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Andy Riesenberg, MSPHFood Security and Obesity

Prevention Team LeaderFood And Nutrition Service –

Western Regional Off ice

Implementing SNAP-Ed 2.0: Translating Obesity Prevention

Research into Practice

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Purpose

1. SNAP-Ed 2.0.2. Evidence-based programs for nutrition

education and obesity prevention. 3. Regional examples.4. Evaluation outcomes.

SNAP-Ed 2.03

Educational strategies, accompanied by environmental supports, designed to

facilitate voluntary adoption of food and physical activity choices and other nutrition-related behaviors among the SNAP-Ed target

audience.

Improve nutrition

Increase physical activity

Maintain appropriate

calorie balance

during each stage of life

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Key Elements

Requires the implementation and evaluation of comprehensive evidence-based activities for nutrition education and obesity prevention;

Allows for gardening and physical activity interventions combined with nutrition education;

Offers greater flexibility in targeting the SNAP population and potentially eligibles.

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Evidence-Based Programs

Requires the use of evidence-based activities:

Tier 1: The strategy is based upon relevant rigorous nutrition and public health nutrition research including systematically reviewed scientific evidence.

Tier 2: The strategy is based upon case studies, pilot studies, and evidence from the field on nutrition education interventions that demonstrate obesity prevention potential.

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Childhood Obesity Prevention Programs: Comparative

Effectiveness

Highest Evidence in Preventing Childhood Obesity

or Overweight

Community Component

School-Based Interventions

Home Component

Source: Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis, June 2013. Available at www.effectivehealthcare.ahrq.gov/child-obesity-prevention.cfm.

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Discussion Question

What is the difference between evidence-based practice and practice-based evidence? Why are both important?

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Socio-Ecological Model

10Source: Institute of Medicine

Ten Essential Public Health Services11

Monitor health status. Diagnose and investigate health problems and health hazards.. Inform, educate, and empower people about health issues.

Mobilize community partnerships.

Develop policies and plans.Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services.

Assure a competent public health workforce.

Evaluate effectiveness, accessibility, and quality of services. Research for new insights and innovative solutions to health problems.

Implementing Environmental Approach12

• Problem Identification• Measuring:• Availability• Access• Usage• Appeal

Conditions

• Interventions• Type of strategies used• Audiences• Communication

channels• Collaboration

Changes • Process and Outcome Measures

• Settings impacted• # of people impacted• Disparities impacted• Changes (short- and long-

term)

Reach

WRO Public Health Strategies13

Retailers

• Restaurants or mobile vendors nutrition standards.• Point‐of‐purchase marketing/signage at food retailers.• Healthy corner stores, grocery stores, or food retail policies.

Assessment and Training

• Measurement of risk factors for obesity in the SNAP‐Ed population.• Assessment of environmental or cultural barriers to healthy eating.• Training to nutrition, health, or community professionals.• Access/appeal to support physical activity or exercise.

WRO Public Health Strategies14

Place/Based Strategies:

• Nutrition and physical activity messaging• Nutrition and physical activity environmental assessments• Physical activity integration in schools or worksites• Walk to school/work, or other active commuting• Joint use of school or community facilities• Healthy meetings/healthy classrooms• Wellness committees or policies

In… qualifying Worksites, Schools, Child care, Emergency Food Pantries, Community Centers, Senior Centers, Public Housing, or Places of Worship, etc.

Public Health Strategies15

Farm/Agriculture

• Farm-to-school or pre-school strategies (in collaboration with Ag, State Education Agencies).• Farm-to-retail or farm-to-fork strategies. • Farmers markets or farm stands strategies.• Community or school edible gardens (Use Extension/Master Gardeners).

Communications Environment

• Community nutrition/activity messaging.• Digital media or text messaging.• Web-based activities or distance education strategies.

Opportunities:Public Health Partnerships

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Partnerships

• Health care partnerships that promote obesity prevention, access to healthy foods and activity.

