PSE Changes Research Articles

Leveraging the strength of comprehensive cancer control coalitions to support policy, systems, and environmental change.

Strategies that facilitate change to policy, systems, and environmental (PSE) changes can enable behaviors and practices that lead to cancer risk reduction, early detection, treatment access, and improved quality of life among survivors. Comprehensive cancer control is a coordinated collaborative approach to reduce cancer burden and operationalizes PSE change strategies for this purpose. Efforts to support these actions occur at the national, state, and local levels. Resources integral to bolstering strategies for sustainable cancer control include coordination and support from national organizations committed to addressing the burden of cancer, strong partnerships at the state and local levels, funding and resources, an evidence-based framework and program guidance, and technical assistance and training opportunities to build capacity. The purpose of this paper is to describe the impact of public policy, public health programming, and technical assistance and training on the use of PSE change interventions in cancer control. It also describes the foundations for and examples of successes achieved by comprehensive cancer control programs and coalitions using PSE strategies.

Changing the Food Environment: What is Feasible in Small Food Stores

Small retail food stores are on the decline in Minnesota, and 1.6 million Minnesotans have little access to a full-service grocery store (Rauch & Mattessich, 2016). Additionally, grocery stores closing in rural communi­ties can be economically and socially detrimental to communities. Small food stores, such as convenience and corner stores, are becoming an increasingly important source of healthy food and an important partner with local food distributors in rural communities. The importance of small food stores is especially pronounced in under-resourced communities, as increasing their stock of healthy, appealing, and affordable foods, especially fruits and vegetables, could make these stores a more attractive destination for shoppers and decrease travel­ing time to other food stores. The Minnesota Department of Health (MDH) is responding to the need in rural Minnesota to develop flexible guidelines that advance place-based food systems. MDH collaborated with 10 local public health (LPH) agencies from across the state and partnered with small food stores to modify the availability, placement, and promotion of healthy food and beverage products. MDH and LPH agencies co-developed the intervention and evaluation and gathered input from storeowners to create innova­tive intervention strategies. Strategies were rooted in policies, systems, and environmental (PSE) change approaches and focused on stocking and selling healthy products. The approaches for sourcing healthy prod­ucts varied, but some strategies included working with local food distributors to stock healthy products, which can not only increase healthy food availability, but also help to stimulate the local economy. In this presentation, we shared how MDH collaborated with partners to develop innovative interventions, strategies, and materials. We highlighted challenges and opportunities in evaluating an evolving, community-based inter­vention where implementation strategies are tailored to unique store needs. We discussed the feasibility of this model and lessons learned about how to successfully make PSE change in stores across Minnesota to create a more robust place-based food system.

P62 Leveraging Partnerships to Implement Policy, Systems, & Environmental Initiatives in Two Rural Counties of California

Objective To implement UC CalFresh policy, systems, and environmental (PSE) initiatives across limited resource settings. Use of Theory or Research Social-Ecological Model (SEM). Target Audience Preschoolers, youth, parents, and seniors across preschools, schools, after school programs, and community settings in Tulare/Kings counties of California. Program Description In collaboration with community partners during FY2017-18, trained nutrition educators implemented USDA funded UC CalFresh PSE initiatives such as school wellness policy, preschool and school gardens, physical activities such as Coordinated Approach to Child's Health (CATCH), walking club, dance exercise, healthy school farmer's market, smarter lunchrooms movement, and food distribution. Evaluation Methods Nutrition educators completed PSE Site Activity Tracking Form that recorded PSE reach, sites, implementation stages, PSE changes adopted, partnerships, and sustainability plan. Evaluation data analyses was completed using the Program Evaluation and Reporting System (PEARS). Results Results indicated: PSE reached preschoolers, youth, parents, seniors, and community members (n = 28,217), total PSE sites with one or more PSE changes adopted (n = 43), total PSE sites by setting for all stages of implementation (n = 35), total sites with sustainability plan (n = 46), total number of type of PSE changes identified (n = 76), and approximately 40 partnerships were reported. PSE changes included established or improved food and beverage, physical activity and/or wellness-related policies, initiated or improved point-of-purchase, decision, and/or distribution prompts (including information intended to influence choices at the point of decision), improved quality of structured physical activity, initiated or expanded use of the garden for nutrition education, and improve access to fresh fruits, vegetables, and/or other healthy foods. Conclusions Results provide essential insight into PSE strategies at the SEM levels to promote healthy food and physical activity messages. Implications of this evaluation suggest that local implementing agencies can successfully deliver PSE strategies by leveraging community partnerships. Funding SNAP-Ed.

