Increasing EFNEP Program Outreach and Enhancing Program Content Through Local Partnerships

The Expanded Food and Nutrition Education Program (EFNEP) has been shown to be a cost-effective investment of federal dollars. The funding for the program has not increased significantly since the 1980\u27s. Growing rates of poverty in cities like Cleveland have increased the demand for the program. This article describes some innovative strategies that EFNEP in Cuyahoga County, Ohio has used to enhance program quality and expand program outreach

Improvements and Disparities in Types of Foods and Milk Beverages Offered in Elementary School Lunches, 2006–2007 to 2013–2014

Introduction Children consume much of their daily energy intake at school. School district policies, state laws, and national policies, such as revisions to the US Department of Agriculture’s school meals standards, may affect the types of foods and beverages offered in school lunches over time. Methods This study evaluated changes and disparities in school lunch characteristics from 2006–2007 to 2013–2014. Data were obtained from annual cross-sectional surveys at 4,630 public elementary schools participating in the National School Lunch Program. Multivariate logistic regressions were conducted to examine lunch characteristics. Results The percentage of schools regularly offering healthful items such as vegetables (other than potatoes), fresh fruit, salad bars, whole grains, and more healthful pizzas increased significantly from 2006–2007 to 2013–2014, and the percentage of schools offering less healthful items such as fried potatoes, regular pizza, and high-fat milks decreased significantly. Nevertheless, disparities were evident in 2013–2014. Schools in the West were significantly more likely to offer salad bars than were schools in the Northeast, Midwest, or South (adjusted prevalence: West, 66.3%; Northeast, 22.3%; Midwest, 20.8%; South, 18.3%). Majority-black or majority-Latino schools were significantly less likely to offer fresh fruit than were predominantly white schools (adjusted prevalence: majority black, 61.3%; majority Latino, 73.0%; predominantly white, 87.8%). Schools with low socioeconomic status were significantly less likely to offer salads regularly than were schools with middle or high socioeconomic status (adjusted prevalence: low, 38.5%; middle, 47.4%; high, 59.3%). Conclusion Much progress has been made in improving the quality of school lunches in US public elementary schools, but additional opportunities for improvement remain

City Fresh: A Local Collaboration for Food Equity

To address limited access to fresh fruits and vegetables in urban neighborhoods, a collaborative of grass-roots organizations designed City Fresh—a sustainable local food system creating new market opportunities for urban and rural growers and promoting access to and consumption of healthy foods by low-income Cleveland residents. Fresh produce is marketed through a network of Fresh Stops that obtain produce from farmers within a 70-mile radius of the city and from urban growers who are trained through the program. Evaluation results indicate increase in participation rates; growth in urban agriculture; and increase in consumption of fruits and vegetables by participants

Strategies Used by Healthy Kids, Healthy Communities Partnerships to Prevent Childhood Obesity

IntroductionHealthy Kids, Healthy Communities (HKHC) is an initiative of the Robert Wood Johnson Foundation to prevent obesity among high-risk children by changing local policies, systems, and environments. In 2009, 105 community partnerships applied for funding from HKHC. Later that year, the Centers for Disease Control and Prevention (CDC) released recommended community strategies to prevent obesity by changing environments and policies. The objective of this analysis was to describe the strategies proposed by the 41 HKHC partnerships that received funding and compare them to the CDC recommendations.MethodsWe analyzed the funded proposals to assess the types and prevalence of the strategies proposed and mapped them onto the CDC recommendations.ResultsThe most prevalent strategies proposed by HKHC-funded partnerships were providing incentives to retailers to locate and serve healthier foods in underserved areas, improving mechanisms for purchasing food from farms, enhancing infrastructure that supports walking and cycling, and improving access to outdoor recreational facilities.ConclusionThe strategies proposed by HKHC partnerships were well aligned with the CDC recommendations. The popular strategies proposed by HKHC partnerships were those for which there were existing examples of successful implementation. Our analysis provides an example of how information from communities, obtained through grant-writing efforts, can be used to assess the status of the field, guide future research, and provide direction for future investments

Evaluation of a Supermarket Environmental Change Intervention: Findings from a Low-Fat Milk Couponing and Educational Marketing Pilot

