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TRT Reviewed Healthy Eating Interventions

ABC Grow Healthy (South Carolina)

Once enrolled in ABC Quality, legally operating centers can opt to participate in the ABC Child Care Voucher System to serve families receiving child care vouchers. Families who meet income qualifications based on gross family income and are working, in school, or in training may choose a child care provider enrolled in the ABC Child Care Voucher System. For entrance to the program, the income criteria are no more than 150% of the federal poverty level. Once enrolled, when the gross family income exceeds 175% of the federal poverty level, the family is no longer eligible for a child care voucher. Children served by these centers statewide range in age from birth through 12 years (up through age 18 for children with special needs). There are no restrictions based on gender, race/ethnicity, or urban/rural location. Priority of funding is based partially on socioeconomic status, but in South Carolina, child care subsidy is extremely limited. Other priorities include those who have child protective services or foster care cases, and special needs children. ABC Quality standards are applied program wide; all children attending a child care center enrolled in the quality rating and improvement system are impacted by the ABC Grow Healthy Standards.

Arkansas Healthy Employees Lifestyle Program (AHELP)

The intent of the Arkansas Healthy Employees Lifestyle Program (AHELP) is to increase healthy behaviors among Arkansas state employees.  AHELP was passed by the Arkansas legislature as a voluntary policy giving state agency heads the authority to grant their full-time state employees the opportunity to participate in the program.  Center TRT evaluated the results of the project’s pilot phase (2005-2008), which had 200 county-based offices and two central offices participating, with the potential to reach 10,000 state health and human services employees.  The fall of 2009, AHELP was launched statewide, increasing its reach significantly.

Baltimore Healthy Stores

Baltimore Healthy Stores was one of five healthy stores interventions led by the Johns Hopkins Center for Human Nutrition.  Healthy stores is a store-based, culturally appropriate intervention designed to increase the supply of healthy foods and the promotion of their purchase for low-income residents through health education and point-of-purchase marketing strategies.

While the components of the intervention were similar for each of the five locations, extensive formative research was conducted to adapt each to a different social and cultural context.  The healthy store intervention has been adapted, implemented and evaluated in the following locations: 

  • Marshall Islands;
  • Apache reservations, Arizona;
  • Baltimore urban, low-income communities;
  • Native Canadian communities; and
  • Hawaii.

Cleveland-Cuyahoga County Food Policy Coalition

The CCCFPC seeks to create a population-level impact in Cuyahoga County by supporting local food policies, environmental change, and programs. According to the U.S. Census Bureau, in 2010 there were 1,280,122 people living in Cuyahoga County. Approximately 63.6% of the population is white, 29.7% is African American, 4.8% is Hispanic, and 2.6% is Asian. Approximately 323,850 residents of Cuyahoga County (25% of the county population) and 221,036 Cleveland residents (55.7% of the city population) live in areas categorized as food deserts. Between 2006 and 2010, the median household income in Cuyahoga County was $43,603, and 16.4% of residents lived below the poverty line. The average household income in food desert areas is $37,312 compared to $70,448 in non-food desert areas.

Color Me Healthy

Color Me Healthy (CMH) is designed to improve fruit and vegetable intake and increase physical activity among 4 and 5 year old children in child care, home day care, Head Start, and preschool settings by increased exposure to nutrition education and opportunities for physical activity.  Early dissemination of Color Me Healthy was funded by the Supplemental Nutrition Assistance Program – Education (SNAP-Ed) and implemented in low-income, under-resourced childcare centers participating in the Child and Adult Care Food Program (CACFP) and the Expanded Food and Nutrition Education Programs (EFNEP). Color Me Healthy has been adopted in many North Carolina counties and by the Eastern Band of the Cherokee Indian Nation.  Additionally, it has been implemented in numerous states, including a research study in Boise, Idaho.

Color Me Healthy materials are available in English and Spanish.

Eat Well Play Hard in Child Care Settings

Eat Well Play Hard in Child Care Settings (EWPHCCS) is a multi-component intervention that focuses on improving the nutrition and physical activity behaviors of pre-school age children and their parents/caregivers and influencing food and activity practices in child care settings. The primary audiences for EWPHCCS are families with pre-school age children (3-4 years), participating in or eligible for the Supplemental Nutrition Assistance Program (SNAP) and children enrolled in child care centers participating in the Child and Adult Care Food Program (CACFP). Eligible centers are those in which 50% or more of enrolled families qualify for free or reduced-price meals.  EWPHCCS is implemented in New York state and participating children and families were racially, ethnically, and geographically diverse.

