50k4Life: A SMART Study Protocol to Improve Walking Engagement in Public School Employees on the US-Mexico Border

Abstract

Introduction:

Mexican Americans living in the U.S.-Mexico border region suffer disproportionately from preventable cardiometabolic and cancer diseases. Workplace health promotion programs that include physical activity promotion are promising strategies to address this public health problem to improve physical activity engagement. Workplace-based programs can increase moderate to vigorous physical activity (MVPA) engagement while addressing barriers associated with inactivity.

Methods:

We plan to conduct a clustered Sequential Multiple Assignment Randomized Trial (SMART) to determine the effectiveness of a workplace walking challenge intervention – 50,000 for Life (50K4Life) – in improving brisk walking engagement (at least 7,000 steps/day, representing approximately 50,000 steps/week) for public school employees. The two-phase trial will include 30 public schools in two cohorts (15 per cohort) with predominantly Mexican American employees from El Paso County area schools in Texas on the U.S.-Mexico border. In Phase 1, the schools will be randomly assigned to 50K4Life or 50K4Life plus app-based push notifications. In Phase 2, schools with 50% or more participants accumulating 50,000 steps/week will continue receiving the same intervention. The remaining schools will be randomly assigned to receive individual or school-level intervention. As part of our intervention evaluation, we will conduct a process and cost-effectiveness evaluation to provide insight into cost and scalability.

Discussion:

This study will provide evidence to support the implementation of walking challenge-based interventions that improve engagement among Mexican Americans living in the U.S.-Mexico border region.

1. Introduction:

El Paso, Texas, located on the United States (U.S.)-Mexico border (82.9% Mexican American residents), has a disproportionate burden of cardiometabolic diseases and cancers [1]. While evidence exists that moderate to vigorous physical activity (MVPA), including regular walking, enhances cardiometabolic health, [2–6] engagement in El Paso is suboptimal. Half of adults do not meet the physical activity recommendation of at least 30 minutes of daily MVPA at least five days a week [7,8]. The recommended MVPA dose is equivalent to brisk walking between 7,000 to 11,000 steps/day [9,10]. While national surveys found that American adults walk on average 5,000 steps a day, an increment of 1,000 or 2,000 steps a day can significantly reduce risks for death, cardiometabolic diseases, cancers, and work productivity [11,12]

There is limited research on the feasibility or effectiveness of walking-based programs from the U.S.-Mexico border region [13]. Evidence suggests that walking programs offer health benefits, potential for scaling up, and a low-cost solution to physical inactivity. Through our Border Coalition for Fitness (community-driven walking programs), we demonstrated the feasibility and efficacy of our walking challenge program [13,14] but have not formally tested this model in workplace settings.

Evidence-based programs (EBPs) to improve walking among Mexican Americans have been primarily implemented in the community and not the workplace [15–17]. Existing EBPs are designed to reduce barriers to physical activity, such as inadequate built environment to support leisure-time physical activity, [15–17] socioeconomic barriers that prevent access to physical activity, [15] and cultural norms around family responsibilities [18, 19].

Nearly a quarter of employed El Paso-residing Mexican American adults work in the public education sector (24.9% [U.S. 16.5%]) [28]. American public schools typically share similar organizational and physical infrastructures that can be leveraged for effective dissemination. There is evidence that school-site workplace wellness programs improve health, physical inactivity, poor diet, and sleep [20–22] Moreover, school staff who practice a healthy lifestyle are more likely to implement policies and practices promoting student health [22].

Strategies targeting workplace behaviors, policies, and built environment at the workplace are effective in increasing physical activity [23–25]. The Sequential Multiple Assignment Randomized Trial (SMART) design allows researchers to combine different treatments initially and then rerandomize participants who are not responsive to adaptive treatment combinations [26]. We describe here the study protocol for our SMART study to increase walking engagement among Mexican American school-based employees residing on the U.S.-Mexico border region.

2. Methods.

The trial protocol (NCT06411769) is registered with ClinicalTrials.gov, and the full protocol is available there. Results will be updated and published on this website. All procedures were performed in compliance with relevant laws and institutional guidelines and have been approved by the University of Texas at El Paso’s Institutional Review Board (2089761-6 October 10,2024) Data from this study may be accessed upon request from the corresponding author at jsalinas7@utep.edu.

