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Health and Nutrition Programs

Healthy Steps to Freedom

Alcohol and drug addiction are serious, chronic and relapsing health problems for both women and men of all ages and backgrounds. Leading to physical and mental health problems, substance abuse often precipitates violence, sexually transmitted diseases, unwanted pregnancy, motor vehicle crashes, homelessness, rising health care costs and obesity.

Healthy Steps to Freedom logo

Healthy Steps to Freedom (HSF) targets women and girls in substance abuse settings especially those who find weight issues to be prevalent in their drug use and/or recovery. HSF teaches nutrition, physical activity and body acceptance as a healthy approach to addressing weight and energy concerns. Participants learn about exercise; nutrition; meal planning; food labels and portions; strength activities; calcium intake; and educational programs which address body image disturbances, eating disorders and other poor lifestyle practices.


More than half of clients in treatment for methamphetamine, cocaine and other stimulants are women. Research indicates that women primarily use meth to lose weight and increase energy. Although women sometimes lose a significant amount of weight during their drug use, much of the weight loss is attributed to loss of muscle, bone mass, other vital body tissues and dehydration. They may also experience hair and teeth loss, numerous health problems and broken relationships with family and friends. Additionally, when they stop using drugs, women often experience rapid, unwanted weight gain. The fear of gaining this added weight can lure many back to using stimulant-type drugs, which are known to have quick weight loss effects.

Many women also gain a significant amount of weight while in substance abuse recovery or mental health treatment, due to discontinuation of the stimulant, physical inactivity, poor nutrition and/or prescribed medications. This often leads to feelings of hopelessness and inability to control their weight, which can worsen their mental health status. Some individuals even stop taking prescription medication because of the negative side effects (e.g., weight gain, lethargy).

What Has Been Done:

More than 240 HSF sessions have been conducted since the program’s inception (2007) with over 2,400 adults and 1,000 youth reached. The Healthy Steps to Freedom 10-week program continues to be implemented in the women’s prison and conservation camp as well as substance abuse and mental health recovery centers across Las Vegas (including but limited to: Choices Group, Inc. (Las Vegas & Henderson locations), CC Juvenile Detention Center, Florence McClure Women’s Correctional Center, Jean Conservation Camp, WestCare Nevada — Community Involvement Center and the Women & Children’s Campus). The original HSF curriculum was published in 2009. The 560-page manual contains lesson plans, instructor notes, weekly personal commitment plans and handouts for participants. Currently, this manual is undergoing a 5-year academic revision, with an expected completion date of spring 2018.

In collaboration with the Center for the Application of Substance Abuse Technologies (CASAT), HSF train-the-trainer (TTT) workshops have been conducted in both Las Vegas and Reno since 2009. These workshops offer substance abuse and mental health care providers with continuing education credits and important knowledge and resources to help present the program at their treatment facilities.


Participant Demographics:

HSF program participant’s average age is 34 years old. BMI averages about 28.8 (which is categorized as overweight). Similarly, average body fat percentage is 29.8% (which is classified as concern for unsatisfactory health). Most (80%) of HSF clients have children (average of 2.1 children per client). For those with children under 18, the average age of the youngest child is 5 years old).

Effectiveness of HSF on Health, Body Dissatisfaction, Thin-ideal Internalization, Eating pathology and Weight Concerns:

After program participation, clients reported significant improvement, including:

  • Positive health and nutrition behaviors
  • Greater knowledge about health and nutrition
  • Lower thin-ideals set by society on women
  • Less body dissatisfaction
  • Less symptoms of disordered eating
  • More realistic weight goals
  • Less binge eating symptoms
  • More intuitive eating behaviors
  • Less concern that gaining weight may trigger drug-use relapse
  • Less concern about using drugs to lose weight after leaving treatment

With a demonstrated increase in health knowledge and positive health behavior change along with reductions in eating attitudes, negative body shape and thin-ideal internalization, attrition rates are likely to be higher and hopefully drug relapses will be diminished. After program participation, clients have the skills to improve dietary practices and family meal planning, physical activity, healthy bodies and body image satisfaction. These newly learned lifestyle behaviors, exemplified in the home, have a direct impact on child health and obesity.


