S.Banjoff BDI Logic Model 2.0

BDI Logic Model to reduce obesity within a community using community participatory principles, employing multiple levels and strategies

Level Intervention Determinant Behaviors Health Goal

Com

mun

ity

Recruitment of area: Academic and Research Institutions, Private and Public Institutions/Org, for research, evaluation, funding, and scientific aspects

Recruitment of area community organizations, political leaders, and other influential individuals to partner with researchers for cultural and environmental assessment, logistical support, implementation, background knowledge, motivation level, and proper identification/recruitment of at risk population, needs and wants of the community

Schedule regular meetings and other lines of communication between Academic, Community leaders, and other partners involved to ensure proper feedback, division of labor, accountability, goal setting, evaluation and trust building.

Manage expectations and tensions through several avenues of communication between stakeholders

Collaboration effort of stakeholders to identify those individuals who are food insecure, using community feedback and scientific research to develop a community sanctioned solution to improve access to adequate amounts of healthy foods

Scheduling of regular Town Hall meetings between all appropriate stakeholders to ensure proper feedback, trust building, evaluation and implementation of the appropriate programs

Establish a flexible community garden program with a cooking and education components using existing community facilities such as schools, or rec centers, employing cultural awareness, district needs and wants. Fun and interactive, complimentary to fitness program

Establish a community after school fitness program for both adult and children participation in collaboration with the garden program, using existing facilities, possibly on a rotating basis with the garden program to best utilize weather conditions and growing season. Fun and interactive, complimentary to garden/cooking program

Ensure program is viewed for all in the community not just for those at risk

Increase awareness of obesity risks, and benefits of a healthy diet

Trusted knowledge source, resource attainment, and support system

Positive reciprocal determinism of environment

Increase Access

Positive, respected role models

Reduced fear, and improved expectations

Social Norms and Cultural Values

Increase reinforcement

Increase capacity

Increase efficacy

Improve ability

Increase interpersonal relationships of stakeholders

Increase empowerment

Increase consumption of fresh fruits, vegetables, whole grains and lean meats by individuals within the community

Increase physical activity by individuals within the community

Helping a community have a realistic ability to achieve Healthy People 2020’s goal of a 10% increase in adults who are of healthy weight and 10% improvement of children and adolescents ages 2-19 considered obese



Interpersona

l

Community based helpers sharing unique characteristics of the district recruited for conducting one on one interviews providing assessment, educational outreach, and dissemination

Encourage family participation in garden/physical activity program, provide appropriate incentives and encouragement to attend through appropriate channels

Program design to encourage examination of emotional state and eating behavior connections

Develop small group discussion/interaction component of Community program to encourage mentoring

Using data collected, assess psychological stressors affecting community, mental health services available, and identify ways to improve and ensure utilization of existing support systems

Peer evaluation, and influence component, possible use of high school students to administer parts of the program as part of a class project

Increase awareness

Reduced fear, improve expectations

Increase capacity

Role models and encouragement

Improve ability

Improve interpersonal relationships and support system

Improve efficacy

Improve ability to cope with stress

Increase level of understanding




Indi

vidu

al

Simple flyer, and mail campaign

Internet available self assessment test

Travel accommodations for participants

Language and literacy accommodations

Cost assistance or free participation

One on one component built into program

Program satisfaction and improvement questionnaire

Provide proper training for strategic community members to ensure ability, protocol, and constructive feedback of those administering the program

Increase awareness

Ease of use

Reduced fear and stigmatization

Improve ability

Improve efficacy

Increase level of understanding

Increase availability






Org

aniz

atio

nal

Partner with local health departments, businesses, churches, community organizations to distribute flyers, increase word of mouth

Partner with local health departments, businesses, churches, community organizations for needed expertise, resources and skills

Ensure community organization partners are treated with respect, are highly motivated, opinions, concerns valued, and given the highest priority

Explore creation of a formal organization of partners for regional and local planning