2.1. Study Design

This SMART study will assess the effectiveness of a daily brisk walking intervention, 50,000 Steps for Life (50K4Life), delivered via two-Phased adaptive treatments to public school employees in 30 public schools (Figure 1). In Phase 1, all study schools will be randomly assigned to one of two 8-week treatments: a) 50K4Life, or b) 50K4Life + app-based push notifications. The 8-week time frame is based on step patterns observed in our prior citywide walking challenge campaign [13]. Responding schools will continue with their Phase 1 treatment assignment in Phase 2. Non-responding schools will be randomized to Phase 2 adaptive treatments. Schools will be considered responders if at least 50% of school participants meet the Phase 1 goal of achieving 50,000 steps per week during the 8 weeks. Based on the Working Women’s Walking Program outcomes, we estimate that 50% of schools from Phase 1 will be non-responders [27]. The non-responding schools will be randomly assigned to an additional 4-month adaptive treatment: a) Individual-based coaching and online education modules (REM) available through a mobile health app (MHA), or b) School-based walking advocacy training and a training handbook. Data collection will occur at baseline, 8 weeks (Phase 2 randomization decision point), 6 months, 12 months, and 18 months.

Figure 1:

50k4Life Study Design Overview

2.2. Study aims

Aim 1:

To evaluate Phase 1 effectiveness of two initial treatments, 50K4Life versus 50K4Life + App-based push notifications, in step goal attainment in school employees.

Hypothesis Aim 1:

50K4Life + App-based push notification schools, will have a higher percentage of participants meeting weekly step goals compared to 50K4Life-only schools.

Aim 2.

Compare the effectiveness of the four adaptive treatments implemented under two-phased SMART design with Phase 2 adaptations (adaptations at the individual level and school level) on step goal attainment in school employees.

Hypothesis Aim 2a:

Schools that receive 50K4Life + App-based push notifications + school walking advocacy training will have a higher percentage of employees meeting weekly step goals than schools that receive 50K4Life + Individual-coaching, 50K4Life + App-based push notifications + Individual-level coaching or 50K4Life + School-level group advocacy training.

Hypothesis Aim 2b:

Schools that receive school walking advocacy training will have a greater percentage of employees who meet their weekly step goals than employees at schools that receive individual coaching.

A cost-effectiveness analysis will be conducted to identify the most cost-effective intervention among the four adaptive treatments. The study also aims to determine fidelity, reach, participant satisfaction through implementation monitoring. We anticipate that schools that integrate 50K4Life into their day-to-day routine will exhibit better outcomes from the 50K4Life program.

2.3. Participants

2.3.1. Study Setting

Schools from three school districts in El Paso Area, Texas are the setting for the proposed study. Participating school districts represent nearly 9,000 staff from urban and rural communities and reflect the predominantly Mexican American community of El Paso. Given that 80% of school district employees are full-time and 90% are campus-based, we estimate that 6,480 employees (an average of 65 employees at each school campus) work at a school in the target districts at the start of each academic year. We will recruit at least 15 employees per school at 30 schools into the study (n=406). This number includes 47% more employees than needed to accommodate for attrition and maintain adequate power in Phase 2.

2.3.2. Sample Size

Power and sample size calculation for this SMART design trial will follow Artman et al. [28], Seewald et al. [29], and Kidwell et al. [30] sample size estimation protocols for an embedded dynamic treatment regime. A SMART design is a dynamic treatment regime that tests more than two treatments to improve individualized response through tailored adaptation.[27] For the proposed study, we calculate the sample size based on the binary outcome: treatment response (1= achieved vs. 0= not achieved. Combining the two initial treatments (50K4Life and 50K4Life+App-based push notifications), along with the potential two adaptive treatments for the non-responders (individual coaching or group training), creates four parallel intervention arms in Phase 2. Using a conservative approach of a success probability of .50 in Phase 1 and between .30 and .50 in Phase 2 intervention arms, at .80 power and .05 alpha for a two-tailed test and intraclass correlation between .30 and .35, we expect to need 9 to 15 employees per school for a total of 295 participants. Because we expect some attrition throughout the study, our target recruitment will be 406 participants (30 schools/11-15 employees per school). Based on results from our most recent Walk the Walk Team Challenge, 61.9% of school employees who participated met the 50,000 steps per week during the challenge. Applying 38.1% not successfully meeting the goal, from the 406 recruited participants, we expect to randomize 10 schools (156 participants) into one of two Phase 2 intervention arms (78 participants in each arm).

