using policy to create behavior change

Using Policy to Create Behavior Change

Amy Meinen, RD, CDMPH Candidate-University of Minnesota

Wisconsin Division of Public HealthNutrition & Physical Activity Program

“It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change”

-Institute of Medicine

Presentation Outline

1. Supporting Policy Development

2. Translating Research to Practice

3. Nutrition Policy Examples

4. Nutrition Policy Resources & Technical Assistance

Supporting Policy Development

Policy Definitions

Informal: Unwritten Rules “the way we do things around here”

Formal: Written Rules Law or Ordinance passed by a

Governmental Body

Policy Definitions

Policy: The rules that guide the activities of government or quasi-governmental organizations, and that provide authority for the allocation of resources.

Policy Talking Points

Use Data: Behavioral Risk Factor Surveillance

System Data (CDC) 60% of Wisconsin adults are overweight or obese

(CDC BRFSS, 2003)

Youth Risk Behavior Survey (CDC) 24% of Wisconsin high school students are at risk for

overweight or are overweight (CDC YRBS, 2003)

Use Data: USDA Economic Research Service

In 2002, 43% of the food dollar was spent on food away from home

Return on Investment (ROI) The average return on investment for employers is $3

for every $1 invested on employee wellness (Wellness Councils of America, 2004)



Use Theoretical Frameworks & Conceptual Models:

Social Ecological Model Social Cognitive Theory Social Learning Theory

Social Ecological Model

PUBLIC POLICY

COMMUNITY

ORGANIZATIONAL

INTERPERSONAL

INDIVIDUAL

Reach Intensity/Cost

Individual

Interpersonal

Organizations

Community and Neighborhood

PoliciesHighest

HighestLowest

Lowest

SEM-Levels of Change & Scope of Impact

Behavior Change Triad


Use Local-Level Champions: Find local leaders

or influential community members

Find people who have been affected by the issue at hand


Use the Media (Media Advocacy): Set the agenda for public debate and

policy change Use to educate the public and key

decision makers

Translating Research into Policy

Quick Terminology

Evidence-Based:

Practice-Based:

Best-Practice:

Opinions about Nutrition Policy

463 high school principals in MN were surveyed 65% think school nutrition policies are important;

32% have a school nutrition policy 64% believed that only healthful choices should

be available to all students 36% believed that students should be offered a

choice between MORE and LESS healthful foodsFrench SA, Story M, Fulkerson JA. School Food Policies and Practices: A state-wide survey of secondary school principals. J Am DietAssoc 2002 102;1785-1789


RWJF Nationwide Survey 92% of teachers and 91% of parents

favored changing vending options to more healthy foods


6 focus groups with 33 parents held in MN Parents were unaware of important details

about the soft drink vending machines at their children’s school

Parents noted that they needed more information about the number of vending machines, the beverages available, and the revenue being generated from the sales

Hendel-Paterson, French SA, Story M. Parental Attitudes Towards Soft Drink Vending Machines in High Schools. J Am Diet Assoc 2004;104:1597-1600.

CHIPS Study

Changing Individuals’ Purchase of Snacks

French, et al. Pricing and Promotion Effects on Low-Fat Vending Purchases: The CHIPS Study. Am J Public Health 2001;91:112-117

CHIPS Study

CHIPS—Changing Individuals’ Purchase of Snacks Study

Offered in a variety of settings (community, worksite, and secondary schools), minimal research has been done on the effects of vending machine use.

Involved examining environmental nutrition strategies including availability, promotional marketing, and pricing strategies.

CHIPS Study

The study examined pricing and point-of-purchase promotion effects on sales of low-fat and regular vending snacks at 12 schools & 12 worksites in St. Paul, MN.

Evaluated pricing reduction of target snacks and use of promotional signage

CHIPS Study

Wausau SCHOOL Project


Random enrollment of students in grades 2,5,8 and 11

Activity and dietary inventories were obtained

Study enrollment began in October 2002 and ended in January 2003.


05

101520253035404550

Ever Smoked Pre-Diabetes Overweight orObese

Abnormal BloodPressure

AbnormalCholesterolMetabolism


The results from the research conducted during 2002-2003 Wausau SCHOOL Project spurred policy change within the Wausau School District.


