• Cut parsley or green onions with kid-safe scissors. • Set the table. beans with a fork.

5- to 6-year-olds can:

• Measure ingredients. • Use an eggbeater.

Be sure to have children wash their hands before and after helping in the kitchen.

Be patient with spills and mistakes. Remember that the goal is to help your children learn about healthy eating.

260 HANDOuT—SESSION 8

Cooking With Children (continued)

Let Them Be Creative

Set out three or four healthy foods, and let your children make a new snack or sandwich from them. Use foods your children can eat without choking.

Start with:

• A new kind of bread

(whole-grain or rye)

• Whole-grain or graham crackers
• Mini rice cakes or popcorn cakes
• Small bagels
• Small pieces of pita bread

Spreads could include:

• Low-fat cream cheese or • Bean dip cheese spread • Jelly or jam with no sugar added

LOW-FAT

• Low-fat peanut butter SPREAD

Toppings could include:

• Slices of apple or banana •

Slices of cucumber or squash

• Raisins or other dried fruit •

Cherry tomatoes cut in small pieces

• Strawberries •

Slices of cheese or hard-boiled egg

As you help your children make the new snack or sandwich, talk about why it is healthy.

Point out the different food groups that are included in the snack or sandwich. Explain that eating a variety of foods is healthy.

Ask why the snack or sandwich tastes good. Is it sweet, juicy, chewy, or crunchy?

Adapted from U.S. Department of Agriculture. “Tips for Using the Food Guide Pyramid for Young Children 4 to 6 Years Old,” 1999.

HANDOuT—SESSION 8 261

Maria’s Veggie Wrap Recipe

1 red bell pepper, sliced

1 yellow pepper, sliced

1 onion, peeled and sliced

1 15-ounce can low-sodium black beans, drained and rinsed

½ avocado, peeled and diced juice from one lime

½ cup chopped fresh cilantro

1 teaspoon of chili powder (optional)

1 cup fat-free sour cream

4 8-inch, whole-wheat tortillas

1 teaspoon canola oil

6 tablespoons of fresh salsa (recipe below)

Fresh Salsa

6 tomatoes, preferably Roma (or 3 large tomatoes)

½ medium onion, finely chopped

1 clove garlic, finely minced

2 serrano or jalapeño peppers, finely chopped

3 tablespoons cilantro, chopped juice of 1 lime

⁄8 teaspoon oregano, finely crushed

⁄8 teaspoon salt

⁄8 teaspoon pepper

½ avocado (black skin), diced

1. Combine all of the ingredients in a glass bowl.
2. Serve immediately or refrigerate and serve within 4 or 5 hours.
3. In a nonstick pan, saute the peppers and onion in the canola oil for 5 minutes over medium heat. Add beans, and stir well. Reduce heat to low, and simmer about 5 minutes, then set aside.
4. In a small bowl, combine the avocado, lime juice, cilantro, and chili powder. Reserve half of the mixture for topping.
5. Add sour cream to beans, and mix well.
6. Warm tortillas in the microwave or on the stovetop.
7. Fill a warmed tortilla with ¼ bean mixture and ¼ avocado mixture. Drizzle 2 tablespoons of salsa over the bean and avocado mixture.
8. Fold ends of the tortilla over. Roll up to make a wrap. Top the veggie wraps with remaining avocado mixture. Follow this process for three other wraps.

Yield: 4 servings

Serving size: 1 wrap

Each serving provides:

Calories: 367

Total fat: 6 g

Saturated fat: 1 g

Cholesterol: 5 mg

Sodium: 318 mg

Total fiber: 14 g

Protein: 16 g

Carbohydrates: 66 g

Potassium: 976 mg

HANDOuT—SESSION 8

s essi o n

Eat in a Heart Healthy Way— Even When Time or Money Is Tight

Objectives

By the end of this session, group members will learn:

• Quick and easy food preparation and mealtime tips
• How to eat out in a heart healthy way
• How to save money on their food bills

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Examples of advertisements from magazines*
• Blackboard and chalk or several large pieces of paper, markers, and tape
• Pencils
• Prepare before the session.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 263

Handouts

Give each group member these handouts during this session:

• “Tips for Busy Families” (page 279)
• “Rosa’s Dilemma: A Real-Life Story” (page 280)
• “Tips for Eating Out the Heart Healthy Way” (page 281)
• “Money-Saving Tips” (page 282)
• “Shopping List” (page 283)
• “Quick Beef Casserole Recipe” (page 284)

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Eat in a Heart Healthy Way Even When There Is Little Time

A. Busy Times

B. Quick and Easy Meal Tips

C. Eating Out

1. Save Money on Your Food Bill

A. Money-saving Tips

B. Food Advertising Activity

C. Quick Beef Casserole Recipe

264 Your Heart, Your Life: A Community Health Worker’s Manual

Review of Today’s Key Points

Weekly Pledge

Closing

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Let’s review what we learned last session.

What is heart healthy about the traditional Latino diet?

• The traditional Latino diet provides a variety of foods that are lower in

fat and sodium, such as bread, corn tortillas, beans, rice, vegetables, fruits, poultry, fish, and milk products.

What are some foods that we should eat less often?

• We should limit foods that are high in saturated fat, trans fat, sodium, added

sugar, and calories, including:

• High-fat foods, such as refried beans, fried chicken, fatty meats, and highfat cheeses
• Salty foods, such as potato chips and taco chips
• Foods such as pastries, cookies, and chocolate that are high in fat and added sugar
• Candy and soft drinks that have added sugar

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 265

How can the heart healthy eating plan be used to choose heart healthy foods?

• Use the heart healthy eating plan to choose foods that are lower in saturated

fat, trans fat, cholesterol, sodium, and added sugar from each of the five food groups. The eating plan also shows you the number of servings that you need from each group every day.

Why is it helpful to know how much you need to eat from each food group each day?

• When you know the amount of food you need to eat every day, it can help

you get the right amount of calories you need.

• Ask:

How are you doing on the pledges to include a variety of heart healthy foods in your diet? What went well? What kind of problems did you have (such as family not liking the change or showing a lack of interest)? What did you do to solve these problems?

Note: Allow about 4 minutes for group members to respond.

3. About This Session

Today you will learn how to eat in a heart healthy way—even when you have very little time and are on a tight budget. During this session, you will learn:

• Quick and easy ways to prepare heart healthy meals

• How to eat right when eating out

• How to make smart food-buying choices that meet your family’s needs

and budget

• How advertising can cause us to buy things that cost more or that we

don’t need

266 Your Heart, Your Life: A Community Health Worker’s Manual

Conducting the Session

1. Eat in a Heart Healthy Way Even When There Is Little Time

A. Busy Times

Many people have little time to shop, prepare food, and clean up after meals. This session will help you eat in a heart healthy way, even when you are in a rush.

Busy people may think they don’t have time to eat in a heart healthy way. These people may:

• Skip breakfast and lunch, and eat one big meal in the evening.

• Eat out several times per week.

• Buy boxed, instant, or already-prepared foods.

• Buy food from vending machines.

• Ask:

What foods do you eat when you don’t have time to cook?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Eating on the run often means that we are eating foods that are higher in fat, sodium, and calories. For example, we eat snacks and candy from vending machines or hotdogs and french fries from fast food restaurants.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 267

People often eat these foods because they are easy to buy or quick to prepare. When people are in a hurry, they often don’t think about what kinds of food are heart healthy.

They may also eat bigger portions of foods that are higher in fat and calories when there is no time to prepare healthy side dishes such as salad, vegetables, or rice.

B. Quick and Easy Meal Tips

Note: This part of the session will help group members to think about ways to prepare meals in less time.

People often find that they are too tired to prepare the kinds of meals they would like their families to eat. Today, we will learn some ways to save time and make meal preparation easier.

• Give each group member the “Tips for Busy Families” handout (page 279).

Note: Show picture card 9.1 while you review the “Plan Your Meals” and “Use a Shopping List” sections of the handout. Show picture card 9.2 when you review the “Cook in Advance” section.

• Ask for volunteers to read the tips aloud, one at a time. Allow group members to comment as the tips are read.
• Ask:

Would you find any of these tips difficult to do?

Note: Allow 3 to 5 minutes for group members to respond.

268 Your Heart, Your Life: A Community Health Worker’s Manual

Group Activity

Note: This activity will help group members think about creative ways that families can enjoy heart healthy meals even when time is limited.

• Divide participants into smaller groups, with about three to four people in each group. Distribute the “Rosa’s Dilemma: A Real- Life Story” handout (page 280).

I am going to read a real-life situation. You can follow the story on the handout. Think about how Rosa can solve her problem.

Rosa’s Dilemma

Rosa is married and has two sons, aged 7 and 10. Her husband Tomás works Monday through Friday for a construction company. He leaves for work at 6:30 a.m. and gets home at 4 p.m. Rosa works Monday through Friday at a restaurant. She leaves home at 10 a.m. and gets home around 7 p.m.

Rosa prepares the family’s dinner after she comes home from work every night. Many times, she is too tired to cook, so she often picks up a pepperoni pizza, hamburgers and fries, or fried chicken on her way home.