Farm to Work (Texas)

The Farm to Work program intends to increase availability and consumption of fresh, locally grown fruits and vegetables among worksite employees.  It is implemented in 36 worksites in Central Texas including DSHS offices, multiple other state office buildings, City of Austin sites, and private worksites.  All employees are invited to participate.  While the racial/ethnic representation of employees taking part in the Farm to Work program is not known, it is reasonable to estimate that most participants live in and around Austin, TX. 

Faithful Families Eating Smart and Moving More

Faithful Families Eating Smart and Moving More (FFESMM) is a practice-tested intervention that focuses on healthy environmental and policy changes within faith communities.  Faithful Families Eating Smart and Moving More was evaluated with faith communities serving predominantly limited resource and African American members. For the 737 individuals providing data, 10.2% had less than a high school education, 46.6% were at or below 200% of federal poverty level, 72.2% were African American, and 76.4% were overweight or obese.

Health Bucks

Health Bucks, $2 coupons, offer a financial incentive for residents of low-income neighborhoods to purchase fruits and vegetables at farmers’ markets. The program makes a concerted effort to get Health Bucks into the hands of low-income people by distributing them through community-based organizations and at farmers’ markets operating in underserved areas. Health Bucks customers often receive USDA nutrition benefits, such as SNAP, Farmers’ Market Nutrition Program coupons for low-income women, infants and children (WIC FMNP) and the FMN program for low-income seniors. All farmers’ markets that accept SNAP through EBT give one Health Buck coupon to each customer for every $5 spent using SNAP.

The Health Bucks program operates in each borough of New York City. Similar programs using different names operate in numerous urban (Philadelphia, Boston and Baltimore) and suburban (Carrboro, NC) areas of the country.

Healthy Cornerstore Initiative Produce Distribution System

The Healthy Cornerstore Initiative intends to increase availability of fresh fruits and vegetables in cornerstores, particularly small WIC-authorized stores.  Currently, produce distributors are making fresh fruits and vegetables available to approximately 500 small stores in Minnesota, including approximately 200 WIC-authorized stores with one or two cash registers.  Because this program aims to increase availability of fresh fruits and vegetables for WIC recipients, the program has the potential to reach low-income populations in Minnesota.  In addition, the Healthy Cornerstore Intiative has the potential to reach populations living in areas where small cornerstores may be the only and primary food shopping location available.

Healthy Food Environments Pricing Incentives

Healthy Food Environments Pricing Policy (HFEPP) is an organizational policy implemented by hospitals to increase availability, visibility, and affordability of healthy foods and beverages for their employees, volunteers, and visitors. The pricing policy incentive encourages the purchase of healthier items through a price decrease and discourages purchase of less healthier items through a price increase. In North Carolina, 95 hospitals have fully adopted the policy and 23 more have an action plan to reach full implementation.  These hospitals are all sizes and located in all parts of the state. HFPP reaches 200,000 hospital employees and millions of visitors. Additionally, hospitals in South Carolina have begun implementing the Healthy Food Environments Pricing Policy.

Healthy Food Procurement in the County of Los Angeles

Los Angeles County is one of the largest and most diverse counties in the United States. Consequently, the adoption of the Healthy Food Promotion in Los Angeles County Food Service Contracts motion has the potential to reach a broad audience. Almost ten million people live in Los Angeles County. As of 2010, approximately 48% of the population is Hispanic or Latino, 28% is non-Hispanic white, 14% is Asian, and 10% is Black. The percent of foreign-born residents in this jurisdiction was 35.6% during 2007-2011. During the same time period, about 16% of county residents lived below the poverty line. Almost 23% of children in grades 5, 7, and 9 were obese (BMI >95th percentile). Nearly 36% of adults were overweight (BMI between 25 and 29.9), and another 22% were obese (BMI >30).

As an institutional policy, it specifically targets County employees (the County currently employs more than 100,000 individuals); patrons who purchase food and beverages at County venues, and populations whose meals are provided by County of Los Angeles food venues and programs. The County distributes meals to youth, seniors, patients, and incarcerated individuals; populations who are at greater risk for obesity and poverty. Once the institutional policy is fully implemented, DPH estimates that it will affect nearly 37 million meals offered/served in various County settings per year.

