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Healthy Steps to Freedom (HSF) is a direct education health, nutrition, and body image program (part of a broader intervention that includes PSE) designed to augment existing broad-based drug treatment and community education programs for women in recovery for substance use/misuse. While the long-term goal of HSF is to reduce recidivism and attrition for females in treatment for substance use disorder (SUD), the more immediate short-term goal is to teach healthy lifestyles, improve fruit and vegetable consumption, help improve healthy behaviors, reduce food insecurity and improve treatment outcomes for women in recovery for substance use/misuse. The program includes nutrition, diet quality, balanced meal planning, physical activity, family mealtimes, understanding nutrition panels, increased fruit and vegetable consumption, food resource management, positive self-esteem and reduced body dissatisfaction.

Intervention Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time 

SNAP-Ed Strategies: Direct Education

Intervention Reach and Adoption

HSF targets women struggling with substance use/misuse through self-enrollment, referrals or court ordered programs. When abstaining from substances commonly used by women, such as stimulants, women experience side effects including rapid weight gain and disordered eating patterns. HSF was developed to target women and their families, who are generally low-income, food insecure, and have limited access. The intervention targets outpatient and inpatient substance use/misuse recovery centers, mental health facilities, and court ordered programs.

Settings: Healthcare, Tribal Reservations, Community-wide

Age/Population Group: Pregnant/Breastfeeding, Parents/Caregivers, Adults, Older Adults

Race: All

Ethnicity: Hispanic or Latino Origin, Not of Hispanic or Latino Origin

Intervention Components

The program is 10 weeks plus a pre-post assessment. Each class can range from 60-90 minutes (90 is ideal for processing with participants, promoting discussion and allowing for group engagement 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 if research outcomes are expected. The Surgeon General reported that for many individuals suffering from substance use disorder, recovery programs, 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 upon request, including lesson plans, PPTs, handouts, and homework assignments. No additional materials are required, however educational props (e.g., MyPlate clings, bone loss display) and participant incentives (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.

Evidence Summary

A peer-reviewed study by Lindsay et al (2012) documented statistically significant positive changes in 12-week program participants. Data from 2020, a 10-week revision demonstrated similar results as the 12-week program.

Evidence Base: 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)



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
  • Modified Health Behavior Checklist
  • The post-only program evaluation queries on usefulness and perceived effectiveness of the program.

Additional measures if desired:

  • EAT-26 (eating attitudes) - attitudes towards eating
  • IES-2 (intuitive eating)
  • BES (binge 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

Professor, Extension Specialist



*Updated as of August 29, 2023

Resource Type
Evaluation Framework Indicators
Intervention Outcome Levels
SNAP-Ed Strategies
Evidence Base