P191 Upstream Partners: Identifying SNAP-Ed Sectoral Collaborations Towards Meaningful Policy, Systems, and Environmental Change

Background SNAP-Ed implementers are encouraged to engage in multi-sector partnerships in order to ultimately lead to long-term impacts, addressing factors at upstream levels. Though, SNAP-Ed programs are beginning to document engagement with multi-sector coalitions, little is known about implementers’ current and perceived future partnerships with individual sectors (e.g., transportation, education, health care). Objective To identify sectors with which South Carolina SNAP-Ed (SC SNAP-Ed) program implementers currently engage or plan to engage with in the future. Study Design, Settings, Participants Educators and managers of SC SNAP-Ed Implementing Agencies (IA) (n = 24) participated in qualitative in-depth interviews. Participants rated the amount of support/collaboration they had or expected to have with 16 sectors. Participants then reflected on their responses for each sector. Measurable Outcome/Analysis Participant responses to the level of support/collaboration were tabulated across Implementing Agencies (n = 4) for each sector. Verbatim transcripts were analyzed in Nvivo 11 to identify perspectives surrounding the selection of each sector. Results The most frequently engaged sectors were Education, Faith-based, and Healthcare. The most frequently cited sectors where no support/collaboration occurred were Business, Economic Development, and Transportation. The most commonly identified reasons for this lack of engagement were: the scope/focus of the specific educator or IA, negative perception/lack of experience with the sector, and perceptions that connection with the sector was unallowable under SNAP-Ed guidance. Conclusion The SC SNAP-Ed program currently has support/collaboration with traditional SNAP-Ed sectors. These sectors have been partners primarily in direct nutrition education. Expanding the scope of SNAP-Ed partnerships into other sectors could provide necessary linkages to developing PSE changes that address SNAP-Ed goals at a larger scale. Guidance and training of allowable, effective strategies for collaboration are needed to change implementer perceptions. Funding SNAP-Ed.

Description and Evaluation of Changes to the Rural Nutrition Environment After Implementation of Community-led Policy, System, and Environment Change Strategies (P04-163-19)

ObjectivesTo assess the nutrition environment in three rural Louisiana parishes (counties) with high rates of poverty (range 25%-41.7%), obesity (>40%), and chronic diseases and to better understand the local nutrition environment in rural, low-income, food insecure areas and to evaluate policy, systems, and environmental (PSE) change strategies aimed at improving the rural food environment. MethodsHealthy Access, Behaviors, Communities was a community-participatory, multi-level approach to obesity prevention in Louisiana. This evaluation used a descriptive, mixed methods design that focused on 1st and 3rd year project data. Nutrition environments were assessed using the reduced Nutrition Environment Measurement Survey (NEMS) for food stores and restaurants. Pre and post NEMS scores were compared to determine if PSE interventions were effective in improving the nutrition environment. ResultsOverall, 48 food stores and 39 restaurants were assessed at baseline, while 45 food stores and 36 restaurants were assessed at follow-up. Different numbers between baseline and follow-up assessments are due to store closures/openings. Except for the grocery store and fast food environments in Madison parish, the food environments were poor across the targeted parishes, with NEMS scores indicating a lack of healthy grocery items (stores) or a lack of healthy menu options (restaurants). With few exceptions, average NEMS scores generally increased slightly over the assessments, which is a positive trend; however, these positive changes did not result in the food retail environment moving from unhealthy to healthy. Five stores were targeted by the coalition to implement PSE changes. Of the partner stores, the average number of healthy foods available increased in all categories, except skim or low-fat milk, from baseline to post-intervention. ConclusionsFindings from baseline indicate that the nutrition environment in these poor, rural parishes can present challenges to individuals attempting to meet preventative health recommendations. PSE interventions can improve the nutrition environment in these locations. Funding SourcesCenters for Disease Control High Obesity 1416 Cooperative agreement.

Improving the Health of Alaska Native People Through Use of a Policy Change Model and Capacity Building.

