Maryland SNAP-Ed: Producing Change. Talking Points FSNE Impact Data

Maryland SNAP-Ed: Producing Change Talking Points FSNE Impact Data Updated April 2018

Maryland SNAP-Ed Produces Change: FSNE Impact Data Talking Points The University of Maryland Extension Food Supplement Nutrition Education (FSNE) Program provides nutrition education to low-income Maryland residents. The goal of the educational programming is to improve the health and well-being of SNAP-eligible participants by encouraging healthy choices and active lifestyles. FSNE assesses the nutrition and physical activity impacts of its programming through the use of statewide evaluation tools and measures. The data is then aggregated to present a comprehensive statewide picture of FSNE programming in Maryland. The current document highlights nutrition-related behavioral changes as reported by participants in FSNE programming. It also identifies health-promoting policy, systems, and environmental (PSE) changes made at sites that partner with FSNE. The FSNE Impact Data Talking Points document presents statewide impact data first by outcome type (individual-level behavior changes or environmental-level changes) and then by the specific nutrition education curriculum that was utilized with the target audience. Finally, the document concludes with general talking points from national health organizations. These statements provide the foundation for FSNE programming and serve as reference points for behavioral change goals. ** Note: Throughout the document, an apple icon ( ) appears next to some of the talking points. This icon indicates that a graphic was designed to further explicate the finding. The graphic immediately follows the relevant talking point. Page 1 of 29

Table of Contents General Talking Points... 3 FSNE Individual-Level Talking Points... 3 Healthy Eating... 3 Physical Activity... 5 FSNE Environmental-Level Talking Points... 7 Improved Nutrition Environment - Healthy Classrooms and Other FSNE Sites... 7 Improved Physical Activity Environment Healthy Classrooms and Other FSNE Sites... 10 Individuals, Policies, and Partnerships to Support Healthy Environments... 11 FSNE Curriculum-Specific Talking Points... 12 1-2-3 Feed Me! Talking Points... 12 Cooking Matters at the Store Talking Points... 13 Feeding for Healthy Eating Talking Points... 14 Fruits & Veggies: Fabulous Foods! Talking Points... 15 Growing Healthy Habits Talking Points... 16 Grow It, Try It, Like It Talking Points... 17 Healthy Cents Talking Points... 18 Market to Mealtime Talking Points... 19 Nutrition Nuggets Talking Points... 20 Nutrition to Go! Talking Points... 21 Read for Health Talking Points... 22 ReFresh Talking Points... 23 Text2BHealthy Talking Points... 24 Walkways Talking Points... 27 Youth Gardening for Nutrition Teacher Training Talking Points... 28 General Nutrition Statements from National Health Organizations... 29 Page 2 of 29

General Talking Points FSNE Individual-Level Talking Points Healthy Eating 55% of younger youth (grades K-2) and 43% of older youth (grades 3-6) tried at least one new vegetable during their time in FSNE s gardening for nutrition programs. More than ¾ of youth (78%) in FSNE nutrition education programs report feeling confident in their ability to prepare their favorite fruits or vegetables at home. 84% of FSNE youth report feeling confident in their ability to select and consume fruits or vegetables when eating away from home. More than 4 out of 10 youth participants (42%) report trying at least one new healthy food during their time in the program. Page 3 of 29

More than 80% of teachers report that students in FSNE nutrition education programs talk about fruits and vegetables in a positive manner, and are willing to try new fruits and vegetables. More than 7 out of 10 teachers (71%) report that students in FSNE nutrition education programs select healthy foods when they are offered with school meals/snacks. 79% of parents of elementary school children who engage in FSNE nutrition education programming report that their child regularly helps them to cook or prepare food. 85% of parents of preschool-aged children who participate in FSNE programs report regularly eating fruits in front of their child. After engaging with FSNE nutrition education programs, almost 40% more preschool parents report engaging in healthy eating behaviors, such as: shopping for fruits and vegetables with their child; eating healthier when dining out; talking about fruits and vegetables with their child; and buying fruits and vegetables at the farmers market. Page 4 of 29