The purpose of this study was to evaluate a multifaceted, collaborative approach to supermarket environmental change that included in-store couponing and educational marketing to increase low-fat milk purchasing across a 48-store supermarket chain serving predominately Hispanic customers. Point-of-sale (POS) and process data collected during the 16-week program implementation included in-store radio advertising, in-store signage, and POS coupons. POS data were analyzed by the coupon marketing partner, and a chi-square test was conducted to test for significant differences between groups. POS data indicated that 44,050 low-fat milk coupons were issued to traditional full-fat milk purchasing customers with a redemption rate of 5.3%. Of these, 42% became repeat low-fat milk purchasers (i.e., after initial purchase with coupon, customer re-purchased low-fat milk). Results from the chi-square test revealed significant differences in rates of purchase between those who received a coupon (5.87%) and those who did not (4.00%), (χ2 = 8.61, p = .0033). Findings indicate that collaborative public health efforts between retail and marketing partners to engage supermarket customers in a multifaceted yet targeted intervention are feasible and can shift purchasing behaviors towards a healthy alternative. This study has implications for informing future environmental change supermarket strategies

Women, Infants, and Children Cash Value Voucher (CVV) Use in Arizona: A Qualitative Exploration of Barriers and Strategies Related to Fruit and Vegetable Purchases

ObjectiveWomen, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them.DesignEight focus groups were conducted to explore attitudes and behaviors related to CVV use.SettingFocus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ.ParticipantsParticipants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households.Phenomenon of InterestPerceived barriers to CVV use and strategies used to maximize their purchasing value.AnalysisTranscripts were analyzed using a general inductive approach to identify emergent themes.ResultsAmong 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power.Conclusions and ImplicationsArizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences

Strategies Proposed by Healthy Kids, Healthy Communities Partnerships to Prevent Childhood Obesity

IntroductionHealthy Kids, Healthy Communities (HKHC) is an initiative of the Robert Wood Johnson Foundation to prevent obesity among high-risk children by changing local policies, systems, and environments. In 2009, 105 community partnerships applied for funding from HKHC. Later that year, the Centers for Disease Control and Prevention (CDC) released recommended community strategies to prevent obesity by changing environments and policies. The objective of this analysis was to describe the strategies proposed by the 41 HKHC partnerships that received funding and compare them to the CDC recommendations.MethodsWe analyzed the funded proposals to assess the types and prevalence of the strategies proposed and mapped them onto the CDC recommendations.ResultsThe most prevalent strategies proposed by HKHC-funded partnerships were providing incentives to retailers to locate and serve healthier foods in underserved areas, improving mechanisms for purchasing food from farms, enhancing infrastructure that supports walking and cycling, and improving access to outdoor recreational facilities.ConclusionThe strategies proposed by HKHC partnerships were well aligned with the CDC recommendations. The popular strategies proposed by HKHC partnerships were those for which there were existing examples of successful implementation. Our analysis provides an example of how information from communities, obtained through grant-writing efforts, can be used to assess the status of the field, guide future research, and provide direction for future investments

Formative Evaluation for a Healthy Corner Store Initiative in Pitt County, North Carolina: Assessing the Rural Food Environment, Part 1

Introduction Obesity prevalence in the rural United States is higher than in urban or suburban areas, perhaps as a result of the food environment. Because rural residents live farther from supermarkets than their urban- and suburban-dwelling counterparts, they may be more reliant on smaller corner stores that offer fewer healthful food items. Methods As part of a Communities Putting Prevention to Work (CPPW) healthy corner store initiative, we reviewed audit tools in the fall of 2010 to measure the consumer food environment in eastern North Carolina and chose the NEMS-S-Rev (Nutrition Environment Measures Survey-Stores-Revised) to assess 42 food stores. During the spring and summer of 2011, 2 trained graduate assistants audited stores, achieving interrater reliability of at least 80%. NEMS-S-Rev scores of stores in rural versus urban areas were compared. Results Overall, healthful foods were less available and of lower quality in rural areas than in urban areas. NEMS-S-Rev scores indicated that healthful foods were more likely to be available and had similar pricing and quality in rural corner stores than in urban corner stores. Conclusion Food store audit data provided a baseline to implement and evaluate a CPPW healthy corner store initiative in Pitt County. This work serves as a case study, providing lessons learned for engaging community partners when conducting rural food store audits