Rosa sees that the whole family is gaining weight. Tomás wants her to make traditional Latino dinners. Rosa tries to get her husband to help her with dinner, but he is also very tired. Besides, he thinks that cooking is the woman’s job.

• Ask each small group to discuss ways that Rosa can make sure that her family eats in a heart healthy way.

Note: Allow about 5 minutes for the groups to come up with suggestions.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 269

• Ask one person from each group to present his or her group’s suggestions to the others.
• Add these ideas if they are not mentioned:

• Rosa could cook two or three meals over the weekend and store them in the

freezer.

®

• She could make meals in a slow cooker (Crock-Pot ), which saves time

during the evenings. Meals cook during the day and are ready when the family gets home.

• Rosa’s family could help her by putting casseroles (from the freezer or made

the night before) into the oven before she gets home from work.

• Several families could get together and share meals. • Rosa’s family could help her by setting the table and doing the dishes. • Rosa could buy roasted chicken instead of fried chicken or burgers and fries. • She could buy vegetable pizza and salads instead of a meat pizza.

C. Eating Out

Note: This activity will teach group members how to make heart healthy choices at fast food restaurants.

• Ask:

Where do you eat when you eat out?

Note: Allow about 3 minutes for group members to answer. Write their answers on the blackboard or on a large piece of paper taped to the wall.

Many people eat at fast food restaurants because:

• The food is served quickly. • The food tastes good.

270 Your Heart, Your Life: A Community Health Worker’s Manual

• The food is less expensive than food at sitdown restaurants. • Special food and toys appeal to children. • There may be a playground for children.

Many fast foods can be higher in saturated fat, sodium, and calories, but you can choose healthier foods from the menu.

• Show picture card 9.3. Keep it on display while you review the handout.
• Give each group member the “Tips for Eating Out the Heart Healthy Way” handout (page 281).
• Ask for volunteers to read the suggestions on the handout aloud.

Do you have other ideas for making heart healthy choices at restaurants?

Note: Allow 2 or 3 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

2. Save Money on Your Food Bill

A. Money-Saving Tips

• Ask:

What do you do to save money on food?

Note: Allow about 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

There are things you can do to save money on your food bill. Let’s go over a list of ideas.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 271

• Give each group member the “Money-Saving Tips” handout (page 282). Ask for volunteers to read the tips aloud.
• Give each group member the “Shopping List” handout (page 283).

You can use this shopping list when you go to the store. Just check off or write on the blank lines what you want to buy.

B. Food Advertising Activity

Note: This section will help group members become more aware of how advertising can affect their food-buying decisions.

Food advertising is big business.

• Advertisements try to get adults and children to buy a certain product.

• Advertising costs money. Billions of dollars are spent on food advertising.

The people buying the food—the consumers—pay for this.

• Nationally advertised items usually cost more than store brands and brands

that are not nationally advertised.

• Most people are more likely to buy items with fancy, eye-catching packaging.

• People, especially Latinos, can be very loyal to certain brands. They will

often buy these products even if they cost more.

• Ask group members to describe advertisements that have caused them to buy certain products.

Note: Allow about 3 minutes for group members to respond.

• Review different advertising themes that are used to get people to buy food products. (Show or describe an example of the following advertising themes. Prepare these examples before the session.)

272 Your Heart, Your Life: A Community Health Worker’s Manual

Note: As you discuss the six themes, write them on the blackboard or on a large piece of paper taped to the wall. You will need these themes for the group activities.

Popular advertising themes often focus on family, health, sex appeal, humor, appearance, or famous people.

• Family

Advertisers try to get you to use their products based on your love for your family. This works well with Latinos, because the family plays an important role in their lives. Ads with a family theme often target Latina women because of their role as family caregivers.

• Health

Some ads focus on the positive health effects of using certain products. This works because people care about their health.

• Sex appeal

Sex appeal sells products. Many people want to believe that they also will be beautiful and sexy if they use the advertised product.

• Humor

A funny situation often helps people remember a product.

• Appearance

Food advertisers show food that may look better than the real thing. This makes people want to try the product.

• Famous people

Famous people are used to sell products. Advertisers also can have a celebrity use a product in a television show or movie.

Group Activity

Note: This activity will help group members think about how advertising affects how we buy food.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 273

• Divide the group members into smaller groups, with about three to four people in each group. Give each group two to three advertisements that you have collected.

I have given you real advertisements. Discuss with your group which themes are used in the advertisements.

Note: Allow about 5 minutes for the group to come up with their ideas.

• Ask one person from each group to present his or her group’s ideas to the others.

Advertising can be helpful, because it tells people about different products they can buy. But ads also can get people to buy products that they do not need or cannot afford or products that appear better than they really are.

• Ask:

What can you ask yourself when you are trying to decide what brand to buy?

Note: Allow 4 to 5 minutes for group members to respond.

• Add the following questions if they are not mentioned.

• Do I really need it?

• Is there a less expensive product that serves the same purpose?

• Have I compared the product’s nutrition label with an item that costs less?

• Am I buying the product because it comes in a nice package?

• Am I buying the product because the advertisement says it will make me

look better or help me lose weight?

• Am I buying it because I have a coupon or because it’s on sale?

• Can I afford it, even with a coupon?

• Can I wait until it goes on sale?

274 Your Heart, Your Life: A Community Health Worker’s Manual

Even if you want to buy name brands, you can save money by buying the products when they are on sale.

C. Quick Beef Casserole Recipe

RECIPE

• Give group members the “Quick Beef Casserole Recipe” handout (page 284). Ask them to try this dish sometime this week.
• Ask:

How can this dish help us eat in a heart healthy way when we have little time?

• Add these answers if they are not mentioned:

• The dish can be prepared in advance and frozen, so that you can save time.

• It includes a lot of vegetables.

• It is lower in fat because the meat is drained after cooking, and no fat is

added while cooking.

Review of Today’s Key Points

Let’s review what we learned today.

What can you do to save time in meal preparation?

• Get help from your spouse.

• Cook several dishes at one time and freeze part of them.

• Make larger quantities and use the leftovers for lunch.

• Pack lunches the night before.

• Learn simple, fast recipes.

• Use a slow cooker.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 275

What can you do to eat healthier when eating out?

• Order sandwiches without mayonnaise or sauces (or with low-fat

mayonnaise or sauces).

• Order small, plain hamburgers or lean roast beef or turkey sandwiches

instead of deluxe sandwiches.

• Ask for low-fat salad dressing or bring your own.

• Choose water, 100 percent fruit juice, or fat-free or low-fat (1%) milk instead

of a soft drink or a milkshake.

• Order smaller portions.

• Choose baked or grilled foods instead of fried foods.

• Remove the skin from chicken, and do not eat it.

• Choose vegetarian pizza, and ask for less cheese.

• Order a green vegetable or salad instead of two or more starches (such as

potatoes, rice, pasta, bread, and corn).

What can you do to save money when shopping?

• Plan weekly meals, and make a shopping list of what you need to buy

for the week.

• Use a shopping list, and don’t go to the store too often.

• Check the food sale ads.

• Choose prepared foods less often.

• Buy only the amount of food that your family needs.

• Try not to shop when you are hungry.

• Check your receipt for errors at the register.

• Try not to shop at convenience stores.

• Try store brands, and use them as often as possible.

276 Your Heart, Your Life: A Community Health Worker’s Manual

Weekly Pledge

You have learned a lot today about eating in a heart healthy way even when you are on a budget or have little time. Now let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to eat in a heart healthy way while sticking to your budget. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Here are some examples:

• I will use a shopping list the next time I go to the grocery store.

• I will try a store-brand product the next time I go grocery shopping to see if

my family likes it.

• I will choose a restaurant that is not buffet style the next time I go out to eat.

• I will plan my dinners for the next week, so that I do not eat fast food.

Note: Allow 5 minutes for group members to think of a pledge.

• Ask:

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

• (Optional) Say:

Keeping a personal value in mind can help you eat in a heart healthy way when you are on a tight budget or have little time. Remember that a personal value is a quality that you consider important.

Session 9. Eat in a Heart Healthy Way—Even When Time or Money Is Tight 277

Today’s value is gratitude. Gratitude can help you appreciate all of your own efforts to change, no matter how small they may be. Gratitude helps you to be thankful for those who help you change old habits and show you how to have a healthier lifestyle.

• Ask:

How could you use gratitude or another value to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to work on your pledges to be more physically active; to cut back on salt and sodium, saturated fat, trans fat, and cholesterol; to reach and keep a healthy weight; to prevent or control diabetes; and to make heart healthy eating a part of your family life.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you at the next session. The next session will be on living smoke free.

Note: Think about today’s session. What worked and what didn’t work? Have you made any changes in your own life that were covered in today’s session?

278 Your Heart, Your Life: A Community Health Worker’s Manual

Tips for Busy Families

Plan Your Meals

♥ Plan weekly meals based on your family’s schedule.

Use a Shopping List

♥ Save money and time by making only one trip to the store. Make and use a shopping list.

Share Meal Preparation Tasks

♥ Teach your family how to shop for groceries.

♥ Include your spouse and children in preparing meals and cleaning up.

♥ Clean up as you cook—you will have less to clean up after you finish cooking.

♥ Share cooking duties with other family members or neighbors. For example, your family can cook enough food to share with another family.