Physical Activity 87% of youth who participate in FSNE nutrition education programming report being physically active at least three times per week, and 70% of youth report being physically active at least seven times per week. 8 out of 10 parents of elementary school children who engage in FSNE programming report that their child is physically active for more than 60 minutes per day during the week. 9 out of 10 parents of elementary school children who participate in FSNE programming report that their child is physically active for more than 60 minutes per day during the weekend. 57% of parents of preschool-aged children who participate in FSNE programs report regularly engaging in physical activity in front of their child. Page 5 of 29

Compared to U.S. children and youth overall, FSNE youth are more successful at engaging in physical activity (60 or more minutes of moderate-to-vigorous activity at least 5 days per week) and limiting their screen time (2 hours or less per day). 1 1 National Physical Activity Plan Alliance (2016). 2016 United States Report Card on Physical Activity for Children and Youth. Columbia, SC. Page 6 of 29

FSNE Environmental-Level Talking Points Improved Nutrition Environment - Healthy Classrooms and Other FSNE Sites 81% of teachers in FSNE classrooms report that healthy foods, such as fruits and vegetables, are offered to students throughout the school/program day. 63% of teachers use healthy foods as examples in their classroom lessons (for instance, counting apples in math lessons, instead of candy bars). More than 6 out of 10 teachers (63%) provide opportunities for students to taste fruits or vegetables in the classroom. 9 out of 10 teachers at FSNE sites report drinking water in front of their students. Page 7 of 29

90% of teachers at FSNE sites report talking about the importance of healthy foods with their students. More than 7 out of 10 teachers (71%) in FSNE classrooms report eating healthy foods (such as fruits and vegetables) in front of their students. 79% of teachers at FSNE sites report that signs, displays, or posters in their school/program emphasize and encourage healthy food choices. Page 8 of 29

Almost ½ of teachers in FSNE classrooms (49%) report that parents serve as advocates for healthy eating in the classroom and the broader school environment. Local FSNE educators report that 87% of collaborating sites have made at least one new or improved change to the nutrition environment. Examples presented by site type are included below: - Almost 3 out of 5 FSNE schools have removed or reduced the number of sugar-sweetened beverages offered on menus. - Almost 60% of Pre-K sites working with FSNE have restrictions on the use of food as rewards or during celebrations. - 3 out of 5 out of school youth settings that partner with FSNE have made improvements in free water access, taste or quality. - 3 out of 4 FSNE food assistance sites encourage clients use of healthy food items by placing recipe cards or other healthy eating information in prepackaged food bags. - 2/3 of FSNE farmers markets use signs, posters, or recipe cards placed near fruits, vegetables, or other healthy foods to encourage the selection of these options and to inform shoppers that they can use their SNAP/EBT or other benefits on these purchases. Page 9 of 29

Improved Physical Activity Environment Healthy Classrooms and Other FSNE Sites Local FSNE educators report that more than ¾ of collaborating sites (76%) have made at least one new or improved change to the physical activity environment. Examples presented by site type are presented below: - More than ½ of FSNE schools have incorporated physical activity into the school day or during classroom-based instruction. - Almost ½ of Pre-K sites working with FSNE maintain policies against staff taking away recess as a form of punishment. - 3 out of 5 out of school youth settings incorporate physical activity into the programs schedule. Almost ¾ of teachers in FSNE classrooms (73%) report using physical activity opportunities as rewards for students. 84% of teachers in FSNE classrooms report that students have the opportunity to engage in at least 30 minutes of physical activity during the school day. 92% of teachers in FSNE classrooms report talking about the importance of physical activity with their students. Almost ¾ of teachers at FSNE sites (74%) report using physical activity as examples in lessons (e.g., counting the number of miles a person ran in math lessons). Page 10 of 29

