Planting a New Seed

Reducing Obesity in Maine, One Seed at a Time

Elise Bolster
Brittany Croteau
Joan Hamel
Tyler Penn

Description and Analysis of a

Health Issue

Obesity amongst Rural Maine Adults

Obesity is defined as abnormal or excess fat accumulation that increases the risk of health
problems (World Health Organization, 2013). Obesity occurs when an individual is 20 percent or
more above the ideal weight, while individuals who weigh 50-100 percent more than the ideal
weight are considered morbidly obese. Obesity is generally measured by calculating the
individuals body mass index, also referred to as BMI, by taking the weight in kilograms and
dividing it by the square of the height in meters (kg/m2). A BMI between 25 and 29.9 is
categorized as overweight, while a BMI over 30 is categorized as obese, and a BMI of 40 or
higher is categorized as morbidly obese (WebMD, 2013). According to the International Obesity
Taskforce, there are currently 475 million obese adults worldwide (International Obesity
Taskforce), while there are 73 million obese adults within our nation (Centers for Disease
Control and Prevention, 2011).
Determinants of Health
There are several determinants of health that can be related to the onset of obesity. The
World Health Organization (WHO) focuses mainly on seven specific health determinants, all of
which either relate to the onset of obesity or can lead to a result in health concerns.
Understanding and acknowledging these health determinants could be very beneficial in the
process of reducing obesity and increasing the health of individuals and communities.
Income and Social Status
Income and social status is a health disparity due to the economic gap between the rich
and the poor, along with access to proper healthcare and nutrition options. Better health is

typically associated with higher income and social status based on having more options and
opportunities to quality services (World Health Organization, 2013). Individuals with lower
income and social status tend to buy foods of lower nutritional value, as they are cheaper and
more easily accessed, however these foods have a major impact on the individuals health and
weight. Lower income and social status can also hinder the accessibility to quality health care
services and prevention centers, which also can contribute to health concerns occurring.
Education
Education is a health disparity because it can alter ones decisions on recommended
health choices associated with their physical and emotional health (World Health Organization,
2013). Not receiving proper education on the importance of nutrition and physical activity can
result in a major impact to ones overall health. Their physical health can be affected by the
foods they eat and how they are prepared; along with the frequency of physical activity they take
part in on a regular basis. Their emotional health can also be affected due to the increase in stress
levels and decrease in self-confidence, which can be triggered by several different factors.
Physical Environment
Physical environment is a major health disparity because it is the environment in which
people live their everyday lives. Within the physical environment there are a variety of
components that contribute to the wellbeing of an individual. The quality of air and water is
crucial, as these are two elements that are consumed or breathed in every day (World Health
Organization, 2013). Safe communities and roads are also very important in relation to an
individuals overall health, along with being important for the safety of individuals who are
engaging in physical activity or trying to complete daily activities. Employment and the
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conditions of a workplace are also very important because it is where people spend a lot of their
time (World Health Organization, 2013). People who have a sedentary job and work at a desk all
day are going to engage in much less physical activity than those who work out in the field,
constantly moving and lifting objects. Without a clean and safe physical environment, the risk of
developing health concerns increases drastically. Not only does an individuals health decrease
with poor air and water quality, but their health can also be affected by not feeling safe in their
communities. Insecurity in ones surroundings can contribute to lack of exercise and food
selection, which could eventually lead to the onset of obesity.
Social Support Networks
Social support networks are a health disparity because it is important to be surrounded by
positive support and influences that eventually affect ones life decisions. An individuals family
has a major impact on the lifestyle they will live, as they typically shadow the behaviors of their
family members (World Health Organization, 2013).

If family members do not eat healthy or

do not exercise, the individual most likely will not either, as that is all they have really known.
Other factors that could be a determinant to ones health are smoking, drinking, and stress, all of
which could be first seen through watching family members.
Friends, communities, and culture are also a huge part of the social support networks
(World Health Organization, 2013). Friends are typically individuals that people spend the most
time with, therefore their actions and interests are going to influence the actions of another
individual. Communities are a place for individuals to come together to share common interests
through a variety of activities and events. Having a good support group throughout the
community allows individuals to try new things, while also maintaining their comfort zones and
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feeling safe. Low social support networks among families, friends, and/or communities could
result in the lack of interest in exploring or engaging in healthy activities, such as proper
nutrition and physical activity. An individuals beliefs and decisions can also be based off of
their culture. Different cultures consume their own traditional foods; therefore some cultures
may be at more risk for obesity or other health conditions based on the nutritional balance or lack
of balance they consume. Culture can also affect the amount of physical activity an individual
engages in based on the lifestyle they live and the daily activities that are required of them.
Genetics
Genetics is a health disparity based on the knowledge that inheritance plays a role in
determining the quality of life an individual will live. Individuals are predisposed to the lifestyle
of their families; therefore if addiction is present among family members, individuals are more
likely to engage in risky behaviors, which could eventually lead to obesity or even more serious
health concerns (World Health Organization, 2013).
Health Services
Health services are another health disparity due to the importance of receiving quality
health care for both preventative services and treatment of diseases (World Health Organization,
2013).

Having access to a variety of health care is crucial in order to experience proper

checkups or receive treatment when needed. As mentioned earlier, income and social status can
play a role in this matter, as people with less money tend to not have as many options, which
could eventually lead to undetected health concerns.

Gender
Gender does not have a major correspondence to obesity and health disparities due to the
fact that all individuals are affected by the health concerns that are related to obesity. Although
males and females are predisposed to different types of diseases, gender may also affect ones
emotional or physical health differently. (World Health Organization, 2013).
Obesity is a growing epidemic, therefore addressing it as a health issue is essential in
order to help with educating the world on the serious health risks associated with this disease.
As mentioned above, there are several health determinants that most likely have assisted in the
increase of obesity over the years, along with lifestyle habits obtained by individuals.

