Healthy Steps to Freedom

University of Nevada Cooperative Extension


Healthy Steps to Freedom (HSF) is a direct education health, nutrition, and body image program designed to augment existing broad-based drug treatment and community education programs for women under correctional supervision for substance use/misuse.  HSF intervenes through self-enrollment, court ordered programs and the corrections system. While the long-term goal of HSF is to reduce recidivism and attrition for females under correctional supervision, the more immediate short-term goal is to teach healthy lifestyles as an alternative approach to substance use/misuse including nutrition, diet quality, balanced meals, physical activity, family mealtimes, reading food labels, increased fruit and vegetable consumption, and positive self-esteem.

Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time, Other: eating behaviors, body image disturbances and substance use/misuse

Intervention Type: Direct Education

Intervention Reach and Adoption

HSF targets women struggling with substance use/misuse through self-enrollment or court ordered programs. When abstaining from stimulant drug use in correctional or court ordered arrangements, women experience side effects including rapid weight gain and disordered eating. HSF was developed to target these women and their families, who are generally a low-income, food insecure, and limited access population. The intervention mostly targets outpatient and inpatient substance abuse treatment centers, mental health facilities, and court ordered programs in the drug court/criminal justice systems.

Setting: Health care, Indian Tribal Organizations Other: inpatient, residential, outpatient

Target Audience: Pregnant/Breastfeeding Women, Parents/Mothers/Fathers, Adults, Older Adults, Other: women or struggling with substance use/misuse

Race/Ethnicity: All

Intervention Components

The program is 10 weeks plus a pre-post assessment. Each class can range from 60-120 minutes (90 is ideal). Longer classes promote discussion and group engagement during activities. Program delivery includes the following: Lesson plans (fidelity of instruction critical), PowerPoint Slides, Self-Reflection Take Home Activities and Handouts. All activities are critical to the effective implementation of the program, and none can be modified or omitted. The Surgeon General reported that for many abusers the correction system or court ordered programs may be the only contact they have for prevention or health intervention programs. HSF aligns closely with the Integrative Model which integrates multiple processes such as nutrition, exercise, body image, eating behaviors, and substance use/misuse which are generally too complex to be captured by any one theory.

Intervention Materials

Materials for teaching the intervention are provided including lesson plans, PPTs, handouts, and homework assignments. No additional materials are required, however participant incentives such as (e.g. water bottles, measuring cups, grocery lists, exercise bands, and pedometers) can be purchased through local vendors with SNAP-Ed funds for reinforcement of topics covered. UNCE is currently migrating their website so the link is not currently available.

Intervention Costs

Materials available at no cost. Will provide a link to order curriculum via the Box (very large). Will track users.

Evidence Summary

A peer-reviewed study by Lindsay et al (2012) documented statistically significant positive changes in 12-week program participants. A 2012 needs assessment demonstrated ongoing need for the program, and data from 2018 10-week revision demonstrated similar results as the 12-week program.

Evidence-based Approach: Research-tested

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Individual MT1, MT2, MT3
Environmental Settings
Sectors of Influence
  • MT1c,d: Ate more than one kind of fruit, ate more than one kind of vegetable (statistically significant)
  • MT1g: Increased drinking water (statistically significant)
  • MT1h: Drank less sugary beverages (statistically significant)
  • MT1l,m: Increase in cups of fruit and vegetables consumed (statistically significant)
  • MT2b: Read nutrition facts label or nutrition ingredient list (statistically significant)
  • MT2j: Shopped with a grocery list (statistically significant)
  • MT3b,c: Increased mod-vig physical activity and muscular strength activities, decreased sitting (statistically significant)
  • MT3i: Decreased sitting (improved but not significant in sitting)

Evaluation Materials

Intervention evaluation materials include pre/post surveys that examine:

  • Information Survey- knowledge gained
  • Health Behavior and Thoughts – changes diet quality and nutrition practices
  • IPAQ physical activity and sitting time
  • The post-only program evaluation queries on usefulness and perceived effectiveness of the program.

Additional measures if desired:

  • EAT-26 (eating attitudes)
  • IES-2 (intuitive eating) and BES (binge eating) – attitudes towards eating
  • SATAQ-3 (socio-cultural attitudes towards appearance)
  • BSQ (body shape) – attitudes about body image and self-perception

Additional Information

Website: The HSF website includes a description of the program, list of partners, and results and impact.

Contact Person:
Anne R. Lindsay, PhD
Associate Professor, Extension Statewide Specialist