Individuals, Policies, and Partnerships to Support Healthy Environments Local FSNE educators have identified 79 champions at collaborating sites who advocate for improved and healthier environments for Maryland residents. Local FSNE educators have identified 45 collaborating sites with active wellness councils or other committees organized for the purpose of creating a healthier environment. Local FSNE educators report that more than 4 out of 10 FSNE school or preschool/daycare sites (43%) require students to spend at least 50% of their time in PE classes engaged in moderate or vigorous physical activity. 94% of collaborating FSNE farmers markets report accepting SNAP benefits and thus increasing access to locally grown fruits and vegetables among SNAP-eligible consumers. Page 11 of 29

FSNE Curriculum-Specific Talking Points 1-2-3 Feed Me! Talking Points After participating in the 1-2-3 Feed Me! training, 78% of childcare providers report plans to always role model healthy eating for the children in their care. 93% of 1-2-3 Feed Me! participants report plans to regularly eat with the children in their care, an increase of 31% from before the program. Almost 8 out of 10 participants in 1-2-3 Feed Me! training sessions report plans to cook or prepare healthy foods with the children in their care after the course, an increase of 49%. 85% of 1-2-3 Feed Me! participants plan to regularly eat the same foods as the children in their care. After the 1-2-3 Feed Me! training, 88% of participants plan to always pay attention to children s satiety cues and 50% plan to stop telling children to eat all of the food on their plates. Page 12 of 29

Cooking Matters at the Store Talking Points Participants in FSNE-led Cooking Matters at the Store tours intend to positively change their food shopping and purchasing behaviors. 72% of participants plan to compare food labels to make healthy choices. 76% of participants intend to regularly read ingredient lists to find whole grains. 81% of participants intend to compare unit prices to find the best deals. An independent evaluation of Cooking Matters at the Store found that the tours produce lasting changes in families shopping habits, especially among SNAP recipients. When asked how many of the skills learned on the tour they remembered six weeks post-tour, 69% of SNAP respondents said all or almost all, compared to 57% of non-snap respondents. 2 A national evaluation of Cooking Matters at the Store found that after families participated in the tours, they reported greater success at stretching their food resources; buying healthier foods; and employing key food resource management skills, including comparing unit prices and food labels, buying whole grains, and planning meals ahead of time. 2 2 No Kid Hungry (2013). Buying healthy food on a budget: An evaluation of Cooking Matters at the Store. Washington, D.C.: Author. Page 13 of 29

Feeding for Healthy Eating Talking Points 92% of Feeding for Healthy Eating participants reported that their preschool-aged child helped them cook a meal the previous week, an increase of 38% from before the program. After Feeding for Healthy Eating lessons, 86% of participants report that they often or always serve fruits and vegetables in different ways in order to find a way their child likes to eat them, an increase of 26%. Almost 80% of Feeding for Healthy Eating participants report often or always offering their preschool-aged child a new food a second time even if they did not like it the first time it was offered, a 26% increase from before the program. 90% of Feeding for Healthy Eating participants report often or always telling their preschool-aged child it is okay to stop eating when the child indicates that she/he is full, an increase of 15%. Page 14 of 29

Fruits & Veggies: Fabulous Foods! Talking Points Adult participants in Fruits & Veggies: Fabulous Foods! sessions consume more servings of fruits and vegetables after program participation. On average, adults report eating almost 5 ½ daily servings of fruits and vegetables, about 2½ servings of fruits and 3 servings of vegetables. Following Fruits & Veggies: Fabulous Foods! sessions, 71% of adult participants report consuming fruits and vegetables often or every day for snacks. Adults who participate in Fruits & Veggies: Fabulous Foods! sessions increase the daily variety of fruits and vegetables they consume. After program participation, 42% of adults report often consuming 2 or more types of fruits each day, while 67% report often consuming 2 or more types of vegetables each day. After participating in Fruits & Veggies: Fabulous Foods! programming, almost 6 out of 10 adults report regularly consuming 2 or more vegetables with their main meal, an increase of 50% from before the program. Page 15 of 29