Cook in Advance

♥ Prepare some foods in advance (such as spaghetti sauce). Use these foods for quick meals. You can add chicken or beef to the sauce and serve it over spaghetti or rice.

♥ Prepare parts of a meal the night before (for example, marinate chicken in the refrigerator overnight).

♥ Pack your lunch the night before.

♥ Cut and wash vegetables, and make enough salad for 2 days. Do not add dressing until serving time.

♥ Cook two or three dishes on your day off, and freeze some of them. Use the frozen dishes on the days when you don’t have time to cook.

♥ Prepare for recipes the night before by cutting and trimming meats.

♥ Prepare meals in a slow cooker.

Cook Simply

♥ Steam vegetables, and serve them without sauces.

♥ Use frozen vegetables without sauces.

♥ Broil, grill, bake, or roast meats.

♥ Make one-pot meals, such as stews and casseroles.

♥ Use frozen chopped vegetables (such as carrots, peas, and broccoli).

♥ Use the microwave for cooking or defrosting.

♥ Learn simple recipes that can be made in less than 30 minutes.

Use Herbs and Spices

♥ Chop fresh herbs and place in ice cube trays. Fill trays with water and freeze. Store the frozen cubes in a plastic bag in the freezer. Use when you need fresh herbs.

♥ Grow cilantro, basil, or thyme on a sunny windowsill.

♥ Keep dried herbs on hand. One teaspoon of dried herbs is equal to 3 teaspoons of fresh herbs.

Keep Quick Snacks on Hand

♥ Try these healthy snacks:

• Fresh fruits and vegetables
• Whole-grain, ready-to-eat, dry cereal
• Fat-free and low-fat yogurt
• Fat-free and low-fat cheese
• Baked corn tortilla chips
• Whole-grain breads

LOW-FAT YOGURT

HAndOuT—SESSIOn 9

Rosa’s Dilemma: A Real-Life Story

Rosa is married and has two sons, aged 7 and 10. Her husband Tomás works Monday through Friday for a construction company. He leaves for work at 6:30 a.m. and gets home at 4 p.m. Rosa works Monday through Friday at a restaurant. She leaves home at 10 a.m. and gets home around 7 p.m.

Rosa prepares the family’s dinner after she comes home from work every night. Many times, she is too tired to cook, so she often picks up a pepperoni pizza, hamburgers and fries, or fried chicken on her way home.

Rosa sees that the whole family is gaining weight. Tomás wants her to make traditional Latino dinners. Rosa tries to get her husband to help her with dinner, but he is also very tired. Besides, he thinks that cooking is the woman’s job.

What can Rosa do?

Write down some ideas for Rosa to try:

280 HAndOuT—SESSIOn 9

Tips for Eating Out the Heart Healthy Way

You don’t have to give up eating fast foods to eat right. Here are some tips on how to make heart healthy choices at fast food restaurants.

Sandwiches

♥ Order sandwiches without mayonnaise, tartar sauce, or special sauces. Or try mustard or low-fat mayonnaise. Ask for vegetables to be added to your sandwich. ♥ Order small, plain hamburgers instead of deluxe sandwiches. ♥ Order sandwiches made with lean roast beef or turkey. Chicken salad and tuna salad made with regular mayonnaise are high in fat. ♥ Choose grilled chicken sandwiches instead of breaded chicken sandwiches.

Main dishes

♥ Choose soft tacos or corn tortillas filled with chicken or lean beef, vegetables, and salsa.

• Ask for low-fat cheese and low-fat sour cream.
• Ask for cheese and sour cream to be served on the side, and use only a

small amount. ♥ Choose rotisserie-style chicken rather than fried chicken. Always remove the skin, and don’t eat it. ♥ Order pizza with vegetable toppings like peppers, mushrooms, or onions. Ask for half the usual amount of cheese.

Side dishes

♥ Share a small order of french fries instead of eating a large order by yourself. ♥ Ask that no salt be added to your serving. ♥ Order a baked potato instead of fries.

• Try salsa or vegetables as a potato topping.
• Ask that high-fat toppings be served on the side, and use

fewer toppings. ♥ Use low-calorie, low-fat salad dressing on salad. Bring your own if the restaurant does not offer a low-fat dressing. You can buy packets at some stores. Ask that dressings be served on the side, and use less. ♥ Order a green vegetable or salad instead of two or more starches (such as potatoes, rice, pasta, bread, and corn).

Beverages

♥ Choose water, 100 percent fruit juice, or fat-free or low-fat (1%) milk, rather than a soft drink or a milkshake. ♥ If you really want to have a soft drink, order a small one.

low-fat

Desserts

milk

♥ Buy a small fat-free frozen yogurt instead of cookies or pies.

HAndOuT—SESSIOn 9 281

Money-Saving Tips

You can save money on groceries. Follow these simple suggestions.

Before Going to the Store

♥ Plan weekly meals. Your family can help you plan the menu.

♥ Make a shopping list based on your meal plan.

Lowest

♥ Check the food sale ads. Prices!

♥ Use coupons. Check the Sunday newspaper, and clip coupons for foods you normally buy or need. Ask your children or another family member to help you. Remember—coupons do not save you money if you buy products that you don’t need. Also, store brands may be cheaper than the name brands with the coupons.

♥ Make fresh foods at home instead of using prepared items such as frozen entrees, bakery cakes, or salads.

Choosing a Store

♥ Shop at the store that has the lowest prices for the items you need. That may be a different store every week.

♥ Remember that convenience stores tend to have higher prices and less variety than supermarkets.

At the Store

♥ Buy what is on your list. You are more likely to buy too much or to buy items that you do not need when you do not use a list.

♥ Convenience can cost more. Some examples include:

• Canned beans
• Boneless chicken breasts
• Precut vegetables

♥ Buy fruits and vegetables that are in season.

♥ Buy only the amount of food your family can use, even if a larger size costs less.

♥ Shop alone when possible. Family members or friends may try to get you to buy items you do not need.

♥ Do not shop when you are hungry.

♥ Watch for errors at the cash register. Sometimes sale items do not ring up on sale. Some stores give customers free items if they are charged the wrong amount.

282 HAndOuT—SESSIOn 9

Shopping List

Make a shopping list. Include the items you need for your menus and any basic items you need to restock in your kitchen.

Produce

Fresh fruits (mangos, apples, oranges, pineapple) Fresh vegetables (cabbage, lettuce, onions, tomatoes, squash, sweet potatoes, cactus, okra, yuca, plantains)

Whole-Grain Breads, Muffins, and Rolls

Bread, bagels, pita bread English muffins Corn tortillas Low-fat wheat tortillas

Cereals, Rice, Crackers, Pasta, and Noodles

Cereal, dry or cooked Brown rice Whole-wheat pasta (noodles, spaghetti) Other Saltines, soda crackers* Graham crackers Other crackers*

Cereal

pasta

Milk Products

Fat-free or low-fat

(1%) milk

Fat-free or low-

Canned Fruits, Vegetables,

Beans, and Soups

Canned fruit in juice

Applesauce

low-fat

fat (1%) cottage milk Canned tomatoes (no salt

cheese

Fat-free or low-fat

cheeses

Fat-free or low-fat yogurt

Light or diet tub margarine

Fat-free sour cream

added)

Low-sodium tomato sauce

or paste

Other canned vegetables

(no salt added)

Canned broth (fat free, low Fat-free cream cheese sodium)* Eggs Other canned soups* Canned beans (no salt or seasoning added)

Meats

Chicken Turkey Fish Beef (round or sirloin) Extra lean ground beef Pork tenderloin, leg, shoulder

Lower-fat lunch meats like Fats and Oils

turkey, chicken, and lean Margarine (liquid, tub, roast beef* stick, diet)* Dry beans and peas Vegetable oil

Frozen

Fat-free or low-fat frozen

Baking Items

yogurt and desserts* Flour Frozen vegetables without Sugar sauces Vegetable oil spray Frozen fruit juices Fat-free canned evaporated milk

Other

Fat-free dry milk

Vegetable

Herbs and spices powder Oil (oregano, cumin, Unsweetened Spray cocoa powder red pepper, Baking powder cilantro, parsley)

• Use the nutrition label to choose foods lowest in saturated fat,

HAndOuT—SESSIOn 9 283

Quick Beef Casserole Recipe

½ pound 1 cup 1 cup 1 cup 3½ cups ¼ teaspoon ½ teaspoon ¼ teaspoon 1 cup 2 1 cup 1½ cups

lean ground beef onion, chopped celery, chopped green pepper, cubed tomatoes, diced salt black pepper paprika frozen peas small carrots, diced rice, uncooked water

Quick Tips

• Drain the meat after cooking

to lower the amount of fat and calories.

• This one-dish meal can be

made and frozen over the weekend. Reheat when you don’t have time to cook.

1. In a skillet, brown the ground beef, and drain off the fat.
2. Add the rest of the ingredients. Mix well. Cook over medium heat, and cover skillet until boiling. Reduce to low heat, and simmer for 35 minutes.
3. Serve hot.