Partner with municipality for transportation/structural accommodations

Governmental community leaders publicly state their support and participation in program

Provide local business partners with information on the value of creating an employee based program, or awareness campaign

Use of all State and Federal applicable funding available

Increase awareness

Improve environment

Resources

Increase knowledge base and skills

Respected role models

Reduce fear and improve expectations

Increase capacity

Reinforcement

Improve efficacy




Polic

y

Secure Local, State, and Federal support Provide contact information of Local, State, and Federal

Government Officials to participants, possible pre-made form such as a pdf file so support, satisfaction, and desire for continuation of program can easily be expressed

Secure all legislation and necessary permits needed by the Community for program operation

Ensure ease of registration and use of existing food insecurity programs such as SNAP

Secure support from local T.V. News stations, cable outlets, Public Broadcasting for promotional needs

Recognize and trust the partner best equipped to handle unique aspects of the program and empower them

Ensure continuous evaluation of program effectiveness, satisfaction and administration components

Celebrate achievements, participation, and recognition of stakeholders

Increase awareness

Increase resources

Provide legitimacy

Improve environment

Improve expectations

Increase capacity

Improve efficacy

Improve ability




Research that served as inspiration for my BDI Logic model


Community

A good example of a program using CBPR principles is the collaboration of the Argentine Neighborhood

Development Association of Kansas City, and researchers from the University of Kansas Medical Center

(Mabachi & Kimminua, 2012). This project used partner community organizations to distribute food

assessment surveys throughout the community to determine food insecurity, healthy food access, and how

the residents would prefer the problem to be solved. The program provided accommodations for

language and literacy needs. Statistical analysis provided in depth information of residents’ food needs

and thoughts on how to improve food access with commencement of the project and results reported to

community members in a town hall style meeting. It was designed to establish a profile of the market to

avoid strategies that do not match the community’s needs and desires (Mabachi & Kimminua, 2012).

Grant writing ability of KUMC was able to secure needed funding. Extensive demographic,

transportation, and infrastructure information was gathered and analyzed. KUMC recognized its

limitations and enlisted the help of nonprofit organizations, Dept. of Family Medicines, and thirteen

independent block associations for different aspects of the program. Accommodations to have regular bi-

weekly meetings (lowered to once every three weeks during data collection, entry, and analysis) between

researchers and the community association to set goals, establish responsibilities and provide feedback

were included in the program. KUMC personnel regularly visited community members for discussion of

community and other issues at times not directly related to the initiative, to establish trust and

constituencies (Mabachi & Kimminua, 2012). The results of data analysis, synthesized with the inclusion

of nationally relevant information, created a business plan, which was presented in a town hall fashion to

the community members. There was opportunity to comment on the results, provide feedback, and start

the discussion on how to move forward. The researchers stressed that options were not mutually

exclusive, and could be used as short or long-term goals. KUMC also restated their commitment to

involvement of the process and offered continued assistance. Through continual process evaluation,

project creation due to community concern not to fulfill a mandate or academic curiosity, and the

collection of data that was culturally sensitive, postdoctoral fellow gaining experience, and the

establishment of working partnerships and real friendships played heavily into the success of this project

(Mabachi & Kimminua, 2012). This research is an excellent template for a community based initiative,

and sets an example to the importance of establishing trust and lines of communication. It demonstrates

the time and commitment needed to form trust and true relationships, addressed the distrust created from


past abandonment experienced by the community, which are important considerations in the success of

the project. The crucial role of properly training key community members to the effectiveness and

acceptance of the initiative is also emphasized by the project. The most important aspect of this project is

the blueprint it provides for building true collaboration across a dynamic range of entities, lasting

relationships, and empowerment of the community.

