0990-Attachment A - MAPPS_Intervention_Table

MAPPS Interventions for Communities Putting Prevention to Work
Five evidence-based MAPPS strategies, when combined, can have a profound influence on improving

health behaviors by changing community environments: Media, Access, Point of decision information,

Price, and Social support/services. The evidence-based interventions below are drawn from the peer-

reviewed literature as well as expert syntheses from the community guide and other peer-reviewed sources,

cited below. Communities and states have found these interventions to be successful in practice.

Awardees are expected to use this list of evidence-based strategies to design a comprehensive and robust

set of strategies to produce the desired outcomes for the initiative.

Media

•

•
•
•

Access

•

•
•
•

•

Tobacco
Media and advertising
restrictions consistent
with federal law.
(k)
Hard hitting counteradvertising
(l-n)
Ban brand-name
sponsorships
(o)
Ban branded
promotional items and
prizes (p)

Usage bans (i.e. 100%
smoke-free policies or
100% tobacco-free
policies)
(f, g, v)
Usage bans (tobacco-free
school campuses)
(e-g, h-j)
Zoning restrictions
(e-g)
Restrict sales (e.g.
internet; sales to minors;
stores/events w/o
tobacco)
(e-g)
Ban self-service displays
& vending
(e-g)

•

•
•

Nutrition
Media and advertising
restrictions consistent
with federal law.
(38-44)

•
•

Promote healthy
food/drink choices
(42, 43, 45)

Counter-advertising for
unhealthy choices

•

(46)

•
•

Healthy food/drink
availability (e.g.,
incentives to food
retailers to locate/offer
healthier choices in
underserved areas,
healthier choices in child
care, schools, worksites)

•

Limit unhealthy
food/drink availability
(whole milk, sugar
sweetened beverages,
high-fat snacks)

•

Reduce density of fast
food establishments

•

(7-9, 10-21, 63-68, 76-82)

(17, 22-25, 69-73)

•

(15, 26)

•

Eliminate transfat
through purchasing
actions, labeling
initiatives, restaurant
standards

•

Reduce sodium through
purchasing actions,
labeling initiatives,
restaurant standards

(29-31)

•

Physical Activity
Promote increased
physical activity
(i, ii, vi, ix, xxix-xxx)
Promote use of public
transit
(i, ii, vi, ix, xxix-xxx)
Promote active
transportation (bicycling
and walking for
commuting and leisure
activities)
(i, ii, vi, ix, xxix-xxx)
Counter-advertising for
screen time
(i, ii, vi, ix, xxix-xxx)
Safe, attractive accessible
places for activity (i.e.,
access to outdoor
recreation facilities,
enhance bicycling and
walking infrastructure,
place schools within
residential areas, increase
access to and coverage
area of public
transportation, mixed use
development, reduce
community design that
lends to increased
injuries)
(xxxix – xli)
City planning, zoning and
transportation (e.g.,
planning to include the
provision of sidewalks,
parks, mixed use, parks
with adequate crime
prevention measures, and
Health Impact
Assessments)
(ii,iii,iv,v,viii,ix)
Require daily quality PE
in schools

•

(32-34)

Procurement policies and
practices

•

(8, 9, 13, 14, 35, 36)

•

Farm to institution,
including schools,
worksites, hospitals, and
other community
institutions

•

(35, 36, 37)

Point of
Purchase/
Promotion

•

•

●

Price

●

Social
Support &
Services

•

Restrict point of
purchase advertising as
allowable under federal
law.
(q)
Product placement
(q)

•

Signage for healthy vs.
less healthy items

•

Product placement &
attractiveness

•

Menu labeling

•

(8, 9, 47, 48, 74-75)

(8, 9, 47, 48, 49, 74-75)

Use evidence-based
pricing strategies to
discourage tobacco use
(a-c)
Ban free samples and
price discounts (d)

•

Quitline and other
cessation services
(r-t)

•

(50-53)

•

Changing relative prices
of healthy vs. unhealthy
items (e.g. through bulk
purchase/procurement/
competitive pricing)

