Thirty Years of SNAP-Ed: The Transition of the Nation's Largest Nutrition Education Program Into a Pillar of the Public Health Infrastructure.

This paper describes the 30-year evolution of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) to provide evidence to support our perspective that SNAP-Ed has earned its position as a pillar of the public health infrastructure in the US. Legislatively designated as a nutrition education and obesity prevention program, its focus is the nearly 90 million Americans with limited income. This audience experiences ongoing health disparities and is disproportionately affected by public health crises. The SNAP-Ed program works to reduce nutrition-related health disparities at all levels of the Social-Ecological Model, follows a robust evaluation framework, and leverages strong partnerships between state-based practitioners, state agencies, and the US Department of Agriculture. The expansion of SNAP-Ed would enable the program to reach more Americans so that our nation can end hunger and reduce diet-related health disparities.

Adults' Reaction to Public Health Messaging: Recall, Media Type, and Behavior Change Motivation.

This paper focuses on effective messaging practices identified in data collected after 10 years of implementing a gain-framed messaging campaign encouraging healthier behaviors in middle-aged and older adults. In Study 1, we measured message recall and intended health behaviors in an intercept survey of 733 adults. Binary logistic regression indicated that women were more likely than men to report intent to change behavior. Recalling messages from billboards or fliers was associated with a lower likelihood of intended behavior change, and media type was associated with intended behavior for those who saw the message online (reducing screen time) or on television (increasing physical activity and ceasing smoking). Study 2 focused on adult generational differences in response to the campaign and types of media used to access information. Data from an intercept survey of 604 clients at agencies serving low-income adults were segmented into three age groups: under 35, ages 35-54, and ages 55+. Recall and reaction to campaign materials differed by age group, and the influence of life stage factors and health costs varied across age groups. Television and newspapers were most frequently reported by the oldest group, and social media and online news/blogs were most frequently chosen by the youngest group. Campaign response of adults older than age 35 aligned with goals of improving health behaviors. Together, these studies indicate that diffuse messaging strategies may raise overall awareness, and targeted strategies may be more influential in motivating behavior change. Influential factors and media should be differentially leveraged to target different age cohorts of adults.

The SNAP-Ed Evaluation Framework: demonstrating the impact of a national framework for obesity prevention in low-income populations.

The United States Department of Agriculture's Supplemental Nutrition Assistance Program Education, known as SNAP-Ed, is the country's largest and most diverse community nutrition program. In 2017, nearly 140 SNAP-Ed implementing agencies (SIAs) and hundreds of contractors delivered nutrition education to almost 5 million people in nearly 60,000 low-resource sites. Millions more were impacted with social marketing campaigns and policy, systems, and environmental changes. This article introduces and describes the benefits of the newly developed SNAP-Ed Evaluation Framework (Framework) and companion Interpretive Guide to consistently measure SNAP-Ed outcomes across different settings. The Framework uses the social ecological model as its underlying theory and features 51 indicators across four levels: Individual, Environmental Supports, Sectors of Influence, and Population Results. Topline findings from the first-year Census to track Framework adoption found that most SIAs intended to impact indicators closer to the inner levels of influence: Individual (mean = 59% of SIAs; SD = 22%) and Environmental Settings (mean = 48%; SD = 23%). As yet, few SIAs targeted outcomes for long-term indicators (mean = 26%; SD = 15%), Sectors of Influence (mean = 20%; SD = 12%), or Population Results (mean = 30%; SD = 11%). An in-depth example of how one state is using the Framework is described. The SNAP-Ed Evaluation Framework offers a new suite of evaluation measures toward eliminating disparities that contribute to poor diet, physical inactivity, food insecurity and obesity. Practitioners will need technical assistance to implement the Framework, especially to measure longer-term, multi-sector and population results, and to maximize effectiveness in SNAP-Ed.