The next intervention study I chose for a community level example is Growing Healthy Kids, a

Community Garden-Based Obesity Prevention Program (Castro, Samuels, & and Harman, 2013). The

purpose of the study was to evaluate a community prevention program aimed to prevent obesity in low-

income family children in a North Carolina. This program sought to educate about healthy eating and

proper nutrition through community gardening. It also provided interpersonal interaction between

parents and children as they learned to grow vegetables in weekly gardening sessions between April and

November of 2008-2010. An added cooking and nutrition component was targeted at the Hispanic family

garden program participants with 36 %( 9 out of 25) Hispanic mothers/families participating in the

additional program added in 2010. Of the 60 families who participated, 27 attended every week in work

sessions, 27 attended two to three times a month in work sessions, four attended once a month, and no

attendance data for two families. The study was open to all families in the area that had at least one child

age 6 or greater. Ninety percent of the voluntary participants were 75% at or below the state median

income (Castro, et al. 2013). Recruitment strategies included outreach programs at schools, childcare

centers, Head Start programs, healthcare centers, public health department, Latino community center,

food pantries, word of mouth, and referrals (Castro, et al., 2013). Social events and activities were also

used to emphasize the community nature of the program. All tools and materials were supplied to the

participants, and the cooking and nutrition component had a Spanish speaking option. The program had

three main goals. The first was to help the children achieve and maintain a healthy body weight. A pre

and post program measuring was conducted using BMI standards. The second was to increase the

availability of fresh, frozen, and canned fruits and vegetables that the children had access to, particularly

the amount available at home. Pre and post program surveys were administered to parents participating in

the program to assess the availability and change in access that occurred. The third goal of the program

was to increase consumption of fresh, frozen, and canned fruits and vegetables, which was also assessed

with a pre and post program survey and an added incentive of a 20$ gift card for completing the post

program survey was given. The survey was designed through an agency wide planning process that

included family focus groups, and feedback from the agency’s community garden committee (Castro, et

al., 2013). Data was collected over three growing seasons spanning 2008, 2009, and 2010. Over the three


growing seasons 60 families with 120 children, 36 of which were considered obese or overweight. Of

these six saw an improvement in their BMI with three of the twenty-three considered obese changed their

status to overweight with twenty remaining obese, and of the thirteen considered overweight, three had

attained the status of normal weight, with the rest remaining at overweight status (Castro, et al., 2013).

The post program survey completed by 48 families showed an increase of 146% in availability of the

targeted foods in the home, and an increase of 123% for targeted foods consumed. Even though this is a

pilot study, that needs further research, this strategy seems to be a promising method to address childhood

obesity (Castro, et al., 2013). This study provides great insight to methods in which to disseminate the

message, and to convey the community nature of the project through events and activities, and cultural

awareness. The interpersonal interaction that takes place between family members creating reinforcement

and role modeling opportunities, as well as furthering the opportunity to discuss the issue, or inspire a

generational change in behavior, makes this program is a good addition to my BDI model. In addition, of

great interest, is the extra reinforcing and awareness factor provided in the cooking and nutrition class.

Having two complimentary programs will be a part of my BDI model to further the reach and

reinforcement of the initiative.

Interpersonal

I chose a study involving a parent and child obesity program to serve as an example of an interpersonal

intervention. In An Approach to Improve Parent Participation In a Child Obesity Prevention Program

(O'Brien, McDonald, & and Haines, 2013), the study was designed to assess the perception of the

children’s component of Parents and Tots Together, a family based obesity prevention program. While

most parent programs provide childcare to alleviate barriers of participation, formative research has

shown parent participation rises when their children are engaged. The program was designed to run

concurrently with the program, with the goal of improving retention and parental satisfaction, and was

modeled after a similar existing Chicago Parent Program (O’Brien, et al., 2013). The Harvard Pilgrim

Health Care Institute Human Subjects Committee approved this study. It was designed to help parents

shape their children’s eating and activity behaviors. The participants were 15 of 16 ethnically diverse

families who took part in an uncontrolled trial of Parents and Tots Together and completed a survey at

the end of the program. Individual one on one interviews were conducted with seven of the families who


agreed to the added interview, which provided more detailed glimpse on the opinion of the program. One

family failed to attend the last session, and failed to fill out the process survey given at the end of that

session. The program had a the children engage in cooking activities, being read aloud, “choice”

activities such as crafts, yoga, dance, etc…, that paralleled what was being taught in the parent session.

