PSE Interventions Research Articles

Nurse-Involved Policy, Systems, and Environmental School-Based Interventions for Supporting Healthy Nutrition and Obesity Prevention Among Children and Adolescents: A Systematic Review.

Overweight and obesity are common in school-age children. Policy, system, and environmental (PSE) approaches-which entail making upstream changes to a school's context-can be leveraged to reduce childhood obesity. Nurses can advance PSE approaches in schools to promote healthy living habits. This review examines the effect of nurse-involved PSE interventions globally to promote healthy nutrition and reduce obesity in schools. We conducted a literature search using multiple databases from 2010 to 2023 for nurse-involved studies that implemented interventions focused on PSE change related to promoting healthy nutrition or reducing obesity in school settings. Twenty interventions globally were included in the systematic review synthesis. Improvements in anthropometrics, health and nutrition knowledge, attitudes, and beliefs were observed. PSE interventions can be leveraged to promote healthy nutrition and reduce obesity in school settings. Nurses in varying roles are uniquely qualified to advocate for and implement school-based interventions focused on PSE change.

Measuring Policy, Systems, and Environmental Changes at Elementary Schools Involved in SNAP-Ed New Mexico Programming, 2018-2022.

In 2018, the New Mexico Supplemental Nutrition Assistance Program-Education (SNAP-Ed NM) incorporated policy, systems, and environmental (PSE) strategies into the state plan to increase healthy eating and physical activity. Studies of multiple PSE strategies in elementary schools are lacking. We conducted assessments of physical activity and nutrition environments at 11 elementary schools in New Mexico before and after schools were given school-specific PSE recommendations and technical assistance. Baseline data were collected in 2018 by using the School Physical Activity and Nutrition Environment Tool (SPAN-ET), which measures policy, situational, and physical environments in elementary schools. PSE scores were calculated as the proportion of criteria met within and across 27 areas of interest. Implementation of evidence-based PSE interventions began in 2019. COVID-19 school closures delayed follow-up assessments until 2022. We analyzed descriptive data to examine changes in PSE scores over time. Overall mean PSE scores increased significantly from baseline (53.6%) to follow-up (62.7%). Nutrition PSE scores significantly increased by 17.6 percentage points; the policy environment showed the largest improvement (+26.0 percentage points), followed by the situational environment (+13.8 percentage points), and physical environment (+9.1 percentage points). We found a nonsignificant increase in the overall average physical activity score (+2.7 percentage points). Use of a standardized instrument for assessing implementation of PSE strategies across multiple schools showed significant overall improvement in nutrition scores and nonsignificant increases in physical activity scores. Providing school-specific recommendations combined with technical assistance may be an effective approach to implementing evidence-based nutrition and physical activity PSE strategies.

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

The LSU AgCenter Healthy Communities Initiative: Community-Participatory Policy, Systems, and Environmental Change

Addressing the Gap Between Academic Research and Grassroots Public Health Practice: Supporting Policy, Systems, and Environmental Changes in Rural Communities.

Public health practice continues to expand beyond traditional partners to increase reach and impact in communities. This is particularly important in rural communities, who face inequities in the social determinants of health and increased chronic disease burden. However, the capacity for non-traditional community organizations to understand and implement public health work varies widely. Promoting policy, systems, and environmental change strategies (PSE's) is a promising method to support public health in rural communities, due to their variety, flexibility, and potential impact.Using a mixed methods approach to data analysis, we explore the barriers, challenges, and lessons learned from efforts in two rural Appalachian counties to stimulate use of PSE strategies through micro-funding. Several significant barriers were identified: challenges with evaluation and reporting, and lack of understanding and limited utilization of PSE strategies. Successful approaches to overcome these barriers included (1) changing reporting processes to reduce reliance on technology and shift reporting burden from community partners to researchers, (2) adapting data collection to capitalize on strengths of project partners, and (3) abandoning scientific language to embrace more common terminology used in communities. Policy changes were the least utilized strategy. This strategy may be less relevant in rural grassroots organizations with a small staff. Additional research into barriers to policy change is recommended. Enhanced training and support for grassroots, local-level PSE interventions could expand public health promotion in rural areas, reducing rural health disparities.