Public health training often includes program and education development but not policy, systems, and environmental (PSE) strategies. The Alaska Native Tribal Health Consortium’s Good Health and Wellness in Indian Country program works to build tribal PSE change capacity. Trainings included community health assessment, facilitation and leadership engagement, policy and systems, and digital storytelling. From 2014 to 2017, 30 PSE changes were made: 3 tobacco-free healthcare organization policies; 2 tobacco-free tribal resolutions; 1 tobacco-free school district policy; 3 healthy food policies and environmental changes; 4 improvements in patient-provider communication; 13 prediabetes, obesity, and/or tobacco screening and referral policies; 3 improvements to health care facility signage; and 1 Baby-friendly Hospital application, protecting the health of 46,000 tribal community members. Targeted training and technical assistance moved tribal staff from a focus on direct services to population-based improvements. This increased self-efficacy may increase the sustainability of chronic disease public health efforts and improve tribal health.

Simulated impacts and potential cost effectiveness of Communities Putting Prevention to Work: Tobacco control interventions in 21 U.S. communities, 2010–2020

In 2010, the Centers for Disease Control and Prevention (CDC) funded communities to implement policy, systems, and environmental (PSE) changes under the Communities Putting Prevention to Work (CPPW) program to make it easier for people to make healthier choices to prevent chronic disease. Twenty-one of 50 funded communities implemented interventions intended to reduce tobacco use. To examine the potential cost-effectiveness of tobacco control changes implemented under CPPW from a healthcare system perspective, we compared program cost estimates with estimates of potential impacts. We used an existing simulation model, the Prevention Impacts Simulation Model (PRISM), to estimate the potential cumulative impact of CPPW tobacco interventions on deaths and medical costs averted through 2020. We collected data on the costs to implement CPPW tobacco interventions from 2010 to 2013. We adjusted all costs to 2010 dollars. CPPW tobacco interventions cost $130.5 million across all communities, with an average community cost of $6.2 million. We found $735 million in potentially averted medical costs cumulatively from 2010 through 2020 because of the CPPW-supported interventions. If the CPPW tobacco control PSE changes are sustained through 2020 without additional funding after 2013, we find that medical costs averted will likely exceed program costs by $604 million. Our results suggest that the medical costs averted through 2020 may more than offset the initial investment in CPPW tobacco control interventions, implying that such interventions may be cost saving, especially over the long term.

Prioritizing Population Approaches in Cancer Prevention and Control: Results of a Case Study Evaluation of Policy, Systems, and Environmental Change.

Development and implementation of policy, systems, and environmental (PSE) change is a commonly used public health approach to reduce disease burden. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program conducted a demonstration with 13 programs to determine whether and to what extent dedicated resources would enhance the adoption of PSE strategies. This paper describes results of the qualitative portion of a longitudinal, mixed-methods evaluation of this demonstration. Case studies were conducted with a diverse subset of the 13 programs, and 106 in-depth interviews were completed with state/tribal program staff, community partners, and decision makers. Interviews addressed PSE change planning and capacity building, partnerships, local context, and how programs achieved PSE change. Dedicated PSE resources, including a policy analyst, helped increase PSE change capacity, intensify focus on PSE change overall, and accomplish specific PSE changes within individual jurisdictions. Stakeholders described PSE change as a gradual process requiring preparation and prioritization, strategic collaboration, and navigation of local context. Findings suggest that the demonstration program, including PSE-dedicated funds and a policy analyst, was successful in both increasing PSE change capacity and achieving PSE change itself. These results may be useful to other state, tribal, territorial, and public health organizations planning or implementing PSE change strategies.