2.3.3. Participant recruitment

A letter signed by school district wellness staff and the principal investigator will be sent to school principals during the spring term before the study launches. Recruitment will occur in two cycles over three years, creating two intervention cohorts. Recruitment for Cohort 1 (15 schools) will begin in August 2025. Recruitment of Cohort 2 (15 schools) will start upon completion of Cohort 1, August 2026, and both challenges will begin in September of their respective recruitment year.

2.3.4. Inclusion and exclusion criteria.

Phase 1 inclusion: A school is eligible if it is located within one of the three target school districts. Individual-level eligibility will include: 1) adult 18 years or older; 2) full-time school-based school district employee; 3) not pregnant and able to walk without physical limitations or assistive device; 4) willing to wear a physical activity tracking device (a personal device or a study-issued device) for 18 months; 5) own a smartphone; and 6) willing to use app on personal smartphone for tracking step counts, to access online intervention content, and to receive notifications. Exclusion: Works at more than one school and does not work on a district school campus.

2.3.5. Retention

Incentives will be provided to encourage employees to participate in each data collection event. The incentives may include program merchandise such as gift cards, food, and refreshments. Employees and management will provide input on the final incentives during the pilot study.

2.3.6. Intervention delivery platform: Mobile health application.

The 50K4Life intervention will be delivered using a HIPAA-compliant mobile health application (MHA) to support the delivery of the walking challenge intervention [31]. The MHA is a no-code app builder platform with a web portal for researchers to create, deliver, and manage the intervention and a front-end user-friendly app. During Phase 1, participants will be onboarded to the MHA. The MHA will be used for self-monitoring daily steps, team challenge ranking, deliver push notifications, and housing Phase 2 education modules. Figure 2 illustrates the five MHA functions that will be used (Challenge Leader Board, Push Notifications, Self-Monitoring, Education and Resources, and Team Forum).

Figure 2.

MHA functions in 50K4Life delivery

2.4. Conceptual Framework

The adapted Social Ecological Model by Sallis et al. [32] for creating active communities considers social and built environment barriers/facilitators to successful MVPA engagement will serve as the framework for 50k4Life (see Figure 3). Literature identified social and structural determinants of health [33–35] and intra- and interpersonal barriers and facilitators [36–39] contribute to low uptake and poor retention in workplace physical activity interventions [39] Research examining feasibility and effectiveness in the Mexican American workplace population is sparse despite this promising evidence. Our proposed multi-level intervention, 50K4Life, is designed to advance health equity by implementing evidence-based treatment strategies. These strategies target intrapersonal, interpersonal, and organizational influences on program barriers and facilitators to increase walking engagement for U.S.-Mexico border public-school employees.

Figure 3.

SEM Conceptual Framework.

2.5. Intervention

50K4Life is a brisk walking challenge program incorporating elements of tested walking challenges, including teams, step counts, and goal setting. In Phase 1 of the intervention, there are two study treatments: 50K4Life only or 50K4Life+MHA push notifications. In Phase 2 adaptive treatments at the individual and school level will be added to the Phase 1 conditions.

2.5.1. Primary Intervention

2.5.1.1. 50k4Life

In Phase 1, the 50K4Life team-based walking challenge will incorporate a socio-ecological approach to health promotion programming by activating a social network, leveraging social support, promoting social comparison, and increasing motivation through perceived control [40–42]. Employees will be challenged to achieve and sustain 50,000 steps per week (~7,000 steps per day). During Phase 1, the goal is to increase steps by 10% working towards 50,000 steps per week by the end of 8 weeks for participants who are not already meeting that goal. Participants will track their steps using an activity tracking device interfaced with the MHA and monitor the progress of their school’s team relative to other schools.

2.5.1.2. App-based push notifications.

Participants in the 50K4Life+App-based push notifications treatment arm will receive regular, tailored push notifications. The strategies are evidence-based and tested as a stand-alone strategy to improve MVPA and walking engagement [42–43]. We will deliver weekly tailored notifications that are strategic, motivational or provide resources to help participants achieve step-goals.

