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Health Behavior Changes Among Adults in the Supplemental Nutrition Assistance Program Education, Los Angeles County, California


The figure shows the specific programmatic strategies implemented within the 3 layers of the social-ecological model: individual, institutional, and environmental level. Level 1 is the Environmental level, characterized by policies to improve availability of affordable, fresh produce for retailers, schools (eg, city ordinances, purchasing plans, supply chain distribution); policies to improve parks, healthy food and beverage availability, water access, pedestrian and bicycle access, or other opportunities for physical activity within green spaces in neighborhoods; policies for active transportation, such as Complete Streets and Safe Routes to School; policies to require greater density of community gardens in qualifying areas. Level 2 is the Institutional level, characterized by produce distribution efforts to establish cost-effective procurement and distribution of fresh fruits and vegetables, including locally sourced produce, community gardens, and gleaning programs (Farm to Fork, Farm to School, increasing produce for sale); behavioral economic strategies, such as product placement and pricing to increase consumption of healthy foods and beverages at qualifying sites (Smarter Lunchroom Movement, healthy marketing at corner stores, healthy vending machines); organizational policies to increase access to healthy foods and beverages and increase physical activity (school wellness policies, healthy vending policies, food insecurity screening in health care settings); community edible gardens and development of corresponding produce distribution plans. Level 3, the Individual level, is focused on nutrition education, physical activity promotion, and food demonstrations; and evidence-based curricula focuses on consumption of fresh fruits and vegetables, guidance on understanding food labels, and cooking skills. Delivery model options for level 3 are 1) a trained, licensed expert — nutrition education and physical activity classes led by an individual who has received formal training or holds a license (eg, registered dietitian); 2) peer-to-peer education (the promotora model) — a peer educator, someone from the community who provides education to members of the community who share similar social backgrounds; and 3) train the trainer — a skilled expert trains other people to reach a wide audience.


Social-ecological model implemented by the Supplemental Nutrition Assistance Program Education, Los Angeles County, 2016–2020.

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