•

(5-9, 60-62)

•

Support breastfeeding
through policy change
and maternity care
practices
(54-59)

•

•
•

(xvi – xxiii)
Require daily physical
activity in
afterschool/childcare
settings
(i, ii, iii, v, viii, ix, xxiv­
xxvii)
Restrict screen time
(afterschool, daycare)
(x, xi, xii, xiii, xiv)
Signage for
neighborhood
destinations in
walkable/mixed-use
areas (library, park,
shops, etc)
(ii, iii, iv, ix, xlxiii)
Signage for public
transportation, bike
lanes/boulevards
(ii, iii, iv, ix, xlxii,
xlxiii)
Reduced price for
park/facility use
(xxxvi – xxxviii)
Incentives for active
transit (xxxvii, xxxviii)
Subsidized memberships
to recreational facilities
(ii, iii, viii,ix)
Safe routes to school
(vii, xv, xxxi-xxxv)
Workplace, faith, park,
neighborhood activity
groups (e.g., walking
hiking, biking)
(ii, iii, viii, ix)

Tobacco references
Use evidence-based strategies to discourage tobacco use
a.
b.
c.

Centers for Disease Control and Prevention. Reducing tobacco use: a report of the Surgeon
General. Atlanta, GA: US Department of Health and Human Services, CDC; 2000
Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC:
The National Academies Press; 2007.
Task Force on Community Preventive Services. Guide to community preventive services: tobacco
use prevention and control. Am J Prev Med 2001;20(2 Suppl 1):1--87.

Ban free samples and price discounts

d. Loomis BR, Farrelly MC, Mann NH. The Association of retail promotions for cigarettes with the
Master Settlement Agreement, tobacco control programmes and cigarette excise taxes. Tob.
Control 2006; 15;458-63.
Access (youth specific)
e. Centers for Disease Control and Prevention. Reducing tobacco use: a report of the Surgeon
General. Atlanta, GA: US Department of Health and Human Services; 2000
f. Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC:
The National Academies Press; 2007.
g. Task Force on Community Preventive Services. Guide to community preventive services: tobacco
use prevention and control. Am J Prev Med 2001;20(2 Suppl 1):1--87.
Usage bans (smoke free campuses)
h. Pentz MA. The power of policy: the relationship of smoking policy to adolescent smoking.
American journal of public health 1989;79(7):857-62.
i. Wakefield MA. Effect of restrictions on smoking at home, at school, and in public places on
teenage smoking: cross sectional study. BMJ 2000;321(7257):333-7.
j.

Kumar R. School tobacco control policies related to students' smoking and attitudes toward
smoking: national survey results, 1999-2000. Health education & behavior 2005;32(6):780-94.

Media and advertising restrictions
k. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco
Control Monograph, No. 19; 2008.
Hard-hitting counter-advertising
l.

Task Force on Community Preventive Services. Guide to community preventive services: tobacco
use prevention and control. Am J Prev Med 2001;20(2 Suppl 1):1--87.
m. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco
Control Monograph, No. 19; 2008.
n. Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC:
The National Academies Press; 2007.
Ban Brand-name sponsorship
o. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco
Control Monograph, No. 19; 2008.
Ban Branded promotional items and prizes
p. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco
Control Monograph, No. 19; 2008.
Restrict point of purchase advertising/product placement
q. National Cancer Institute. The role of the media in promoting and reducing tobacco use. Tobacco
Control Monograph, No. 19; 2008.
Quitline and other cessation services

r.
s.
t.

Fiore MC, Jaen CR, Baker, TB, et al. Treating tobacco use and dependence: 2008 Update. Quick
Reference Guide for Clinicians. Public Health Service; 2008.
Task Force on Community Preventive Services. Guide to community preventive services: tobacco
use prevention and control. Am J Prev Med 2001;20(2 Suppl 1):1--87.
Institute of Medicine. Ending the tobacco problem: a blueprint for the nation. Washington, DC:
The National Academies Press; 2007.

