67% 100 of adults or more in communities were overweight or obese

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1 SWAP IT TO DROP IT Hearts Beat Back developed the SWAP IT to DROP IT social marketing campaign and offered it in the rural Minnesota communities of New Ulm (pop. 13,500), Springfield (pop. 2,215) and Sleepy Eye (pop. 3,600). The grant-funded campaign helped people learn to make healthier SWAPs to lose weight and improve their overall health. 67% FEWER of adults or more in communities were overweight or obese LBS. CALORIES DAILY helps people lose 10 pounds in a year GOOD DECISIONS by consumers are important for heart-healthy eating IDENTIFICATION AND PROMOTION of healthier choices outside the home help people make better selections CAMPAIGN ACTIVITIES SWAP SIMPLE VISUAL MESSAGES on healthier SWAPs FOR 95% OF GROCERY STORE TOUR PARTICIPANTS IN ONE COMMUNITY WERE REFERRED BY CLINICAL DIETITIAN MASS MEDIA Newspaper, billboards, cable TV, social media 70% recognition of SWAP IT to DROP IT logo MALES in particular showed increases in perceptions of healthy foods availability and ability to identify healthier choices PARTNERSHIPS AND POINT-OF-DECISION MESSAGES at grocery and convenience stores, restaurants, local worksites 92% were confident they could make healthier food and beverage choices SUCCESS STORIES featuring local people who successfully made SWAPs 1-HOUR educational tours led by registered dietitians at grocery stores; also experiential food tasting opportunities H 85% swapped unhealthful items for healthier items SUSTAINABILITY Local health system continued funding for dietitian-led tours; local grocery store hired part-time dietitian

2 SWAP IT TO ROCK IT Hearts Beat Back worked with local athletic and food personnel from schools and sports organizations throughout New Ulm, Minn., to make healthier concessions available at area sporting events. The campaign used the slogan SWAP IT to ROCK IT on the courts in the stands on the field in the classroom at home. CANDY, SODA and other low-nutrient foods are often the only choice at concession stands leaving no healthful options SODA CONCESSION STANDS often need to provide meal as well as snack for busy athletes and families HEALTHIER FOOD CHOICES help students and adults stay energized and achieve optimal performance 1/3+ or more of children and adolescents are overweight or obese CAMPAIGN ACTIVITIES on concession offerings to inform campaign messages SWAP STUDENT SURVEY FOR SIMPLE VISUAL MESSAGES on healthier SWAPs to "ROCK IT" FRESH FRUIT and other new offerings, such as subs on whole grain bun, string cheese, carrots, clementines, water, big pickles, granola bars STEALTH IMPROVEMENTS = = featuring pizza with fewer calories; popcorn made with trans-fat free oil $ $$$ PRICING INCENTIVES to encourage selection of healthier items, with fruit such as clementines priced less than candy at 50 cents LIFE-SIZE PHOTO SIGNS of coaches, players to promote campaign messages STRATEGIC EVENTS featuring sub sandwich nights; healthier tailgate events at select games DEFAULT MODIFICATIONS to include water in combo meals instead of soda; 85 combo meals sold at one football tailgate via partnership with local grocery store BREAK-EVEN OR PROFITABLE for organizations from the onset 10 PIECES CUT from each lower-cheese healthier topping pizza vs. 8 = fewer calories per serving SOLD-OUT of fruit at local basketball tournament; had to restock to fulfill demand RAVE REVIEWS One fan: Love, love, LOVE the SWAP IT to ROCK IT project so cool!

