Download Implementing SNAP-Ed 2.0 - University of Missouri Extension

Implementing SNAP-Ed 2.0:
Translating Obesity Prevention
Research into Practice
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Andy Riesenberg, MSPH
Food Security and Obesity
Prevention Team Leader
Food And Nutrition Service –
Western Regional Office
Purpose
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SNAP-Ed 2.0.
2. Evidence-based programs for nutrition education
and obesity prevention.
3. Regional examples.
4. Evaluation outcomes.
1.
SNAP-Ed 2.0
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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
Key Elements
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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.
Evidence-Based Programs
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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.
Childhood Obesity Prevention
Programs: Comparative Effectiveness
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School-Based
Interventions
Home
Component
Community
Component
Highest Evidence in Preventing
Childhood Obesity or Overweight
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
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 What is the difference between evidence-based
practice and practice-based evidence? Why are both
important?
Socio-Ecological Model
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Source: Institute of Medicine
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Ten Essential Public Health Services
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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 Approach
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• Problem Identification
• Measuring:
• Availability
• Access
• Usage
• Appeal
Conditions
Changes
• Interventions
• Type of strategies used
• Audiences
• Communication channels
• Collaboration
• Process and Outcome
Measures
• Settings impacted
• # of people impacted
• Disparities impacted
• Changes (short- and longterm)
Reach
WRO Public Health Strategies
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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 Strategies
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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 Strategies
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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 Burley
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• Multi-Level: Active Life
• Collaboration: SAFB
• Evidence based: UNM, Chili Plus
• Innovation: OSU, Farm To you
MPRO Examples: Star Morrison
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 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 Bryant
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 School Health and Wellness Committees
 Nutrition and Physical Activity Self-Assessment for
Child Care (NAP SACC)
 Cooking Matters – retail grocery stores
 Farmer’s Markets’ – marketing campaigns
 Department 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 Costs
 Point-of-purchase
marketing
 In-store nutrition displays
 Recipe cards/leave-behinds
 NERI
 Cooking demos/taste tests
 Store tours
 Technical assistance to
retailers
Unallowable costs
 Refrigeration units
 Beautification/Upkeep




Painting
Shelving
Flooring
Televisions
 Manufacturers coupons
 Retailer incentives
Non-allowable
Policy Activities
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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 # 2
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 What is an appropriate balance between nutrition
education and environmental supports?
Turning Reach into Impact
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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 4th – 5th graders in
Philadelphia
WRO SNAP-Ed
Evaluation Outcomes Framework
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WRO developed a common set of statewide SNAP-Ed outcome indicators.
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:
• 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.
SNAP-Ed Evaluation Questions
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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?
Evaluation Framework
Logic Model
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Individual and Family
Level Activities
Environmental Level
Activities
Short-Term Outcomes
(Knowledge and Behavioral
Intentions)
Short-Term Outcomes
(Readiness)
Medium-Term Outcomes
(Behaviors)
Medium-Term Outcomes
(Adoption)
Long-Term Outcomes (Risk
Factors)
Long-Term Outcomes
(Implementation)
Impacts (Health)
Impacts (Maintenance)
Discussion Question # 3
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 What does success in SNAP-Ed look like? How
should we measure it?
Wrap-up
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 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.
Q&A
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THANK YOU
Andrew, Star, Richard, Veronica, and…
Nancy, Martha, Sally