1. Using the Nutrition Environment Measures Survey to Inform & Evaluate a Restaurant and Food Store Community Intervention Josie Golembiewski, MPH Candidate Ana P. Martínez-Donate, PhD Department of Population Health Sciences University of Wisconsin, Madison Bev Hall, BS CD Waupaca County NuAct Coalition Healthy Food for All Summit Neenah, WI - 3/27/14

2. Background Community nutrition environment: The number, type, location, and accessibility of food outlets in a community Consumer nutrition environment: What consumers encounter when they buy food, such as availability, cost, and quality of healthful food choices

3. Assessing and Improving the Nutrition Environment in Wisconsin Communities Funded by UW School of Medicine and Public Health Wisconsin Partnership Program 2010 - 2013 ANEWC Project

4. Assessing the Nutrition Environment in Wisconsin Communities (ANEWC) ANEWC Surveillance Intervention Dissemination & Policy Implications

5. Assessing the Nutrition Environment in Wisconsin Communities (ANEWC) ANEWC Surveillance Intervention Dissemination & Policy Implications Aim: To develop and test a pilot intervention to improve the nutrition environment in restaurants and grocery stores

6. Our intervention: Waupaca Eating Smart (WES) Two nutrition and physical activity coalitions 10 months: Oct 2011- July 2012 7 restaurants & 2 stores in each community Broad strategies: – Offer, label, and promote healthier foods Stevens Point Waupaca

7. Activities in Restaurants Offer more healthy items – WES-approved meal: <700 calories & 1 cup fruit or vegetables Label & promote healthy items – Materials, signs, wait staff

8. Activities in Stores Offer more healthy items – Recipes for bundled family meals: <700 calories & 1 cup fruit or vegetables Label & promote healthy items – Promote fruits, vegetables, & family meals – Displays & samples – Signs & flyers

9. WES Promotion in the Community Wheres Jim Eating? articles in Waupaca newspaper Local media pieces Facebook Blog

10. Our Process Formative assessment Build partnerships with restaurants & grocery stores Implement strategies: offer, label, & promote healthy items Improve the nutrition environment Improve attitudes and behaviors in customers & owner/ managers

11. Methods Assessment tool: – Nutrition Environment Measures Survey (NEMS) Goal: – Measure changes in the food environment attributable to the intervention Evaluation design: – Before and after the intervention – Intervention community – Comparison community

12. Assessment Tool: Nutrition Environment Measurement Survey Restaurants Stores Convenience Stores Vending machines Other tools – Perceived nutrition environment – Grocery store promotions (GroPromo) Online training – Free, 20 hours www.med.upenn.edu/nems/ Karen Glanz et al. at the University of Pennsylvania and Emory University

13. Availability Cues, signs, & information Price Total score: -27 to 63 points NEMS for Restaurants

15. Availability Quality Price Total score: -9 to 54 points NEMS for Stores 10 food categories that contribute the most fat and calories to the American diet AND those that are most recommended for healthful eating Fruits, vegetables, milk, ground beef, hot dogs, frozen dinners, beverages (soda, 100% juice), baked goods, bread, chips

17. Discussion NEMS-restaurant – Availability – Cues, signs, info – Price NEMS-store – Availability – Quality – Price Adapt NEMS? Use other tools? Offer, label, and promote healthy items

18. Future directions Analyze statewide data Disseminate toolkits Sustain WES Partner with Thedacare Expand WES through a larger study

19. Acknowledgments Community Partners: Bev Hall Anne Menzies Marilyn Herman Gary Garske Waupaca NuAct Portage County CAN Thedacare Wisconsin Partnership for Physical Activity and Nutrition (WIPAN) Wisconsin Department of Health Services Nutrition and Physical Activity Coalition UW-Madison Team: Ana Martinez-Donate Josie Golembiewski Amy Meinen Kristen Malecki Anne Escaron Norma-Jean Simon Anne Roubal Dan Fisher Sahra Kahin Natalie Rhoads Jen Valdivia Natalie Guerrero Susan Nitzke Javier Nieto And many others Questions? Please contact Dr. Ana Martinez-Donate: martinezdona@wisc.edu

20. Questions