  • Center for the Application of Substance Abuse Technologies (CASAT)
  • Choices Group, Inc.
  • Clark County Juvenile Detention Center
  • Nevada Department of Corrections
  • University of Nevada, Las Vegas
  • WestCare Nevada


Lindsay, A. & Velasquez, S. (2009). Healthy Steps to Freedom: A Health and Body Image Curriculum. University Nevada Cooperative Extension (CM-09-02)


  • Lindsay, A., Warren, C., Velasquez S., & Lu, M. (2012). A Gender-Specific Approach to Improving Substance Abuse Treatment for Women: The Healthy Steps to Freedom (HSF) Program. Journal of Substance Abuse Treatment, 43(1), 61-69.
  • Warren, C., Lindsay, A., White, E., Claudat, K., & Velasquez, S. (2012). Weight-related Concerns Related to Drug Use for Women in Substance Abuse Treatment: Prevalence and Relationships with Eating Pathology. Journal of Substance Abuse Treatment 44(5), 494. doi:10.1016/j.jsat.2012.08.222
  • Lindsay, A. (2015). A comparison of beliefs and attitudes about body image, eating and weight between incarcerated and non-incarcerated females. University of Nevada Las Vegas Dissertation. Paper 2557.
  • Lindsay, A. & Velasquez, S. (2012). Nevada Substance Abuse Treatment Providers — Assessing the Needs & Characteristics of Female Clients in Recovery. University of Nevada Cooperative Extension Special Publication SP-12-09, 23 pp.


Anne Lindsay, PhD, Associate Professor, Public Health & Exercise Physiology Specialist,

Health and Nutrition Programs

Programs Program Information

All 4 Kids

University of Nevada Cooperative Extension’s All 4 Kids: Healthy, Happy, Active, Fit program is an interdisciplinary approach to addressing child obesity. Developed by Cooperative Extension faculty from maternal/child nutrition, exercise physiology and child development, the All 4 Kids program helps children meet the Nevada Pre-Kindergarten (Pre-K) Standards while encouraging preschool children and families to practice healthy eating habits and be active every day.

Expanded Food and Nutrition Education Program (EFNEP)

Food Safety Project

Grow Yourself Healthy

Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS)

Healthy Eating Active Living: Mapping Attributes using Participatory Photographic Surveys (HEAL MAPPS) is a compilation of evidence-based engagement and assessment tools that is used to audit and map community environmental features that support and/or hinder healthful eating and physical activity among community members. The MAPPS method integrates photography, participatory community mapping using global positioning system (GPS) technology, and residents’ voiced perceptions of their community. HEAL MAPPS engages people in community-based participatory research to document attributes of the rural community environment that are perceived by residents as obesity preventing or promoting and assess the local resources and readiness to implement community-level obesity prevention strategies to prevent unhealthy weight gain/overweight and obesity among children and their families.

Healthy Eating on a Budget

The Healthy Eating on a Budget program has been integrated into the TANF Work Readiness workshop as a SNAP-Ed program. The purpose of the 8-lesson series is to provide SNAP recipients with education on healthy nutrition and physical activity practices, food resource management, food safety and food security.

Healthy Kids Festival

The goal of the Healthy Kids Festival is to provide sustainable tools and opportunities for low income families with young children (ages 3-8) to make healthy choices as he/she approaches the adolescent years. The event, hosted by the University of Nevada Cooperative Extension’s All 4 Kids program in collaboration with local community partners provides long term solutions to childhood obesity through physical activity, healthy eating and other behaviors related to childhood obesity prevention.

Healthy Steps to Freedom

Alcohol and drug addiction are serious, chronic and relapsing health problems for both women and men of all ages and backgrounds. Leading to physical and mental health problems, substance abuse often precipitates violence, sexually transmitted diseases, unwanted pregnancy, motor vehicle crashes, homelessness, rising health care costs and obesity.

Nevada Radon Education Program

The Nevada Radon Education Program is a partnership with the Nevada State Health Division to educate Nevadans about the possible health risk posed by elevated levels of radon in the home. University of Nevada Cooperative Extension (UNCE) offers literature, educational programs and radon test kits in many county Extension offices.

Pick a better snack™ (formerly Chefs for Kids)

This evidence-based campaign focuses on building fruit and vegetable consumption in children through healthy snacking. Pick a better snack™ is a monthly, in-school nutrition education program for primary grade children in at-risk elementary schools in Clark and Washoe counties in Nevada. In addition to direct instruction, staff works with school wellness coordinators to build meaningful and sustainable programming to create a well environment in every school.

Small Steps 4 Big Changes

Parent involvement is recognized as a key factor in making wise food selections and shaping food and health behavior attitudes that affect the child’s habits and food preferences. Conducted in partnership with the 4-H Youth Development Program, a series of ten nutrition lessons incorporate recipe preparation, food sampling and physical activity segments, with additional nutrition education content for the parent or adult caregiver. All lesson segments are focused on thriving within a limited budget, as well as increasing fruit and vegetable intake. This program has been successfully offered to five Reno Housing Authority (RHA) and other 4-H After School Program sites since the initial launch of the pilot program. The program fosters behavior changes identified by the Centers for Disease Control as being linked to childhood obesity prevention.

Team Nutrition “Smart Choices”

This program strives to address the public health issue of childhood obesity through building basic skills related to food selection and promoting an increased variety of nutritious foods consumed especially vegetables and fruits.

Veggies for Kids

University of Nevada Cooperative Extension’s (UNCE) Veggies for Kids program takes a proactive approach toward eating and experiencing different kinds of vegetables for American Indian children at a young age.