Schools to yank soft drinksMarch 12, 2004, (Wausau, WI). Beginning next school year, the high-sugar, low-nutrition soft drinks in the vending machines in the high schools of the Wausau School District will be replaced with healthier juices, sports drinks and water…

Featured in the Wausau Daily Herald

Nutrition Policy Examples

A Few Considerations

People choose foods based on: Cost Taste Convenience

Drewowski & Rolls, J Nutr, 2005

By Tony Auth, The Philadelphia Inquirer

Advertising by Food Manufacturers

Product category Advertising expenditures$ million Share

Prepared, convenience foods 1,563 22.1Confectionery and snacks 1,095 15.5Alcoholic beverages 1,082 15.3Soft drinks and bottled water 702 9.9Cooking products and seasoning 675 9.5Beverages 625 8.8Dairy products and substitutes 505 7.1Bakery goods 408 5.8Meat, poultry, and fish 210 3.0Fruits, vegetables, grains, and beans 159 2.2General promotions 50 0.7

Total 7,074 100.0

Increasing year-round availability of fruits and vegetables is a factor that influences consumption (GAO, 2002)

Current Focus of Nutrition Policies

1. Access and Availability of Healthy, Low-Cost Foods

2. Competitive Pricing3. Healthful Food Advertising/Marketing

Policy in Schools

School Policy

Places to Start: Promote signage/labeling for healthy food

choices at school and at food outlets near school Promote point-of-decision prompts or cues to

support healthy eating Promote development of policies that set

nutrition standards for all foods available in schools

Ensure that students have adequate time to eat during meal periods.

School Polices

School Wellness Policy Reauthorization of the Child Nutrition Act,

Section 204

Requires local education agencies participating in Federal school meal programs to have “school wellness policies”

Effective in the 2006-2007 school year

School Polices

School Wellness Policy Reaches beyond USDA-funded meal

programs to influence childhood health Puts responsibility at the local level Recognizes the critical role of schools in

curbing the childhood obesity epidemic Provides an opportunity for school districts

to create an environment conducive to healthy lifestyle choices

School Polices

School Wellness Policy must contain: Appropriate goals for nutrition education,

physical activity, and other school based activities designed to promote student wellness

Nutrition guidelines for all foods available during the school day, with objectives for promoting health and reducing childhood overweight

School Polices

Competitive Foods Defined as “foods offered at school, other

than meals served through USDA school meal programs”

43% of elementary schools, 74% of middle schools, 98% of high schools have vending machines, school stores, or snack bars that sell competitive foods

School Polices

Marshfield School District Food items must be <7 grams of fat/per serving,

<10% calories from saturated fat No vending of soft drinks during lunch/breakfast;

milk, water, & 100% juice available all day

Appleton School District Eliminated soda and candy, switched to 100%

fruit juice, water, and healthy snacks

School Policies

Governor’s School Health Award

The purpose of the Governor’s School Health Award is to package a group of key policies and programs in order to deliver a more comprehensive nutrition & physical activity plan http://www.schoolhealthaward.wi.gov/

Policy in Worksites

Worksite Policy

Places to Start: Promote guidelines for healthy

foods/beverages served or available at the worksite

Promote signage/labeling of healthy food options in worksite cafeterias

Ensure an appropriate space for breastfeeding; policy in support of breastfeeding

Worksite Policy

Places to Start: Ensure healthy food items can be offered

at the same or lower price as less healthy items

Ensure healthy eating guidelines are being met by worksite childcare facilities

Worksite Policy

Healthy Lifestyles Marshfield Area Coalition Created a policy for Ordering Food for

Company Events

Worksite Policy

Lands End, Dodgeville, WI Provided portable breastfeeding pumps

to traveling mothers Provided a breastfeeding room

Policy in the Community

Community Policy

Places to Start: Ensure that food assistance programs

are offering healthy food options Create or promote food markets with

healthy options in low socioeconomic neighborhoods

Promote healthy food items in vending machines in public places

Community Policy

Places to Start: Promote serving of healthy foods and

beverages at community events Promote designation of funds to promote

healthy eating Support restaurants for adding healthy

menu items or altering recipes to make them healthier

Community Policy

Use community-wide campaigns to raise awareness.

