METHODA complete enumeration was made of all Salinas taquerias $($n $=35)$ and fast$-$food restaurants $($n $=38)$ listed with the health department as possessing current food$-$ serving licenses. A taqueria was defined as a business serving Mexican$-$style dishes $($e$.$g$.,$ burritos, tacos$)$ where customers placed their orders at a counter and customers orders were called out or brought to them. A fast$-$food restaurant was defined similarly except as a business serv$-$ ing American$-$style dishes $($e$.$g$.,$ hamburgers, French fries$).$A site$-$specific survey was developed to provide a comparative overview of taqueria and fast$-$food menu options. A review of the literature of existing nutrition$-$ related surveys did not produce any comparable sur$-$ veys, so most questions were newly developed to address specifics of the proposed intervention. The survey focused on organizational areas related to healthy food marketing strategies and menu options. The survey was assessed for face validity by a senior epidemiologist and several chronic disease intervention specialists and for content validity by a nutritionist.Health department survey workers administered the surveys in person, which took $15$ to $20$ minutes to com$-$ plete, and the surveys were administered in English or Spanish. Most survey questions were completed by assessing the restaurant menu, the area around the coun$-$ ter, and the seating area. For the questions related to taqueria or restaurant customer options for menu items, the survey workers asked the questions of the owner $($if present$)$ or the shift supervisor or manager. The surveys were administered at baseline in Year $1(2004)$ before the start of the intervention. They will be administered again in Year $5$ at the conclusion of the intervention.Although it is hoped that all taquerias will eventually adopt measures related to healthy food marketing, limitedstaff and resources required prioritization of which taquerias to partner with during the initial years of the intervention. To assist with selecting initial partners, the $25$ Salinas census tracts were divided into three groups based on annual family income: low income $($the bottom $25\%$ of family income distribution; range of average incomes, $$25,14534,112),$ moderate income $($the mid$-$ dle $50\%$; range, $$34,16253,500),$ and high income $($the top $25\%$; range, $$54,57183,123).$ All taquerias in Salinas were geographically located in relation to income level of the census tract in which they were located. The $16$ taquerias selected for the initial intervention were then selected from neighborhoods with the greatest financial need. As the intervention has progressed, additional taquerias have been added.A health department educator compiled a list of healthy menu options for the taquerias to promote or introduce, such as whole beans, whole wheat tortillas, or fresh fruit. Promotion was accomplished by marking healthier items on the menu with the logo of Steps to a Healthier Salinas Value It social marketing campaign $($a purple exclamation mark$)$ and creating new signage for posting in the taqueria. The health educator, in collabora$-$ tion with nutritionists from both the Monterey County Health Department and Stanford, also developed a list of healthy food preparation suggestions, such as having at least one$-$half cup of vegetables $($excluding iceberg let$-$ tuce$)$ and decreasing fat during the cooking of the food. This list served as criteria for creating new healthier menu items $($e$.$g$.,$ vegetable$-$stuffed fish fillet, grilled fish fillet with salad greens, small burrito with grilled chicken, vegetables, and whole vs$.$ refried beans$).$ The suggested menu modifications were presented to taqueria owners during the nutrition counseling component of the inter$-$ vention. The methods that resulted in changes to menus were identified and packaged into a healthy nutrition tool kit by the lead health educator for dissemination to other taquerias in Salinas and elsewhere.$>$RESULTSTaquerias in Salinas were significantly more concen$-$ trated in lower than higher income neighborhoods $($Chi$-$ square analysis, p $=\mathrm{.}01$; Figure $1).$ This led to the initial intervention focus on taquerias in the lower income cen$-$ sus tracts with the greatest financial need.The baseline survey, before the start of the interven$-$ tion, indicated several significant differences between Salinas taquerias and fast$-$food restaurants $($Table $1).