P56 - Easy Choices: Making the Healthy Choice the Easy Choice

Objective: To increase nutrition educators' ability to provide programming that promotes healthy behaviors for limited-resource participants and communities through changes in policies, systems and environments. Target Audience: Extension agents working with partners at a variety of community sites serving SNAP-Ed audiences. Theory, Prior Research, Rationale: This program used the socioecological model. Description: Easy Choices is a collection of tools and resources designed for Extension agents to facilitate change among SNAP-Ed audiences at partner sites. The focus was on providing programs that targeted changes in policies, systems, and environments (PSE) that would increase healthy behaviors for limited-resource audiences. Extension agents worked with agency partners to assess the needs for their site related to active living and healthy eating choices. This assessment informed the type of intervention to be conducted. Extension agents facilitate the process and changes are implemented and sustained by the partners at the site. State SNAP-Ed staff provided ongoing support to educators to assist with implementation issues and concerns. Evaluation: Extension agents completed surveys at each phase of the project to provide feedback and information about outcomes. Eight sites participated in the project with 141 limited-resource participants actively involved in the program. Sites were primarily senior centers. PSE changes included unwritten policies regarding types of food offered at meetings and gatherings and mapping of walking routes. Additional changes included offering exercise classes and walking groups. Conclusions and Implications: This program promoted PSE changes with limited-resource audiences. For Extension agents or other professionals to facilitate PSE interventions, programs such as Easy Choices need to provide tools and resources to help agents and other professionals work effectively with partners and participants. This presentation will focus on the materials and training provided, including the assessment tool and implementation guidance and support. Funding: Supplemental Nutrition Assistance Program—Education.

Qualitative Analysis of Partnerships' Effect on Implementation of a Nationally Led Community-Based Initiative.

The American Heart Association (AHA) was funded to implement a nationally led initiative to implement policy, systems, and environment (PSE) interventions in communities across the United States. In Cohort 1, 15 communities were tasked with working with local community partners to plan and implement initiatives. Engaged as the evaluators, Texas A&M researchers conducted telephone interviews with project managers (employed by AHA) and community partners representing the 15 communities. Interviewees were asked questions pertaining to partnership planning and involvement in initiatives and overall perceptions of the impact of the program. Interviews were analyzed qualitatively using the Consolidated Framework for Implementation Research as the guiding framework. Thematic analysis revealed that partners were used in planning and implementing initiatives and felt that initiatives were successful in building community engagement. Some noted success in PSE changes, although this was not a major focus of respondents, regardless of it being a main indicator for the funder. Themes reveal several recommendations for those embarking on community-level work. Those recommendations include (1) build on existing priorities, (2) focus on incremental steps that build toward the bigger goal, (3) use national organizations to move more quickly, and (4) leverage resources through collaborative efforts.

From Tobacco to Obesity Prevention Policies: A Framework for Implementing Community-Driven Policy Change.

Efforts to reverse the obesity epidemic require policy, systems, and environmental (PSE) change strategies. Despite the availability of evidence-based and other promising PSE interventions, limited evidence exists on the "how-to" of transitioning them into practice. For the past 13 years, the Los Angeles County Department of Public Health has been building capacity among community residents and other stakeholders to create effective community coalitions and to implement well-designed policy strategy campaigns using an evidence-based approach to policy change, the policy adoption model (PAM). Implementing a phase-based approach to policy change, the PAM was initially used to support the passage of over 140 tobacco control and prevention policies in Los Angeles County. Following these successes, Los Angeles County Department of Public Health applied the PAM to obesity prevention, operationalizing the policy process by training community residents and other stakeholders on the use of the model. The PAM has shown to be helpful in promoting PSE change in tobacco control and obesity prevention, suggesting a local-level model potentially applicable to other fields of public health seeking sustainable, community-driven policy change.

Levels of Community Change: A Game to Teach About Policy, System, and Environment Change

