1. Andy Riesenberg, MSPH Food Security and Obesity Prevention Team Leader Food And Nutrition Service – Western Regional Office Implementing SNAP-Ed 2.0: Translating Obesity Prevention Research into Practice 1

2. Purpose 1. SNAP-Ed 2.0. 2. Evidence-based programs for nutrition education and obesity prevention. 3. Regional examples. 4. Evaluation outcomes. 2

3. SNAP-Ed 2.0 3 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

4. 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. 4

5. 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. 5

6. Childhood Obesity Prevention Programs: Comparative Effectiveness 6 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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8. Discussion Question 8 What is the difference between evidence-based practice and practice-based evidence? Why are both important?

9. 9 Socio-Ecological Model

10. 10 Source: Institute of Medicine

11. Ten Essential Public Health Services 11 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.

12. Implementing Environmental Approach 12 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

13. WRO Public Health Strategies 13 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.

14. WRO Public Health Strategies 14 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.

15. Public Health Strategies 15 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.

16. Opportunities: Public Health Partnerships 16 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

17. SWRO Examples: Richard Burley 17 Multi-Level: Active Life Collaboration: SAFB Evidence based: UNM, Chili Plus Innovation: OSU, Farm To you

18. MPRO Examples: Star Morrison 18 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

19. SERO Examples: Veronica Bryant 19 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

20. Influencing, but Not Implementing Environmental Changes Retail Stores (Example) 20 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

21. 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 changesInfrastructure, 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 commoditiesSNAP Outreach/application assistanceReinforcement items costing over $4.00 each 21

22. Discussion Question # 2 22 What is an appropriate balance between nutrition education and environmental supports?

23. Turning Reach into Impact 23 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 – 5 th graders in Philadelphia

24. WRO SNAP-Ed Evaluation Outcomes Framework 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. 24

25. 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? 25

26. 26 Individual 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

27. Discussion Question # 3 27 What does success in SNAP-Ed look like? How should we measure it?

28. Wrap-up 28 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.

29. Q&A 29 THANK YOU Andrew, Star, Richard, Veronica, and… Nancy, Martha, Sally