An

individual who is storing and carrying excess body weight is much more likely to develop
conditions that could be detrimental to their health (Mayo Clinic, 2012), making obesity an
important topic in the world today.
The State of Maine
The state our group will be assessing for a health promotion implementation is Maine.
Currently Maine is ranked 9th as the healthiest state in the U.S. according to Americas Health
Rankings, a research organization about health of the states conducted by the United Health
Foundation. Even though there is a positive number correlated with good health in Maine, it is
ranked as the 25th most obese state according to Americas Health Rankings. With 27.8% of the
population being classified as obese, Maine like many other states in the U.S. is at a stand still on
how to lessen the rate of obesity as it pertains to the specific needs of the state. (United Health
Foundation, 2012)

The dangers of obesity and the health concerns are a problem for Maine. Diabetes is a
large problem for Maine and it is rising, which is mostly due to the high rate of obesity. Maine
has the 26th highest number of diagnosed diabetes cases in the U.S. with almost 10% of the
whole population being affected with the disease. (United Health Foundation 2012) Another
problem for the state is a high rate of cancer mortality, which is also a factor linked to obesity.
Addressing obesity will in turn help Maine to lessen the prevalence of diabetes cases and death
due to cancer.
This obesity epidemic stretches across the state and varies from town to town and county
to county. The geographical difference most apparent when looking at a spread of Maine and the
statistics of obesity found at Healthy Maine Partnerships website, is rural areas are much more
affected than urban. Areas observed include Aroostook County which encompasses most of the
whole Northern region of the state, Waldo County which has in it only Belfast for a major town
or city, and Penobscot. All counties have obesity rates reaching 26% - 27% of the population.
(Healthy Maine Partnerships, 2010) What these areas have in common is a small population
within a large area and a remote rural setting.
Difference in Age
Aside from the geographical differences in Maine, there are also many individual
differences that contribute to obesity. As stated before 27.8% of the whole population is obese.
Every year statistics rise for the amount of children, adolescents, and adults who are obese. From
2012 14.3% of all children in Maine were classified obese which was a higher number then
adolescents whose obesity rate was 12.5%. (Center for Disease Control and Prevention 2012)
Along with this information the percentage of children 18years and younger who were either
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obese or overweight was 28.2% and rising. (Center for Disease Control and Prevention 2012) As
this young generation gets older the percentage of obese individuals will rise unless there is
intervention.
Difference in Gender
Obesity also affects men and woman differently. In the United States the percentage of
men who are obese or overweight is 69.9%. Maine exceeds this percentage with 72.1% of the
male population being obese or overweight. (Kaiser Family, 2011) The same problem exists with
the female population in Maine as well. 56.6% of the female population in the United States is
overweight or obese but in Maine 58.1% of the female population is overweight or obese.
(Kaiser Family, 2011) This information helps to better understand who is being effected but
more research is needed to understand the dramatic difference in overweight and obesity rates for
men and woman in Maine. It has been discussed that for both men and women across the
country, men are more prone to health disparities due to the lack of education and motivation to
seek professional health care regarding any health concerns. Women are more cautious about
their health and tend to seek information regarding various health issues. Not having the direct
education and sources to improve healthy lifestyles can be an influence as to why men have a
higher percentage of obesity (Smith, 2011).
Difference in Ethnicity
Maine is not an ethnically diverse state, being that 95% of the population is white, 1%
black, 1% Hispanic, and 4% for others not listed (Kaiser Family, 2011). Among this population
obesity is more prevalent in non-Hispanic whites than it is in other ethnic groups. 27% of
non-Hispanic whites are obese and 20.9% of other ethnicities are obese (United Health
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Foundation, 2012). This could be in part because of varying cultural values and lifestyle
differences among the ethnic groups. One such factor is physical activity, which is one of the
important determinants of a healthy weight. Not being physically active or living a sedentary life
can severely impact the occurrence and chance of obesity and 23% of the population in Maine
lives a sedentary lifestyle. (United Health Foundation, 2012) The prevalence of sedentary
lifestyle is higher in non-Hispanic whites with 21.8% of the population being sedentary
compared to other ethnicities at 16.7% living sedentary lives. (United Health Foundation, 2012)
Sedentary lifestyle choice for the different ethnic groups could directly be related to the obesity
rate which helps to better understand the needs of the groups.
Difference in Socioeconomic Status
Low socioeconomic status is another determinant that directly relates to obesity rates. In
a study done of all 50 states by the National Center for Biotechnology Information there was a
distinguished relationship between low socioeconomic status and health status, which would
including obesity and the health outcomes that coincide (Kennedy, Kawachi, Glass,
Prothrow-Stith, 1998). The study encompassed Maine, and there was no information suggesting
the state differed from overall results so we are lead to believe low socioeconomic status in
Maine would directly relate to health and obesity. David Hartley a director of the Maine Rural
Health Research Center at the Muskie School of Public Service at the University of Southern
Maine conducted research study to better understand obesity rates in rural low-income children.
The study focused on food security and home food environments for the children and found that
those who are living in rural low-income homes have a higher rate of obesity than any other
home life (Hartley, 2011).

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Organizations & Policy

As Maine struggles with this ongoing obesity epidemic, organizations have been called
upon to help the health crisis in the state. Many state and local groups have intercepted the need
for better understanding of the problem and also action oriented approaches to addressing
obesity. The Healthy Maine Partnership works out of Maine Health and Human Services, Maine
Center for Disease Control and Prevention, Maine Office of Substance Abuse, and Maine
Department of Education to promote a healthier place to live and work at a statewide level
(Healthy Maine Partnerships, 2010). This program will be addressed more extensively further
into the paper. Other groups include Maine Rural Health Network which is a site devoted to
helping rural adults learn how to live a healthier lifestyle even with the geographical disparities.
The site includes ways to eat healthy and be physically active among other topics such as mental
health and substance abuse. The Maine Public Health Association have collaborated an in the
making policy regarding obesity in Maine and the calls to action necessary to stop this rise or
obesity. The actions are as follows:
1. Increase the amount of physical education (PE) available to children in school. A typical 2nd
grade student in Maine receives an average of 36 minutes per week of PE; a typical 8th grader,
86 minutes.6 National guidelines recommend 150 minutes per week of instructional PE for
elementary school children and 225 minutes for middle and high school students.7
2. Ensure that all meals and snacks sold and served in schools, childcare and early childhood
settings are consistent with current evidence-based nutrition standards as established by a leading
national scientific authority.
3. Include established standards for the amount and type of physical activity offered to children
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in schools, childcare and early childhood settings.