Yield: 8 servings

Serving size: 10 cups

Each serving provides: Calories: 201 Total fat: 5 g Saturated fat: 2 g Cholesterol: 16 mg Sodium: 164 mg Total fiber: 3 g Protein: 9 g Carbohydrates: 31 g Potassium: 449 mg

HAndOuT

s essi o n

Enjoy Living Smoke Free

Objectives

By the end of this session, group members will learn:

• How cigarette smoking harms smokers
• How secondhand smoke harms people who are near smokers
• Tips that can help smokers who want to quit
• Ways to ask people not to smoke around you

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Blackboard and chalk or several large pieces of paper, markers, and tape
• (Optional) VCR or DVD and TV
• (Optional) “The Big Game: Quit Smoking” telenovela or fotonovela (pages 420–421)

Note: The telenovela is available in Spanish only.

Session 10. Enjoy Living Smoke Free 285

Handouts

Give group members these handouts during the session:

• List of places where smoking cessation programs are offered*
• “Smoking Harms You” (page 304)
• “Smoking Harms Infants and Children” (page 305)
• “Costs of Smoking” (page 306)
• “Role Play: Someone Is Smoking. What Can You Do?” (pages 307–309)
• “Smoke-Free Family Sign” (page 310)
• “Tips To Quit Smoking” (page 311)
• “Help Your Heart—Don’t Smoke” (page 312)
• “Break Free From the Smoking Habit” (page 313)

Note: Posters and other materials may be ordered from the following organizations:

• National Cancer Institute—1–800–4–CANCER (1–800–422–6237) or http://cancer.gov • American Lung Association—1–800–LUNGUSA (1–800–586–4872) or

www.lungusa.org

• American Cancer Society—1–800–ACS–2345 (1–800–227–2345) or www.cancer.org • American Heart Association—1–800–AHA–USA–1 (1–800–242–8721) or

www.americanheart.org

• Prepare this list before the session. You may find information at your local health department, a hospital, or a clinic.

286 Your Heart, Your Life: A Community Health Worker’s Manual

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. (Optional) “The Big Game: Quit Smoking” Telenovela or Fotonovela (pages 420–421)
2. Facts About Smoking
3. Smoking Harms Infants and Children
4. Youth and Smoking
5. Smoking and Your Wallet
6. Secondhand Smoke

A. Secondhand Smoke Can Harm You and Those Around You

B. Secondhand Smoke Role-Playing Activity

1. Quitting Smoking

Review of Today’s Key Points

Weekly Pledge

Closing

Session 10. Enjoy Living Smoke Free 287

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

At the last session, we talked about ways to save money on our food bills. Who can name some of them?

• Write group members’ ideas on the blackboard or on a large piece of paper taped to the wall.
• Add these ideas if they are not said:

• Plan weekly meals, and shop with a list.

• Clip coupons for products you use.

• Check the food sale ads.

• Use fewer prepackaged foods.

• Buy only the amount of food that your family needs.

• Try not to shop when you are hungry.

• Check your receipt for errors at the register.

• Shop at convenience stores less often.

• Use store brands as often as possible.

288 Your Heart, Your Life: A Community Health Worker’s Manual

• Ask:

How are you doing with your pledge to eat in a heart healthy way even when time or money is tight? What went well? Did you have problems? If so, what did you do to solve them?

Note: Allow 5 to 8 minutes for group members to respond.

3. About This Session

This session is about the importance of not starting to smoke and quitting smoking. During this session, you will learn:

• How cigarette smoking harms smokers

• How secondhand smoke can harm you and those around you

• Ways to ask people not to smoke around you

• Tips to quit smoking (for you and others)

• Ask:

• How many of you smoke?

• How many of you live with a smoker?

• How many of you would like to live smoke free?

Tobacco is used in a variety of ways—cigarettes, cigars, pipes, and chewing tobacco. This session focuses on cigarette smoking, because it’s the most common use of tobacco.

Note: Other names for cigarettes include “smokers,” “cigs,” and “butts.”

Session 10. Enjoy Living Smoke Free 289

Conducting the Session

1. (Optional) “The Big Game: Quit Smoking” Telenovela or Fotonovela

• Show the telenovela “The Big Game: Quit Smoking,” or ask volunteers to read the fotonovela (pages 420–421).

Note: The telenovela is available in Spanish only.

2. Facts About Smoking

There are many reasons why you should quit smoking or not start smoking. Let’s go over these reasons.

• In the United States, about 440,000 people die each year from diseases

related to smoking. This is more than 1,200 people each day. Smoking causes about one in every five deaths.

• Health care costs due to smoking are about $75 billion each year in the

United States.

• Nearly one in every four Latino men smokes (about 23 percent). Fewer

Latina women smoke (one in eight, or about 12 percent), but this number is increasing.

• Smokers use tobacco regularly because they become addicted to nicotine,

which is a powerful drug. Nicotine is found in all tobacco products. Most cigarettes contain 10 milligrams (mg) or more of nicotine. From inhaling smoke, the average smoker takes in 1 to 2 milligrams of nicotine per cigarette.

• Smoking can harm those around you! Cigarette smoking puts the health of

your family and friends at risk.

290 Your Heart, Your Life: A Community Health Worker’s Manual

• Show picture card 10.1.

Today, we are going to talk about what can happen when you smoke. We also are going to talk about ways to stop smoking and ways to support a friend or family member who wants to quit.

• Give group members the “Smoking Harms You” handout (page 304), and review the information.

Note: Ask for volunteers to read each tip aloud. Keep the picture card on display while you review this handout.

3. Smoking Harms Infants and Children

• Show picture card 10.2.

Do you think that pregnant women should smoke?

Note: Allow a moment for group members to respond.

Pregnant women should not smoke, because it will affect their babies’ health and well-being. They also should stay away from others who smoke, because of the harm that secondhand smoke causes.

Let’s go over some problems that can happen if pregnant women smoke.

• Give group members the “Smoking Harms Infants and Children” handout (page 305).

Note: Ask volunteers to read the handout aloud, or you can cut out the facts, following the dotted lines on the handout, and put them in a box. Let group members draw slips of paper and read the facts aloud. Keep the picture card on display while you review the handout.

Session 10. Enjoy Living Smoke Free 291

4. Youth and Smoking

• Show picture card 10.3.
• Ask:

Why do you think many people begin smoking as teenagers?

Note: Review the picture card to show the reasons that teens smoke.

• Add the following reasons if they are not mentioned:

• Teens want to be like their friends.

• Young people smoke to try to look older.

• Some teens want to be like celebrities who smoke in movies or on television.

• Some teens are influenced by advertisements that make smoking look “cool”

or glamorous.

• Some teens may want to be like their parents or other family members

who smoke.

• Some teens will smoke just to do something their parents don’t want them

to do.

• Young people downplay the harm smoking can do, or they think they will

not be harmed.

• Teens may like the jackets, hats, and other prizes tobacco companies offer.

Let’s look at some of the facts about young people and smoking.

• Each day, about 2,000 young people under age 18 become smokers. That’s

nearly 750,000 teens per year. If this continues, more than 6 million young people who are regular smokers could die from a tobacco-related disease.

292 Your Heart, Your Life: A Community Health Worker’s Manual

• It can be hard for young people who use tobacco to play sports.

Smoking causes shortness of breath and dizziness. Chewing tobacco causes dehydration.

• Use of spit tobacco can cause cracked lips, white spots, sores, and bleeding

in the mouth.

• People who start smoking at a young age are likely to smoke all their lives.

• The longer a person smokes, the more likely it is that he or she will develop

the problems caused by smoking.

• Young people who smoke cigarettes are also more likely to try other drugs,

especially marijuana.

• It is illegal in all States to sell cigarettes, smokeless tobacco, and other

tobacco products to people under age 18.

If you smoke, set an example for your family by quitting. Be honest. Admit that you are having trouble kicking the habit. Let young people know that it is best not to start smoking, rather than trying to quit. Try not to smoke in front of your children. Never ask your children to bring you cigarettes or to light a cigarette. Asking them to do those things can send the message that smoking is okay for them to do.

5. Smoking and Your Wallet

Smoking costs a lot in other ways. Let’s look at some things a smoker could buy with the money that he or she spends on cigarettes.

• Give out and review the “Costs of Smoking” handout (page 306).

Session 10. Enjoy Living Smoke Free 293

6. Secondhand Smoke

A. Secondhand Smoke Can Harm You and Those Around You

• Ask:

What have you heard about secondhand smoke?

Note: Allow 3 to 5 minutes for group members to respond.

Secondhand smoke is the smoke that you breathe in from someone else’s cigarette or cigar. Even nonsmokers can be harmed if they are near secondhand smoke.

Let’s take a look at some facts about secondhand smoke.

• Secondhand smoke contains poisons, such as arsenic, cyanide, ammonia,

and formaldehyde.

• Breathing secondhand smoke may cause eye irritation, nose and throat

discomfort, headaches, and coughing.

• Secondhand smoke causes nearly 1 in 10 smoking-related deaths.

• Each year, about 3,000 nonsmokers die of lung cancer caused by

secondhand smoke.

• Infants and children who live with someone who smokes are twice as likely

to have respiratory illness, bronchitis, and pneumonia as are children who do not live with someone who smokes.

• Secondhand smoke can bring on an asthma attack.

294 Your Heart, Your Life: A Community Health Worker’s Manual

B. Secondhand Smoke Role-Playing Activity

ACTIVITY

Let’s try role-playing. Some people have a hard time telling smokers not to smoke around them or their children. This activity will let you practice what to say when someone smokes around you or your family.