3 RESTAURANT PROGRAM In 2011, Hearts Beat Back developed and launched a restaurant program in New Ulm, Minn., as part of its efforts to improve the availability, identification and promotion of affordable healthier foods (especially fruits and vegetables). The project partnered with local restaurants that were committed to serving the same great-tasting food, while making it easier for people to eat healthier. 2MEALS/WEEK eaten at restaurants by New Ulm residents Menu ONLY 59% of restaurants offered a nonfried vegetable choice; 41% offered fruit; 29% offered reduced-size portions; 26% offered whole-grain bread ONLY 1 IN 5 adults was eating recommended five daily servings of fruits and vegetables in 2009 HEALTHY UNHEALTHY 1 IN 4 people found it challenging to identify healthy items on the menu. PROGRAM ACTIVITIES 34 restaurants were assessed using the Nutrition Environment Measures Survey; report with recommendations for improvements was shared by a registered dietitian. HEALTHY WIN-WIN Restaurants say healthy items are easy to make and profitable too 2012 baseline consumer survey on attitudes and perceptions; 2013 follow-up survey 18 participating restaurants in 2014; up from 9 in 2011 RESTAURANT INCENTIVES Consulting support, recipe analysis, staff training, onsite signage, community promotions, paid advertising, earned media opportunities 67% consumer awareness of restaurant program in 2012 CULTURAL CHANGES One restaurant sells more salads than fries; one added Mediterranean lunch buffet; one accommodated request to add more fruits and vegetables for meeting menu ACHIEVEMENT LEVELS 3(Gold, Silver, Bronze) based on the number of healthy practices each establishment agreed to offer (e.g. more fruits and vegetables, fewer calories, healthier fats, whole grain options) 80% agree or strongly agree that healthy choices in restaurants are easy to identify; increase from 76% POINT-OF- DECISION PROMPTS table tents, menu inserts 94% agree or strongly agree they can make healthier food choices in restaurants; increase from 86%

4 FOOD EXPLORERS Due to unhealthful eating and activity habits, the current generation of children is expected to live less healthful, and likely shorter, lives than their parents. Based on the belief that food skills are foundational to healthful eating, we created the school-based Food Explorers program integrating nutrition into the core curriculum to support healthier schools and healthier futures NOW 3X as many obese children as in IN 10 KIDS are not eating enough fruits and vegetables COOKING SKILLS are essential to good health; many youth are not learning them at home or school SUPPLY & DEMAND It s not enough to offer more fruits and veggies at school, kids need to want to eat them WHAT WE DID COLLABORATED with school principals, teachers, food service and other school leaders to develop integrated, effective and experiential nutrition curriculum CONNECTED classroom, cafeteria and home to create environments that support healthful choices TRAINED teachers, parent volunteers and cafeteria staff to deliver Food Explorers program and support school wellness policies TAUGHT more than 1,100 kindergarten and 1st-grade students to cook in the classroom using parent and college student volunteers to save teachers valuable time I TRIED IT INCREASED PREFERENCE among kids for fruits and vegetables like spinach, tomatoes and honeydew melon I TRIED IT! Kids were more likely to try new foods at home and school MORE COOKING TOGETHER at home, according to parents 100% of teachers and food service managers agree Food Explorers would build support for school wellness among students, teachers and parents 100% of teachers and parent volunteers desire to do program again

5 FARMERS MARKET PROMOTION PROGRAM The Farmers Market Promotion Program In New Ulm, Minn., (population 13,500) was funded in by a USDA grant and aimed to expand the promotion of local produce along with community resources. FOR FARMERS Presentations and networking events helped educate farmers on how to improve and expand their farming techniques. FOR THE COMMUNITY Along with media messages and educational materials, experiential learning and skills training helped facilitate behavior change. SUSTAINABILITY KEEP IT LOCAL #1HEART DISEASE CAUSE OF DEATH WORLDWIDE ORGANIC FARMING HEALTHY LIFESTYLE fruits and vegetables lower the chances of developing HEART DISEASE Cooking Demonstrations the 12at farmers markets * Cooking Classes with a chef at a local restaurant/ cooking school *NEW ULM, MINN Worksites received information on the program ONLY 14% of market visitors ate 5 or more fruits and vegetables/day 100% 97 % SATISFACTION AMONG PARTICIPATING FARMERS MARKET VISITORS INTENDING TO RETURN =X100 4,700 VISITS DURING 2013 OPEN >21,000 POUNDS fruits and vegetables sold NEW FOOD CO-OP OPENED SOLD OUT One farm sold out of Community Supported Agriculture shares Farmers Markets often closed early because produce sold out