Nutrition References
1. Dietary Guidelines for Americans, 2005. U.S. Department of Health and Human Services and U.S.
Department of Agriculture. Dietary Guidelines for Americans, 2005. 6th Edition, Washington, DC: U.S.
Government Printing Office, January 2005. Foods Encouraged, Available at:
http://www.health.gov/DietaryGuidelines/dga2005/document/html/chapter5.htm
5. French, S.A., M. Story, and R.W. Jeffery, Environmental influences on eating and physical activity.
Annu Rev Public Health, 2001. 22: p. 309-35.
6. French SA, Wechsler H. School-based research and initiatives: fruit and vegetable environment, policy,
and pricing workshop. Prev Med. 2004 Sep;39 Suppl 2:S101-7.
7. Ayala G. et al., 2009 – Evaluation of the Healthy Tienda project. The Public Health Effects of Food Deserts.
Workshop Summary. Institute of Medicine and National Research Council, p 49-51.
http://www.iom.edu/Object.File/Master/62/082/Session%204%20920%20am%20Ayala.pdf.
8. Glanz K, Yaroch AL. Strategies for increasing fruit and vegetable intake in grocery stores and
communities: policy, pricing, and environmental change. Prev Med. 2004 Sep;39 Suppl 2:S75-80. Review.
9. Nonas C, 2009. Health Bucks in New York City. The Public Health Effects of Food Deserts. Workshop
Summary. Institute of Medicine and National Research Council, p 59-60.Available at
http://www.iom.edu/CMS/3788/59640/62040/62078.aspx
Increase healthy food/drink availability (e.g., grocery, child care, schools, worksites)
Grocery
10. Bodor, J. N., Rose, D., Farley, T. A., Swalm, C., & Scott, S. K. (2007). Neighbourhood fruit and
vegetable availability and consumption: the role of small food stores in an urban environment. Public
Health Nutrition.
11. Gittelsohn J, Ethelbah M. Evaluation of the White Mountain and San Carlos Apache Healthy Stores
Program, a multi-component intervention that included stocking healthier food items. Available at
http://www.farmfoundation.org/news/articlefiles/450-Gittelsohn.pdf).
12. Morland K, Diez Roux AV, Wing S. Am J Prev Med. 2006 Apr;30(4):333-9 Supermarkets, other food
stores, and obesity: the atherosclerosis risk in communities study.
13. Larson, N., Story, M., & Nelson, M. (2009). Neighborhood Environments Disparities in Access to
Healthy Foods in the U. S. American Journal of Preventive Medicine. 36(1):74-81.
14. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating
environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.
15. Moore, L.V., et al., Associations of the local food environment with diet quality--a comparison of
assessments based on surveys and geographic information systems: the multi-ethnic study of
atherosclerosis. Am J Epidemiol, 2008. 167(8): p. 917-24.

Childcare
16. Ward, D. S., Benjamin, S. E., Ammerman, A. S., Ball, S. C., Neelon, B. H., & Bangdiwala, S. I. (2008).
Nutrition and physical activity in child care: results from an environmental intervention. Am J Prev Med.,
35(4), 352-356. Epub 2008.
School
17. IOM (2007). Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth
Committee on Nutrition Standards for Foods in Schools. Washington, D.C., The National Academies Press.
18. Ritenbaugh C, Tuefel-Shone N, et al. A lifestyle intervention improves plasma insulin levels among
Native American high school youth. Prev Med.2003;36:309-319.
19. Jaime, P.C. and K. Lock, Do school based food and nutrition policies improve diet and reduce obesity?
Prev Med, 2009. 48(1): p. 45-53.
Worksite
20. Sorensen, G., Linnan, L., & Hunt, M. K. (2004). Worksite-based research and initiatives to increase
fruit and vegetable consumption. Prev.Med., 39 Suppl 2, S94-100.
21. The Community Guide to Preventive Services. Obesity prevention through worksite programs.
Available at http://www.thecommunityguide.org/obesity/workprograms.html