4. Provide Maine people with access to nutrition information at chain restaurants.
As for already implemented policies Maine has adopted such programs as Lets Go!
Which is a program aimed at the prevention of childhood obesity by the simple plan 5-2-1-0 or 5
servings of fruits and vegetables a day, 2 hours or less of screen time a day, 1 hour of more of
physical activity, and 0 sugary drinks. (Lets Go, 2012) Healthy ME is another program in effect
which aims at helping parents who are concerned about their childs weight to gain education
and lifestyle advice on how to better the health of their child. Healthy ME works with primary
care doctors and pediatricians, nurses, social workers, and dieticians to help parents guide their
children and get to a healthy weight (Maine Medical Center).
Target Population
Based on the information regarding obesity in Maine the population we have chosen for
our program will be adults living in rural communities. This is where the highest rates of obesity
are occurring in the state of Maine. The need for local implementation in these areas is critical to
helping the state lessen the prevalence of obesity. As Hartley was stating before children of rural
low-income homes are the most obese children of the state, and the percentage of children obese
in the state outnumbers that of adolescents. Why adults have been chosen for our population may
be a question but our philosophy is children cannot learn to change their behaviors without the
help of their parents. Best stated by Anita Courtney, the head coordinator of Kentuckys We Can!
project, Of all the things we parents can do to try to help our children, this gift of teaching them
healthy behaviors as part of life is the best gift we can give our kids (Ferrell, 2007). Hartley also
discusses how it is not the responsibility of children to get to a healthy weight but the parents
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who need to model good eating habits for their children. He believes parental behaviors are key
to their childrens habits and the healthy choices they make (Hartley, 2011). The population
adults we plan to implement policy to will address many different perspectives of obesity in the
state. This includes adult obesity, childhood obesity, and strength in communities by teaching
people how to use the resources available to them.
Planting a New Seed
The focus for this intervention is going to be on adults, parents, and those individuals
who are role models for the children of our future. The United States is highlighting childhood
obesity and the need for immediate attention to exercise and follow specific nutritional
guidelines. Schools are targeted and the kinds of food that are being distributed in schools to
children. Great progress has been made, but some may overlook how children are supposed to
learn and practice healthy lifestyles when not all parents, teachers, and role models are practicing
these lifestyles as well. The simple saying monkey see, monkey do is an easy way to justify
that children will learn their behavior by copying what they see happening around them. As a
state, Maine needs to make those behaviors positive and healthy for these children.
Many people have a hard time finding the time and motivation to be physically active.
Some people live in neighborhoods that are not safe, some do not have access to a gym, and
some may have never learned how to properly exercise. People do not have access to or the
funds to retain healthy fruits and vegetables, and some were simply never educated on good
nutrition. Society has changed their priorities. There has been a great change in technological
advancement, and people are struggling to get back to our roots.
Lack of physical activity is a key contributor the obesity epidemic in our country, but
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exercise or not, everyone has to eat. The question is what are we eating? The leading cause of
obesity is the imbalance between physical activity and diet. The food that is consumed directly
associates with health and weight. Society is consuming excessive amounts of high-energy foods
that are high in fat, and foods and drinks that are high in sugar. One can exercise two hours a day
but if they are putting two times the amount of calories into their body than they are only going
to gain weight; the foundation for diabetes, heart disease, cancer, and a lesser quality of life
(World Health Organization, 2013).
The intervention, Planting a New Seed, is going to focus on nutrition. It is a priority to
educate people on how to eat healthy fresh fruits and vegetables that provide an array of nutrients
while also tasting good. In the specific town of Penobscot, Maine just like the many other towns
in Maine, there were 690 restaurants in 2007 which was increased from 2002 when there was
only 560. There are 118 conveniences stores, 32 grocery stores, and only 9 specialized food
stores in the year 2009. 16.2% of the population has low access to a grocery store. There were 8
local farmers markets in the year 2009 and was decreased to 5 in 2012 (FoodAtlas). Factors
relating to food and where we get it from have a direct association with the preventable nutrition
related diseases.
This being said the program is going to focus on integrating the education aspect of
agriculture into the adult work place by creating a program where faculty have the opportunity to
receive fruits and vegetables from the local greenhouse that they helped establish. The rural areas
of Maine will have the opportunity to take advantage of their ability to produce fruits and
vegetables. Not only will the staff have the opportunity to receive the harvested crop, but there
will also be workshops where professional cooks and nutritionists will come in a couple times a
month and teach and educate on how to cook the crop. It will allow for people to appreciate the
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food they are eating, get back to the place where cooking was enjoyable, and also be able to
share these experiences with their children in hopes to create a positive relationship between
food and health. The last piece to this program is going to incorporate healthy food trucks in
local neighborhoods providing access to fresh produce. In summary, the intervention will
educate, make use of the land, promote local healthy food, and also increase accessibility to
healthy food.
As the issues with obesity start to become recognized many local and state organizations
are stepping forward to combat this ongoing issue and educate the citizens of Maine in order to
leave a healthier and more active lifestyle. Among the organizations beginning to take action as
stated before is Healthy Maine Partnership. This is a large organization that is home to
committees in charge of coming up with action-oriented approaches to combating health
disparities in the state of Maine. This is the organization we will be working with to promote and
help fund our health promotion project for the state.
The Maine healthy partnerships organization is home to a plan known as Physical activity
and Nutrition plan. This serves as a guiding document for the physical activity and nutrition plan
and seeks to inform health professionals, business leaders, food industry policy makers,
educators, the media, and citizens to improve the health and well being of Maine residence
according to Healthy Maine Partnerships web page. The newly implemented plan brought forth
focuses on key areas regarding physical activity, consumption of fruits and vegetables, caloric
imbalance and expenditure, television time, food safety, and food security.