• Divide group members into groups of three. Give each group a scene from the role-play handouts on pages 307–309 to act out. Ask them to act out a solution to the problem, too.

Note: Read the scenes one at a time, or hand out copies to each group. Allow about 5 minutes for each group to role-play a solution.

• Ask group members if they have any comments or questions about the role play.

One thing we all can do in our homes to prevent these situations is to post a sign that says “Thank You for Not Smoking” or “This Is a Smoke-Free Home.” This lets guests know your house is smoke free.

• Give group members the “Smoke-Free Family Sign” handout (page 310).

This sign can be used on a tabletop or taped to the wall or refrigerator.

Session 10. Enjoy Living Smoke Free 295

Scenes for Role-Playing Activity: Someone Is Smoking. What Can You Do?

• Scene 1

Your in-laws are at your house visiting your family. Your spouse is at the store buying a few things. The rest of the family is sitting in the living room, talking. Your fatherin-law asks you for an ashtray as he lights a cigarette. You know smoking around the children is harmful. What can you do?

Solutions:

• Tell him that cigarette smoke is harmful to your children.
• Ask him if he would please go outside to smoke.
• Tell him your home is smoke free.
• Tell family members ahead of time that your home is smoke free.
• Post a “Thank You for Not Smoking” sign for visitors.
• Scene 2 You and your family go to a friend’s house to celebrate her son’s birthday. There are many adults and children inside the house. A few of the guests are smoking, which is making the house very smoky. The smoke is hurting your throat and your daughter’s eyes. You promised your friend you would help her, so you don’t want to leave. What can you do?

Solutions:

• Tell your friend ahead of time that you can help her if she has a smoke-free party.
• Help your friend make a “Thank You for Not Smoking” sign.
• Tell your friend that you are very sorry, but you cannot help her during the party.

You must leave because the smoke is affecting the health of you and your child.

• Scene 3 You go out to eat with a friend to celebrate a special occasion. You ask to sit in the nonsmoking section of the restaurant. The nonsmoking area is in a corner of the restaurant. There are no walls separating the smoking section from the nonsmoking section. As you order your meal, four people sit down a few tables away from you in the smoking section. They begin to smoke cigarettes. After a minute or two, you begin to smell their smoke at your table. You tell the waiter the smoke is a not good for your health. He says he can’t ask them to stop, because they are in the smoking section. What do you do?

Solutions:

• Ask to be moved to another table farther away from the smokers.
• Ask the waiter to wrap up your food, and then leave the restaurant.
• Tell the manager that you cannot be around smokers.

296 Your Heart, Your Life: A Community Health Worker’s Manual

7. Quitting Smoking

Quitting smoking is not easy, but it can be done. To quit smoking for good, some smokers need help to overcome their urges to smoke. They also need encouragement and support to help them break the habit.

• Ask:

Have any of you quit smoking, or do you know anyone who has quit smoking? What are the benefits of quitting smoking?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add the following answers if they are not mentioned:

• You will live longer and have better health.

• You will reduce your chances of having a heart attack, stroke, cancer, and

respiratory problems.

• If you are pregnant, quitting smoking will improve your chances of having a

healthy baby.

• The people you live with, especially children and older adults, will

be healthier.

• You will have extra money to spend on things other than cigarettes.

• You will be free of a morning cough.

• Your clothes, hair, and breath will smell better, as will your home and car.

To quit smoking, you need to know your personal feelings or situations that trigger your urge to smoke. This will help you to overcome the urge to smoke.

Session 10. Enjoy Living Smoke Free 297

• Ask:

What are some of these feelings or situations that bring on the urge to smoke?

Note: Allow 3 to 5 minutes for group members to respond.

• Write their answers on the blackboard or on a large piece of paper taped to the wall. Add the following answers if they are not mentioned:

• Drinking coffee

• Drinking alcohol

• Talking on the phone

• Watching someone else smoking

• Feeling stressed

• Feeling bored

Let’s review what a smoker can do to overcome the urge to smoke.

1. Find ways to relax. If stress causes you to want to smoke, try deep breathing to calm you. Let’s try it now. Take a slow, deep breath, count to five, and release it.
2. Keep busy. Do activities that require the use of your hands, such as sewing, arts and crafts, or a project around the house.
3. Keep moving. Try going for a walk, working in the garden, doing stretching exercises, or practicing your favorite dance steps.

298 Your Heart, Your Life: A Community Health Worker’s Manual

1. Know what to expect. The nicotine that is in cigarettes and other tobacco products causes addiction. When smokers try to cut back or quit, the lack of nicotine in their bodies makes them have withdrawal symptoms. You may experience withdrawal symptoms. These symptoms are:

• Headaches

• Feeling irritable

• Feeling tired

• Having trouble concentrating

Although withdrawal symptoms are not pleasant, it is important to know that they are signs that your body is recovering from smoking. Most symptoms will go away in 2 to 4 weeks.

• Give group members the “Tips To Quit Smoking” handout (page 311). Ask for volunteers to read the tips aloud.

These tips have helped other people. If you are a smoker, they can help you quit. If you’re not a smoker, share the tips with a family member or friend who would like to quit. Studies have shown that these steps will help you quit smoking for good.

Nagging people about their smoking can make them become angry or defensive. Try these positive ways to help family members or friends who want to quit:

• Say things such as “Quitting is hard, but I know you can do it.”

• Help them stay away from smokers in the beginning, when it is the hardest

to quit.

• Suggest other activities that will help them beat the urge to smoke. For

example, ask them to take a walk with you.

Session 10. Enjoy Living Smoke Free 299

• Ask:

Do you have any questions about the information we covered today?

• Give group members the “Help Your Heart—Don’t Smoke” (page 312) and the “Break Free From the Smoking Habit” handouts (page 313).
• Ask for volunteers to read the handouts out loud.

More Information

• Tobacco companies spend billions of dollars advertising their products to get

people to smoke. They do this through advertising in magazines, on billboards, and on posters in stores.

• Tobacco ads usually show happy, attractive people enjoying life while they

smoke cigarettes. Many individuals want to be like these attractive people, so they start smoking.

• Tobacco companies also advertise their products by supporting special sporting

events such as soccer games and car racing events. They go to dances, festivals, and other community events to promote their products by giving away free merchandise and cigarettes.

• Tobacco companies pay movie companies to have actors smoke on screen. This

allows them to get around the law that bans cigarette advertising on television or in the movies.

• Tobacco companies attract new smokers to make up for the thousands of people

who die each day of diseases related to cigarette smoking. They target young people because young smokers are likely to be lifelong smokers. Teenage smokers are important for the tobacco companies, because teens will continue to buy cigarettes for many years.

• The advertising programs from tobacco companies influence young people.

The number of youth who began smoking increased when tobacco companies introduced cartoon-like characters to sell cigarettes. Tobacco companies also give away gifts that appeal to youth to get them to smoke a certain brand.

300 Your Heart, Your Life: A Community Health Worker’s Manual

Review of Today’s Key Points

Let’s review what we learned today.

• Ask these questions:

When people smoke, which diseases are they likely to develop?

• Smoking contributes to heart disease, cancer, stroke, and respiratory diseases

(such as chronic obstructive pulmonary disease and asthma).

Should a pregnant woman smoke?

• Pregnant women should not smoke. Smoking reduces the oxygen the baby

receives, contributes to lower birth weight, and increases the chance of a baby being born dead.

What is secondhand smoke?

• Secondhand smoke is smoke that you breathe in from someone else’s

cigarette. It is filled with harmful chemicals.

What can you do if someone is smoking around you, and you don’t like it?

• Ask the person not to smoke inside, or leave the area yourself. Post a

sign in your home that says “Thank You for Not Smoking” or “This Is a Smoke-Free Home.”

Session 10. Enjoy Living Smoke Free 301

Weekly Pledge

You have learned a lot today about living smoke free. Now, let’s think about how you can apply what you have learned. Please think of one change you can make in your everyday life to quit smoking or avoid secondhand smoke. This will be your pledge for the week.

Be specific about what you plan to do, how you plan to do it, and when you will start. Let’s take a look at some examples:

• If I smoke, I will choose a quit date within the next 2 weeks and quit

smoking on that day.

• I will ask my children to make a sign to let people know that our home is

smoke free.

Note: Allow 5 minutes for group members to think of a pledge. Tell group members to write their pledges on the “Break Free From the Smoking Habit” handout.

• Ask:

Would anyone like to share his or her pledge with the group?

Note: Write down pledge ideas on the blackboard or on a large piece of paper taped to the wall.

• (Optional) Say:

Keeping a personal value in mind can help you quit smoking for good. Remember that a personal value is a quality that you consider important.

Today’s value is peace. When you feel at peace with your life, you can overcome the fears that may prevent you from breaking the smoking habit. Peace helps you to trust in yourself and remain optimistic in spite of the problems you may face.

302 Your Heart, Your Life: A Community Health Worker’s Manual

• Ask:

How could you use peace, or another value, to help you keep your pledge?

Note: Allow 3 minutes for group members to share their thoughts.