Health promotion organizations increasingly encourage multilevel, multisector interventions, because such approaches can produce more widespread and sustainable impacts than individual behavior change efforts alone. 1 Bunnell R. O'Neill D. Soler R. et al. Fifty communities putting prevention to work: accelerating chronic disease prevention through policy, systems, and environmental change. J Community Health. 2012; 37: 1081-1090 Crossref PubMed Scopus (176) Google Scholar Many public health agencies and foundations recommend or require that funded projects include policy, system, and environment (PSE) change activities. Growing numbers of health coalitions and youth advocacy programs inspire members to implement community-level changes. The Cooperative Extension System, which includes the 4-H Youth Development Program, has adopted a National Framework for Health and Wellness 2 Braun B. Bruns K. Cronk L. et al. Cooperative extension's national framework health and wellness. http://www.aplu.org/members/commissions/food-environmentand-renewable-resources/CFERR_Library/national-framework-for-health-and-wellness/fileDate: 2014 Date accessed: February 1, 2017 Google Scholar calling for strategies informed by the social ecological model (SEM) principle that behavior is influenced by multiple interacting factors. 3 Sallis J.F. Cervero R.B. Ascher W. et al. An ecological approach to creating active living communities. Annu Rev Public Health. 2006; 27: 14.1-14.26 Crossref Scopus (2053) Google Scholar , 4 Sallis J.F. Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009; 87: 123-154 Crossref PubMed Scopus (487) Google Scholar , 5 Sallis J.F. Owen N. Ecological models of health behavior. in: Glanz K. Rimer B.K. Viswanath K. Health Behavior: Theory, Research, and Practice. 5th ed. Jossey-Bass, San Francisco, CA2015: 43-64 Google Scholar , 6 Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996; 10: 282-298 Crossref PubMed Scopus (1707) Google Scholar In reality, however, practitioners often lack familiarity with and confidence in applying PSE change strategies or find terms such as policy change daunting. 7 Smathers C.A. Lobb J.M. Extension professionals and community coalitions: professional development opportunities related to leadership and policy, system, and environment change. J Extension. 2015; 53 (6FEA1)https://www.joe.org/joe/2015december/a1.phpDate accessed: June 2, 2017 Google Scholar Recognizing that educational games convey and reinforce knowledge, 8 Magnus M. Nutritional science jeopardy. J Nutr Educ Behav. 2005; 37: 159-160 Abstract Full Text PDF PubMed Scopus (2) Google Scholar , 9 Person A.L. Colby S.E. Eubanks J.W. Nutritionopoly: let healthy choices “monopolize” your lifestyle. J Nutr Educ Behav. 2011; 43: 303-305 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar an interactive game was developed to help practitioners identify various PSE strategies, understand basic tenets of the SEM, and explore ways to initiate PSE changes. Feedback from 94% of 118 nutrition educators who engaged in the game (n = 111) supports the efficacy of the game in meeting these objectives and points to the feasibility of its use with various groups.

Assess, Identify, Make it Happen (AIM) for Preschools: A Tool to Decrease Early Childhood Obesity.

Early childhood obesity is at epidemic proportions and is a major risk factor for the development of chronic diseases in adulthood. Since the majority of preschoolers are placed in center-based care, best practice policy, system, and environment (PSE) changes in early child care settings plays an important role in defining early development of obesogenic behaviors. However, implementation of best practice PSE changes is often a challenge in low resource settings due to staff turnover, time constraints, cultural beliefs, and lack of health-related knowledge. Assess, Identify, Make it Happen for Preschools (AIM-P) is a strategic planning process that was used with wellness teams in early child care centers to implement PSE changes that support adoption of health behaviors. AIM-P uses key change-making strategies based on intervention mapping including assets and needs assessments, prioritization of changes based on importance and feasibility, development of action steps and action plans, and identification of dissemination and sustainability plans. The AIM-P process resulted in implementation of 6.5 best practice PSE changes per site. Qualitative findings highlight lessons learned and the facilitators and barriers associated with using AIM-P to implement PSEs.

Evaluation of Community-Based Policy, Systems, and Environment Interventions Targeting the Vending Machines.

The American Heart Association conducted policy, systems, and environmental (PSE) focused interventions to increase healthy vending in 8 communities. PSE interventions were assessed using the Nutrition Environment Measures Survey Vending Assessment to see changes in the food environment. Baseline and follow-up assessments were conducted with 3 settings and a total of 19 machines. PSE changes resulted in increased availability of healthy options and decreased unhealthy options. Implementation of PSE interventions targeting the food environment can be an effective method of providing increased access to healthy foods and beverages with the goal of increasing consumption to decrease chronic diseases.

Reducing Cancer Burden in the Population: An Overview of Epidemiologic Evidence to Support Policies, Systems, and Environmental Changes.

"Reducing Cancer Burden in the Population: Epidemiologic Evidence to Support Policies, Systems, and Environmental Changes" is a compilation of 11 reviews addressing aspects of primary prevention of cancer (early life factors, vitamin D, and periodontal disease and the oral microbiome); primary and secondary prevention (in the transgender population); surveillance following secondary prevention (personalizing follow-up of patients diagnosed with an adenoma based on colorectal cancer risk); tertiary prevention (physical activity as an adjuvant to cancer treatment, measurement of patient-reported physical functioning in cancer treatment trials, and implementation of palliative care recommendations); and all 3 (changing epidemiology of oral cancers). Authors discuss policies, systems, and environment (PSE) changes that may be supported by epidemiologic evidence, for example, how existing public health and clinical policies and guidelines targeting noncancer outcomes may indirectly reduce cancer burden and how some cancer control policies could be refined to enhance effectiveness. Authors also discuss where systems and environment changes are necessary to ensure routine implementation of up-to-date, evidence-based policies and guidelines. Two other articles discuss infrastructure to support identification of existing and emerging cancer problems that could be reduced or avoided, including by PSE changes. These frameworks may guide impactful cancer research relevant to cancer centers' catchment areas, as well as cancer control efforts in countries where noncommunicable diseases including cancer are on the rise. The weight of the evidence of these reviews supports opportunities for PSE changes and infrastructure that could reduce the cancer burden in populations.