The children also had an incentives to help support healthy behavior such as water bottles with a health

message on them, or books with specific health messages at the end of every session. The participants

included fourteen mothers, two fathers, eight self identified as Latino, six as African American and two as

white (O’Brien, et al., 2013). The process survey included two closed end questions. The first was

concerning the satisfaction of the parents, ranging on a four point scale of “very dissatisfied” to “very

satisfied”, and the second question on how useful the program was in helping children learn the

importance of healthy eating and being physically active, which was rated on a three point scale from

“not useful at all” to “very useful”. All 16 families completed the study with eleven (69%) attending 6 or

more of the 9 sessions, 2 attending between two and five, and 3 only attended once. Of these people 87%

reported being very satisfied with 13% being satisfied and 73% found it very useful in helping their

children, with 27% finding it somewhat useful (O’Brien et al., 2013). The one on one interview was

conducted over the phone and by researchers not involved with implementation of the program, and

though not a random sample, the responses matched those of the quantitative data. Many parents

discussed how the children’s program served as a catalyst for attendance. Further research to back this

study is currently being conducted in North Carolina, and results for this and other large trials are needed

to determine the extent a children program has on adult participation. Despite a larger pool of evidence,

increasing the interpersonal communication between parents and their children is an excellent option to

include in a BDI health model. It increases satisfaction, motivates attendance, and appears to increase

retention. One thing revealed during the one on one interviews was a desire on the parent’s part to have

an update on what the kids did and how much they enjoyed it. That is why in my BDI model the

programs are intended to not only mirror one another but to include activities with each other. The

program also possesses unique activities and incentives creating a more fun and imaginative atmosphere

that could be important elements of a program.

The Interaction of Social Networks and Child Obesity Prevention Effects: The Pathways Trial (Shin, et

al., 2014) investigates the influence peers have on an obesity prevention program. Much research has

been done on peer influence, but their effect on prevention initiatives has not been adequately

investigated. This research uses 557 students living in Southern California who were surveyed to assess

their health promoting and negative behaviors i.e. fruit and vegetable intake, physical activity, high


calorie nutritious poor food intake, and sedentary behavior. Peer exposure was determined by social

nominations as indicators of peer influence. Multiple level models were conducted separately on

outcomes predicted by the program, peer exposure, and program participation by peer exposure. This

study is part of a multi-component, longitudinal study of a childhood obesity trial called Pathways (Shin,

et al., 2014). The program is a cohort, randomized study that follows students from 4th to 6th grade in

Southern California. Twenty-eight schools are paired by district using similarity in school demographics

and randomly selecting one a control and the other program status. The initial sample size was reduced

from one thousand and five to the sample size of five hundred and fifty seven by using the caveat of those

who successfully provided complete social network data for both 5th and 6th grade. All data was collected

by a trained researcher and a second person who assisted in answering student questions. The survey was

self reported by the student and included 143-item questionnaire that dealt with BMI percentile, team

sports, food intake, physical activity, sedentary activity and social network indicators. It was found that

Pathways participants whose friends engaged in unhealthy, the program acted as a moderator with the

participants eating more healthy foods than their friends do. However, when the peers’ exhibit healthy

behavior the program is associated with less fruit and vegetable intake, and appears to have no effect.

This is possibly indicating adverse peer influence may need to be present for the program to be effective

(Shin, et al., 2014). There seemed to be no significant connection between peer exposure and physical

activity, possibly due to lack of peer influence outside of school, lack of physical programs in the school,

and the environment some of the students resided (Shin, et al., 2014). This research is significant to a

BDI Logic model in many ways. It is obvious that peer influence must be taken under consideration with

what research has shown its effect on behavior. The point I find most salient in this study, was the

somewhat negative view those that exhibited healthy behavior had of the program. Considerations must

be made that not only target the “at risk” population, but also create an all-inclusive aura, possibly

moderating negative views that program participation equals having a problem. This may increase the

number of positive role models that participate in the program and strengthen a community’s acceptance

of and commitment to the program.