Healthy Vending Iowa

Healthy Vending Iowa is an environmental change intervention intending to affect as many people as possible, creating a population-level impact. At the time of the Center TRT review, the intervention had been implemented in an estimated 100 non-governmental worksites, 13 State Capitol Complex buildings, and 19 county-owned buildings located throughout Iowa.  Employees and visitors to these worksites vary widely with respect to demographic characteristics, such as race/ethnicity, age, and socioeconomic status.  Additionally, the worksites differ by urban/rural status, public/private sector, and number of employees.

More targeted evaluation was conducted in 13 Iowa worksites through a mini-grant program supported by the Iowa Comprehensive Cancer Consortium.  Seventy-seven percent of these worksites had over 100 employees.  In addition, worksites in one rural county and one urban county have been evaluated as part of Iowa’s Community Transformation Grant.  Evaluation of the vending environment at worksites will permit the exploration of another demographic cohort, as well as the impacts on low-income workers and rural workers when compared to their urban and higher-income counterparts. 

Kaiser Permanente Cafeteria Menu Labeling

Kaiser Permanente Cafeteria Menu Labeling has been adopted by and implemented in hospital cafeteria in three western states (California,Oregon, and Hawai’i) in a multi-ethnic, multi-racial population of hospital employees and visitors. The majority of respondents to the evaluation surveys during the pilot study were female, healthcare professionals, college graduates, and over the age of 30. The exact racial/ethnic breakdown of those reached by the intervention is not available.

Kindergarten Initiative

The Kindergarten Initiative (KI) is designed to promote healthy eating habits in kindergarten students, through nutrition and agriculture education, school snacks from local farms, and parent engagement activities. The Kindergarten Initiative (the program) and Healthy Farms and Healthy Schools Act (the Pennsylvania state-wide policy) give preference to schools located in areas where a high percentage of children are eligible for free and reduced-price school meals.  At the time of the review, 53 schools statewide participated in the program. The intended audience for the program and policy is kindergarten students and their parents. The Kindergarten Initiative has also been adopted in schools in Pennsylvania, Missouri, New Jersey, and Massachusetts. 

Minneapolis Healthy Cornerstore Program

Minneapolis Health Department focused the Healthy Corner Store Program on neighborhoods with the greatest health disparities and the highest rates of poverty. The city’s population of 400,070 (2013 estimate)1 is diverse with many cultural groups and immigrants, including Somali and Hmong. According to 2010 US census data, 18.6% of residents are black or African American, 10.5% are Hispanic or Latino and 5.6% are Asian. Historically, residents of color live in the neighborhoods of Near North of North Minneapolis and the Philips neighborhood of South Minneapolis. While the percentage of households reporting receipt of cash public assistance or SNAP in Minneapolis is 17%; the percentage of households reporting the same in Phillips Community is 63% and 67% in Near North Community.  Residents who live in Phillips Community have a 2.6 times greater chance of reporting household receipt of SNAP or other cash public assistance than residents of Minneapolis as a whole.  Residents who live in Near North have a 2.7 times greater chance of reporting household receipt of SNAP or other cash public assistance than residents of Minneapolis as a whole.2

Minneapolis has approximately 90 convenience stores subject to requirements of the Staple Food Ordinance. Stores are often a main source of food for many low-income families and over 50% of convenience stores are WIC-authorized.



1 http://quickfacts.census.gov/qfd/states/27/2743000.html

2 Based on the 2009-2012 ACS, Table DP03; due to their nature, numbers are imprecise and should be considered estimates only. Created by the City of Minneapolis Health Department, Research and Evaluation Division on 7/16/2014.

Nutrition and Physical Activity Self-assessment for Child Care (NAP SACC)

The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program targets child care policy, practice and environmental influences on nutrition and physical activity behaviors in young children.  NAP SACC was tested in a randomized control trial in childcare centers located in both urban and rural areas of North Carolina.  Children attending centers in the study were ages 3, 4, and 5.  Childcare centers in the study served a diversity of children (35-40% were nonwhite), the majority of whom were low-income.  Seventy-seven percent (77%) of the children participated in the USDA’s Child and Adult Care Food Program, which provides nutritious meals and snacks to children from low-income families as a regular part of their childcare.

OSNAP Initiative: Strategies to Increase Drinking Water Access

The OSNAP study was conducted in afterschool programs in urban Boston. The population served by the afterschool programs was racially, linguistically, and economically diverse. Schools at which the programs were located had student populations that were 37.7% black, 10.6% white, and 37.9% Hispanic. On average, 81.2% of children qualifıed for free/reduced-price lunch. The mean enrollment across afterschool programs was 72.0 children and the mean child age was 7.8 years.