Promotores As Advocates for Community Improvement: Experiences of the Western States REACH Su Comunidad Consortium.

The REACH Su Comunidad Consortium worked with 10 communities to address disparities in access to healthy food and physical activity opportunities among Hispanic populations through policy, systems, and environmental (PSE) strategies. Community health workers took leadership roles in the implementation of PSE strategies in partnership with local multisector coalitions. This article describes the role of community health workers in PSE change, the technical and professional development support provided to the REACH Su Comunidad Communities, and highlights professional development needs of community health workers engaging in PSE strategies.

Adopting Healthy Habits: Nutrition Educators Expand Roles to Include Policy, Systems, and Environmental Change

ObjectiveTo identify programmatic supports necessary for professional and paraprofessional nutrition educators to expand beyond direct education and engage in policy, systems, and environmental (PSE) changes that make healthy choices easier in environments where children and adults live, learn, work, and play.Design, Setting and ParticipantsAdopting Healthy Habits (AHH), a formative, community-based participatory research study, supported 16 existing Cooperative Extension staff in seven diverse counties across New York. AHH staff translated statewide strategies (staff development, worksite wellness programs in their own and partner organizations, and engagement in local coalitions) into site-based efforts driven by local needs and opportunities.Outcome Measures and AnalysisOutput and outcome data were collected through yearly work plans, periodic focus groups and interviews with staff and partners, community readiness and other needs assessments, and monthly documentation of activities. Data analysis identified successes and challenges and programmatic supports and resources required for adoption of expanded roles.ResultsWith guidance, dedicated time, and skill development, nutrition educators can expand their roles and become agents of PSE changes. Results documented best practices for work with partners in primary sectors, i.e. schools, community organizations, and coalitions. Specific successes and challenges elucidated additional needs regarding effective evaluation tools, resources to support dedicated time for PSEs, and staff training relevant to multiple community roles undertaken by professional and paraprofessional staff.Conclusions and ImplicationsAHH outcomes illuminate opportunities within current partnerships to engage in and implement PSEs. Site-specific case studies detail contextual variation and serve as roadmaps for PSE initiation. Challenges remain and additional research is needed to develop sensitive and effective evaluation tools.FundingUSDA. ObjectiveTo identify programmatic supports necessary for professional and paraprofessional nutrition educators to expand beyond direct education and engage in policy, systems, and environmental (PSE) changes that make healthy choices easier in environments where children and adults live, learn, work, and play. To identify programmatic supports necessary for professional and paraprofessional nutrition educators to expand beyond direct education and engage in policy, systems, and environmental (PSE) changes that make healthy choices easier in environments where children and adults live, learn, work, and play. Design, Setting and ParticipantsAdopting Healthy Habits (AHH), a formative, community-based participatory research study, supported 16 existing Cooperative Extension staff in seven diverse counties across New York. AHH staff translated statewide strategies (staff development, worksite wellness programs in their own and partner organizations, and engagement in local coalitions) into site-based efforts driven by local needs and opportunities. Adopting Healthy Habits (AHH), a formative, community-based participatory research study, supported 16 existing Cooperative Extension staff in seven diverse counties across New York. AHH staff translated statewide strategies (staff development, worksite wellness programs in their own and partner organizations, and engagement in local coalitions) into site-based efforts driven by local needs and opportunities. Outcome Measures and AnalysisOutput and outcome data were collected through yearly work plans, periodic focus groups and interviews with staff and partners, community readiness and other needs assessments, and monthly documentation of activities. Data analysis identified successes and challenges and programmatic supports and resources required for adoption of expanded roles. Output and outcome data were collected through yearly work plans, periodic focus groups and interviews with staff and partners, community readiness and other needs assessments, and monthly documentation of activities. Data analysis identified successes and challenges and programmatic supports and resources required for adoption of expanded roles. ResultsWith guidance, dedicated time, and skill development, nutrition educators can expand their roles and become agents of PSE changes. Results documented best practices for work with partners in primary sectors, i.e. schools, community organizations, and coalitions. Specific successes and challenges elucidated additional needs regarding effective evaluation tools, resources to support dedicated time for PSEs, and staff training relevant to multiple community roles undertaken by professional and paraprofessional staff. With guidance, dedicated time, and skill development, nutrition educators can expand their roles and become agents of PSE changes. Results documented best practices for work with partners in primary sectors, i.e. schools, community organizations, and coalitions. Specific successes and challenges elucidated additional needs regarding effective evaluation tools, resources to support dedicated time for PSEs, and staff training relevant to multiple community roles undertaken by professional and paraprofessional staff. Conclusions and ImplicationsAHH outcomes illuminate opportunities within current partnerships to engage in and implement PSEs. Site-specific case studies detail contextual variation and serve as roadmaps for PSE initiation. Challenges remain and additional research is needed to develop sensitive and effective evaluation tools. AHH outcomes illuminate opportunities within current partnerships to engage in and implement PSEs. Site-specific case studies detail contextual variation and serve as roadmaps for PSE initiation. Challenges remain and additional research is needed to develop sensitive and effective evaluation tools.