Individual

An Internet Obesity Prevention Program for Adolescents (Whittmore, Jeon, & and Grey, 2013) examines

the effectiveness of two school-based internet obesity prevention programs for diverse adolescents on

BMI, health behaviors, and self-efficacy to explore the moderators of program efficacy. The study was a


randomized clinical trial using cluster randomization of class that was represented by 384 students, from

three high schools from two cities in the northeast. Measurements were taken initially, three months, and

six months into the project. Any student enrolled in biology or health class was able to participate in the

program. Participants were awarded gift card for completion of data collection 25$ initial 30$ for the third

month and sixth month interval. The programs were based on Theory of Interactive Technology and

Social Learning Theory (Whittmore, et al., 2013). Health (e) Teen with components of interactive

education, behavior support on healthy eating and activity, and Health (e) Teen + CST with additional

training in moderating psychological responses, coping skills training (CST), as an added element. CST

has shown efficacy during in person trials of improving metabolic control and quality of life in

adolescents with type II diabetes and improving health behaviors and insulin resistance in children who

are at risk of type II diabetes (Whittmore, et al., 2013). Teachers and school administrators were involved

in all the decisions of program protocols to ensure optimal implementation. Researchers monitored

student participation bi-monthly and if participation was low enhancement options were discussed with

teachers to find ways to improve participation. Sixty-six of those students approached consented to

participate, and the satisfaction score of the program was high (Whittmore, et al., 2013). After all

necessary adjustments it was found the programs both showed significant improvement in healthy

behavior and self-efficacy. There was no significant difference with the added CST component, and its

differential effect may require longer follow up (Whittmore, et al., 2013). There was excellent

participation and satisfaction with the program, and adolescents preferred interactive learning over print

material and the ability to learn at their own pace. I believe this study provides good evidence for

constructing an internet component into a community intervention program. The infrastructure is already

in place, adolescents prefer this method of prevention, participation is high, and it has been shown to be

an effective intervention that increases self-efficacy and increases healthy behaviors. The ease of use and

implementation make this a highly attractive addition to a multi-faceted community intervention program.

Results of a Multi-Media Multiple Behavior Obesity Prevention Program for Adolescents (Maureillo, et

al., 2010) is a study of effectiveness in trial outcomes of Health in Motion, a computer tailored

intervention for adolescents that target multiple behaviors. The program is based on the Transtheoretical

Model of Behavior Change, and addresses recommended guidelines for three targets of behavior, physical

activity, fruit and vegetable consumption, and limiting T.V. viewing (Maureillo, et al., 2010). School was

used for level of assignment with 1800 students from eight different high schools in four states (RI, TN,

MA, and NY) were stratified and assigned either no treatment or a multi-media intervention. Self-

directed thirty-minute sessions were completed by the student, in which a series of TTM based


assessments that gave them back tailored feedback and stage related responses. Health in Motion

incorporated assessments and feedback on a full range of TTM constructs, unlike other TTM –based

interventions (Maureillo, et al., 2010). The program was administered in three sessions, a baseline, one

month, and two months, with an additional follow up assessment at six and twelve months. The control

group was assessed baseline, two months, six months and twelve months. All sessions were administered

with computers in school computer labs, with researcher assistants on hand to help with log in or other

technical difficulties. Most treatment participants attended at least three sessions, and the majority of the

students were in the pre-action stage (not meeting the recommended daily requirements for that behavior)

(Maureillo, et al., 2010). The results showed more program participants moved to the action or

maintenance stage than the control group for physical activity, fruit and vegetable consumption, limiting

T.V. viewing, and the intervention was significantly more effective at keeping students in action or

maintenance stage and risk reduction instead of regressing back to pre-action stage (Maureillo, et al.,

