Using Policy to Create
Behavior Change
Amy Meinen, RD, CD
MPH Candidate-University of Minnesota
Wisconsin Division of Public Health
Nutrition & 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)
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)
Policy Talking Points

Use Theoretical Frameworks &
Conceptual Models:



Social Ecological Model
Social Cognitive Theory
Social Learning Theory
Social Ecological Model
PUBLIC POLICY
COMMUNITY
ORGANIZATIONAL
INTERPERSONAL
INDIVIDUAL
SEM-Levels of Change &
Scope of Impact
Intensity/Cost
Reach
Lowest
Highest
Individual
Interpersonal
Organizations
Community and Neighborhood
Highest
Policies
Lowest
Behavior Change Triad
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
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
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
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
Opinions about Nutrition Policy

RWJF Nationwide Survey

92% of teachers and 91% of parents
favored changing vending options to
more healthy foods
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.
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
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.
Wausau SCHOOL Project
50
45
40
35
30
25
20
15
10
5
0
Ever Smoked
Pre-Diabetes
Overweight or
Obese
Abnormal Blood
Pressure
Abnormal
Cholesterol
Metabolism
Wausau SCHOOL Project

The results from the research
conducted during 2002-2003 Wausau
SCHOOL Project spurred policy
change within the Wausau School
District.
Wausau SCHOOL Project
Schools to yank soft drinks
March 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
22.1
Confectionery and snacks
1,095
15.5
Alcoholic beverages
1,082
15.3
Soft drinks and bottled water
702
9.9
Cooking products and seasoning
675
9.5
Beverages
625
8.8
Dairy products and substitutes
505
7.1
Bakery goods
408
5.8
Meat, poultry, and fish
210
3.0
Fruits, vegetables, grains, and beans
159
2.2
50
0.7
7,074
100.0
General promotions
Total

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 Pricing
3. 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
General Policy Resources

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
General Policy Resources

CDC’s State Legislative Information


Allows searching for state bills by topic (i.e.
nutrition)
http://apps.nccd.cdc.gov/DNPALeg/
General Policy Resources

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
General Policy Resources

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/
School Policy Resources

CDC’s DASH Program


Wisconsin Team Nutrition


http://www.cdc.gov/HealthyYouth/healthtopics/wellness.htm
http://www.dpi.state.wi.us/ne/tn.html
Wisconsin Association of School Boards

http://www.wasb.org/policy/index.html
School Policy Resources

Making it Happen:
School Nutrition
Success Stories
(USDA)
http://www.fns.usda.gov/tn/Resources/makingithappen.html
School Policy Resources
http://www.fns.usda.gov/tn/Resources/changing.html
http://dpi.wi.gov/fscp/pdf/tnbooklt.pdf
Save the Date!
Local Wellness Policies: Putting School
Nutrition Legislation into Practice
(teleseminar)
Wednesday November 16th
3:00-4:30 pm
TBD
School Policy Resources
Wisconsin Public Health &
Health Policy Institute
Released in March 2005
Discusses how policies
addressing school vending
may be a part of a multipronged 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 @
julie.allington@dpi.state.wi.us
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
Worksite Policy Resources

Guidelines for
Offering Healthy
Foods at Meetings,
Seminars, &
Catered Events
(University of
Minnesota)

http://www.ahc.umn.e
du/ahc_content/colle
ges/sph/sph_news/N
utrition.pdf
Worksite Policy Resources
CDC Guide to
Breastfeeding
Interventions
http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf
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
 pesikmj@dhfs.state.wi.us or 608-267-3694
 Amy Meinen, Nutrition Coordinator
 meineam@dhfs.state.wi.us or 608-267-9194
 Jon Morgan, Physical Activity Coordinator
 morgajg@dhfs.state.wi.us 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