Limit unhealthy food/drink availability (whole milk, sugar sweetened beverages, snacks)
See Ref 17
22. Schwartz, M. B., Novak, S. A., & Fiore, S. S. (2009). The Impact of Removing Snacks of Low
Nutritional Value From Middle Schools. Health Educ Behav, 5, 5.
23. Kubik, M.Y., et al., The association of the school food environment with dietary behaviors of young
adolescents. Am J Public Health, 2003. 93(7): p. 1168-73.
24. Cullen, K.W. and I. Zakeri, Fruits, vegetables, milk, and sweetened beverages consumption and access
to a la carte/snack bar meals at school. Am J Public Health, 2004. 94(3): p. 463-7.
25. Templeton, S.B., M.A. Marlette, and M. Panemangalore, Competitive foods increase the intake of
energy and decrease the intake of certain nutrients by adolescents consuming school lunch. J Am Diet
Assoc, 2005. 105(2): p. 215-20.
Reduce density fast food establishments
See Refs 12, 15
26. Ashe M, Jernigan D, Kline R, Galaz R. Land use planning and the control of alcohol, tobacco, firearms,
and fast food restaurants. Am J Pub Health. 2003;93(9):1404-1408.
Eliminate trans fat
29. Mozaffarian D. Katan MB. Ascherio A. Stampfer MJ. Willett WC. Trans Fatty Acids and
Cardiovascular Disease. New England Journal of Medicine. April 13, 2006. 354;15:1601-13.
30. Panel on Macronutrients, Institute of Medicine. Letter report on dietary reference intakes for trans fatty
acids drawn from the Report on dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids,
cholesterol, protein, and amino acids. Washington, DC 2003.

31. Trans Fat Regulation: NYC Department of Health and Mental Hygiene – Board of Health Approves
Regulation to Phase Out Artificial Trans Fat. Available at:
http://www.nyc.gov/html/doh/html/cardio/cardio-transfat-healthcode.shtml; How to Comply: What
Restaurants, Caterers, Food-Vending Units, and Others Need to Know” Accessed June 24, 2009
http://www.nyc.gov/html/doh/downloads/pdf/cardio/cardio-transfat-bro.pdf
Reduce sodium
32. Sacks, FM et al.(2001) Effects on blood pressure of reduced dietary sodium and the Dietary
Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. New
England Journal of Medicine 344(1):3-10.
33. City Purchasing Standards: New York City executive order for formal nutrition standards for all food
purchased or served by New York City agencies including sodium. Available at :
http://www.nyc.gov/html/doh/downloads/pdf/cardio/cardio-food-standards.pdf
34. New York City, Advocacy for External Efforts: Initiative to develop a voluntary partnership with
industry leaders to reduce the level of sodium in processed and prepared foods nationwide. Available at:
http://www.nyc.gov/html/doh/html/cardio/cardio-salt-initiative.shtml
Procurement policies and practices
See Refs 8, 9, 13, 14
35. Joshi, A., & Azuma, A. (2008). Do Farm-to-School Programs Make a Difference? Findings and Future
Research Needs. Journal of Hunger & Environmental Nutrition, 3, 2-3.
36. Zudrow D (2005) Food Security Begins at Home: Creating Community Food Coalitions in the South.
Southern Sustainable Agriculture Working Group, pp 45-67, Available at: http://www.ssawg.org/cfs­
handbook.html
Farm to institution
See Ref 35
37. Texas, Farm to Work program. Farm to Work Initiative of the Texas State Health Service provides a
Farm to Work Toolkit. Available at http://www.texasbringinghealthyback.org/ and
http://www.dshs.state.tx.us/obesity/pdf/F2WToolkit1008.pdf

Media and advertising restrictions
38. The Guide to Community Preventive Services - Obesity Prevention: Interventions to Reduce
Screen Time http://www.thecommunityguide.org/obesity/screentime/index.html
39. Story M, French S. Food Advertising and Marketing Directed at Children and Adolescents in the US.
Int J Behav Nutr Phys Act. 2004 Feb 10;1(1):3.
40. Chou SY, Rashad I, Grossman M. Fast-Food Restaurant Advertising on Television and Its Influence on
Childhood Obesity. The Journal of Law and Economics, 2008:51; p 599-618
41. Coon KA, Tucker KL: Television and children's consumption patterns. A review of the literature.
Minerva Pediatr 2002, 54:423-436.