2010). There was significant difference found in those who moved to overweight status, with the

program group being fewer, but when controlled with longitudinal analysis the difference disappeared. It

was found the program also helped those students who were already doing behaviors to maintain a

healthy lifestyle. The effects for the intervention were most pronounced in the fruit and vegetable

consumption area. The design of the program decreased both participant assessment burden, and the

length of the intervention (Maureillo, et al., 2010). This study provides further evidence in the efficacy of

using technology based intervention methods, and its ease of use and implementation make it an attractive

addition to my BDI Model. It is self-directed, with a feasible platform that requires little to no staff

training and time make this a very cost effective intervention is easily disseminated and uses accepted

theoretical constructs. There is no need for screening or determining eligibility of the participants making

able to be distributed widely across the community.

Organizational

Afterschool Program Participation, Youth Physical Fitness and Overweight is a study that examines

whether community based afterschool physical activity programs lead to improved fitness and lower

obesity rates in adolescents (London & Gurantz, 2013). Experimental studies tend to be highly focused

research trials, that are time constrictive developed and run by research officials rather than community

designed and led there is difficulty in scalability and sustainability at the community level (London &

Gurantz, 2013), and the relationship between afterschool program participation and health outcomes is


under-examined. This study was to determine if community resources that enhance opportunity for

adolescents to take part in physical activity outside of school lead to improved physical fitness and lower

obesity rates. Two school districts in the San Francisco Bay area community were used for a

longitudinal, individually linked, administrative records, to study youth participation in an afterschool

community based programming, and health outcomes measured by overweight status and physical fitness

(London & Gurantz, 2013). The community has a high population of low income and Latino families.

Community partners from afterschool programs, school districts, the County Health Department, and

others designed research questions through university and community collaboration. Data included

demographic information, physical fitness, and academic achievement. Physical fitness status was

determined by those who took the California Physical Fitness Test (PFT) consisting of six fitness

standards, and taken in the fifth, seventh, and ninth grades. Trajectories were created using cohorts of

students who took the PFT in 2006-07 and 2008-09 with one thousand fifty five students. This group

consisted of a young group who took the test in grades 5-7 totaling five hundred sixty-six, and an older

group who took the test in grades 7-9 for five hundred and thirty-nine. Students were considered

physically fit if they passed five of the six components of the PFT (London & Gurantz, 2013). School

records were individually linked to participation records of after school programs. The afterschool

programs were split into two categories, one was fitness based, the other enrichment that was non-fitness

based designated as “other enrichment” even if it had a fitness component. Thirty-six percent of students

participated in an afterschool program. Participating in a fitness-based program was associated with a

10% increase in probability of being physically fit after two years. It was also found, students who

participated for two years had a 14.7% increase in likelihood, compared to 8.8% for one year

participation. Participation in “other enrichment” type programs did not show this association (London &

Gurantz, 2013). This study shows that afterschool programs designed and run by community

organizations can accomplish positive health outcomes. Communities with existing resources and

sustainability due to their control can create programs that have lasting, positive health outcome effects.

It is postulated that the lower participation rates in the higher risk groups could be due to these groups

also struggling in school causing them to be referred to afterschool academic programs limiting their

availability for physical activity and outdoor play. It should be considered to add a physical activity

component, or other physical activity opportunity to these students. This study fits well in my BDI model

because it shows that a community organization can make a program more sustainable, and may have a

greater lasting effect than the short trials usually run by researchers. The use of existing resources, school


officials, and others to devise the program makes it cost effective, and easy to duplicate. It also

empowers the community and helps to put their destiny in their control.