Oregon Farm to School and School Garden Policy Approach

Oregon chose a state-level policy approach, working within the Oregon Departments of Education and Agriculture, to increase children’s access to and consumption of locally grown foods. Farm to school and school garden activities in Oregon are designed to reach all primary and secondary school children, either through the school meal programs, school garden activities, school wellness policies, and/or other food-related educational activities.

Pennsylvania Fresh Food Financing Initiative

Fresh Food Financing Initiative is a state-level policy designed to increase access to affordable, quality, healthful foods in underserved areas by providing critical, one-time loans and grants for the development, expansion or renovation of fresh food retail establishments, such as supermarkets or grocery stores. Eligible communities are defined as low- or moderate-income census tracts, areas of below-average supermarket density, areas with a supermarket customer base where the majority live in a low-income census tract or in other areas demonstrated to have significant access limitations to supermarkets due to travel distance.

Since it aims to increase the geographic access and availability of healthy foods in underserved areas in both urban and rural parts of Pennsylvania, this program has the potential to broadly reach low- to moderate-income populations.

Additionally, several other states and cities have passed similar legislation; they are New York, Illinois, New Jersey and the city of New Orleans, La.

Policy Regulations for Day Care in New York City

New York City amended its Child Care Services regulations, part of the City’s Health Code, to improve the physical activity and nutrition practices in NYC group day care facilities. This amendment included specific guidelines for outdoor play and physical activity, limits on television viewing, and requirements for food and food areas. As a public policy, it affects children from birth to age five attending group day care centers. The NYC day care policy reaches approximately 116,000 children in 2000 group day care center sites.

Riverside Unified School District Farmers’ Market Salad Bar Program

The Riverside (CA) Unified School District (RUSD) Farm to School Program is designed to promote healthy eating in children by increasing the availability of fruits and vegetables in school lunches and providing nutrition education to increase knowledge of and improve attitudes toward eating a variety of locally grown produce. The RUSD Farmers’ Market Salad Bar Program was evaluated with 29 elementary schools in the district with a student population of 24,077. The school district’s student population is 53% Latino, and 60% of all students are eligible for free or reduced-price lunch.

TrailNet – Healthy Active Vibrant Communities

Trailnet’s Healthy, Active, & Vibrant Communities Initiative (HAVC) is a model that uses community engagement and community development principles to empower communities to support and promote healthy eating and active lifestyles. The intent of this intervention is to build communities’ capacity to implement policy and environmental changes and build healthy social networks to address obesity. The HAVC Initiative is focused in low-income and at-risk communities.  HAVC activities are tailored to complement the unique assets, needs, and interests of each community. The citizens in the communities engaged in the initiative are economically, racially, and ethnically diverse. The HAVC Initiative has been implemented in three Missouri communities: rural De Soto, suburban Ferguson, and the urban neighborhood Old North St Louis.

Since the HAVC approach is designed for communities to choose the specific policies, environmental changes, and events they want to implement, specific components of the initiative are tailored to the target community and target population.

Weight-Wise

Weight-Wise is a behavioral weight management program designed to help women lose weight. Center TRT reviewed the Weight-Wise pilot research study, which was conducted in one North Carolina county. Pilot study participants were midlife women (ages 40-64), low income, almost all lacked health insurance, and 38% were African-American. Subsequent to the pilot study, a multi-county research study was conducted (not yet reviewed by Center TRT).  Study participants demographic data include 53% of women were African-American, 20% reported an annual household income of less than $10,000 and 43% did not have health insurance.  Intervention sites were located in both urban and rural areas.

The University of Rochester Prevention Research Center in Rochester, NY has adapted Weight-Wise for deaf adults, both men and women, ages 40-70 years.

WV School Nutrition Standards

The West Virginia Board of Education Policy 4321.1: Standards for School Nutrition ("nutrition standards") primary focus is to improve the school food environment through changes in school district policies and practices. Two key intended outcomes of the policy are to improve the nutritional quality of foods available in schools and reduce marketing of unhealthy foods and beverages to students. The West Virginia School Nutrition Standards were evaluated as state-level policy affecting all the children in the state who attend schools in the 55-county system.  This is a mandatory policy that reaches 282,000 students, pre-K through 12th grade. Almost 52% of the student population in West Virginia is eligible for free or reduced-price school meals.