Growing Healthy Habits Talking Points Youth participants in Growing Healthy Habits increase the number of times per day that they eat fruit. After participating in Growing Healthy Habits, 89% of students reported consuming fruit at least once on the day prior to completing the survey, as compared to 82% of youth before the program. After participating in Growing Healthy Habits, almost 8 out of 10 youth report feeling confident that they can ask a member of their family to purchase their favorite fruits and vegetables and that they can consume fruits and vegetables when eating away from home. Almost ½ of youth (48%) who participate in Growing Healthy Habits try one or more vegetables for the first time during the program lettuce, broccoli, and tomatoes are the most popular new vegetables tried by students. More than 1 out of 3 youth participants (36%) in Growing Healthy Habits try at least two new vegetables during their time in the program. Students have multiple opportunities to grow and taste vegetables during the Growing Healthy Habits program. After participating in the program, youth report an increased preference for tomatoes and spinach, two of the locally grown Maryland vegetables they tasted during lessons. After participating in Growing Healthy Habits, 69% of youth report engaging in behavior that made them sweat, made their legs feel tired, or made them breathe hard at least five times during the week prior to completing the survey, an increase from 63% before the program. Teachers report that students increasingly share nutrition information with their family and friends and consume more fruits and vegetables after participating in the Growing Healthy Habits curriculum. Youth often learn healthy behaviors by watching important people in their lives demonstrate such behaviors. Teachers who are trained to implement Growing Healthy Habits report a significant increase in their modeling of healthy behaviors, including drinking water and choosing fruits or vegetables as snacks. 3 out of 4 teachers report wide-reaching impacts of Growing Healthy Habits beyond the classroom, influencing changes in the cafeteria and school policies, as well as the eating habits of students both inside and outside of school. Students participating in Growing Healthy Habits programs show an increased interest in the nutritional value of the foods they consume. Page 16 of 29

Grow It, Try It, Like It Talking Points Almost ½ of youth (47%) who participate in Grow It, Try It, Like It try one or more vegetables for the first time during the program, with almost ¼ of youth (23%) trying at least 2 new vegetables. Students have multiple opportunities to grow and taste vegetables during the Grow It, Try It, Like It program. After participating in the curriculum, youth report an increased preference for 8 vegetables, all of which can be grown locally in Maryland. Teachers who are trained to implement Grow It, Try It, Like It in their classrooms report a significant increase in their modeling of healthy behaviors, including drinking water and choosing fruits or vegetables as snacks. Teachers who use the Grow It, Try It, Like It curriculum change their teaching practices to encourage positive nutrition behaviors among their students they incorporate nutrition into their existing subject areas, use MyPlate to plan snacks for their students and engage students in gardening through hands-on learning experiences. Grow It, Try It, Like It teachers report that the impacts of their gardening-based lessons extend beyond the classroom environment - 88% of teachers advocate for changes that support a school focus on nutrition and physical activity for students after implementing the curriculum. Page 17 of 29

Healthy Cents Talking Points Healthy Cents participants express a strong desire to improve their nutrition and food shopping skills. After participating in Healthy Cents, adults intend to more frequently: Eat a variety of fruits and vegetables Consume a greater number of fruits and vegetables Plan meals and snacks ahead of time Make single servings from larger quantities of food Eat before shopping to avoid buying extra food items Buy store brands Create and use a grocery list Use coupons Make unit price comparisons. Page 18 of 29