Pantry clients and Supplemental Nutrition Assistance Program-Education practitioners' perspectives on factors influencing healthy eating policy, system and environmental interventions in food pantries.

The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries' capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.

P137 Southeast Regional FFY2020 SNAP-Ed Policy, Systems and Environmental Change Evaluation

<h3>Objective</h3> The study objective was to evaluate the policy, systems, and environmental (PSE) changes implemented by Southeast Region (SER) SNAP-Ed programs during the COVID-19 pandemic in 2020. <h3>Use of Theory or Research</h3> This study was guided by the SNAP-Ed Evaluation Framework and Interpretive Guide. <h3>Target Audience</h3> PSE interventions were targeted toward sites that serve SNAP-Ed eligible populations that are at or below 185% of the federal poverty level. <h3>Program Description</h3> The SNAP-Ed program was implemented across eight states, including 25 implementing agencies. States focused on expansion of PSE interventions in 2020, to include long-term implementation strategies, which incorporates a multicomponent such as evidence-based education, marketing, community involvement, and/or staff training in addition to the PSE change. During the pandemic, many agencies focused on strengthening nutrition security. <h3>Evaluation Methods</h3> States reported PSE changes, multicomponent strategies, sites, promotional efforts, COVID program adaptations, and estimated reach. Data were reported via the Program Evaluation and Reporting System or through an Excel template. All data were cleaned and descriptive statistics for all PSEs were analyzed using R statistical software. <h3>Results</h3> Implementing agencies reported a total of 1,359 PSE changes across 7 states with a combined reach of 1,161,289. Common PSEs included novel food distribution systems, expanding access to fresh produce and edible gardens. A total of 666 sites (91%) reported a multicomponent intervention with their PSE nutrition change. <h3>Conclusions</h3> The study found that SNAP-Ed agencies were able to quickly and successfully pivot their programs to meet the needs of their communities during the pandemic reaching 1.1 million people with over 1,300 SNAP-Ed PSE changes compared to 830,049 in 2017. A shift in PSE implementation was seen. For example, more PSE changes occurred in food assistance sites, which included drive-through pantries. Also, there were increases in home and community garden projects to support families facing nutrition insecurity. Results indicate that most sites in SER are implementing multi-component interventions, that if continued, will lead to sustained, effective change over time. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education

P141 Where Do We Go From Here? California Local Health Departments Navigate School-based SNAP-Ed During COVID-19

BackgroundCOVID-19 forced California Supplemental Nutrition Assistance Program Education (SNAP-Ed) to suddenly shift planned strategies to meet SNAP-eligible population needs. K-12 schools, important SNAP-Ed partners for reaching children and families, were profoundly affected. Most (77%) local health departments (LHDs) reported they were unable to accomplish previously planned activities at school sites in 2020.ObjectiveTo understand pandemic-related changes to school-based SNAP-Ed and identify areas of opportunity.Study Design, Settings, ParticipantsWe conducted secondary mixed-methods analyses of California LHDs’ school-based SNAP-Ed activity and needs assessment data from fiscal years 2020-2021.Measurable Outcome/AnalysisOutcomes include number and type of SNAP-Ed programs that were halted or newly implemented, number of participants reached, policies, systems, and environmental change strategies (PSEs) adopted, new methods of education delivery, and extent to which schools implemented nutrition and physical activity (Nut-PA) best practices. Qualitative analysis examined COVID-19-related barriers and facilitators to SNAP-Ed implementation.ResultsIn 2020, 270 PSE interventions were initiated in schools; 21% were discontinued and 12% were created in response to COVID. New opportunities included using school meal distributions to provide free groceries, home gardening kits, and brief face-to-face nutrition education. Many LHDs transitioned to virtual Nut-PA education, increasing SNAP-Ed participant reach. In Fall 2020, as schools adjusted to alternative learning models, school-level assessments of Nut-PA practices indicated the most common area of opportunity was nutrition education. Over 75% of schools reported that PSE strategies requiring on-site/in-person implementation, such as improving lunchroom facilities, were not feasible. Facilitators of SNAP-Ed implementation included community support and strong partnerships between schools, community-based organizations, and SNAP-Ed implementing agencies; barriers included regulations and staff turnover.ConclusionsSNAP-Ed programs nationwide can continue to serve SNAP-eligible children and families during crises like COVID-19 by partnering with schools and other community organizations. These partners identified the nutrition and physical activity needs of a community and the best practices to address them.FundingSupplemental Nutrition Assistance Program - Education

