[Date]

1
State Indicator Report on Fruits and Vegetables,
2009
NAME ORGANIZATION Using the State Indicator
Report on Fruits and Vegetables, 2009
Date
Information provided by Division of Nutrition,
Physical Activity Obesity (DNPAO) National
Center for Chronic Disease Prevention and Health
Promotion Centers for Disease Control and
Prevention (CDC)
2
Presentation Outline

• Background
• Why fruits and vegetables
• Development of Report
• Describe purpose of State Indicator Report on
  Fruits and Vegetables, 2009
• Present key components and data
• Behavioral indicators
• Policy and environmental indicators
• Describe application of the Indicator Report
  Call to Action

2
3
Why focus on Fruits and Vegetables?

• Fruits and vegetables (FV), as part of a healthy
  diet, are important for
• Optimal child growth
• Weight management
• FV have a protective role in
• Diabetes
• Heart disease
• Stroke
• Some cancers
• Hypertension
• Source http//www.health.gov/DietaryGuidelines/dg
  a2005/document/

3
4
State Indicator Report on Fruits and Vegetables

• State Indicator Report on Fruits and Vegetables,
  2009 can be used
• As a surveillance tool, part of states
  surveillance plan
• Identify current successes opportunities for
  growth and improvement in environmental and
  policy supports for making FV more available and
  affordable within the state
• Provide data for advocacy for change

4
5
Approaches for increasing supportive environments
for FV

• Socioecological (SE) Model
• Physical environment
• Schools
• Communities
• Macro-level environments
• Policy actions
• Land use

Story, M., K. M. Kaphingst, et al. (2008).
"Creating healthy food and eating environments
policy and environmental approaches." Annual Rev
Public Health 29 253-72, Figure 1.
5
6
State Indicator Report on Fruits and Vegetables

• Reports information for each state on two
  categories of indicators.
• Reports information for each state on two
  categories of indicators.
• The behavioral indicators profile the extent to
  which a states population is meeting Healthy
  People 2010 Fruit and Vegetable objectives.
• The policy and environmental indicators measure
  elements of supportive policies and environments
  for FV consumption.
• The indicators show where a state has been
  successful in supporting the FV target area and
  where more work is needed.
• CDC plans publish to regularly throughout decade
• Inform, Influence, and Monitor Change

6
7
State Indicator Report on Fruits and Vegetables

• Insert state indicators, or data to augment
  Indicator Report information

7
8
Development of the State Indicator Report on
Fruits and Vegetables

• Criteria for inclusion of an indicator included
• Promising area within the physical and
  macro-level environments of socioecological model
  approach for FV
• Data measurable and available for most states,
  e.g. BRFSS as the adult dietary data source
• Data from reputable source
• Transparent methodology in obtaining information
• CDC received feedback from partners
• ASTPHND, State FV Nutrition Coordinators

8
9
State Indicator Report on Fruits and Vegetables

• Behavioral Indicators are derived from Healthy
  People 2010 Fruit objective and Vegetable
  objective
• Monitor the objectives and their targets in our
  state
• Increase the proportion of residents in the state
  consuming fruit at least two times per day
  (objective 19-5, target 75 of residents in the
  state)
• Increase the proportion of residents in the state
  consuming vegetables at least three times per day
  (objective 19-6, target 50 of residents in the
  state)
• Source http//www.healthypeople.gov/Document/HTML
  /Volume2/19Nutrition.htm

9
10
Behavioral Indicators

• Adult fruit and vegetable consumption
• Proportion of adult residents in the state
  consuming fruit at least two times per day
  (objective 19-5, target 75 of residents in the
  state)
• Proportion of adults residents in the state
  consuming vegetables at least three times per day
  (objective 19-6, target 50 of residents in the
  state)
• Proportion of adult residents in the state
  consuming fruit at least two times per day and
  consuming vegetables at least three times per day
  (both objectives)
• State source for monitoring Healthy People 2010
  Fruit and Vegetable Objectives Behavioral Risk
  Factor Surveillance System (BRFSS 2007, Odd year
  data collection)