Market to Mealtime Talking Points Almost 100% of Market to Mealtime participants who attend events with recipe demonstrations report that they enjoyed the way the recipe tasted; 91% believe their families would like the recipe as well. 9 out of 10 participants (92%) in Market to Mealtime plan to buy or choose the produce they learned about from FSNE educators. After participating in Market to Mealtime, 63% of participants take home more fruits and vegetables than they typically bring home from other food purchase or selection sites. 93% of Market to Mealtime participants plan to use the fruits and vegetables they obtain from farmers markets or food banks in the meals and snacks they prepare throughout the week. More than 8 out of 10 adult participants (81%) report that the Market to Mealtime education influenced their purchases at the market that day, with 40% indicating that they would try a new recipe as a result of the tasting opportunity and the take-home materials. 78% of Market to Mealtime participants plan to involve their families in preparing the fruits and vegetables they obtained from farmers markets or food banks. More than ½ of participants plan to involve their family in preparing the foods (ex. washing, chopping, or measuring), and 16% plan to involve their family in the cooking process. The majority of Market to Mealtime participants (62%) indicate that the Market to Mealtime display and/or tasting is useful for discovering new, healthy recipes. Page 19 of 29

Nutrition Nuggets Talking Points Youth participants in Nutrition Nuggets programming report a significant increase in their preference for healthy foods, especially vegetables, whole grain foods, and fruits, after participating in the program 86% report liking vegetables, 97% report liking whole grain foods, and 98% report liking fruits. After participating in Nutrition Nuggets, 54% of youth report consuming at least two fruits the previous day; 44% of youth report always eating fruit with their lunchtime meal. Page 20 of 29

Nutrition to Go! Talking Points Adult participants in Nutrition to Go! lessons report strong intent to seek out the calorie content of their meals and beverages and to make healthy decisions, including choosing smaller portions of foods, based on nutrition information. After participating in Nutrition to Go! lessons, adults report plans to significantly increase the amount of healthy beverages they consume by choosing water and unsweetened beverages over less healthy options like soda; drinking water with meals, snacks, and throughout the day; and seeking out the nutrition information and calorie content of the beverages they drink. Nutrition to Go! participants increase their intent to implement smart shopping strategies, such as using a list when food shopping, comparing unit prices, planning ahead for weekly meals, and reading sales flyers. Page 21 of 29

Read for Health Talking Points Youth who participate in Read for Health report significant increases in preferences for foods that they tried during the program, including berries, cucumbers, lettuce, oranges, and peaches. After participating in Read for Health, students report significant increases in their preferences for foods containing whole grains: 91% of youth report liking whole grain foods after participating in the curriculum lessons. Almost ½ of youth (48%) who participate in Read for Health try one or more healthy foods for the first time during the program. Youth who participate in Read for Health report trying a significant number of new foods during their time in the program, including broccoli, lettuce, oranges, tomatoes, yogurt, and whole grain bread. After participating in Read for Health, 7 out of 10 students report high confidence in their ability to prepare their favorite fruit or vegetable at home, an increase of 9% from before the program. Teachers who are trained to implement Read for Health pass along healthy eating information to their students parents or caregivers, extending the reach of FSNE into students homes. Teachers who use the Read for Health curriculum change their teaching practices to encourage positive nutrition behaviors among their students they role model healthy behaviors for their students, provide more opportunities to taste fruits or vegetables in their classrooms, and ask students to share examples of their healthy eating and physical activities at home and school with their classmates. Page 22 of 29

ReFresh Talking Points After participating in ReFresh, 86% of students report consuming at least one fruit the previous day. Youth who participate in ReFresh make healthy choices regarding their lunchtime meals. 96% of students report regularly eating fruit with lunch. Youth who participate in ReFresh report significant increases in their preferences for fruits and whole grain foods: 98% report liking fruit and 92% report liking whole grain foods after participating in the curriculum lessons. 4 out of 10 youth participants in ReFresh tried at least one new healthy food during their time in the program. After participating in ReFresh, 80% of students report feeling confident in their ability to prepare their favorite fruit or vegetable at home, an increase from 76% before the program. Students who participate in ReFresh increase their physical activity from pre to post-program. More than ½ of youth (55%) report engaging in physical activity (behaviors that make them sweat, breathe hard, or that make their legs hurt) seven or more times in the previous week, an increase of 7% from before the program. Page 23 of 29