The Central California Regional Obesity Prevention Program: Changing Nutrition and Physical Activity

Environments in California’s Heartland is a study on the effectiveness of an organization created to assist

regional and local efforts by creating community driven policy and environmental change model created

by CCROPP. CCROPP is designed to work with local and regional communities that are low-income,

disadvantaged ethnic and rural communities in an environment of poor resources and inadequate

infrastructure (Schwartze, et al., 2010). To demonstrate that CCROPP had made progress in changing

physical activity and nutrition environments through mobilization of communities, influence and

engagement of policy makers, and forming organizational partnerships, evaluation of data from the years

2005-2009 was conducted. The data includes evaluation of Health Department capacity, community

engagement and partnerships, changes to nutrition and physical activity policy, and policy change

strategies (Schwartze, et al., 2010). The CCROPP model of change was mirrored after Healthy Eating,

Active Communities The California endowment program. It was developed through integrating ideas and

principles from a multiple of theoretical approaches that were complimentary. Evaluation of data was

accomplished by using logic models developed by the evaluation team and grantees, environmental

assessment of public health departments, environmental assessment of farmer’s markets/produce stands,

environmental assessment of physical activity resources, community focus groups, elected

official/stakeholder interview, grantee interview and profile, community resident survey, and policy

maker survey (Schwartze, et al., 2010). It was found CCROPP was able to increase access to healthy

food and physical activity opportunities through engagement, inclusive partnerships and local policy

making. The central strategy was engagement of the community was and to contribute significantly for

needed policy change (Schwartze, et al., 2010). CCROPP demonstrates obesity strategies formed around

regional framework to change the food and physical environment can be successful and helpful in setting

a course for statewide policy advocacy. The element of having a regional organization to assist

communities in the varying logistic complexities of implementing an intervention appears to be a quite

useful strategy. This added consideration to a BDI logic model could aid in sustainability, capacity,

knowledge, political influence and awareness that a single community would not be able to obtain on its

own. This concept needs further implementation around the country to aid communities in the struggle

against obesity and the risk factors it entails.


Policy

Policy Instruments Used by States Seeking to Improve School Food Environments investigates types of

policy instruments used by State governments between 2001 to 2006 (Schroff, Jones, Frongillo, & and

Howlett, 2012). The study aims to better understand the various mechanisms used by policymakers and

the effectiveness of the mechanisms used to prevent obesity using a theoretical framework (Schroff et al.,

2012). Legislation related to the sale or availability of competitive foods in school s to classify the types

and ranges of policy instruments used during 2001 to 2006 in all 50 States that sought to improve school

food environments as a strategy to combat childhood obesity. Policy is separated into two basic groups,

symbolic policy that articulates goals/aspirations but does not necessarily lead to implementation of new

efforts, and material policy, which are likely to result in actually implementation strategies. The

examination of 1,267 bills in various stages of the legislative process resulted in the selection of 126 bills

that were enacted across the fifty states that were coded for either symbolic or material. It was found that

a pattern of enacting only 10% of the bills introduced except for the year 2005 when nearly 15% were

enacted. There were 44 symbolic resolution bills, and 82 bills that had at least one material element

contained within them. Of these eighty-two 38 only prescribed procedural instruments, 32 only

prescribed substantive instruments, and 12 had a mix of both procedural and substantive instruments

(Schroff et al., 2012). It is argued that a nuanced understanding of material and substantive policy is

lacking understanding in the public health literature as to how it affects the delivery of goods and services

to policy targets. There is a need to understand and examine policy developed by legislation,

administrative rule and voluntary regulatory guidance in a substantive or material procedural manner

because they exhibit different effects. The types of instruments used in this typology are, information

(seeks to educate), authority (regulate), treasury (finances), and organizational structure. Understanding

policy, how it is classified, and the expected realm of effect are important considerations needed for a

BDI logic model. The examination of policy effectiveness provides an avenue to lobby for their change,

or implementation and is an important component for a logic model.

