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Using Policy to Create Behavior Change

Using Policy to Create Behavior Change. Amy Meinen, RD, CD MPH Candidate-University of Minnesota Wisconsin Division of Public Health Nutrition & Physical Activity Program .

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Using Policy to Create Behavior Change

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  1. Using Policy to Create Behavior Change Amy Meinen, RD, CD MPH Candidate-University of Minnesota Wisconsin Division of Public Health Nutrition & Physical Activity Program

  2. “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

  3. Presentation Outline 1. Supporting Policy Development 2. Translating Research to Practice 3. Nutrition Policy Examples 4. Nutrition Policy Resources & Technical Assistance

  4. Supporting Policy Development

  5. Environmental Change Policy & Organizational Practices Social & Physical Environment Policy

  6. Policy Definitions • Informal: • Unwritten Rules • “the way we do things around here” • Formal: • Written Rules • Law or Ordinance passed by a Governmental Body

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

  8. 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)

  9. Policy Talking Points • 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)

  10. Policy Talking Points • Use Theoretical Frameworks & Conceptual Models: • Social Ecological Model • Social Cognitive Theory • Social Learning Theory

  11. PUBLIC POLICY National, state, local laws COMMUNITY Relationships among organizations ORGANIZATIONAL Organizations, social institutions INTERPERSONAL Family, friends, social networks INDIVIDUAL Attitudes, Knowledge, Skills Social Ecological Model

  12. SEM-Levels of Change & Scope of Impact Intensity/Cost Reach Lowest Highest Individual Interpersonal Organizations Community and Neighborhood Policies Highest Lowest

  13. Behavior Change Triad Policy Environment Behavior

  14. Policy Talking Points • Use Local-Level Champions: • Find local leaders or influential community members • Find people who have been affected by the issue at hand

  15. Policy Talking Points • Use the Media (Media Advocacy): • Set the agenda for public debate and policy change • Use to educate the public and key decision makers

  16. Translating Research into Policy

  17. Quick Terminology • Evidence-Based: • Practice-Based: • Best-Practice:

  18. 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 foods French 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

  19. Opinions about Nutrition Policy • RWJF Nationwide Survey • 92% of teachers and 91% of parents favored changing vending options to more healthy foods

  20. Opinions about Nutrition Policy • 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.

  21. 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

  22. 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.

  23. 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

  24. CHIPS Study

  25. Wausau SCHOOL Project

  26. 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.

  27. 50 45 40 35 30 25 20 15 10 5 0 Ever Smoked Pre-Diabetes Overweight or Abnormal Blood Abnormal Obese Pressure Cholesterol Metabolism Wausau SCHOOL Project The Results...

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

  29. Wausau SCHOOL Project 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

  30. Nutrition Policy Examples

  31. A Few Considerations • People choose foods based on: • Cost • Taste • Convenience Drewowski & Rolls, J Nutr, 2005

  32. By Tony Auth, The Philadelphia Inquirer

  33. Advertising by Food Manufacturers

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

  35. Current Focus of Nutrition Policies 1. Access and Availability of Healthy, Low-Cost Foods 2. Competitive Pricing 3. Healthful Food Advertising/Marketing

  36. Policy in Schools

  37. 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.

  38. 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

  39. 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

  40. 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

  41. 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

  42. 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

  43. 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/

  44. Policy in Worksites

  45. 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

  46. 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

  47. Worksite Policy • Healthy Lifestyles Marshfield Area Coalition • Created a policy for Ordering Food for Company Events

  48. Worksite Policy • Lands End, Dodgeville, WI • Provided portable breastfeeding pumps to traveling mothers • Provided a breastfeeding room

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