• Community obesity prevention partnerships or food policy councils.• Public-private partnerships that promote obesity prevention.• Let’s Move cities and towns initiative.• Healthy Base initiative, veterans health

SWRO Examples: Richard Burley17

• Multi-Level: Active Life• Collaboration: SAFB• Evidence based: UNM, Chili Plus• Innovation: OSU, Farm To you

MPRO Examples: Star Morrison18

Community Based Strategies (INEP)

Community Based Social Marketing (“Pick a better snack”)

Community Partnerships (School Health Wellness Coalitions, Family Gardening, Two-Buck Lunch)

Public Health Programs

Intergenerational Poverty Task Force

SERO Examples: Veronica Bryant19

School Health and Wellness CommitteesNutrition and Physical Activity Self-

Assessment for Child Care (NAP SACC)Cooking Matters – retail grocery storesFarmer’s Markets’ – marketing campaignsDepartment of Health and Environmental

Control (DHEC) – nutrition education and BMI measurements

Influencing, but Not Implementing Environmental Changes Retail Stores (Example)

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Allowable CostsPoint-of-purchase

marketingIn-store nutrition displaysRecipe cards/leave-

behindsNERICooking demos/taste testsStore toursTechnical assistance to

retailers

Unallowable costsRefrigeration unitsBeautification/

Upkeep Painting Shelving Flooring Televisions

Manufacturers coupons

Retailer incentives

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Non-allowable Policy Activities

Planning, implementing, or evaluating populati0n-level health activities not targeting the SNAP-Ed population (costs must be pro-rated for % SNAP-Ed)Lobbying for legislative/policy changes

Infrastructure, land, or construction

Money, coupons, or vouchers provided to SNAP-Ed recipients

Healthy incentives paid with FNS funds*

Childcare or transportation services

Disparaging food or beverage brands, manufacturers, or commodities

SNAP Outreach/application assistance

Reinforcement items costing over $4.00 each

Discussion Question # 222

What is an appropriate balance between nutrition education and environmental supports?

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Turning Reach into Impact

Michigan Double Up Food Bucks (DUFB)• 80% of farmers report selling more fruits and vegetables• 81% of customers reported that because of DUFB they increased the amount of fruits and vegetables they

Baltimore Healthy Stores• More corner stores stocked and promoted

healthy foods, such as baked/low-fat chips, low-salt crackers, cooking spray, and whole wheat breads

• Increase in healthy food preparation behaviors

SNAP-Ed School Nutrition Policy initiative• The intervention resulted in a 50% reduction in the development of overweight among 4 th – 5th graders in Philadelphia

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WRO SNAP-Ed Evaluation Outcomes Framework

WRO developed a common set of statewide SNAP-Ed outcome indicators. • Arizona Department of Health Services , California Department of Public

Health , California Department of Social Services, Hawaii Department of Health , Nevada Division of Welfare and Supportive Services, Oregon State University Extension, University of California at Davis Extension, University of Idaho Extension, University of Nevada Cooperative Extension, Washington State Department of Social and Health Services, and the Washington State University Extension. Western Region SNAP-Ed Collaborators can choose from these

indicators when preparing their Annual Plans, and when reporting results to FNS on annual basis.

Project collaborators include representatives from State Agencies and Implementing Agencies, including:

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SNAP-Ed Evaluation Questions

Individual‐level: To what extent does SNAP‐Ed programming improve participants’ diet, physical activity, and maintenance of healthy weight?

Environmental‐level: To what extent does SNAP‐Ed programming facilitate access and create appeal for improved dietary and physical activity choices in settings where nutrition education is provided?

Sectors of Influence: To what extent is the SNAP‐Ed grant program integrated into comprehensive strategies that collectively impact lifelong healthy eating and active living in low‐income communities?

Social and Cultural Norms and Values: To what extent do community‐level obesity prevention strategies impact social and cultural norms and values about nutrition, physical activity, and healthy weight?

26Individual and Family Level

Activities

Short-Term Outcomes (Knowledge and Behavioral Intentions)

Medium-Term Outcomes (Behaviors)

Long-Term Outcomes (Risk Factors)

Impacts (Health)

Environmental Level Activities

Short-Term Outcomes (Readiness)

Medium-Term Outcomes (Adoption)

Long-Term Outcomes (Implementation)

Impacts (Maintenance)

Evaluation Framework Logic Model

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Discussion Question # 3

What does success in SNAP-Ed look like? How should we measure it?

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Wrap-up

SNAP-Ed 2.0 emphasizes nutrition education and obesity prevention and offers more flexibility for targeting and programming.

SNAP-Ed activities must be grounded in the best available evidence for preventing overweight and obesity in the low-income population.

Outcomes should demonstrate behavioral changes for SNAP-Ed audiences.

FNS is here to help.

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Q&A

THANK YOU

Andrew, Star, Richard, Veronica, and…

Nancy, Martha, Sally