We will discuss the results of your pledges next week. Don’t forget to work on your pledges to be more physically active; to cut back on salt, sodium, saturated fat, trans fat, and cholesterol; to reach and keep a healthy weight; to prevent or control diabetes; to make heart healthy eating a part of your family life; and to eat in a heart healthy way, even when you are on a tight budget or have little time.

Closing

Thank you for coming today. What did you think of today’s session?

Note: Allow a moment for group members to respond.

I am looking forward to seeing you next week. The next session will be a review and graduation celebration.

• Ask group members if they want a potluck dinner at the final session. If so, ask for volunteers to bring heart healthy dishes. Don’t forget nonfood items such as paper plates, plastic forks, and spoons.

Note: Think about today’s session. What worked and what didn’t work? Have you made any changes in your own life that were covered in today’s session?

Session 10. Enjoy Living Smoke Free 303

Smoking Harms You

Smoking can cause:

• Heart attack and stroke

• Cigarette smokers are two to four times more likely to develop heart disease

than nonsmokers.

• Smoking doubles your chances of having a stroke. • One year after a person stops smoking, the risk of having a heart attack or stroke

will drop by more than half.

• Cancer

• Smoking increases your risk of developing cancers of the bladder, kidney, larynx

(voice box), lung, pancreas, stomach, and uterus.

• Smoking causes about 80 to 90 percent of lung cancer. • The cancer death rate for men who smoke cigarettes is more than double that of

nonsmokers.

• Men who smoke are 22 times more likely to develop lung cancer than men who

have never smoked.

• Women who smoke are 12 times more likely to develop lung cancer than

women who have never smoked.

Smoking and secondhand smoke can cause:

• Chronic obstructive pulmonary disease
• Serious respiratory diseases, such as emphysema and chronic bronchitis
• More colds, sore throats, and respiratory infections
• Asthma attacks

Unpleasant effects include:

• Yellow stains on teeth and fingers
• Bad breath
• Gum disease
• Early wrinkling of the skin
• Decreased sense of smell and taste

304 HAndOuT—SeSSIOn 10

Smoking Harms Infants and Children

Each time a pregnant woman smokes, her baby’s heart rate increases.

When a pregnant woman smokes, her baby gets less oxygen.

The birth weight of babies born to smokers is lower than the birth weight of babies born to nonsmokers.

Smoking during pregnancy increases the chance of the baby being born dead.

Babies whose mothers smoke have a greater risk of dying from SIDS (sudden infant death syndrome).

Harmful chemicals from smoking pass through the placenta and directly into the baby’s blood.

If the mother continues to smoke after the baby is born, the baby is more likely to get chest colds, ear infections, bronchitis, pneumonia, and asthma.

Babies who are exposed to secondhand smoke are more likely to cry, sneeze, and cough than are babies who are not.

Children who grow up in a home with smokers are more likely to become smokers.

HAndOuT—SeSSIOn 10 305

Costs of Smoking

306 HAndOuT—SeSSIOn 10

Pair of shoes

CD player for the family

Color TV and DVD player

Computer

Dream vacation for the family

Car down payment

House down payment

Role Play: Someone Is Smoking. What Can You Do?

• Scene 1 Your in-laws are at your house visiting your family. Your spouse is at the store buying a few things. The rest of the family is sitting in the living room and talking. Your father-in-law asks you for an ashtray as he lights a cigarette. You know smoking around the children is harmful. What can you do?

Solutions:

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

HAndOuT—SeSSIOn 10 307

Role Play: Someone Is Smoking. What Can You Do?

(continued)

• Scene 2 You and your family go to a friend’s house to celebrate her son’s birthday. There are many adults and children inside the house. A few of the guests are smoking, which is making the house very smoky. The smoke is hurting your throat and your daughter’s eyes. You promised your friend you would help her, so you don’t want to leave. What can you do?

Solutions:

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

308 HAndOuT—SeSSIOn 10

Role Play: Someone Is Smoking. What Can You Do?

(continued)

• Scene 3 You go out to eat with a friend to celebrate a special occasion. You ask to sit in the nonsmoking section of the restaurant. The nonsmoking area is in a corner of the restaurant. There are no walls separating the smoking section from the nonsmoking section. As you order your meal, four people sit down a few tables away from you in the smoking section. They begin to smoke cigarettes. After a minute or two, you begin to smell their smoke at your table. You tell the waiter the smoke is a not good for your health. He says he can’t ask them to stop because they are in the smoking section. What do you do?

Solutions:

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

_____________________________

HAndOuT—SeSSIOn 10 309

Smoke-Free Family Sign

for Not Smoking. Thank You

Family. Smoke-Free We are a

We are a Smoke-Free Family.

Thank You for Not Smoking.

310 HAndOuT—SeSSIOn 10

Tips To Quit Smoking

Cigarette smoke contains more than 4,000 chemicals, and 200 of them are poisonous.

• Get ready.

• Set a quit date. • Throw away ALL cigarettes, lighters, matches, and ashtrays in your home,

car, and place of work. 9 10 11 12 13 14 15 16

17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

• Don’t let people smoke in your home. • Review your past attempts to quit. Think about what worked and what didn’t. • Once you quit, don’t smoke—NOT EVEN A PUFF! One cigarette can cause

you to start smoking again.

• Line up support.

• Tell your family, friends, and coworkers that you are going to quit smoking and want their help.

Ask them not to smoke around you and not to offer you cigarettes.

• Get individual, group, or telephone counseling. The more counseling you have, the better your

chances are of quitting.

• Find ways to relax.

• Try to distract yourself from urges to smoke. Talk to a friend, go for a walk, or get busy with

a task.

• Change your routine. Use a different route to work. Drink tea instead of coffee. • Do something to reduce your stress. Listen to music, do aerobics, or dance to your

favorite music.

• Plan something enjoyable to do every day. • Drink a lot of water when you feel the urge to smoke.

• Use other quitting aids.

• Talk to your doctor or other health care providers. Consider using the nicotine patch, nicotine

gum, or nicotine spray to help you stay off cigarettes.

• Check with your doctor about a medicine called bupropion SR. This medicine can help reduce

your cravings for smoking.

• Be prepared if you do not have immediate success.

• Avoid drinking alcohol. Drinking lowers your chances of success. • Spend more time with friends who do not smoke. Being around smokers can make you want

to smoke.

• Many smokers will gain weight when they quit, usually fewer than 10 pounds. Eat a healthy

diet, and stay active. Don’t let weight gain distract you from your main goal—quitting smoking.

• If you’re in a bad mood or feel depressed, try a new activity. Take a walk, talk to a friend, or

meditate to improve your mood.

• Be kind to yourself. Remind yourself of the reasons you want to quit. If you slip, do not be

discouraged. Try again!

HAndOuT—SeSSIOn 10 311

Help Your Heart—Don’t Smoke

Smoking cigarettes is harmful. It becomes an addiction

that leads to serious health problems. Quitting smoking will lower your risk of heart attack, stroke, and lung disease. It will help you breathe easier and have more energy. In addition, your clothes, hair, and breath will smell fresher, and you will save money by not buying cigarettes. Most important, when you quit smoking, your children won’t be exposed to your secondhand smoke. They will have your good example to follow.

Even if you don’t smoke, it is important that you learn about the best ways to quit. Help those around you, and keep your children smoke free.

Quit smoking and add years to your life!

Mariano and Néstor decided to quit smoking. Néstor made a firm pledge one morning, threw away his cigarettes, and used his willpower to quit for good. Mariano used the following three tips and also quit.

1. Learn how to 3.

handle urges Use the to smoke. nicotine patch

2. or gum.

“Every time I felt Get support. stressed, I wanted “The doctor at the to smoke. Instead of “I also attended a clinic suggested smoking, I said a prayer quit-smoking program that I use the patch. to ask for courage and in the clinic every The patch helped strength, talked to Thursday night, me control the urge a friend, or and I got a lot to smoke.” walked around the of help from neighborhood.” my family and the support group.”

312 HAndOuT—SeSSIOn 10

Break Free From the Smoking Habit

Doña Fela’s tips to make your home smoke free Protect your children!

Talk to your children about the harm that When a friend comes to our

house and lights up a cigarette,

smoking will do to their health. Help them

I say very politely, “I’m sorry, we

practice saying, “No, thanks. I don’t smoke.” have a smoke-free home. Please

smoke outside.” And I keep a sign in my home that says, “Thank

If your children already smoke, the way you

You for Not Smoking.”

react can make a difference. Tell your children that you really care about them and what happens to them. Listen to their thoughts and feelings. Give them facts that can help them choose good health over smoking.

Make your personal pledge to protect your family

from cigarette smoke. Write the changes you will make this week.

Here are some examples: 1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16 __________________________

17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

• If you smoke— __________________________

I will set a quit date today. (The important thing is for you to pick the date—not your doctor, not your family, __________________________ not your kids. It’s your decision.)

_____________

• To help your children stay smoke-free—

I will talk to my children about the harmful effects of __________________________ smoking. I will encourage them to create a sign that says, “We are a smoke-free family.” __________________________

• To protect your family, friends, __________________________ and others from smokers—

I will let my family, friends, and others know __________________________ that I do mind if they smoke around me. I will put a

_____________

“No Smoking” sticker or sign in my house and car.