Nutrition Policy Resources

General Policy Resources

The Prevention Institute www.preventioninstitute.org Nutrition Policy Profiles:

Breastfeeding Competitive Foods Pricing of Healthy Food Soft Drink Contracts Supermarket Access Nutrition Labeling Regulations


ENACT Environmental Nutrition and Activity

Community Tool Menu of strategies designed to help

communities improve nutrition and activity environments on a local level

http://www.preventioninstitute.org/sa/enact/enact/index.htm


CDC’s State Legislative Information Allows searching for state bills by topic (i.e.

nutrition) http://apps.nccd.cdc.gov/DNPALeg/


Nutrition & Physical Activity: A Policy Resource Guide Developed by the Washington State Health

Department Purpose was to create an evidence-based guide for

prioritization and development of policies at the state and local level

http://www.orggroup.com/WANPA-PLG.html


Center for Science in the Public Interest (CSPI) Pestering Parents: How Food Companies Market

Obesity to Children http://www.cspinet.org/

National Alliance for Activity & Nutrition (NANA) http://www.cspinet.org/nutritionpolicy/nana.html

School Policy Resources

USDA Team Nutrition Web-Based Technical Assistance http://teamnutrition.usda.gov/Healthy/wellnesspolicy.html

Center for Science in Public Interest School Foods Toolkit http://www.cspinet.org/schoolfoodkit/


CDC’s DASH Program http://www.cdc.gov/HealthyYouth/healthtopics/wellness.htm

Wisconsin Team Nutrition http://www.dpi.state.wi.us/ne/tn.html

Wisconsin Association of School Boards http://www.wasb.org/policy/index.html


Making it Happen: School Nutrition Success Stories (USDA)

http://www.fns.usda.gov/tn/Resources/makingithappen.html


http://dpi.wi.gov/fscp/pdf/tnbooklt.pdf

http://www.fns.usda.gov/tn/Resources/changing.html

Save the Date!

Local Wellness Policies: Putting School Nutrition Legislation into Practice

(teleseminar)

Wednesday November 16th

3:00-4:30 pm TBD


Wisconsin Public Health & Health Policy Institute

Released in March 2005

Discusses how policies addressing school vending may be a part of a multi-

pronged approach for preventing childhood

overweight

Childcare Policy Resources

Recommended Policies for Healthy Eating and Physical Activity in Wisconsin Childcare Facilities

What’s Right for Young Children: Improving the Childcare Nutrition Environment

For copies, contact Julie Allington @ [email protected]

Worksite Policy Resources

Choosing Foods and Beverages for Healthy Meetings, Conferences, and Events (CDC) http://www.cdc.gov/nccdphp/dnpa

/pdf/Healthy_Worksite_Food.pdf


Guidelines for Offering Healthy Foods at Meetings, Seminars, & Catered Events (University of Minnesota) http://www.ahc.umn.e

du/ahc_content/colleges/sph/sph_news/Nutrition.pdf


http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf

CDC Guide to Breastfeeding Interventions

Community Policy Resources

Food Policy Councils http://www.statefoodpolicy.org

National Conference of State Legislatures: State Policies for Increasing Access to Healthy Foods http://www.ncsl.org/programs/health/publichealth/foodaccess/factsheets.htm

Community Policy Resources

Community Toolbox Organizing for Effective Advocacy http://ctb.ku.edu/

Community Food Security Coalition http://www.foodsecurity.org

For more information...

Mary Pesik, Program Coordinator [email protected] or 608-267-3694

Amy Meinen, Nutrition Coordinator [email protected] or 608-267-9194

Jon Morgan, Physical Activity Coordinator [email protected] or 608-266-9781

“Never doubt that a small group of dedicated people can change the world. Indeed, it is

the only thing that ever has.”

-Margaret Mead

using policy to create behavior change

Documents

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school nutrition policies

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