6 HOW IT WORKS HEARTBEAT CONNECTIONS Since 2010, the HeartBeat Connections phone coaching program has focused on primary prevention of heart disease in New Ulm, Minn., by helping those at highest risk improve their risk factors. Individualized approaches include lifestyle changes such as eating healthier, increasing physical activity, quitting smoking or losing weight, as well as prescribing preventive therapies for blood pressure and cholesterol as needed. INDIVIDUALIZED APPROACH Individuals invited to participate based on electronic health record data or referral MIN MONTH 1,100 Participants talk via phone for 15 to 20 minutes with a professional health coach (registered dietitian or registered nurse) typically once/month =X100 Coaching participants since 2010 WHY IT WORKS $ COST-EFFECTIVE APPROACH Providers can focus on patients acute care needs while health coaches with specialized training in behavior change can focus on lifestyle issues in-between usual clinic visits STRONG PROVIDER COLLABORATION Health coaches document progress in patient s electronic health record, providing seamless communication with providers SIX-MONTH 5+ SERVINGS 200% INCREASE IN PERCENTAGE OF PARTICIPANTS EATING 5+ DAILY SERVINGS FRUITS AND VEGETABLES 1 IN 3 ELIGIBLE PEOPLE ENGAGE IN PROGRAM 50% DROP IN SMOKING AMONG PARTICIPANTS 30% INCREASE IN PARTICIPANTS MEETING RECOMMENDED LEVEL OF 150 MINUTES PHYSICAL ACTIVITY/WEEK HDL LDL 70% OF PARTICIPANTS IMPROVED CHOLESTEROL 95% WOULD RECOMMEND PHONE COACHING TO FAMILY MEMBER OR FRIEND 94% MEDICATION ADHERENCE AMONG THOSE TAKING CHOLESTEROL MEDICATION

7 COMPLETE STREETS Hearts Beat Back wanted to make it easier for people to be more physically active in the community of New Ulm, Minn. With the help of federal grant funding, project leaders worked to help create more opportunities for people to safely walk and bike in the community. OVERLY WIDE 73% of adults in New Ulm considered overweight or obese design on important street near high school promoted speed; created unsafe environment for pedestrians and bicyclists WALKABLE, LIVABLE COMMUNITY helps promote active commuting, Safe Routes to School Program and increased physical activity COMPLETE STREETS approach means streets are planned to be safe and accessible for all users pedestrians, transit riders, bicyclists and drivers regardless of age or ability WHAT WE DID 17 COMMUNITY LEADERS from many sectors engaged in new Coalition for Active, Safe 2 3 and Healthy Streets national planning and transportation experts toured community, then created report with 6 major, specific safety improvement recommendations; new coalition prioritized them coalition action teams created: Safe Routes to School, Revitalize Downtown, Bike Trail Connections CITY BUY-IN City Council approved several improvements to make street near high school significantly safer; improvements incorporated into already planned resurfacing project SAFETY FIRST INCREASED SAFETY Complete Street redesign included elimination of parking on residential side of the street, addition of bike lanes on each side of the street, mid-block crosswalk with island and angled crosswalk SLOWER SPEEDS people say drivers paying more attention while driving 2x use of new crosswalk has doubled since before street redesign