Even with this

program in place there are still gaps in the coverage area. The program targets more heavily
populated areas such as Portland Maine where they believe that they will have the biggest impact
on the population but neglects to focus on rural areas such as Penobscot that lack the education
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in physical activity, nutrition, and obesity prevention due to the fact that those citizens live in
such rural areas. The Healthy Maine partnerships organization would be able to house our
program because it would help them expand their Nutrition and Physical activity plan to citizens
in rural areas such as Penobscot, and other rural counties.
For maximum population impact, the focus should be on strategies that alter the food
and physical activity environments in places where persons live, learn, work, play, and pray
(Centers for Disease Control and Prevention, 2011). This being said our plans for the project
incorporate these characteristics of a successful intervention. The intervention will include
creating a versatile plan that can be implemented in any town or county that provides a place for
agriculture. To start the process, work sites will be visited by professionals who can educate and
teach individuals how to construct and maintain a farm/garden that produces local fruits and
vegetables. Once education is in place, the farm/garden can be built based on decisions and
needs of the workplace staff, such as if they want to construct a greenhouse versus using fertile
land. As stated before once the garden or greenhouse is established, crops can begin to provide
the county or town with nutritional benefits that will accompany education about the crops and
interactive exercises to facilitate and encourage locally grown produce. In order for this
intervention to take place we will need work places that are willing to fund the intervention and
also find importance in promoting healthy lifestyles starting with nutritional education. In hopes
that the workplace gets involved and all goes well, other fun events could be implemented that
will motivate them to continue to maintain the farm/garden. For example, the staff could have
weekly cook-offs with a vegetable or fruit of the week. There could be events held to bring the
community together while incorporating the fruits of their labor. Through this intervention, the
work place will alter how food, fruits and vegetables, are distributed to the population, which
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will aid in creating a better living, learning, working, and playing environment.

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Strategic Planning

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Strategic Planning
The focus of the program, Planting a New Seed, will be to implement green houses within
workplaces in rural Maine to promote healthy lifestyles through health education, built
environment intervention, and health policy intervention. This program will target the adult
Maine rural population to provide knowledge to spread to the community through education and
hands on experience.
When creating intervention programs there are three prevention strategies to consider,
primary, secondary, and tertiary. Primary prevention is preventive measures that forestall the
onset of illness or injury during the prepathogeneis period, such as vaccinations (McKenzie,
Neiger, & Thackeray, 2009, p. 6). Secondary prevention is preventive measures that lead to early
diagnosis and prompt treatment of disease, illness, or injury to limit disability, impairment, or
dependency and prevent more severe pathogenesis, such as screening tests (McKenzie, Neiger,
& Thackeray, 2009, p. 6). Tertiary prevention is preventive measures aimed at rehabilitation
following significant pathogenesis, such as implementation of clinics (McKenzie, Neiger, &
Thackeray, 2009, p. 6).
Primary prevention strategies are not the main focus in the program. The main prevention
strategy for our project is tertiary prevention. This was chosen because of the high rate of obesity
for Maine rural adults. The plan will be implemented to decrease the number of obese people so
it will be working at rehabilitating individuals back into a healthy lifestyle. The health initiative
goals set for this project reflect the overall goal to increase healthy weight in Maine rural adults
by 20% in the year 2020.

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Mission Statement
The mission of Planting a New Seed is designed to reduce the obesity epidemic among
rural Maine adults by promoting healthy lifestyles through educating on healthy foods, creating
an interactive agricultural environment throughout the community, and lastly to increase access
to healthy foods by providing food trucks throughout the community with healthy produce.
a.) By 2020 the overall percentage of obese and overweight Maine rural adults will decrease by
20% and there will be an increase in use of vegetables in home cooking.
1. The goal will be accomplished by providing nutrition and agricultural education
sessions. Employees will be asked to fill out a survey that asks them how beneficial they
are finding the education sessions and how often they are eating vegetables.
2. The goal will be accomplished by giving the adults the skills to use the vegetables that
are grown in the greenhouse independently at home, ultimately to prepare healthier
meals. The program will hold an annual check-in where BMI and weight will be
measured to check on the progress of healthier eating.
b.) 50% of businesses in rural Maine will have a successful producing greenhouse implemented
at their worksite by year 2025.
1. This goal will be accomplished by obtaining the funding and support for Planting a
New Seed to develop greenhouses on the worksite to ensure that there are measures being
taken to increase access to healthier foods. This will be measured by how many
businesses have implemented a greenhouse on their worksite.

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2. This goal will be accomplished by ensuring that the greenhouses receive proper
attention and care from professional agriculturalist and employees, which is needed for
successful growth. Planting a New Seed will measure the amount at which the business is
flourishing by how much the greenhouse is producing for employees and the community.
c.) By year 2020, moving food trucks will be stationed at certain locations that provide fresh
produce to increase access for the community.
1. Planting a New Seed will hire local farmers to set-up a truck near local convenience
stores that provide solely fruits and vegetables. The program will determine if the food
trucks are beneficial toward our overall goal based on sales of the produce at the food
trucks.
2. By putting these trucks in locations that are located in rural areas Planting a New
Seed is enhancing the access to healthier produce. A tally will display how many people
purchase produce from the trucks to see if there is a higher demand for the food trucks.