Text2BHealthy Talking Points After participating in Text2BHealthy, 58% of parents report often or always eating more than one kind of fruit daily, and 68% of parents say their child is doing the same. 65% of Text2BHealthy parents report regularly eating more than one kind of vegetable each day. Further, 53% of parents report that their children eat more than 1 type of vegetable each day, an increase from 44% before the program. After Text2BHealthy, 13% more parents (almost 5 out of 10) report that their children eat fruits and vegetables every day. Before Text2BHealthy, 42% of parents indicated that their child ate at least 2 vegetables with their main meal, as compared to 53% of parents after the program. After participating in Text2BHealthy, almost 9 out of 10 parents (87%) regularly keep fruit available for their child to eat and almost 8 out of 10 parents (79%) regularly keep vegetables ready for their children to eat. After participating in Text2BHealthy, 56% of parents report that their children regularly consume healthy snacks (fruits and vegetables), an increase from 49% before the program. Further, 21% of parents report that their children regularly consume unhealthy snacks (candy, chips and cookies), a decrease of 12% from before the program. Page 24 of 29

Text2BHealthy parents are significantly more likely to role model healthy eating behaviors: 51% of parents regularly talk with their children about the fruits and vegetables they eat during the school day, 81% of parents regularly eat fruits in front of their child, and 88% of parents regularly consume vegetables in front of their child. Parent participants in Text2BHealthy report that their children are drinking less sugar-sweetened beverages before the program, 18% of children drank soda or sugared drinks most or all days, as compared to 11% after the program. Page 25 of 29

Most Text2BHealthy parents report that their children are meeting or exceeding the recommended 60 minutes or more of physical activity per day, with 90% of parents reporting that their children engage in more than 60 minutes of daily physical activity during the week, and 93% doing so during the weekend. Almost 9 out of 10 parents (87%) who participate in Text2BHealthy report that their children meet or exceed the American Academy of Pediatrics recommendations for screen time. Page 26 of 29

Walkways Talking Points Across four years of programming, Walkways participants significantly increased the number of daily steps they take: adults who participate in at least 4 sessions report an average increase of 182 steps per day. Adult participants in Walkways plan to improve their physical activity behaviors by engaging in at least 30 minutes of daily physical activity and by making small changes, such as taking the stairs and parking further away from their destination. After participating in Walkways, adults plan to maintain a healthy weight by choosing smaller portions of food and by balancing the calories they consume with the physical activity they complete. Page 27 of 29

Youth Gardening for Nutrition Teacher Training Talking Points Teachers who integrate gardening for nutrition education lessons into their classroom activities report strong plans to increase their students levels of engagement in healthy classroom behaviors. 57% of teachers report that they plan to often or always involve students in preparing healthy foods in the classroom. 70% of teachers intend to regularly involve their students in growing fruits or vegetables in an outdoor or container garden. 57% of teachers who integrate gardening for nutrition lessons into their classroom report plans to often or always share healthy recipes with students families. Youth Gardening for Nutrition teachers report plans to increase their focus on physical activity 96% plan to make physical activity fun through the use of games, while 88% plan to regularly provide physical activity breaks to their students during class. Page 28 of 29

General Nutrition Statements from National Health Organizations The Dietary Guidelines for Americans, 2015 recommends that Americans eat more fruits and vegetables as part of a healthy diet. MyPlate food guidance emphasizes the need to focus on fruits and vary your vegetables as building blocks for a healthy diet. 16.3% of Maryland Farmers Markets accept SNAP benefits (CDC State Indicator Report, 2013). 36.4% of Maryland adults report that they consume fruits and vegetables less than one time a day (CDC State Indicator Report, 2013). Only 13% of Americans consume the recommended amount of fruits each day, and 9% consume the recommended amount of vegetables each day (CDC, 2013). According to some estimates, 18% of men and 21% of women consume less than 1 serving of vegetables each day and approximately 50% of people consume less than 1 serving of fruit each day (Nutrition Decisions Text, p. 94). Note: CDC/ BRFFS gathers data based on times per day NHANES uses cups USDA uses pounds and ounces per capita Page 29 of 29