Cost Recovery for Extension Wellness Programming: A Memorandum of Understanding With West Virginia’s State Insurance Provider

participants to change their eating and physical activity patterns. Description: EFNEP educators deliver the first nine lessons focusing on basic nutrition, physical activity, food safety, and food resource management. Cooperative Extension Agents, under SNAP-Ed direction, deliver the remaining lessons focusing on health management for chronic disease prevention. All lessons are co-taught with faith community lay leaders who help participants make connections between faith and health. Agents encourage and support faith leaders in making policy, systems, and environmental (PSE) changes. Throughout implementation best practices for effective collaboration are identified. Evaluation: Behavior change is evaluated by pre/post, mid-point, and follow-up surveys with a 24-hour dietary recall. Faith community assessments capture PSE change. Formative evaluation includes observation, interviews, and educator feedback. Conclusions and Implications: This initiative provides strategies for EFNEP/SNAP-Ed partnerships for extended, comprehensive programming that includes education on the individual level and support for change on the community level. Program components, lessons learned, a plan for coordinating partnerships, and preliminary outcomes will be shared. Funding: Supplemental Nutrition Assistance Program Education, Expanded Food and Nutrition Education Program.

EFNEP and SNAP-Ed Collaborate to Encourage Faithful Families to Eat Smart, Move More, and Take Control of Their Health