_____________

• To help your community—

I will encourage my neighbors to have smoke-

_____________

free homes. I will give them “Thank You for Not Smoking” posters.

The health of yourself and your family is priceless. Make an investment in it!

HAndOuT—SeSSIOn 10 313

s essi o n

Review and Graduation

Objectives

This session is designed to:

• Review information learned in Sessions 1 through 10 using games and activities.
• Recognize the group’s efforts and accomplishments.

Materials and Supplies

To conduct this session, you will need:

• “Your Heart, Your Life” manual and picture cards
• Heart Health Bingo Facts (pages 322–323)
• Heart Health Bingo Cards (pages 324–338)
• Bingo card markers (pennies, dry beans, or other items)
• Pens
• Stamped envelopes
• (Optional) Food (if having a potluck)
• (Optional) Small gift or certificate for each group member (page 341)

Session 11. Review and Graduation 315

Handouts

Give group members these handouts during this session:

• “Heart Health Bingo Facts” (pages 322–323)
• “Heart Health Bingo Cards” (pages 324–338)
• (Optional) “Letter to Myself Sample” (page 339)
• “Letter to Myself” (page 340)
• “Certificate of Achievement” (page 341)*
• Prepare the certificates before the session. You can photocopy the “Certificate of Achievement” handout and write in the name of each participant, or you can find certificates in a business supply store.

Session Outline

Introducing the Session

1. Welcome
2. Review of Last Week’s Session
3. About This Session

Conducting the Session

1. Heart Health Bingo*
2. Letter to Myself Activity

Recognition for Completing the Your Heart, Your Life Project (Optional) Potluck Meal

Closing

• Prepare the bingo cards and bingo facts before the session.

316 Your Heart, Your Life: A Community Health Worker’s Manual

Introducing the Session

1. Welcome

• Welcome group members to the session.

2. Review of Last Week’s Session

Note: If group members went on a grocery store tour, ask them to share what they learned from the tour. If not, go to the following review of Session 10.

During Session 10, we talked about the ways cigarette smoking can harm you. Who can name some of the harmful effects of smoking?

Note: Allow 3 to 5 minutes for group members to respond. Write their answers on the blackboard or on a large piece of paper taped to the wall.

• Add these effects if they are not mentioned.

• Cigarette smoking can cause health problems, such as:

• Heart disease — Stroke — Asthma
• Cancer — Emphysema

• Cigarette smoking irritates the eyes and can trigger asthma attacks.

• Less serious, but very unpleasant, effects of smoking include:

• Yellow stains on teeth and fingers — Early wrinkling of the face
• Bad breath — Many colds and sore throats
• Poorer sense of smell and taste

Session 11. Review and Graduation 317

• Ask:

How did you do with your pledge to do one thing to quit smoking or to protect your family from secondhand smoke? Did anything work very well? Did anything cause a problem?

Note: Allow 5 to 8 minutes for group members to comment.

3. About This Session

During this session, we will go over information we learned in Sessions 1 through 10. Thank you all for taking part in the sessions, and congratulations for making the effort to learn how to lower the risk of heart disease, stroke, and diabetes for you and your families.

Conducting the Session

1. Heart Health Bingo

Note: Make one copy of the “Heart Health Bingo Facts” handout (pages 322–323) on stiff paper, and cut the paper on the dotted lines. Mix the pieces, and place them in a box. Also make one copy of each of the Heart Health Bingo Cards (pages 324–338) on stiff paper, and cut them out.

• Give one card to each person. Give each group member nine pennies, nine dry beans, or a set of nine other items that can be used to mark the cards.

We are going to play a bingo game to review facts about preventing heart disease, stroke, and diabetes. Here’s how to play:

1. To start, place a marker on the free space in the center of the card.

318 Your Heart, Your Life: A Community Health Worker’s Manual

1. Listen as the bingo caller reads facts about heart health. These facts will be drawn from a box.
2. If the fact that is read matches a fact on your card, place a marker on it.
3. If you get three markers in a row, call out “Bingo.” The row can be up and down, across, or diagonal.

• Hold up a card to show the group how rows can look.

Note: Play two or three games as time permits. At the end of each game, have the group members turn in their card for new ones. If possible, you may want to award small prizes to the winners.

2. Letter to Myself Activity

Note: Bring a stamped envelope and pen for each group member. If you have group members who do not write well, let them tell you the information and you can write it down for them.

• Give each group member a pen, the “Letter to Myself” handout (page 340), and a stamped envelope. You may want to show or read aloud the “Letter to Myself Sample” handout (page 339) to give group members ideas.
• Ask the group members to use the handout to list healthy changes they will continue to work on until these changes become habits.
• Tell them to address the envelope to themselves and place the letter inside. Collect the sealed, self-addressed envelopes.

I will mail your letter to you in about 3 months. Getting this letter will help remind you to keep using what you’ve learned in these sessions to care for your heart.

Session 11. Review and Graduation 319

Recognition for Completing the Your Heart, Your Life Training

• Show picture card 11.1.

PICTURE CARD

Everyone gave time and effort to attend the sessions. I hope you will use the information to help improve your heart health and your family’s heart health.

• (Optional) If you choose, give small gifts to group members.

Now, I would like to give each of you a certificate to honor your efforts and your achievements.

• Call each group member’s name and give each person the “Certificate of Achievement” handout (page 341) or the small gift of recognition.

Now you have a chance to talk about what you have found helpful. Would anyone like to share your family’s reactions to your pledged activities?

Note: Allow a moment for group members to respond.

I would also like to know if you have done any activities from the “Tender Care for a Happy Heart” list that I gave you during Session 2. How did you do with the actions for a happy heart? Are you listening to soft music? Have you planted a garden? Have you learned to breathe deeply? Have you shown gratitude to others? Which of these actions has affected you the most? Have you done any of these actions as a daily activity?

Note: Allow 2 to 3 minutes for group members to respond.

320 Your Heart, Your Life: A Community Health Worker’s Manual

(Optional) Potluck Meal

Now is the time for the potluck meal. Please place the dishes you brought on the table. We will begin the celebration.

Closing

Thank you for coming and for completing the program. I wish everyone well, and I hope you continue your journey toward good health and a healthy heart.

Note: Think about today’s session and about all of the training that you have done during the last few months. What do you think worked and didn’t work? What changed in your own life as a result of what you learned during these sessions?

Session 11. Review and Graduation 321

Heart Health Bingo Facts

(Photocopy, and cut on the dotted lines.)

Protect your heart. When the heart stops, life stops.

Physical activity makes your heart and lungs stronger.

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

A blood pressure reading of 140/90 millimeters of mercury (mmHg) or greater is high.

Hypertension is another term for high blood pressure.

Use herbs and spices instead of salt.

Being overweight increases your risk of heart disease and diabetes.

People with diabetes can die from heart disease or stroke.

To lose weight, cut down on portion size and be more active.

A body mass index (BMI) tells you if you are overweight. A BMI under 25 is a healthy weight.

If your waist measurement is high, you are at risk for heart disease.

Each day, do at least 30 to 60 minutes of physical activity and encourage your children to be active for 60 minutes.

It is best to have a blood pressure reading below 120/80 millimeters of mercury (mmHg).

Eat less salt and sodium to help prevent high blood pressure.

Heart attack warning signs are pain in the chest, arms, back, neck, or jaw; difficulty breathing; light-headedness; cold sweat; and feeling sick to your stomach.

If you are prescribed blood pressure or cholesterol medication, take it as the doctor tells you.

Being overweight increases your risk of high blood pressure and high blood cholesterol.

If someone is having a heart attack or stroke, do not drive him or her. Call 9–1–1 right away.

The food label gives the serving size and the number of calories in a serving.

Eat more fruit each day. Have a banana with your cereal for breakfast.

HAndOuT—SeSSiOn 11

Heart Health Bingo Facts

(Photocopy, and cut on the dotted lines.)

Eat more vegetables each day. Have a salad for lunch.

To save food dollars, plan weekly menus. Shop with a list!

Smoking causes serious health problems, such as heart disease and lung cancer.

Children of smokers are more likely to become smokers.

Prediabetes means that you are on the way to developing diabetes. Act now—lose weight if overweight and become active.

The signs of diabetes are increased thirst, hunger, and urination; fatigue; weight loss; blurred vision; and sores that don’t heal.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

High blood pressure makes your heart work harder.

Beans, rice, fruits, and vegetables are naturally low in fat.

A healthy triglyceride level is less than 150 milligrams per deciliter (mg/dL).

When eating out, order baked, broiled, or grilled foods to cut down on fat and calories.

Try fruit and fat-free yogurt for snacks.

Pregnant women should not smoke.

A desirable LDL (bad) blood cholesterol level is below 100 mg/dL.

Cholesterol can clog your arteries and cause a heart attack or stroke.

Trim visible fat from meat before cooking.

Saturated fat is found in high-fat meat, cheese, milk, and butter.

Cook more food than you need and freeze part to use when you don’t have a lot of time to cook.

Drain meat after it is cooked to get rid of some of the fat.

To prevent diabetes, keep your weight down, and be physically active.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 1

Heart Health Bingo

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

Trim visible fat from meat before cooking.