8 WORKSITE WELLNESS Since 2009, Hearts Beat Back has worked to engage employers in the rural area of New Ulm, Minn., (population 13,500) in worksite wellness programs. Healthy employees are more productive and enjoy their work more, and research shows employers may realize reduced health care costs. Employers can improve employee health by making small changes to create a culture of wellness in the workplace. With a supportive environment, employees are empowered to learn about healthful habits and develop and maintain them at work and at home. ONLY 5 of largest 100 employers had some sort of wellness program in /3 of a typical day is spent at work, providing an ideal location to inspire people to make healthful lifestyle changes LESS THAN employees is the 100 average size of a New Ulm employer 75% of health care costs and productivity losses are related to lifestyle choices WE PROVIDED 89% of employers now promote community programs and resources for health; focus groups showed employers prefer this vs. separate worksite programming FREE HEART-HEALTH SCREENINGS Comprehensive aggregate screening data provided to largest employers pinpointed top heart attack risk factors among employees and compared results with the entire community 72 WORKSITES engaged in LOSE IT to WIN IT community weight loss challenge; representing participants X100 RESOURCES Consulting, educational materials, newsletters, presentations, packaged health improvement programs EMPLOYERS completed the WELCOA Well Workplace Checklist in both 2010 and 2014 to evaluate current wellness promotion efforts and worksite wellness environment EMPLOYERS are now engaged in some level of wellness programming TOP 5 risk factors among worksites screened in 2011 were overweight/obesity, high LDL cholesterol, metabolic syndrome, high blood glucose and tobacco use Visit to read success stories from New Ulm employers. HEART HEALTH WELLNESS NUTRITION ANNUAL WORKSITE SUMMIT Featuring nationally recognized presenter on wellness initiatives, policies or programs 5,703 PARTICIPANTS in worksite programs through December 2013

9 MARKETING HEALTH Often with community initiatives, communications happen in the form of marketing a specific program, product or service. Hearts Beat Back markets a way of life with messages that penetrate the entire community, helping propel a shift to a culture where health is the new norm. WITH HEARTS BEAT BACK, WE... SPREAD EDUCATIONAL LIFESTYLE MESSAGES EVERYWHERE HOME DIRECT MAIL NEWSPAPER CABLE TV ON THE ROAD RADIO BILLBOARD WORKSITES AND HEALTH CARE CLINICS ONLINE WEBSITES SOCIAL MEDIA COMMUNITY RESTAURANTS STORES SCHOOLS CHAMBER CHURCHES HIGHLIGHT SUCCESS If Tom or Mary can do it, so can you! Communications highlight personal success stories of people in the community whenever possible to help inspire others and increase engagement. Stories emphasize how small steps lead to success! ENCOURAGE SOCIAL SUPPORT When it comes to successfully making healthful lifestyle changes, the power of social support can't be empasized enough. A person's healthful choices influence their family, coworkers and friends. Messages reinforce how the entire community wins when everyone works together to support each other. CULTIVATE CHAMPIONS From churches to workplaces to city hall and social or civic groups, we find community champions and key influencers engage them in helping us spread the word in a wide variety of ways. People naturally want to be a part of something bigger than themselves. HOW DOES THIS IMPACT HEALTH? BAD AVERAGE EXCELLENT HEALTHY LIFESTYLE METER MOVING THE NEEDLE Creating cultural change to improve a population's health is a marathon, not a sprint. A comprehensive long-term communications strategy is necessary to infiltrate the community with key messages to reach target audiences and influence a cultural shift toward health. MAINTAINING MOMENTUM Helping the community build on small successes is key to keeping the momentum going. We report back to the community regularly so community members gain a sense of cumulative community pride from knowing they are improving in certain health measures. WHAT'S OUR SUCCESS? 94% of ADULTS IN THE NEW ULM community were aware of the project after the first year and the same percentage stated they believed the project would be successful. WORKSITES ARE A FANTASTIC PLACE TO SPREAD THE WORD in one program heard about it from their employer or coworker. OF PARTICIPANTS 49% 2X HEARTS BEAT BACK 70% Name recognition for SWAP IT to DROP IT health promotion campaign in the New Ulm community PER MONTH OR MORE Coverage in media