title: Developing and Implementing "Waupaca Eating Smart": A Restaurant and Supermarket Intervention to Promote Healthy Eating Through Changes in the Food Environment.
abstract: OBJECTIVE
  Restaurants and food stores are suitable settings for healthy eating interventions. A community-academic partnership developed and implemented "Waupaca Eating Smart" (WES), a healthy eating program in restaurants and supermarkets of a rural, Midwest community. Previous interventions targeted either restaurants or small food stores nearly all in urban areas. Intervention design and implementation is rarely documented, making replication difficult for interested researchers and communities. In this article, we report the activities we undertook to develop and implement WES.
  
  
  METHODS
  Working with a local nutrition and activity coalition, we used evidence-based strategies guided by the social ecological model and social marketing principles to inform the content of WES. Formative assessment included a review of the literature, statewide key informant interviews and focus groups with restaurant and food store operators and patrons, a local community survey, and interviews with prospective WES businesses. WES was implemented in seven restaurants and two supermarkets and evaluated for feasibility and acceptance using surveys and direct observation of WES implementation.
  
  
  RESULTS
  Prior to this intervention, only one of seven restaurants had three or more meals that met WES nutrition criteria. By the end of the program, 38 meals were labeled and promoted to restaurant customers, and the team had staffed four side salad taste tests for supermarket customers. Four and 10 months after intervention launch, the majority of the program's strategies were observed in participating outlets, suggesting that these program's strategies are feasible and can be sustained. Operators reported strong satisfaction overall.
  
  
  CONCLUSIONS
  A combined restaurant- and supermarket-based healthy eating intervention is feasible and positively valued in rural communities. Further research is needed to better understand how to foster sustainability of these interventions and their impact on customer food choices.
authors.affiliation: AltaMed Health Services Corporation, Los Angeles, CA, USA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Escaron
authors.affiliation: University of Wisconsin-Madison, Madison, WI, USA Drexel University, Philadelphia, PA, USA martinez-donate@drexel.edu.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Martinez-Donate
authors.affiliation: Yakima Valley Farm Workers Clinic, Portland, OR, USA.
authors.forename: Ann Josie
authors.initials: AJ
authors.lastname: Riggall
authors.affiliation: University of Wisconsin-Madison, Madison, WI, USA Wisconsin Obesity Prevention Network in Madison, WI, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Meinen
authors.affiliation: Waupaca County WIC Program in Waupaca, WI, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Hall
authors.affiliation: University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Nieto
authors.affiliation: University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Nitzke
mesh_terms: D001294:Attitude to Health; D000072001:Diet, Healthy / Q000523:psychology / Q000706:statistics & numerical data; D005247:Feeding Behavior / Q000523:psychology; D005523:Food Supply; D006293:Health Promotion / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D016730:Program Development; D012147:Restaurants; D014922:Wisconsin
keywords: food stores; formative research; healthy eating; intervention planning; obesity; restaurants