10
11
Behavioral Indicators

• Youth fruit and vegetable consumption
• Proportion of adolescent residents in the state
  consuming fruit at least two times per day
  (objective 19-5, target 75 of residents in the
  state)
• Proportion of adolescent residents in the state
  consuming vegetables at least three times per day
  (objective 19-6, target 50 of residents in the
  state)
• Proportion of adolescent residents in the state
  consuming fruit at least two times per day and
  consuming vegetables at least three times per day
  (both objectives)
• Source Youth Risk Behavior Surveillance System
  (YRBSS 2007, odd year data collection, grades
  9-12)

11
12
Summary of Behavioral Indicators Among Adults

• Note Change your state percentage!
• Double-click on the graph to open the datasheet.
  If that doesn't bring up the datasheet, right
  click on the plot area (white background), and
  select datasheet).
• Type your state name in the cell entitled State
  Percentage.
• Replace the "100"s in the state data with your
  actual state data.
• Do not change the HP2010 numbers as these are
  providing a reference to the HP2010 objectives.
• Close out of the datasheet. The bar chart should
  now reflect your state data.
• Delete this text box (but not the slide number
  box)!

12
13
Summary of Behavioral Indicators Among Adolescents

• Note Change your state percentage!
• Double-click on the graph to open the datasheet.
  If that doesn't bring up the datasheet, right
  click on the plot area (white background), and
  select datasheet).
• Type your state name in the cell entitled State
  Percentage.
• Replace the "100"s in the state data with your
  actual state data.
• Do not change the HP2010 numbers as these are
  providing a reference to the HP2010 objectives.
• Close out of the datasheet. The bar chart should
  now reflect your state data.
• Delete this text box (but not the slide number
  box)!

13
14
State Indicator Report on Fruits and Vegetables

• Policy and environmental indicators
• Represent three different types of strategies to
  support FV
• Availability of healthier food retail in
  communities
• Availability of healthier foods nutrition
  services in schools
• Food systems support

14
15
Policy and environmental indicators

• Availability of Healthier Food Retail in
  Communities
• of census tracts that have healthier food
  retailers located within the tract or within 1/2
  mile of tract boundaries
• Supermarkets, larger grocery stores, fruit and
  vegetable markets, warehouse clubs
• Policy for healthier food retail, 2001-2009 y/n
• Policies that support building of new food
  outlets renovations of existing outlets
  increases in promotion of healthier foods
• Financial incentives (e.g. grants, loans, tax
  credits)
• Technical assistance
• Sources Commercial retail establishment data
  Dun Bradstreet November 2007 US Census Bureau
  2000 Legislative databases (DNPAO 2001-2008,
  NCSL 2004-2009)

15
16
Policy and environmental indicators

• Availability of Healthier Food Retail in
  Communities (cont)
• Farmers markets per 100,000 state residents
• of farmers markets that accept electronic
  benefits transfer (EBT)
• of farmers markets that accept WIC Farmers
  Market Nutrition Program coupons
• Source USDA Agricultural Marketing Services
  2009 U.S. Census Bureau
  2008

16
17
Summary of policy and environmental indicators

• Availability of healthier food retail in
  communities
• census tracts
• Nationally 72
• Range across states 56 84
• STATE X
• 8 states have supportive state-level policies
  for healthier food retail
• STATE Yes/No

17
18
Summary of policy and environmental indicators

• Availability of healthier food retail in
  communities (cont)
• Farmers market availability
• Nationally 1.7 / 100,000
• Range across states 0.2 10.5 / 100,000
• STATE X/100,000
• Farmers markets that accept EBT
• Nationally 7.6
• Range across states 0-50
• STATE X
• Farmers markets that accept WIC FMNP
• Nationally 28.2 Range across states 0-94
• STATE X

18
19
Policy and environmental indicators

• Availability of Healthier Foods and Nutrition
  Services in Schools
• of middle and high schools that offer fruits
  (not juice) and non-fried vegetables as
  competitive foods
• Fruits (not juice) non-fried vegetables are
  offered to middle and high school students when
  other food is offered or sold
• Policy for Farm to School, 2001-2009 y/n
• Legislative policies that support any component
  of a Farm to School program (e.g. school or
  district procurement of local produce, school
  gardens, staff training)
• Sources CDC School Health Profiles survey 2008
  legislative databases (DNPAO 2001-2008, NCSL
  2004-2009)