$ Fast$-$food restaurants were significantly more likely to have printed information with nutritional content available for customers and adult entr$$es labeled as healthy$/$low fat with nutritional information. Ninety$-$ five percent of the fast$-$food restaurants and $17\%$ of the taquerias had menus printed in English; none of the fast$-$food restaurants and $80\%$ of the taquerias had menus in Spanish. Taquerias were significantly more likely than fast$-$food restaurants to offer nonfried carbo$-$ hydrate offerings $(100\%$ vs$.63\%),$ but fast$-$food restau$-$ rants were more likely to offer one or more low$-$fat meal choices $(84\%$ vs$.43\%).$ Although not significant, taque$-$ rias also had other healthier food options, such as more fruit or vegetable offerings $(74\%$ vs$.55\%).$The baseline survey helped identify organization$-$ specific concerns about the proposed intervention. Health educators found that taqueria owners initially mistrusted the health department because their past involvement with the health department mainly related to obtaining operating permits and inspections. This mistrust was partially overcome when health educators developed a personal rapport with the owners and pro$-$ vided them with health information about diseases common to families and customers, in particular diabe$-$ tes and obesity. Throughout $2005,$ a health educator attempted to develop an intervention based on theadoption of a written healthy food policy by taqueria owners. This approach was unsuccessful as it required the adoption of a written policy, and the policy did not start from the needs identified by the taqueria owners. As a result of conversations with taqueria owners and the rapport developed from talking about health issues specific to the Mexican American population, the intervention was changed from one that focused on encouraging taquerias to adopt written healthy food policies to one that focused on a nutrition awareness and counseling approach that assisted taqueria owners with developing and promoting healthier food choices.The initial response to the intervention has shown the following positive changes. Of the $16$ taquerias contacted by outreach efforts from July $2006$ through August $2007,94\%$ of owners agreed to and began distributing health education materials on healthy lifestyle choices, such as eating healthy and exercising. Eighty$-$one percent intro$-$ duced or began promoting one or more healthier side options $($whole beans, whole wheat tortillas, and$/$or freshly made fruit juice$).$ Fifty percent began promoting entr$$es that were based on healthier food options; of these, seven $(88\%)$ modified existing entr$$es or created entr$$es that were healthier $($chicken or vegetable burritos, whole beans with vegetables, salad entr$$e$,$ or a grilled fish entr$$e$).$ Smoke$-$free entryway materials were also distributed as part of the broader community$-$based inter$-$ vention and these were also well$-$received by taqueria owners$100\%$ posted the nonsmoking decal in their entryways.Healthy Nutrition Tool KitBased on these successes, the health educator in charge of the project developed a healthy nutrition tool kit to aid in the dissemination of the intervention to the other taquerias within Salinas, as well as to enable other staff to approach taquerias across the county. This tool kit includes the following:$1.$ Introductory program materialsan introductory letter from the health department, preparation tipsfor making taqueria Mexican Americanstyle menu options healthier $($Table $2),$ results from the $2004$ baseline survey showing that taquerias offer some healthier food options than fast$-$food restaurants, an order form for nutrition$-$related health educa$-$ tion materials, and a healthier dish assessment example$\mathrm{.}2.$ Consumer education materialsa Steps to a Healthier Salinas social marketing brochure, a diabetes risk assessment form, a medical brochure about diabetes management, and information about the California Smokers Helpline, a free over$-$the$-$phone smoking cessation program$\mathrm{.}3.$ Taqueria health education visualsone$-$page exam$-$ ples of dietary fats, portion sizes, and healthy Mexican$-$ style food options for reference by owners$\mathrm{.}4.$ Consumer outreach informationexamples of a tip sheet on eating healthy at Mexican$-$style restaurants or taquerias, coupons for newspaper advertising, menu labels to highlight healthier options, and educational table signs for use by the participating taquerias.

How much exposure or interaction $($time and dose$)$ did the participants have to the program$/$intervention$?$How much exposure or interaction $($time and dose$)$ did the participants have to the program$/$intervention$?$a$.$ Time$($s$)-$b$.$ Dose $-$