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Interventions

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Interventions
Health Education and behavior change intervention
Learning Objectives:
One of the learning objectives is for Maine rural adults to gain the knowledge of how to
prepare a healthy meal using fresh local produce. By becoming more aware of how to cook
healthy foods their attitudes will change and promote positive feelings towards the greenhouse.
There is evidence that education about healthy living is deficient in rural areas in regards
to nutrition. Studies have found that rural residents have less understanding of how to prepare
nutritious meals and a shortage of nutritionists in rural areas likely exacerbates the problem
(Blankenau, 2009). This being said, Planting a New Seed will hold Nutrition education sessions
that target employees at the worksite and the sessions will be held in the employee lounge at the
worksite depending on the population size. There will be two nutrition sessions held each week
for six months, adding up to a total of 48 nutrition sessions. A nutritionist will be the presenter
for the education session. An example of what a session might consist of is displayed through a
sample lesson plan. (See Appendix A) There will be 15 minutes of education on the benefits of
local fresh food, followed by 30 min of cooking with different vegetables that are grown in the
green house based on the recipe given by the nutritionist. Within the education session, there will
be a handout given. (See Appendix B for sample handout)
The second learning objective is for Maine rural adults to develop the skills on how to
grow and maintain a garden through participation at the greenhouse that is provided onsite. At
one of these sessions the agricultural specialist will come in and educate on the necessary skills

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of maintaining a successful garden, including planting, harvesting, watering, etc. This will be
held at the green house that is build onsite. After he/she gives a brief overview of the days topic
the employees will be able to practice the skills as he/she supervises.
The objective for this session is for the employees to learn the nutritional value and
benefits of fresh vegetables within the first 15 minutes. The remaining 30 minutes will be kept
for the nutritionists to demonstrate different ways to prepare vegetables with two different
recipes.
Information will be provided through a newsletter given to each employee that has
educational facts regarding vegetables. The hands on aspect of the session will include washing
the vegetables, cutting the vegetables, and then ultimately tasting the recipe and engaging in
discussion. At the end of the session a brief evaluation will be given out to measure the
understanding the effectiveness of the education session. The call to action will be to go home
and recreate the recipe made in class or come up with a new one using the knowledge they
gained through preparing the vegetables within the session
The leadership of the program will be determined with the assistance of a board of
directors who will meet twice a month to discuss the session evaluations and the overall progress
of the employees. Once these meetings occur, a staff meeting will be held at the end of the month
to decide if changes or adaptations need to be made or implemented. The staff at this point will
be able to give their opinions and discuss their concerns. This exemplifies the programs
humanistic approach towards a healthy management theory.
After each session, participants are required to fill out two evaluations regarding the
nutrition session. This evaluation is considered to be impact evaluation, which focuses on the
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immediate observable effects of the program leading to the intended outcomes of the program
(McKenzie, Neiger, & Thackeray, 2009). (See Appendix C and D)
The education provided through the nutrition and agricultural sessions will allow
consumers to have better knowledge of healthier food options and be able to have the tools to
grow their own garden. With this, they will have the knowledge on the importance of eating
healthier to meet the overall goal of decreasing the percentage of obese and overweight rural
Maine adults.
Community-Based / Built Environmental Intervention
According to Dr. Cornelia Butler Flora of Iowa State University, factors within the
community can hinder individual decisions on how they live. It is important to consider the food
system of the community when changing the built environment because one needs base line
knowledge of what they have to work with. Food choices are embedded within the structure of
the food system, food producers, food procurers, food providers and food preparers
(Blankenau, 2009). The greenhouses that are put up within the rural workplaces are the
community-based intervention. It is going to change the built environment in Penobscot, Maine
community because the greenhouse is going to create an educational piece for the employees to
learn how to prepare and maintain a garden. This will allow for the employees to have the tools
to create their own gardens in their homes in rural areas that relate back to food producers, food
providers, and food preparers. Once the vegetables are produced in the greenhouse, they can use
the vegetables and bring them home to their families. Having fresh homegrown vegetables will
be an education piece to those adults with children and help create healthier lifestyles for these
families. People can only eat as healthy as their food system allows (Blankenau, 2009). The
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program Planting a New Seed will target this issue.

Potentially with a successful greenhouse and overproduction of produce, the product can
be served to the community through Community Supported Agriculture, CSA. A few advantages
of CSA are that members who are not involved in Planting a New Seed will have the opportunity
to access fresh vegetables and learn the process how food is grown (Local Harvest Inc). The
money provided by this program can be used to maintain the greenhouses.
This intervention will meet the needs of the target population because it allows for rural
population to have accessibility to resources needed for a healthy diet at a low expense. Not only
will it benefit the employees and their families, but it will also benefits those individuals who are
members of the community and those that chose to participate in CSA.
Considering the county of Penobscot, Maine has 118 conveniences stores, 32 grocery
stores, and only 9 specialized food stores in the year 2009. 16.2% of the population has low
access to a grocery store. There were 8 local farmers markets in the year 2009 and was decreased
to 5 in 2012 (FoodAtlas). Implementation of the greenhouses is going to increase access to fresh
produce for the community.

Policy Intervention
The policy that this intervention will acquire for increasing access to healthy foods will
be incorporating food trucks into the local rural areas where grocery stores are not easily
accessible. This meets the mission by giving the population more opportunity for receiving
healthier food and making healthier choices that will help reduce obesity percentages of adults in
rural Maine. Research indicates that access to healthy food corresponds to healthier eating and
lowering rates of obesity and diabetics (Yang & Flournoy, 2010). An important aspect of having
27

better access includes transportation, which can be difficult when grocery stores are located so
distal from the homes. To decrease this inaccessibility in Maine, the food trucks will be stationed
closer to local convenience stores. Many rural communities rely on convenience stores for their
food, which often offer little to no healthy choices (Blankenau, 2009). For instance, in
Philadelphia they are aware of this issue and have introduced fresh produce at nearly 600 corner
stores. There are specific cities that have started this food truck movement, such as Kansas City
where it has a version of a rolling market, led by the nonprofit Beans & Greens, selling fresh
vegetables, meat, and dairy. Or say in Chicago where they created a Chicagos Fresh Moves, a
nonprofit start-up, turned a Chicago transit bus into a rolling produce market serving Westside
neighborhoods (Hall, 2011). Planting a New Seed will focus on carrying fresh healthy whole
foods.
It relates to the community based interventions and health education because the main
focus is to create healthier lifestyles through the knowledge of good nutrition, whether it be
through implementing greenhouses or providing nutrition and agricultural education sessions.
Also by doing this, a learning experience is provided for these adults to spread information to
their families on why certain foods should not be consumed and what are some healthier
alternatives.
The main focus for Maine rural adults is to reduce the access of unhealthy foods and
increase the access of healthy foods. The policy that sets up food trucks near local convenience
stores will make healthy foods more easily accessible to the community. Through implementing
these healthy food trucks it will allow adaption to healthier eating habits. The trucks being put
into effect in the community will change the built environment. They will generate conversation
for not only the adults but also it will add an educational piece to the children of the community.

