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
Community
 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 otherpartners 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

strategies
Interpersonal
 Community based helpers sharing unique characteristics
of the district recruited for conducting one on one
interviews providing assessment,educationaloutreach,
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 psychologicalstressors
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
 Reduced fear,
improve
expectations
 Role models and
encouragement
 Improve ability
 Improve
interpersonal
relationships and
support system
 Improve efficacy
 Improve ability to
cope with stress
 Increase level of
understanding
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
to achieve Healthy
a 10% increase in
adults who are of
healthy weight and
10% improvement of
children and
considered obese
Individual
 Simple flyer, and mail campaign
 Internet available self assessment test
 Travel accommodations for participants
 Language and literacy accommodations
 Cost assistance orfree 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
 Ease of use
 Reduced fear and
stigmatization
 Improve ability
 Increase level of
understanding
 Increase
availability
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
to achieve Healthy
a 10% increase in
adults who are of
healthy weight and
10% improvement of
children and
considered obese

strategies
Organizational
 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
 Improve
environment
 Resources
 Increase knowledge
base and skills
 Respected role
models
 Reduce fear and
improve
expectations
 Reinforcement
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
to achieve Healthy
a 10% increase in
adults who are of
healthy weight and
10% improvement of
children and
considered obese
Policy
 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 ofthe program and empower them
 Ensure continuous evaluation of program effectiveness,
satisfaction and administration components
 Celebrate achievements, participation, and recognition
of stakeholders
 Increase resources
 Provide legitimacy
 Improve
environment
 Improve
expectations
 Improve ability
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
to achieve Healthy
a 10% increase in
adults who are of
healthy weight and
10% improvement of
children and
considered obese

strategies
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

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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

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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

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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 Networksand 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

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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 Programfor Adolescents (Whittmore, Jeon, & and Grey, 2013) examines
the effectiveness of two school-based internet obesity prevention programs for diverse adolescents on

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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 Programfor 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-

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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 ProgramParticipation, Youth Physical Fitness and Overweight is a study that examines
whether community based afterschoolphysical 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 &

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Gurantz, 2013), and the relationship between afterschoolprogram 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 afterschoolprogram. 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

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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 modelof 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 wasable to increase access to healthy
food and physical activity opportunities through engagement, inclusive partnerships and local policy
making. The centralstrategy 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 successfuland 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.

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Policy
Policy InstrumentsUsed 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 RecipientsImproved 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

strategies
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 Cited
Castro,D. C., Samuels,M.,& and Harman, A.E. (2013). GrowingHealthyKids,aCommunityGarden-
BasedObesityPreventionProgram. American Journalof Prevention Medicine,,193-199.
London,R. A.,& Gurantz, O.(2013). Afterschool ProgramParticipation,YouthPhysical Fitnessand
Overweight.American Journalof PreventativeMedicine,200-207.
Mabachi, N.M., & Kimminua,K.S.(2012). LeveragingCommunity-AcademicPartnershipstoImprove
HealthyFoodAccessinan Urban, KansasCity,KansasCommunity. Progressin Community
Health Partnerships:Research,Education,and Action,Volume6,Issue3, 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). Resultsof a multi-mediabehaviorobesitypreventionprogramfor
adolescents. PreventativeMedicine51, 451-456.
Nord,M., & Prell,M.(2011). FoodSecurityof SNAPRecipientsImprovedFollowingthe 2009 Stimulus
Package. AmberWavesVol9 issue 2, 16-23.

strategies
O'Brien,A.,McDonald,J.,& andHaines,J.(2013). An ApproachtoImprove ParentParticipationina
ChildObesityPreventionProgram. Canadien Journalof Dietetic Practice and Research,Vol74 No
3, 143-145.
Schroff,M. R., Jones,S.J.,Frongillo,E.A.,& andHowlett,M. (2012). PolicyInstrumentsUsedbyStates
SeekingtoImprove School FoodEnvironments. American Journalof PublicHealth Vol 102, No.2,
222-229.
Schwartze,L.,Samuels,S.E.,Capitman,J.,Ruwe,M., Boyle,M.,& and Flores,G.(2010). The Central
CaliforniaRegional ObesityPreventionProgram:ChangingNutritionandPhysical Activity
EnvironmentsinCalifornia'sHeartland. American Journalof PublicHealth,Vol. 100, No.11,
2124-2128.
Shin,H.-S.,Valente,T.W.,Riggs,N.R., Huh, J.,Spruijt-Metz,D.,Chou,C.-P.,&andPentz,M. A. (2014).
The Interactionof Social NetworksandChildObesityPrevention:The PathwaysTrial. Obesity,
Volume22 Number6 June,1520-1526.
Whittmore,R.,Jeon,S.,& andGrey, M. (2013). AnInternetObesityPreventionProgramforAdolescents.
Journalof AdolescentHealth,52, 439-447.

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