2.5.2. Adaptive treatments

2.5.2.1. Individual-based treatments

2.5.2.1.1. One-to-One Coaching (1:1C)

Evidence-based one-to-one coaching strategies and content adapted from Enlace and Healthy Frio studies will be delivered in video conferencing-based sessions (up to 6 per participant) [45]. Phone and video conference (Zoom, Teams, etc.)-based sessions are effective, convenient, flexible, and safe [46]. A Motivational Interviewing (MI) trained health educator or master’s level social work student will conduct the sessions. Goal setting will focus on walking frequency and duration, increasing step counts, and how to leverage community resources to support weekly step goal achievement. All sessions will be delivered in English or Spanish based on participant’s preference.

2.5.2.1.2. Online Interactive Education Lessons

Using adapted content and strategies from Enlace and e-learning approaches from Healthy Frio [45], we will deliver interactive education content created with Articulate Storyline 360 (Articulate Global, LLC, New York, New York). All lessons will be narrated in Spanish and English to facilitate content comprehension. Educational topics will include the benefits of an active lifestyle, physical activity guidelines, and behavioral skills to support health behavior change (e.g., goal setting, self-monitoring, problem-solving). The lessons will also cover strategies to overcome barriers to walking goal achievement, such as meeting weekly step goals. Lessons will be made available to participants through the 50k4Life MHA.

2.5.2.2. School-based Treatment

2.5.2.2.1. School Environmental Change Training

We will deliver twelve weeks of environmental change intervention content during Phase 2. Walking Champions will self-identify from current participants in 50k4Life at schools randomized to the School Environmental Change condition. A 50k4Life facilitator will provide content on identifying barriers to walking at school, selecting and prioritizing strategies that address existing barriers to walking, team goal setting, action planning, advocating with leadership, and planning for sustainability. Walking Champions will be provided with an electronic copy of the Walking Champion Handbook. Session content and worksheets will be delivered in-person by a 50k4Life facilitator or through pre-recorded videos available on the study app based on Walking Champion availability. Intervention content also will include examples of evidence-based strategies for social and built environmental change and policy updates including forming and maintaining walking groups, mapping walking routes, low- or no-cost building modifications, and motivational signage and decision prompts. 50k4Life facilitators will check in with Walking Champions weekly for progress updates and to assist in problem-solving as needed.

2.6. Procedures

2.6.1. Study timeline

The proposed project will take place over five years. The intervention will be implemented in two cohorts starting in Year 2, with assessments continuing into Year 5. We will finalize data analyses and disseminate results in Years 4 and 5.

2.6.2. Study Preparation and Formative Work

2.6.2.1. Community Advisory Board

During Year 1 we convened working groups to plan and prepare for the intervention. We will work closely with a Community Advisory Board (CAB). CAB members are school employees, city and county employees and special interest group representatives. The CAB meets monthly and will ensure the following: 1) intervention components and activities are tailored to the needs (logistical, cultural, and linguistic) of the study population; 2) protocols are feasible; and 3) effective communication and decision-making processes are in place to resolve study implementation problems.

2.6.2.2. Beta Testing and Pilot Study

During the beta test, participants used the MHA to participate in a two-week-long walking challenge. Participants provided feedback on their experiences using the MHA during the walking challenge. Information from the beta test was used to inform the pilot test. During the pilot test, participants took part in Phase 1 and Phase 2 intervention treatments during walking challenges delivered during fall and spring school semesters. Baseline and follow-up, and program evaluation were collected. Other activities included protocol development, hiring and training research staff, completing IRB submission and review, developing training and recruitment materials, preparing schools for intervention implementation, and conducting a formative evaluation.

2.7. Study Outcomes Measurement

Study outcomes (see Table 1) will be measured following a standardized data collection protocol.

Table 1.