ObjectiveTo provide a fifteen-week, multi-level nutrition education program in faith communities through a collaboration between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program – Education (SNAP-Ed), while developing strategies to guide future partnerships.Target AudienceFaith communities in low-income areas.Theory, Prior Research, RationaleThis pilot initiative encompasses and expands upon Faithful Families Eating Smart and Moving More, a practice-tested intervention for nutrition education in faith settings that utilizes the socio-ecological model to address multiple levels of influence. On the individual level, it uses the theory of planned behavior to inform, empower, and motivate participants to change their eating and physical activity patterns.DescriptionEFNEP educators deliver the first nine lessons focusing on basic nutrition, physical activity, food safety, and food resource management. Cooperative Extension Agents, under SNAP-Ed direction, deliver the remaining lessons focusing on health management for chronic disease prevention. All lessons are co-taught with faith community lay leaders who help participants make connections between faith and health. Agents encourage and support faith leaders in making policy, systems, and environmental (PSE) changes. Throughout implementation best practices for effective collaboration are identified.EvaluationBehavior change is evaluated by pre/post, mid-point, and follow-up surveys with a 24-hour dietary recall. Faith community assessments capture PSE change. Formative evaluation includes observation, interviews, and educator feedback.Conclusions and ImplicationsThis initiative provides strategies for EFNEP/SNAP-Ed partnerships for extended, comprehensive programming that includes education on the individual level and support for change on the community level. Program components, lessons learned, a plan for coordinating partnerships, and preliminary outcomes will be shared.FundingSupplemental Nutrition Assistance Program - Education, Expanded Food and Nutrition Education Program. ObjectiveTo provide a fifteen-week, multi-level nutrition education program in faith communities through a collaboration between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program – Education (SNAP-Ed), while developing strategies to guide future partnerships. To provide a fifteen-week, multi-level nutrition education program in faith communities through a collaboration between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program – Education (SNAP-Ed), while developing strategies to guide future partnerships. Target AudienceFaith communities in low-income areas. Faith communities in low-income areas. Theory, Prior Research, RationaleThis pilot initiative encompasses and expands upon Faithful Families Eating Smart and Moving More, a practice-tested intervention for nutrition education in faith settings that utilizes the socio-ecological model to address multiple levels of influence. On the individual level, it uses the theory of planned behavior to inform, empower, and motivate participants to change their eating and physical activity patterns. This pilot initiative encompasses and expands upon Faithful Families Eating Smart and Moving More, a practice-tested intervention for nutrition education in faith settings that utilizes the socio-ecological model to address multiple levels of influence. On the individual level, it uses the theory of planned behavior to inform, empower, and motivate participants to change their eating and physical activity patterns. DescriptionEFNEP educators deliver the first nine lessons focusing on basic nutrition, physical activity, food safety, and food resource management. Cooperative Extension Agents, under SNAP-Ed direction, deliver the remaining lessons focusing on health management for chronic disease prevention. All lessons are co-taught with faith community lay leaders who help participants make connections between faith and health. Agents encourage and support faith leaders in making policy, systems, and environmental (PSE) changes. Throughout implementation best practices for effective collaboration are identified. EFNEP educators deliver the first nine lessons focusing on basic nutrition, physical activity, food safety, and food resource management. Cooperative Extension Agents, under SNAP-Ed direction, deliver the remaining lessons focusing on health management for chronic disease prevention. All lessons are co-taught with faith community lay leaders who help participants make connections between faith and health. Agents encourage and support faith leaders in making policy, systems, and environmental (PSE) changes. Throughout implementation best practices for effective collaboration are identified. EvaluationBehavior change is evaluated by pre/post, mid-point, and follow-up surveys with a 24-hour dietary recall. Faith community assessments capture PSE change. Formative evaluation includes observation, interviews, and educator feedback. Behavior change is evaluated by pre/post, mid-point, and follow-up surveys with a 24-hour dietary recall. Faith community assessments capture PSE change. Formative evaluation includes observation, interviews, and educator feedback. Conclusions and ImplicationsThis initiative provides strategies for EFNEP/SNAP-Ed partnerships for extended, comprehensive programming that includes education on the individual level and support for change on the community level. Program components, lessons learned, a plan for coordinating partnerships, and preliminary outcomes will be shared. This initiative provides strategies for EFNEP/SNAP-Ed partnerships for extended, comprehensive programming that includes education on the individual level and support for change on the community level. Program components, lessons learned, a plan for coordinating partnerships, and preliminary outcomes will be shared.

Policy, systems, and environmental change in the Mississippi Delta: considerations for evaluation design.

Community-level policy, systems, and environmental (PSE) change strategies may offer an economical and sustainable approach to chronic disease prevention. The rapidly growing number of untested but promising PSE strategies currently underway offers an exciting opportunity to establish practice-based evidence for this approach. This article presents lessons learned from an evaluation of a community-based PSE initiative targeting stroke and cardiovascular disease prevention in the Mississippi Delta. Its purpose is to describe one approach to evaluating this type of PSE initiative, to stimulate discussion about best practices for evaluating PSE strategies, and to inform future evaluation and research efforts to expand practice-based evidence. The evaluation used a descriptive mixed-methods design and focused on the second year of a multisectoral, multiyear initiative. Cross-sectional data were collected in the summer and fall of 2010 using four data collection instruments: a grantee interview guide (n = 32), a health council member survey (n = 256), an organizational survey (n = 60), and a grantee progress report (n = 26). Fifty-eight PSE changes were assessed across five sectors: health, faith, education, worksite, and community/city government. PSE strategies aligned with increased access to physical activity opportunities, healthy food and beverage options, quality health care, and reduced exposure to tobacco. Results showed that grantees were successful in completing a series of steps toward PSE change and that sector-specific initiatives resulted in a range of PSE changes that were completed or in progress. Considerations for designing evaluations of community-based PSE initiatives are discussed.