28

Program Evaluation Plan

29

Program Evaluation Plan

As health professionals, an important aspect of the intervention process is seeing whether
or not the program is effective. To do this, an evaluation is created for a constituent population.
This evaluation will be targeted towards the board of directors of which are professionals in the
field and also volunteers of the program that have taken roles to carry out the project at each
given worksite. They are evaluating the professionals that are hired for Planting a New Seed
based on their success and potential for progress. (See Appendix E for Evaluation)

The outcome-based measurements chosen to relate to the objective include asking

employees to fill out a survey that asks them how often they use local fresh food with cooking at
home and to attend an annual check-in with health professionals where BMI and weight will be
measured. These two measurements are specifically for our health education intervention. For
the built environment intervention, the program will measure the amount at which the business is
flourishing by how much the greenhouse is producing for employees and the community. In
addition will determine how many businesses have implemented a greenhouse on their worksite.
Lastly the measurements that relate to policy intervention will include the sales of the produce at
the food trucks and also by the amount of people who purchase produce from the trucks.
To determine if the objectives are met for Planting a New Seed, data will be collected by
health professionals who specialize in healthy body measurements. Professionals will come in to
measure BMI at annual check-ins. The evaluations given to the employees regarding the
nutrition education sessions will help assess our outcome objectives. These measurements will
help determine if Planting a New Seed is progressive in meeting our outcome objectives which
30

states that by 2020 the overall percentage of obese and overweight Maine rural adults will
decrease by 20% and there will be an increase in use of vegetables in home cooking.
At the beginning of the program, it is important to have a pre test to create baseline
measurements for each individual participating, so as the program develops there are comparable
data. This is important so that progression can be seen within the program.

31

Leadership & Organization

32

Leadership & Organization

The organization that will house our project will be at three schools throughout
Penobscot County targeting the staff/teachers. One in the northern region of Penobscot County,
one in the town of Penobscot, and one in the lower more southern region of Penobscot County.
Focusing on schools is going to be a major influence on not only a large teaching population but
will also influence the children and families that are within the communities.
One of three position needed for the success of the implementation of Planting a New
Seed is going to community support, specifically a board of directors who will volunteer their
time to oversee the progress of the program. The board of directors will listen for comments and
concerns from the professionals providing services in addition to the active participants of the
program. The second of the three is the vice president of finance. This is a key position because
the program needs to have proper funding in order for the program to run efficiently. With any
program, it is important to ensure to never promise more than can be delivered. The third key
role in the success of implementation of the program is the vice president of the health promotion
piece. This person is in charge of hiring the nutritionist and agriculturalist. This person is
reinforcing policies and enforcing the education component of practicing a healthier lifestyle.
Planting a New Seeds Organizational Chart creates an outline of the positions needed for the
Program. (See Appendix F)
The managerial approach Planting a New Seed will take on is the contingency approach.
This is an umbrella for several of the other management theories; scientific approach, systems
approach, and humanistic approach. There are so many different aspects to the program, it is
important to combine the style of management. The scientific approach involves written rules,
33

discipline, and responsibility, all of which are necessary in implementing definite policies.
Systems approach is breaking job specific tasks into different parts. This applies to Planting a
New Seed through the different employment opportunities, such as the nutritionist or the
agriculturist position that have tasks specific to their title. Humanistic approach is an approach
that gives the employees and the management equal opportunities. Success lies with open
communication and this approach allows for employees to voice their opinion on how they think
the program is running and what they think needs to be changed. The contingency approach is a
mix of the previously described approaches and depends on the specific needs of the different
parts of the program.

34

Staffing

35

Staffing
Job Description
Title:

Nutrition Specialist

Job Description:

As a member of the Planting A New Seed team, the nutrition specialist

will assist participants in the program by providing information on healthy
eating and living including such information as: how to create a
nutritionally dense diet, how to cook with a wide variety of foods, how to
make healthy eating less expensive, how diet effects the body, and more.
Nutrition specialists are expected to be on site daily to be available for
participants to seek extra information regarding nutrition and wellness,
and must provide a minimum of two, 45-minute education sessions a
week. As part of an interdisciplinary health team, it is crucial for nutrition
specialists to work with team members from onsite business partnerships,
agriculture specialists, and wellness directors to evaluate the most
effective means of behavior change for target population in community.

Reporting Responsibilities:
Nutrition specialist will prepare a biweekly performance report to be
reviewed at team meetings. The reports will include how many people
took part in weekly educational sessions, how many people reached out
for extra information, how well participants did on evaluations, and a
review of the education sessions held in the past 2 weeks.
If immediate conflict arises nutrition specialists and agricultural specialists
at site should work through problem. If conflict is not resolved reports to
executive project coordinator can be sent for review.
Job Duties:
Main job duties of an onsite nutrition specialist for Planting A New Seed
include motivating and inspiring participants to partake in healthy eating
by:
Providing education on nutritional values of a wide variety of foods,
experimental cooking techniques, food shopping methods to save money,
and overall wellness information
Providing the skills needed to properly use utensils and appliances for safe
cooking
Providing the skills needed to properly prepare produce
36

Holding 2 educational sessions weekly which will include:

-

A 15 minute lecture educational session

A 30 minute interactive session to provide skills

Being on site 3 hours a day with an open door policy for participants
Picking up food and preparing classroom/kitchen for use during
educational sessions

Supervisory Responsibilities:
Nutrition specialist is responsible for the learning of all participants in the
classroom. Assuring individual needs are met regarding education and
skills are essential for the success of Planting A New Seed. Evaluations of
sessions need to be taken to the seriously and information which needs to
be reinforced is met.
Making sure the classroom is safe and participants feel comfortable

Job Specifications:

BS in Nutrition of other Health Sciences

Salary:

24-week program
$ 20,000.00

Performance Evaluation
Will be given the first month of working with Planting A New Seed and then every 2-months
following. Rate the nutrition specialist on the following with a scale of 1-5. 1 being very poorly
and 5 being very well.
How well does ______________ motivate and inspire participants to partake in healthy eating
and living?
1

How well does ______________ provide information at education sessions held 2-times weekly?
1

How well does_______________ provide the skills needed to properly use utensils and
37

appliances for safe cooking?