42. WHO. 2004. Global Strategy on Diet, Physical Activity and Health. WHA 57.17. Geneva: WHO.
Available at
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43. Norwegian ministry of Children and Family Affairs, 2005. Norway enacted a ban on TV
advertisements to children ages 12 years and younger in 1992. Available at
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plan-to-reduce-comm.html?id=462256
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York City’s Black neighbourhoods. International Journal of Epidemiology. 2007; 36 (5): 988-990.
Promote healthy food/drink choices
See Refs 42, 43
45. Evidence of impact of advertising on food and beverage purchase requests of 2-11 year olds and usual
dietary intake of 2-5 year olds: IOM (2006), Committee on Food Marketing and the Diets of Children and
Youth. Food Marketing to Children and Youth: Threat or Opportunity? Washington, D.C., National
Academies Press.
Counteradvertising for unhealthy choices
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Signage for healthy vs. less healthy items
See Refs 8, 9
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interventions on point-of-purchase behavior in adults: a review. Prev Med. 2004 Sep;39 Suppl 2:S108-36.
Review.
48. Glanz K, Hoelscher D. Increasing fruit and vegetable intake by changing environments, policy and
pricing: restaurant-based research, strategies, and recommendations. Prev Med. 2004 Sep;39 Suppl 2:S88­
93.
Product placement & attractiveness
Ref 8, 9, 47, 48
49. Curhan, R.C., The effects of merchandising and temporary promotional activities on the sales of fresh
fruit and vegetables in supermaket. Journal of Marketing Research 1974. 11: p. 286-94.
Menu labeling
50. Bassett, M.T., et al., Purchasing behavior and calorie information at fast-food chains in New York City,
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Epidemic: A Health Impact Assessment. Los Angeles, CA: Los Angeles County Dept of Public Health;
2008
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53. Kozup KC, Creyer EH and Burton S. “Making Healthful Food Choices: The Influence of Health
Claims and Nutrition Information on Consumers’ Evaluations of Packaged Food Products and Restaurant
Menu Items.” Journal of Marketing, 67(2): 19-34, 2003.
Support Breastfeeding
54. Philipp BL et al. 2001. Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a
US Hospital Setting. Pediatrics 108(3):677-681.
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breastfeeding by employed mothers. American Journal of Health Promotion 1994;8(6):436–41.
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Selective Pricing (schools)
60. French, S.A., Story, M., Jefferey, R.W., Snyder, P., Marla, E., Sidebottom, A., & Murray, D. (1997).
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1008-1010.
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(2001). Pricing and promotion effects on low–fat vending snack purchases: The CHIPS study. Am J Public
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lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am J Hlth Prom, 17(1): 1­
6.
Healthy food/drink availability (schools)
63. Cullen, K.W., Hartstein, J., Reynolds, K.D., Vu, M., Resnicow, K., Greene, N., et al., 2007. Improving
the school food environment: results from a pilot study in middle schools. J. Am. Diet Assoc. 107 (3), 484–
489.
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healthful food choices in school and home environments: results from the TEENS study. Prev. Med. 43 (1),
8–13.
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Health Educ. Behav. 31 (1), 65–76.

66. Sahota, P., Rudolf, M.C., Dixey, R., Hill, A.J., Barth, J.H., Cade, J., 2001. Evaluation of
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Limit unhealthy food/drink
69. Cullen, K.W., Hartstein, J., Reynolds, K.D., Vu, M., Resnicow, K., Greene, N., et al., 2007. Improving

the school food environment: results from a pilot study in middle schools. J. Am. Diet Assoc. 107 (3), 484–

489.

70. Cullen, K.W.,Watson, K., Zakeri, I., Ralston, K., 2006. Exploring changes in middle-school student

lunch consumption after local school food service policy modifications. Public Health Nutr. 9 (6), 814–820.

