Implementing and Sustaining Environmental Change Interventions: Findings From A Multi-Component Obesity Prevention Initiative

Over the past 20 years, the prevalence of obesity in the United States has increased dramatically. Currently, 1 in 3 adults and nearly 1 in 5 children are obese (CDC, 2011). Many experts attribute increases in the prevalence of obesity to the rise of obesogenic environments (e.g., accessibility and low price of fast food; reliance on automobile transportation; increase in sedentary work and leisure activities). As a result, environmental change interventions that aim to modify settings to promote increased physical activity and consumption of healthy food and discourage sedentary behavior and consumption of unhealthy food increasingly are recommended by expert panels such as the Task Force on Community Preventive Services and the Institute of Medicine.  The available research suggests that evidence-based environmental change strategies implemented successfully and sustained over time show great promise at preventing obesity. This presentation will discuss findings from Douglas County Putting Prevention to Work, a two-year, multi-component obesity prevention initiative focused on implementing evidence-based environmental change interventions in Douglas County, Nebraska.  The initiative consists of nine strategies, including: (1) development of signage focused on sharing the road with cyclists; (2) development of bike share programs at local college campuses; (3)  modifications to the city’s Master Plan to accommodate active living; (4) promotion of active transportation to and from primary schools; (5) collaboration with local businesses and organizations to encourage adoption of policies that promote physical activity and healthy eating; (6) collaboration with local afterschool agencies to encourage adoption of policies that promote physical activity and prohibit sugar sweetened beverage consumption; (7) provision of technical assistance to store owners in underserved areas to help them incorporate and maintain healthy food selections; (8) promotion of the use of locally grown foods within schools; (9) and implementation of a social marketing campaign to promote active living and healthy eating. Given the two-year timeline, the evaluation focused on measuring process and short-term outcomes (e.g., intervention implementation and reach). As a whole, the nine initiatives were implemented as planned. Key findings from the project will be discussed with an emphasis on the factors that supported implementation such as community readiness, cross-sector collaboration, ongoing progress monitoring, and alignment with community leaders. Additionally, efforts to encourage and measure long-term sustainability will be discussed.