1

How prepared is _____________ for education sessions held 2-times weekly?

1

How well does ______________ use the 45-minute time slots for effective learning on how to
eat healthy?
1

How well does _____________ initiate new learning and skills ideas for use in the educational
sessions?
1

How well does ______________ work with other members of Planting A New Seed to make the
program as successful as possible?
1

How time managed are the educational sessions __________ holds?

1

How time managed is ___________ holding sessions, creating new lessons, and holding out
duties of nutrition specialist?
1

Job Advertisement
Planting A New Seed Nutrition Specialist
Job Description:
As a member of the Planting A New Seed team, the nutrition specialist will assist
participants in the program by providing information on healthy eating and living
through educational sessions held 2times weekly. The program runs for 24weeks
at one job site and then will move to a new location in same county or region.
Main duties include motivating and inspiring participants to eat healthy by
providing information and skills sessions to better their understanding of how to
eat healthier and how to prepare healthier meals. Education sessions will be
45-minutes long and include a 15-minute lecture based session and 30-minute
38

hands on learning session. Nutrition specialist is expected to report to team

meetings with evaluations from sessions and any problems which arise.
Job specifications:

Salary:

Minumum of BS in nutrition or other health sciences

Complex understanding of community wellness

Ability to teach a divorce population

Experience in experimental foods and willingness to learn new cooking

styles to better fit target population

Must be available for travel to new areas in county or region

24-week program for a pay of $20,000.00

39

Ethical Implications

40

Ethical Implications
An ethical issue that is associated with obesity and health promotion is employee
confidentiality. It is important for employees to feel safe and protected when dealing with
personal health and body measures. Through out Planting a New Seed, employees have annual
check-ins where health professionals are assessing the employees on their BMI and weight
measurements. It is important for the program to have these results in assessing the progress of
the program, but it is also important for individual information to be left anonymous to the public
or coworkers.
A controversy that may relate to confidentiality is that records or results could get
released to outsiders. If employees found out that personal information has been released than
they may not feel as comfortable to participate in the program. This could be detrimental in
determining the progress of the program and also may give the program a bad reputation.
Beneficence and nonmaleficence are two important bioethical principles that relate to
obesity. Beneficence is the principle of doing good. This would mean that by keeping the
employees BMI and weight measurements confidential they would be more inclined to receive
service for their health and feel safe in their environment. Nonmaleficence is the principle of
causing no harm. An example of this in Planting a New Seed is that the company is reinforcing
and securing safe practices for their employees to feel comfortable giving personal information
regarding their weight. Together they are maximizing anticipated benefits and minimizing harms
(McKenzie, Neiger, Thackeray, 2009, p 327).

41

Risk Management

42

Risk Management
Title Banner: Properly Handling of Utensils
Purpose of the Policies: Considering the safety of employees and participants in making sure
they are properly handling and using the utensils, specifically knives.
Policy Statement: The participants need to make sure that when the utensils are not in use, they
are in a location free of harm to others.
Applicability: This policy applies to creating a safe work environment within the education
session.
Definition of Terms: Utensils include sharp objects that could cause potential harm.
Responsible Office: The facility will make sure that there is a proper location for the utensils.
Related procedure: There are clear and concise labels on locations.

Title Banner: Proper Dress Code

Purpose of the policy: To ensure the safety of the participants by reinforcing proper dress code
when working in a kitchen.
Policy statement: The participants must wear appropriate attire when coming to cooking classes
that meet the standards of the dress code.
Applicability: This policy applies to creating a safe work environment within the education
session.
Definition of Terms: Proper dress code includes no open toed shoes; no lose clothing, hair
pulled back.
Responsible Office: The nutritionist in charge of the education session will be supervising and
evaluating the participants on proper dress code.
43

Related procedures: Aprons and hairnets are provided in the beginning of class and mandatory
for the duration of the session.

Title Banner: Organic Fertilizers

Purpose of the Policies: The purpose of the policy is to make sure that there are no pesticides or
fertilizers used on the plants in the greenhouse to ensure that there are no chemicals decreasing
the quality of the product.
Policy Statement: The participants must use only organic fertilizers and appropriate equipment
that repels pests.
Applicability: This policy allows for there to be healthy safe produce where there are no
chemicals that could be harmful to the persons health or the environment.
Definition of Terms: Organic fertilizers would include but not limited to manure, slurry, worm
castings, peat, seaweed, humic acid, and guano. Appropriate equipment would include enclosed
spaces, elevated beds, proper screening
Responsible Office: The agriculturalist will provide the necessary materials to proceed with the
project.
Related procedure: Check the inventory of the materials to make sure everything is available,
as well as do monthly inspections on the greenhouse to make sure its being maintained properly.

These policies were selected in correspondence with a Planting a New Seed to ensure a
healthy and safe working environment. These policies specifically focus on Risk Management.
The first policy, Properly Handling of Utensils, provides proper education on how to safely
handle the equipment. The policy sets a standard for everyone to meet to comply with safety
regulations. The second policy, Proper Dress Code, ensures safety of the own individual by
44

requiring no loose clothing and to have hair always pulled back. The last policy, Organic
Fertilizers, is put in place to ensure the health of not only the facility and workplace, but also the
community. The use of organic fertilizers minimizes chemical exposure.