Factors Influencing Capacity and Readiness to Implement Healthy Eating Interventions in Food Pantries Through SNAP-Ed Programming

ObjectivesFood pantries provide free food to households, including those receiving Supplemental Nutrition Assistance Program (SNAP), thereby buffering food insecurity in communities. The SNAP-Ed program identified food pantries as a targeted setting for policy, system, and environmental (PSE) changes to promote healthy eating. This study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. MethodsWe conducted qualitative interviews with 26 residents and 12 SNAP-Ed staff from rural and urban counties in Ohio to identify themes and indicators related to community readiness and organizational and practitioner capacity to implement healthy eating PSEs in food pantries. Themes and related indicators were generated based on inductive and deductive coding of interview transcripts. Eleven food pantry and nutrition experts prioritized and weighted themes and indicators during a virtual consensus conference. ResultsFive themes emerged, and expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries; (1) food pantry capacity and logistics [0.253], (2) networks & relationships [0.228], (3) community nutrition practitioner capacity [0.212], (4) food pantry user characteristics [0.156], and (5) stigma and stereotypes [0.1.52]. Overall, 17 indicators were identified across these themes. ConclusionsFood pantries are unique settings for implementing healthy eating PSE interventions, thus successful and sustained PSE change will require a tailored approach that considers food pantries capacity, needs and opportunities within the community, and capacity of community nutrition practitioners, including SNAP-Ed. The themes and indicators identified through this study will be incorporated into an online assessment tool to support tailored approaches that meet communities where they are. Funding SourcesFinancial support for this work was provided by the U.S. Department of Agriculture, Food and Nutrition Service, Supplemental Nutrition Assistance Program – Education (SNAP-Ed).

Sugar-sweetened beverage consumption among adults in rural Appalachia

Sugar-sweetened beverage (SSB) consumption is decreasing nationally, yet intakes remain high in certain sub-populations as new varieties of SSBs are introduced. This study aims to expand on SSB intake patterns among adults living in Appalachia to develop policy, systems, and environmental (PSE) interventions to reduce consumption. Baseline cohort surveys were conducted to examine beverage consumption patterns of adults in one rural Appalachian county in Kentucky using a validated BEVQ-15 instrument. Ages were collapsed into three generational groups – Millennials (22–38 years), Generation X (39–54 years), and Boomers/Silents (≥55 years). Over half (n = 81; 54%) of the sample (n = 150) were Boomers/Silents. Age was a significant predictor of SSB consumption, with Millennials drinking more daily calories of SSB compared to older adults (329.2 kcal v 157.0 kcal v 134.6 kcal, p = 0.05); a significant amount of those calories coming from non-soda SSBs. Millennials were twice as likely to drink sweetened fruit juice drinks (p = 0.0002) and energy drinks (p = 0.01) daily and consumed six times more daily calories from sweetened fruit juice drinks than the other groups (73.5 kcal v 11.1 kcal v 8.0 kcal, p < 0.01). To our knowledge, this is the first study to show beverage choices and consumption patterns in Appalachian adults vary by age and non-soda SSBs are significant sources of added sugar. These findings inform PSE interventions for reducing SSB consumption, such as tailored marketing approaches and technology-based strategies, within a unique setting, and offer insight for nutrition educators and public health professionals working within rural, remote communities.