Food Security of SNAP Recipients Improved Following the 2009 Stimulus Package examines the effect

extra funds for the SNAP program had on food security, participation in the program, and the increase in

food spending by low-income families (Nord & Prell, 2011). The Economic Research Service (ERS)

examined the USDA’s annual report Household Food Security in the United States, 2009 to draw

conclusions on the effect of the American Recovery and Reinvestment Act. The report is an annual,

nationally representative food-security survey conducted by the Census Bureau. The stimulus increase


was implemented as a constant dollar amount for each household size that provided a greater percentage

increase for those households with some net income that did not receive the maximum benefit. Analysis

focused on likely Snap eligible households. It was found that SNAP participation increased by 25% in

2009, and the added benefits and eligibility provided by the stimulus played a role in program

participation. It is postulated the higher benefits and suspension of time limits for jobless adults without

children that the stimulus provided overcame the monetary, time, and psychological costs of obtaining

benefits, before the stimulus 66% of eligible recipients applied for benefits. After adjustment for income,

employment changes, and other household factors the stimulus was responsible for nearly half of the 25%

increase (Nord & Prell, 2011). It was also found that SNAP enhancements also increased the amount of

money spent on food, and after adjustments for inflation and other factors it is speculated the stimulus

was responsible for a 2.2% rise in food spending by SNAP eligible households. It is estimated the

stimulus-enhanced improvements to food security corresponds to 530,000 fewer household that were food

insecure, and 480,000 fewer very food insecure households that would have been expected due to the

economic downturn (Nord & Prell, 2011). The fate of millions of people’s food security rests in the

hands on National policy. It is important that a BDI logic model to incorporate existing policy and to

make sure that maximum use of the benefits the policy provides. The evidence is clear sufficient funding

of National programs are the most effective way of improving the food security of millions, and provides

ammunition for the continued lobbying for greater funds to meet this goal.

Works CitedCastro, D. C., Samuels, M., & and Harman, A. E. (2013). Growing Healthy Kids, a Community Garden-

Based Obesity Prevention Program. American Journal of Prevention Medicine,, 193-199.

London, R. A., & Gurantz, O. (2013). Afterschool Program Participation, Youth Physical Fitness and Overweight. American Journal of Preventative Medicine, 200-207.

Mabachi, N. M., & Kimminua, K. S. (2012). Leveraging Community-Academic Partnerships to Improve Healthy Food Access in an Urban, Kansas City, Kansas Community. Progress in Community Health Partnerships: Research, Education, and Action, Volume 6, Issue 3, 279-288.

Maureillo, L. M., Chiavatta, M. M., Paiva, A. L., Sherman, K. J., Castle, P. H., Johnson, J. L., & and Prochoska, J. M. (2010). Results of a multi-media behavior obesity prevention program for adolescents. Preventative Medicine 51, 451-456.

Nord, M., & Prell, M. (2011). Food Security of SNAP Recipients Improved Following the 2009 Stimulus Package. Amber Waves Vol 9 issue 2, 16-23.


O'Brien, A., McDonald, J., & and Haines, J. (2013). An Approach to Improve Parent Participation in a Child Obesity Prevention Program. Canadien Journal of Dietetic Practice and Research, Vol 74 No 3, 143-145.

Schroff, M. R., Jones, S. J., Frongillo, E. A., & and Howlett, M. (2012). Policy Instruments Used by States Seeking to Improve School Food Environments. American Journal of Public Health Vol 102, No. 2, 222-229.

Schwartze, L., Samuels, S. E., Capitman, J., Ruwe, M., Boyle, M., & and Flores, G. (2010). The Central California Regional Obesity Prevention Program: Changing Nutrition and Physical Activity Environments in California's Heartland. American Journal of Public Health, Vol. 100, No. 11, 2124-2128.

Shin, H.-S., Valente, T. W., Riggs, N. R., Huh, J., Spruijt-Metz, D., Chou, C.-P., & and Pentz, M. A. (2014). The Interaction of Social Networks and Child Obesity Prevention: The Pathways Trial. Obesity, Volume 22 Number 6 June, 1520-1526.

Whittmore, R., Jeon, S., & and Grey, M. (2013). An Internet Obesity Prevention Program for Adolescents. Journal of Adolescent Health, 52, 439-447.

Documents

S.Banjoff BDI Logic Model 2.0