45

Program Budget

46

Program Budget
A sample budget for Planting a New Seed includes the necessities needed for start-up
costs, building the greenhouses, tools and supplies for the nutrition and agriculture sessions,
staffing, and social marketing costs. (See Appendix G)
In order to run a cost-effective program, policies and regulations need to be set in place.
To start the program there will be a start up budget that will consist of materials that are only a
one-time cost. This includes building the greenhouse and providing materials for both the
greenhouse and the kitchen. The program will also have a master budget, which includes flexible
and fixed. The flexible budget will include every day supplies. This includes food for the
nutrition sessions, and occasional replacement of tools and equipment. There will also be a fixed
budget, which would include staffing, rent, and electricity.

47

Grants

48

Grants
Share Our Strength: Great American Dine Out Grants (See Appendix H)
The mission of Planting a New Seed is designed to reduce the obesity epidemic among
rural Maine adults by promoting healthy lifestyles through educating on healthy foods, creating
an interactive agricultural environment throughout the community, and lastly to increase access
to healthy foods by providing food trucks throughout the community with healthy produce.
There are three goals for this program, the first one is that by 2020 the overall percentage of
obese and overweight Maine rural adults will decrease by 20% and there will be an increase in
use of vegetables in home cooking. The second goal is for 50% of businesses in rural Maine will
have a flourishing greenhouse at their worksite by year 2025. And our last goal is that by year
2020 there will be moving food trucks that provide fresh produce stationed at certain locations
where access to the community is more prevalent. The concept of the program combines the
mission and goals in achieving lower rates of obesity by setting up a sustainable system for the
community to have access and education on healthy living.

In order for the program to be

successful, Planting a New Seed, needs to be implemented in three locations throughout the
county to reach a broader population. To do so, proper funding needs to be provided for the
start-up costs and assembly of greenhouses. The Great American Dine Out Grants reach out to
programs that provide food to children and their families; strengthen community resources that
connect children to these programs; educate families about nutrition; improve familys
knowledge about food and nutrition programs; and facilitates their access to related programs
and services, especially in vulnerable and underserved communities. This grant directly relates to
Planting a New Seed and is anticipated to meet all of three goals within the mission stated above.

49

Appendices

50

Works Cited
Blankenau, J. (2009, January). Nutrition, physical activity, and obestiy in rural america.
Retrieved from http://files.cfra.org/pdf/Nutrition-Physical-Activity-and-Obesityin-Rural-America.pdf
Centers for Disease Control and Prevention. (2011, January 21). Cdc grand rounds: Childhood
obesity in the united states. Retrieved from http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm6002a2.htm
Center for Disease Control and Prevention. (2012). Maine: State nutrition, physical activity, and
obesity profile. Retrieved from http://www.cdc.gov/obesity/stateprograms
/fundedstates/maine.html
Ferrell, K. (2007) NIH Medline Plus. Reducing childhood obesity. Retrieved from
http://www.nlm.nih.gov/medlineplus/magazine/issues/summer07/articles/summer07pg26
-27.html
Food Environment Atlas. (2012) United States Department of Agriculture. Retrieved from
http://www.ers.usda.gov/data-products/food-environment-atlas/go-to-the-atlas.aspx
Hall, K. (2011, November 13). Bringing food trucks and fresh vegetables to communities
good for atlanta families. Retrieved from http://saportareport.com/blog/2011/11/
bringing-food-trucks-and-fresh-vegetables-to-communities-good-for-atlanta/

Hartley, D., (2011) Portland press harold. Maine Voices: Maine's rural low-income children at
greatest risk of obesity. Retrieved from http://www.pressherald.com/opinion/mainesrural-low-income-children-at-greatest-risk-of-obesity
Healthy Maine Partnerships. (2010) Maine physical activity & nutrition program. Retrieved from
http://healthymainepartnerships.org/panp/index.aspx
Internation Obesity Taskforce. (n.d.). The global epidemic. Retrieved from

51

http://www.iaso.org/iotf/obesity/obesitytheglobalepidemic/
Kennedy, B., Kawachi, I., Glass, R., Prothrow-Stith, D. (October 1998) National center for
biotechnology information. Income distribution, socioeconomic status, and self rated
health in the United States: multilevel analysis. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28675/
Lets Go. (2012) 5210 Lets go. Retrieved from http://www.letsgo.org/
Local Harvest, Inc. (2012). Community supported agriculture. Retrieved from
http://www.localharvest.org/csa/
Maine Medical Center. Countdown to a healthy me program. Retrieved from
http://www.mmc.org/mmp_spcare.cfm?id=5690
Mayo Clinic. (2012, August 3). Obesity. Retrieved from
http://www.mayoclinic.com/health/obesity/DS00314
McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing, &
evaluating health promotion programs. (5th ed.). San Francisco, CA: Pearson Benjamin
Cummings.
The Kaiser Family Foundation, (2011) Maine: Overweight and Obesity Rates for Adults by
Gender. Retrieved from http://www.statehealthfacts.org/profileind
The Kaiser Family Foundation, (2011) Maine: Population Distribution by Race/
Ethnicity. Retrieved from http://www.statehealthfacts.org/profileind
Smith, P. (instructor). (2011, Fall) Lecture [October 5]. Nutrition Through the Lifespan.
Keene State College, Keene, New Hampshire.
United Health Foundation. (2012). Maine. Americans health rankings. Retrieved from
http://www.americashealthrankings.org/ME/2012
WebMD. (2013). Obesity. Retrieved from http://www.webmd.com/diet/what-is-obesity
World Health Organization. (2013). Obesity. Retrieved from
http://www.who.int/topics/obesity/en/
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World Health Organization. (2013). The determinants of health. Retrieved from

http://www.who.int/hia/evidence/doh/en/index1.html
Yang, L., & Flournoy, R. (2010). Healthy food, healthy communities: Promising
strategies to improve access to fresh, healthy food and transform communities.
Retrieved from keene.blackboard.com/webapps/portal/frameset.jsp?tab_tab_
group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ft
ype%3DCourse%26id%3D_44721_1%26url%3D

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