Triad-based, Scenario Role-Play Training Increases Staff Self-Efficacy in Recruiting For and Delivering PSE Interventions to SNAP-Ed Community Sites

Discuss how triad-based, scenario role-play is an effective method in increasing staff self-efficacy in delivery of PSE interventions to SNAP-Ed community sites.

P139 A Trauma-Informed Approach to Charitable Food Distribution: The Nutrition Pantry Program

<h3>Objective</h3> This study's objective was to evaluate the change in environment, inventory, policies, services, and overall healthy scores of pantries in the Nutrition Pantry Program (NPP), a trauma-informed policy, systems, and environment (PSE) intervention. <h3>Use of Theory or Research</h3> One out of 8 Californians faces food insecurity and 1 out of 7 utilize food pantries. This population also faces higher rates of diet-related diseases and traumatic experiences related to food insecurity. NPP utilizes behavioral economics, trauma-informed principles, and the transtheoretical model of change to create environments that promote healthy choices and mitigate retraumatization. <h3>Target Audience</h3> NPP is open to all California pantries; participants included 53 pantries during 2018 and 2019 within the following settings: faith-based, higher-education, general social services, housing, and K-12. <h3>Program Description</h3> NPP provides a framework for pantries to provide trauma-informed nutrition security, and lasts on average 10 months. Pantries start by completing the Healthy Food Pantry Assessment Tool (HFPAT) and a client needs assessment and obtaining client feedback. Next, a personalized work-plan is created, and trainings, technical support, and resources are provided. <h3>Evaluation Methods</h3> The HFPAT is a validated survey used to evaluate PSE initiatives in pantries. Those using the tool viewed a 2-hour instructional webinar. Researchers analyzed pre- and post-HFPAT scores to evaluate the effectiveness of NPP on pantry practices. <h3>Results</h3> Fifty-three pantries completed a baseline HFPAT and 19 completed a follow-up HFPAT. On average, overall healthy scores increased by 9 points, with the most improvements in the "Food Distribution to Clients" and "Policies" sections. Sections with the lowest improvements include "Frozen Foods" and "Services for Clients." <h3>Conclusions</h3> When given a framework, technical support, and resources, pantries are able to improve their overall "healthy" score by using PSE and trauma-informed interventions. Pantries are, however, limited on changes requiring larger infrastructure investments, such as increased refrigeration/freezer space and increased staff time for support services.

O4 Ripple Effects Mapping to Explore Sustainability for Changes in Policies, Systems, and Environments

Background To improve healthy food systems, collective interventions that focus on promoting positive changes in policies, systems, and environments (PSEs) need sustained involvement and promotion from community members. Ripple Effects Mapping (REM)—a participatory method used to collect qualitative data about interventions impacts—has the potential to capture perceived effectiveness of these interventions as well as provide an opportunity to explore potential for sustainability. Objective The objective was to use REM to identify perceived effectiveness of the PSE interventions and opportunities for sustainability at the end of an obesity prevention grant in 4 rural Southern counties. Study Design, Setting, Participants At the conclusion of a 5-year grant, REM was used to capture qualitative data about perceived effectiveness and unanticipated consequences of PSE interventions focused on increasing access to healthy foods. Four REM sessions were conducted—1 in each county involved in the grant. Forty community members who had contributed to PSE implementations participated. Measurable Outcome/Analysis Trained facilitators guided participants through discussions about project activities and impacts and created a ripple map. The maps visually represented perceived community impacts and how these impacts were interconnected. The facilitators used the maps and detailed notes to code information using the Community Capitals Framework and to identify themes. Results Community capitals centered primarily on increases in human, cultural, and social capitals. One major theme that emerged from the sessions was the ongoing sustainability efforts that participants identified and discussed. The sessions helped participants frame how they could move forward to continue the interventions after the initial grant concluded. Participants discussed future funding efforts and how they could continue to collaborate and expand on interventions. Conclusion REM is a qualitative method that can capture perceived intervention impacts as well as help groups identify areas for sustainability. Funding Centers for Disease Control and Prevention.