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Food Selection and Sales in Texas. Am J Public Health. 2009 Apr;99(4):706-12

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dietary behaviors of young adolescents. Am J Public Health 2003;93:1168-73.

73. Stone, E.J., Osganian, S.K., McKinlay, S.M., Wu, M.C., Webber, L.S., Luepker, R.V., et al., 1996.

Operational design and quality control in the CATCH multicenter trial. Prev.

Med. 25 (4), 384–399.

Farm to institution
See Ref 35
Point of purchase promotion (in schools)
74. French, S. A., Jeffery, R. W., Story, M., Breitlow, K. K., Baxter, J. S., Hannan, P. & Snyder, M. P.
(2001) Pricing and promotion effects on low-fat vending snack purchases: The CHIPS study. Am. J. Public
Health 91:112-117.
75. French SA, Story M, Fulkerson JA, Hannan P. An Environmental Intervention to Promote Lower-Fat
Food Choices in Secondary Schools: Outcomes of the TACOS Study. Am J Public Health 2004;94:1507-12
76. Institute of Medicine. Local Government Actions to Prevent Childhood Obesity.Washington, DC: The
National Academies Press; 2009.
77. Centers for Disease Control and Prevention. Recommended Community Strategies and Measurements
to Prevent Obesity in the United States. MMWR 2009; 58(No. RR-07): 1-26.
78. Ed Bolen et al., Neighborhood Groceries: New Access to Healthy Food in Low-Income Communities,
(San Francisco, CA: California Food Policy Advocates, 2003).
79 PolicyLink: Equitable Development Toolkit: Healthy Food Retailing provides an online tool that
focuses on increasing access to retail outlets that sell nutritious, affordable food in low-income
communities of color. http://www.policylink.org/EDTK/HealthyFoodRetailing

80. Gittelsohn, J., et al., Process Evaluation of Baltimore Healthy Stores: A Pilot Health Intervention
Program With Supermarkets and Corner Stores in Baltimore City. Health Promot Pract, 2009.
81. Flournoy R and Treuhaft S (2005). Healthy food, healthy communities: improving access and
opportunities through food retailing. Oakland, CA: PolicyLink.
82. Bitler, M., and S. J. Haider. An Economic View of Food Deserts in the United States. Research
Conference on Understanding the Economic Concepts and Characteristics of Food Access. Washington,
DC: USDA, Economic Research Service and University of Michigan National Poverty Center, 2009.

Physical Activity References
i. US Department of Health and Human Services. Physical Activity Guidelines for Americans. Available at:

http://www.health.gov/PAGuidelines/

ii. The Guide to Community Preventive Services: What works to Promote Health?. Oxford University

Press, 2005, pp 80-113.

The Guide to Community Preventive Services is also Available at:

http://www.thecommunityguide.org/pa/index.html
iii. Kahn, E.B., Ramsey, L.T., Brownson, R.C., Health, G.W., Howze, E.H., Powell, K.E. et al. 2002. The
effectiveness of interventions to increase physical activity. A systematic review by the U.S. Task Force on
Community Preventive Services. American Journal of Preventive Medicine 22, S73–102.
iv. Heath GW, Brownson RC, Kruger J, et al. The effectiveness of urban design and land use and transport
policies and practices to increase physical activity: a systematic review. J Phys Act Health. 2006;3(suppl
1):S55-S76.
v. Hoehner CM, Soares J, Parra DP, Ribeiro IC, Joshu C, Pratt M et al. 2008. Systematic review of physical
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Additional references
Comprehensive State and Community Programs
Arkansas Center for Health Improvement. Assessment of childhood and adolescent obesity in Arkansas;
Year Four
Economos CD, et al. A community intervention reduces BMI z-score in children: Shape Up Somerville
first year results. Obesity 2007;15:1325
Hoelscher DM et al. Regional and state initiatives lead to significant decreases in the prevalence of child
overweight in Texas. Manuscript submitted.
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the use of stairs? Results from a community intervention, Ann Intern Med 129 (1998), pp. 363–369.
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W Russell, D Dzewaltowski and G Ryan, The effectiveness of a point-of-decision prompt in deterring
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