Study Outcome Measures

Measure	Instrument	Measure Time
Daily step counts	Step counts from electronic physical activity tracking device (steps/day)	Daily
Cardiorespiratory Fitness (CVF).	the YMCA 3-minute submaximal bench-stepping test [48]	T0, T1, T2, T3
Anthropometrics	Weight (kg), height (cm), waist circumference (cm), and body mass index (kg/m2)	T0, T1, T2, T3
Exercise intention	The Theory of Planned Behavior Questionnaire [49]	T0, T1, T2, T3
Exercise motivation	Behavioral Regulation in Exercise Questionnaire-2 [50]	T0, T1, T2, T3
	Basic Psychological Need Satisfaction and Frustration Scales [51]	T0, T1, T2, T3
Exercise self-efficacy	Sallis’ self-efficacy scales for exercise behaviors [52]	T0, T1
Presenteeism	Work Limitations Questionnaire [53]	T0, T1
Absenteeism	Health and Work Performance Questionnaire [54]	T0, T1
Social Support	Sallis’ physical activity support scale [55]	T0, T1
Perceived physical activity benefits and barriers	Decisional Balance Scale [56]	T0, T1
Social control	Collective Efficacy Scale [57]	T0, T1
Workplace support	Perceived support from supervisors, coworkers, and overall organizational commitment [58]	T0, T1
Demographic Variables	Age, current marital status, educational attainment, acculturation, nativity, current employment status and occupation, household size, and family income	T0

Key: T0 = Baseline, T1 = 6 Months, T2 = 12 Months, T3 = 18 Months.

The primary study outcome is daily step counts (steps/day).

The participants will wear a physical activity tracker for step count tracking that will be synchronized to MHA database on a daily and weekly basis. Fitbits and Apple Watches have been used extensively to collect step counts in similar studies [46]. Although there is some concern over devices’ accuracy, contemporary activity trackers are reliable and acceptable for tracking normal-paced activity, such as walking [47].

2.7.1. Secondary Outcome Measures.

Secondary outcome measures include: 1) The YMCA 3-minute submaximal bench-stepping test [48]. 2) Weight (to the nearest 0.1 kg), 3) Height (measured to the nearest 0.1 cm), and 4) Body Mass Index (BMI) will be calculated as weight (kg)/height squared (m2). All measurements will occur twice, and the average will be used.

2.7.2. Covariate Measures.

2.7.2.1. Physical Activity-Related Variables.

Physical activity-related measures will include the Theory of Planned Behavior Questionnaire (TPB), Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2), Basic Psychological Need Satisfaction and Frustration Scales (BPNSFS), and Sallis et al.’s self-efficacy scales for exercise behaviors [49–51].

2.7.2.2. Individual Work-Related Outcomes.

Productivity losses will be measured as physical or mental illness or injury, and absenteeism [53,54].

2.7.2.3. Demographic Variables.

Demographics will be collected at baseline only and will include age, current marital status, educational attainment, acculturation, nativity, current employment status and occupation, household size, and family income.

2.7.2.4. Psychosocial Variables.

Physical activity psychosocial variables will include Sallis et al.’s scale social support scale, Marcus et al.’s Decisional Balance Scale and Sampson et al. mutual trust/cohesion and shared expectations for social control indices [55–58].

2.8. Data Management

2.8.1. Data Analysis Plan

2.8.1.1. General Analytical Approach for Primary Aims.

Analyses will be conducted to determine: 1) the effect of the Phase 1 intervention arms on step goal achievement at 8 weeks (decision point), 8 months, 12 months, and 18 months; 2) the the non-randomized comparison of four adaptive treatments in Phase 2 in non-responder schools participants at 8 months, 12 months and 18 months; and 3) the effectiveness of the two Phase 2-introduced adaptive treatments (Individual vs. School). Data collected at baseline, 8 weeks, 8 months, 12 months, and 18 months will be cleaned and evaluated for general trends. Analyses will be conducted to determine employee reach (participation per school), dosing (duration in challenge, adaptive treatments received), and fidelity (intervention delivered as intended).

2.8.2.2. Analytical approach for hypothesis testing of Primary Aims.

Frequencies and percentages of participants and schools who achieved the step goal of 50,000 per week will be calculated, and comparisons made by intervention strategies in Phase 1 (Primary Aim 1), Phase 2 four treatment strategies (Primary Aim 2) and effectiveness of adaptive strategies: Individual vs. School. Additionally, we do not anticipate the point estimation of responding rate from phase 1 to be less than 50% given results from the pilot test indicated an approximate 10% attrition rate. However, we will assess attrition closely during cohort 1 and if needed will make adjustments in recruitment to offset the effects of attrition observed during the first cohort. Additionally, if the response rate deviates substantially from 0.50, we will request robust (empirical) standard errors from our random-effects regression model. We will also use the Morel, Bokossa, Neerchal bias correction of the traditional sandwich estimator which incorporates a sample size correction.