Environmental, social, and economic factors related to the intersection of food security, dietary quality, and obesity: an introduction to a special issue of the Translational Behavioral Medicine journal.

This special issue of Translational Behavioral Medicine solicited papers focusing on the intersection of food security, dietary quality, and obesity. Specifically, the special issue seeks to highlight research that provides actionable takeaways related to policy, systems, and environmental (PSE) approaches for practitioners and policymakers. The purpose of this introduction was to summarize relevant background literature and then briefly introduce topics covered by the articles included in the special issue. There are economic, environmental, and social factors that create systemic barriers that drive persistent poverty in communities and underlay the intersection of food security, dietary quality, and obesity. Although equitable healthful food access is needed, the issue is exceedingly complicated. Understanding and operationalizing effective and efficient PSE approaches is in its infancy. More research is needed to better understand how to appropriately measure determinants of health (and how they relate to the conditions that ultimately promote obesity through food insecurity and compromises to dietary quality), implement deliberate interventions that address the underlying factors, and disseminate that information to policymakers and practitioners in the field. This special issue of Translational Behavioral Medicine includes articles that relay practical findings, measurement methods, and lessons learned related to PSE approaches such as federal food assistance programs (e.g., National School Lunch Program), systems-based interventions (e.g., clinic-community connections), and environmental modifications(e.g., food retail marketing). Although much more practical and action-oriented research is needed in this area, these articles will contribute to the evidence base supporting better future assessment and PSE interventions that address food security, dietary quality, and obesity.

Expanding Bicycle Infrastructure to Promote Physical Activity in Hidalgo County, Texas.

The role of the built environment as both an asset and a barrier in promoting physical activity is well documented. However, literature on the role of communities in catalyzing policy, systems, and environmental (PSE) change to address gaps in the built environment is scant. We describe a community-driven PSE intervention, resulting in expanded bicycle infrastructure and physical activity opportunities in a South Texas border community. Funded through the Centers for Disease Control and Prevention, the Working on Wellness project engaged community-based coalitions in efforts to increase opportunities for physical activity in Hidalgo County, Texas. Coalitions collaborated with the city of Weslaco to install bicycle lanes and with the Hidalgo County Metropolitan Planning Organization to establish a countywide Bicycle Friendly Business program. Community-driven PSE interventions can be effective public health strategies in creating long-term sustainable solutions that address environmental determinants of obesity.

Obesity and Diabetes in the Winnebago Tribe of Nebraska: From Community Engagement to Action, 2014-2019.

The Winnebago Tribe of Nebraska implemented interventions to promote the health of their people, focusing on community-selected and culturally adapted policies, systems, and environmental (PSE) improvements to reduce the prevalence of obesity and type 2 diabetes. The interventions were implemented as part of the Centers for Disease Control and Prevention’s (CDC’s) 2014–2019 Good Health and Wellness in Indian Country program. The Winnebago Tribe used CDC’s CHANGE community health assessment tool to prioritize and direct their interventions. They integrated findings from a community health assessment tool with observations from tribal working groups and implemented 6 new evidence-based PSE interventions. Their successful approaches — selected by the Winnebago community, culturally relevant, and driven by scientific assessment —demonstrate the value of flexibility in CDC grant programs.

