Critical analysis: Taking social marketing to the "next level" with low-income families

New provisions for nutrition education through the Supplemental Nutrition Assistance Program (SNAP-Ed) call for comprehensive, multi-level community and public health approaches, and the 2010 Dietary Guidelines for Americans calls for a social ecological approach. Since at least 2006, experts challenged businesses, non-profits and public agencies to increase access to healthy food and physical activity, create supportive environments, and drive normative change, especially for low-income Americans. Few large-scale efforts have been reported.

Through USDA SNAP-Ed reimbursement, the Network for a Healthy California has used such approaches since 1997. Incentive funding enabled the California Department of Public Health to engage local health departments, school districts, food stamp offices, federally-qualified health centers, pre-school, after-school and faith organizations, lower-wage worksites and retail food stores in education and social marketing to California's 7 million low-income parents and children in thousands of community locations. Empowerment approaches through community interventions and mass media were used. From 1997 to 2007, statewide surveys showed a 90% increase in low-income adults who reported eating 5+ servings of fruits and vegetables (24% to 49%), a contrast to national declines. Over 6 years, the proportion who reported recommended levels of physical activity increased 30% (35% to 50%), exceeding the national increases. Trends for school-aged children and youth did not improve; obesity trends were not positive for any low-income segment. This paper will critically evaluate what worked and recommend approaches that increase the effectiveness for future efforts.

APHA abstract, 2011 2-2-11