2.8.2.1. Primary Aim 2.

We will conduct modeling that accounts study design’s multi-level and temporal nature. Mixed-effects models will be conducted using STATA 16, depending on the structure of the outcome variable (goal achievement vs. weekly step average) [59]. In this case, time-points of measurement are nested within subjects in a random intercept model [59]. Random coefficient modeling will be conducted using random-effects variables at the participant level that will be both fixed (nativity, occupation, education, baseline age, etc.) and time-varying (e.g., behavior over time, etc.).

2.8.2.2. Primary Aim 1 and 2.

As outlined by MacKinnon, mediation will be assessed by conducting two regression models [60]. The first model will regress the change in the hypothesized mediators on Phase 1 and Phase 2 intervention arms (α coefficient path). The second model will regress the change in the outcome variable (e.g., steps) on Phase 1 and Phase 2 intervention arms and change in the hypothesized mediator (β coefficient path). To assess the magnitude of the effect for each potential mediator, the Sobel-Goodman test will be conducted using mediation in STATA 16 SE [59]. This method provides direct and indirect effect estimates, the proportion of effect explained by a mediator, and significance testing. All analyses will use intent-to-treat principles.

Primary Aim 2:

Weekly step trajectories will be assessed to determine differences between adaptive strategies introduced in Phase 2 using mixed-effects linear regression analysis. Additionally, an analysis will be conducted to identify any critical inflection points during the post-intervention follow-up period using growth-curve modeling or other linear time series modeling. Assessment will be made to determine the direction (i.e., increases or decreases) of changes in step goal achievement at 8 months (immediate post-intervention), 12 months (4 months post-intervention), and 18 months (10 months post-intervention).

2.8.2.3. Secondary Aim:

The secondary aim has three objectives: 1) refine the intervention implementation, 2) garner administrator and principal support, and 3) conduct a cost-effectiveness analysis. Through this process, we will identify implementation strategies that will assure adaptability to context, sustainability, and potential for scale-up across the U.S.-Mexico border region.

2.8.2.3.1. Program Evaluation:

We will use the Consolidated Framework for Implementation Research (CFIR) as a structure for our formative evaluation and implementation monitoring [61]. Figure 2 provides an overview of activities in the secondary aim. Formative data will be collected through focus group interviews, individual interviews, and an environmental assessment. Through interviews and focus groups, we will identify key CFIR domains related to perceived characteristics of 50K4Life as an intervention (e.g., acceptability, compatibility with local cultural norms), characteristics of individuals (e.g., baseline physical activity habits), and factors at the school (inner context) and community (outer context) levels likely to serve as barriers or facilitators for implementation success. An environmental assessment will be used to gather information about the organization’s physical environment and the surrounding community environment using the physical activity component of the Environmental Assessment Tool (EAT), developed and validated by our research team as part of a previously NIH-funded program [62,63].

2.8.2.3.2. Programmatic Cost Analysis.

We will systematically collect personnel and non-personnel costs and value all resources needed to deliver each intervention treatment. Personnel costs. The largest contributor to programmatic costs is personnel expenditure, including hours spent in pre-implementation activities on training, recruitment, administrative functions, and implementation activities like meetings, communication, and other support activities linking intervention staff with participants [64, 65]. Non-personnel costs. Other costs include office rent and utilities for intervention staff and holding training or meetings with participants, and non-consumable equipment used by intervention staff, such as phones and computers, and participation costs. Only costs that can be directly tied to intervention delivery (excluding research-related costs) are allocated here [66].

2.9. Study Limitations

There are study limitations that should be noted here. First, there is the potential for contamination between school employees, particularly in smaller districts where staff know each other or are family. Second, participants will be aware of the different intervention arms through the consent process and may change their behavior to affect their likelihood of randomization in Phase 2 of the intervention. Third, participating school districts are suburban and rural and may not represent urban school employees or those from other areas of the U.S.-Mexico border.

3. Discussion

Mexican Americans living on the U.S.-Mexico border region disproportionately suffer from preventable chronic conditions that could be improved with walking. The 50k4Life intervention study is the first time a SMART design approach has been used to improve physical activity engagement among Latino/Hispanics in the U.S.-Mexico border region. Workplace interventions have not been widely used in Latino populations. Using school districts as a mechanism for dissemination has the potential for widespread scalability. Moreover, this study will inform future initiatives that are most beneficial and cost-effective.