O1 Web-Based Training Videos to Promote Changes in Policies, Systems and Environments for Nutrition Educators

Objective To increase nutrition educators’ ability to implement interventions related to changing policies, systems, and environments (PSEs) through web-based information. Use of Theory or Research This program is based on the socioecological model. Target Audience Nutrition educators who are working with PSE interventions. Course/Curriculum Description A website was developed to promote PSE interventions for SNAP-Ed and EFNEP professionals ( https://psechange.org ). The purpose of this website was to provide a centralized location for PSE training materials that included online videos and links to additional information. These videos provide information about PSE interventions based on where people eat, learn, live, play, shop and work—the framework used in the SNAP-Ed Evaluation Framework. The videos are short, have targeted information about implementation and evaluation, and highlight specific projects such as how to work with faith-based institutions, small food retail initiatives, and promoting change in food systems. Evaluation Methods The website training was created based on a Delphi study conducted with 33 nutrition education professionals from across the country. They identified the need for short videos that could provide quick, introductory information with additional identified resources. Anonymous surveys were collected from 112 nutrition education professionals who attended a workshop about PSEs that included information about the website videos. Results Survey respondents indicated that the website modules were informative, provided a good introduction to PSE interventions, and supplemental materials were helpful. Comments related primarily to how the videos contributed to increased accessibility. This included access to subject matter experts, ability to view targeted information based on their needs rather than having training that focused on broad topics, and videos under 15 minutes each so they could be viewed quickly by busy professionals. Conclusions Short, web-based videos can be a helpful training tool for nutrition educators. These videos were a useful method for introducing new information and ideas, as well as providing a resource for additional training. Funding NIFA.

P140 The University of Arizona's SNAP-Ed Used the Health Food Pantry Assessment Tool to Identify Policy, Systems, and Environmental Changes in Food Pantries

Objective To use the Health Food Pantry Assessment Tool (HFPAT) to identify policy, systems, and environmental (PSE) changes in Arizona's food pantries. Use of Theory or Research The HFPAT was selected as an observational survey that measured the healthfulness of food pantry environments and provided PSE resources to guide food pantries and the University of Arizona Supplemental Nutrition Education - Program (UA SNAP-Ed) programming. Target Audience Four food pantries (Apache-2, Maricopa-2 Counties) that participated in SNAP-Ed completed the HFPAT. Program Description The SNAP-Ed sent the HFPAT in advance of site visits. Two Arizona SNAP-Ed staff independently completed the observational portions of the survey and results were compared. The survey was completed by interviewing the food pantry staff. Reports were generated using Qualtrics® and given to the food pantries. The HFPAT Resource Guide, which provides a resource for each section, was included. Evaluation Methods The HFPAT contained 69 questions divided into five sections: pantry location and entrance, food available to clients, policies of the food pantry, frozen chilled, dry storage and food safety, and services for clients. It provided a numeric score on a scale of 0-100; with a score of 100 signifying the healthiest food pantry environment. Results Four food pantries were assessed. The total scores ranged from 41 to 50 (mean: 46.25 out of 100). The food pantries’ mean scores for each section were: a) 9.25 out of 15 possible points; b) 19.25 out of 57 possible points; c) 6 out of 12 possible points; d) 6.25 out of 10 possible points; and e) 4.5 out of 6 possible points. Conclusions The UA SNAP-Ed used the HFPAT to assist food pantries in identifying potential PSE interventions. This evaluation tool provided direction to the UA SNAP-Ed to give specified technical assistance to the food pantries, and resources to improve their low-scoring areas. Funding None.

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.

Intervention to Improve Access to Fresh Fruits and Vegetables Among Arkansas Food Pantry Clients.

Food pantries serve millions of Americans, yet the nutritional quality of foods distributed has been poor. Policy, systems, and environmental (PSE) changes were implemented in 3 food pantries in northwest Arkansas with the aims of improving the nutritional quality of foods distributed and increasing distribution of fresh fruits and vegetables (FFVs). Between pre-intervention and 1 year follow-up, food pantry bag audits showed increases from 20,256.38 to 25,108.46 calories distributed per household (P = .009) and 0.22 to 3.33 servings of FFVs distributed per person per household (P < .001). Findings highlight the promise of pantry-level PSE interventions.

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.