Nutrition Facts

Serving Size 1 oz Servings Per Container 7

Amount Per Serving

Calories 120 Calories from Fat 90

% Daily Value*

Total Fat 10g 15% Saturated Fat 7g 35% Trans Fat 0g

Sugars 0g Protein 6g

Vitam in A 6% V itamin C 0 % Calcium 20% Ir on 0%

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

Use herbs and spices Children of smokers are instead of salt. more likely to become smokers.

FREE

The signs of diabetes are increased thirst, hunger,

SPACE and urination; fatigue;

weight loss; blurred vision; and sores that don’t heal.

Chicken Stew

Cook more food than you need and freeze part to use Eat more vegetables each when you don’t have a lot day. Have a salad for lunch. of time to cook.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 2

Heart Health Bingo

High blood pressure makes your heart work harder.

Beans, rice, fruits, and vegetables are naturally low in fat.

FREE If someone is having a SPACE

heart attack or stroke, do not drive him or her. Call 9–1–1 right away.

Danger! 140/90 or more

A blood pressure reading of 140/90 mmHg or greater is high.

If your waist measurement is high, you are at risk for diabetes.

HAndOuT—SeSSiOn 11

16 – Cheddar Cheese

Nutrition Facts

Serving Size 1 oz Servings Per Container 7

Amount Per Serving

Calories 120 Calories from Fat 90

% Daily Value*

Total Fat 10g 15% Saturated Fat 7g 35% Trans Fat 0g

Sugars 0g Protein 6g

Vitam in A 6% Vitamin C 0%

Calcium 20% Iron 0%

• Percent Daily Values are based on a 2,000- calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Use the food label to choose foods lower in saturated fat, trans fat, and cholesterol.

Saturated fat is found in high-fat meat, cheese, milk, and butter.

Pregnant women should not smoke.

Heart Health Bingo Card 3

Heart Health Bingo

Children of smokers are more likely to become smokers.

Protect your heart. When the heart stops, life stops.

To lose weight, cut down on portion size, and be more active.

Chicken Stew Date: 1/8/2000

Cook more food than you

need and freeze part to use when you don’t have a lot of time to cook.

To prevent diabetes, keep your weight down, and be physically active.

FREE SPACE Eat less salt and sodium

to help prevent high blood pressure.

Prediabetes means that you are on the way to developing diabetes. Act now—lose Eat more vegetables each weight if overweight and day. Have a salad for lunch. become active.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 4

Heart Health Bingo

Cholesterol can clog your Eat more fruit each day. arteries and cause a heart Have a banana with your Hypertension is another term attack or stroke. cereal for breakfast. for high blood pressure.

16 – Cheddar Cheese

Nutrition Facts

Serving Size 1 oz Servings Per Container 7

Amount Per Serving

Calories 120 Calories from Fat 90

% Daily Value*

Total Fat 10g 15% Saturated Fat 7g 35% Trans Fat 0g

♥ Cholesterol 30mg 10%

Sugars 0g Protein 6g

FREE

Vitam in A 6% Vitamin C 0%

Calcium 20% Iron 0%

• Percent Daily Values are based on a 2,000- calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.

Smoking causes serious SPACE The food label gives the

health problems, such as serving size and the number heart disease and lung cancer. of calories in a serving.

Weight in Pounds (lbs)/Kilograms (kg)

100 lbs45 kg 110 lbs50 kg 120 lbs54 kg 130 lbs59 kg 140 lbs63 kg 150 lbs68 kg 160 lbs73 kg 170 lbs77 kg 180 lbs82 kg 190 lbs86 kg 200 lbs91 kg 210 lbs95 kg 220 lbs100 kg 230 lbs104 kg 240 lbs109 kg 250 lbs113 kg

Desirable! 1.60 m5’4”

1.63 m5’5” 19 21 22 24 26 28 29 31 33 34 36 38 40 41 43

1.65 m5’6” 18 20 22 23 25 27 28 30 32 33 35 37 38 40 42

18 19 21 23 24 26 27 29 31 32 34 36 37 39 40

less than 1.70 m1.68 m5’7” 19 20 22 24 25 27 28 30 31 33 35 36 38 39

1.73 m5’8” 18 20 21 23 24 26 27 29 30 32 34 35 37 38

Height in Feet and Inches/Meters (m)1.75 m5’9”1819 21 22 24 25 27 28 30 31 33 34 35 37

100 1.78 m5’10” 19 20 22 23 24 26 27 29 30 32 33 35 36

1.80 m5’11” 18 20 21 22 24 25 27 28 29 31 32 34 35

1.83 m6’0” 16 18 19 20 22 23 24 26 27 28 30 31 33 34

6’1” 16 19 20 21 22 24 25 26 28 29 30 32 33

Heart attack warning signs 1.85 m Healthy Weight Overweight Obese are pain in the chest, arms, back, neck, or jaw; difficulty A BMI (body mass

breathing; light-headedness; cold sweat; and feeling sick to your stomach.

A desirable LDL (bad) blood cholesterol level is below 100 mg/dL.

index) tells you if you are overweight. A BMI under 25 is a healthy weight.

HAndOuT—SeSSiOn 11 327

Heart Health Bingo Card 5

Heart Health Bingo

Each day, do at least 30 to 60 minutes of physical activity and encourage your children to be active for 60 minutes.

When eating out, order baked, broiled, or grilled foods to cut down on fat and calories.

Trim visible fat from meat before cooking.

Fat-free Yogurt

Being overweight increases Try fruit and fat-free your risk of heart disease yogurt for snacks. and diabetes.

FREE SPACE

A healthy triglyceride level is below 150 mg/dL.

If you are prescribed blood

pressure or cholesterol medication, take it as the doctor tells you.

To save food dollars, plan weekly menus. Shop with a list!

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 6

Heart Health Bingo

FAT

The signs of diabetes are increased thirst, hunger, and

urination; fatigue; weight loss; blurred vision; and sores that don’t heal.

Drain meat after it is cooked to get rid of some of the fat.

FREE People with diabetes can SPACE

die from heart disease or stroke.

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

If your waist measurement is high, you are at risk for heart disease.

HAndOuT—SeSSiOn 11

Below 120/80

It is best to have a blood pressure reading below 120/80 mmHg.

Use herbs and spices instead of salt.

Hypertension is another term for high blood pressure.

Heart Health Bingo Card 7

Heart Health Bingo

Desirable! less than

A desirable LDL (bad) blood cholesterol level is below 100 mg/dL.

Eat more vegetables each day. Have a salad for lunch.

Pregnant women should not smoke.

Physical activity makes your Hypertension is another term heart and lungs stronger. for high blood pressure.

FREE SPACE

A healthy triglyceride level is below 150 mg/dL.

Danger! 140/90 or more

Use herbs and spices A blood pressure reading instead of salt. of 140/90 mmHg or greater is high.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 8

Heart Health Bingo

Beans, rice, fruits, and vegetables are naturally low in fat.

Smoking causes serious health problems, such as heart disease and lung cancer.

Danger! 140/90 or more

A blood pressure reading of 140/90 mmHg or greater is high.

Being overweight increases your risk of high blood Physical activity makes your pressure and high heart and lungs stronger. blood cholesterol.

FREE

Saturated fat is found in

SPACE

high-fat meat, cheese, milk, and butter.

To save food dollars, plan weekly menus. Shop with a list!

To lose weight, cut down on portion size, and be more active.

HAndOuT—SeSSiOn 11 331

Heart Health Bingo Card 9

Heart Health Bingo

Pregnant women should not smoke.

Chicken Stew Date: 1/8/2000

Cook more food than you need and freeze part to use when you don’t have a lot of time to cook.

If someone is having a heart attack or stroke, do not drive him or her. Call 9–1–1 right away.

FAT

Eat more vegetables each day. Have a salad for lunch.

Drain meat after it is cooked to get rid of some of the fat.

FREE SPACE

A stroke happens when blood and oxygen can’t get to the brain. The brain starts to die.

When eating out, order baked, broiled, or grilled foods to cut down on fat Protect your heart. When and calories. the heart stops, life stops.

HAndOuT—SeSSiOn 11

Heart Health Bingo Card 10

Heart Health Bingo

High blood pressure makes your heart work harder.

Chicken Stew Date: 1/8/2000

Cook more food than you need and freeze part to use when you don’t have a lot of time to cook.

If your waist measurement is high, you are at risk for heart disease.

Saturated fat is found in Eat less salt and sodium high-fat meat, cheese, milk, to help prevent high and butter. blood pressure.

FREE Heart attack warning signs

are pain in the chest, arms, back, neck, or jaw; difficulty

SPACE

breathing; light-headedness; cold sweat; and feeling sick to your stomach.

If someone is having a

Children of smokers are more likely to become smokers.

heart attack or stroke, do not drive him or her. Call 9–1–1 right away.

HAndOuT—SeSSiOn 11 333

Heart Health Bingo Card 11

Heart Health Bingo

Weight in Pounds (lbs)/Kilograms (kg)

100 lbs45 kg 110 lbs50 kg 120 lbs54 kg 130 lbs59 kg 140 lbs63 kg 150 lbs68 kg 160 lbs73 kg 170 lbs77 kg 180 lbs82 kg 190 lbs86 kg 200 lbs91 kg 210 lbs95 kg