19
20
Summary of policy and environmental indicators

• Availability of healthier foods and nutrition
  services in schools
• of middle and high schools that offer fruits
  (not juice) and non-fried vegetables as
  competitive foods
• Average percentage across participating states
  21
• Range across participating states 0-39
• STATE X
• 21 states have state-level
• policies for Farm to School
• STATE Yes/No

20
21
Policy and environmental indicators

• Food System Support
• of cropland acreage harvested for fruits and
  vegetables
• Of the total land in the state that is harvested
  for crops, the that is used for fruits and
  vegetables
• State-level Food Policy Council y/n
• Number of local Food Policy Councils
• Sources USDA NASS 2007
  Community Food Security
  Coalition 2009

21
22
Summary of policy and environmental indicators

• Food system support
• of cropland harvested for fruits and
  vegetables
• Nationally 2.5
• Range across states 0-42.9
• STATE X
• 20 states have state-level Food Policy Councils
• STATE Yes/No
• 59 local Food Policy Councils across the country
• Range across states 0-14
• STATE X local councils

22
23
State Indicator Report on Fruits and Vegetables
Call to Action

• Incorporate into state plan
• Surveillance
• Priority strategies
• Advocate for improvement
• Evaluate progress over time
• Identify success stories
• Broaden community support for FV
• Strengthen policy action and support

23
24
State Indicator Report on Fruits and Vegetables
Call to Action

• Availability of Healthier Food Retail Potential
  Action Steps
• Provide financial and nonfinancial incentives to
  food retailers1,2
• Provide support for farmers markets to purchase
  wireless electronic benefit transfer (EBT)
  devices SNAP WIC2
• Engage in outreach and education to residents of
  lower-income neighborhoods and SNAP and WIC
  recipients in communities where farmers markets,
  stands, and other venues accept benefits2
• Improve zoning and transportation policies
  retail accessibility2
• 1Keener D, 2009
• 2 IOM, 2009

24
25
State Indicator Report on Fruits and Vegetables
Call to Action

• Availability of Healthier Food Retail Resources
• Policy Link tool for improving access to healthy
  food in underserved communities
  http//www.policylink.org/site/c.lkIXLbMNJrE/b.513
  7405/k.6042/Healthy_Food_Retailing.htm
• Planning for Healthy Places provides Model
  General Plan Language to Protect and Expand
  Farmers Markets http//www.healthyplanning.org/mo
  delpolicies.html
• Leadership for Healthy Communities Action
  Strategies Toolkit is a guide to create healthy
  communities and prevent childhood obesity
  http//www.rwjf.org/files/research/20090508lhcacti
  onstrategiestoolkit.pdf
• The National Policy Legal Analysis Network to
  Prevent Childhood Obesity (NPLAN) provides model
  policies, fact sheets, toolkits, on various
  topics related to obesity and public health
  http//nplanonline.org/

25
26
State Indicator Report on Fruits and Vegetables
Call to Action

• Availability of Healthier Foods and Nutrition
  Services in Schools Potential Action Steps
• Establish nutrition standards for competitive
  foods as part of school wellness policies.3
• Monitor and evaluate the implementation and
  enforcement of nutrition standards.3
• Support Farm-to-School initiatives.1
• 1Keener D, 2009
• 3 IOM, 2007

26
27
State Indicator Report on Fruits and Vegetables
Call to Action

• Availability of Healthier Foods and Nutrition
  Services in Schools Resources
• National Farm to School http//www.farmtoschool.o
  rg/
• Council of State Governments, School Wellness
  Policies, Legislator Policy Brief
  www.healthystates.csg.org/NR/rdonlyres/C87EB28D-B2
  F6-4399-B1BD-BC5617940019/0/SchoolWellnessPolicies
  FINAL.pdf
• CDC resource on Local Wellness Policy Tools
  Resources for school setting http//www.cdc.gov/H
  ealthyYouth/healthtopics/wellness.htm

27
28
State Indicator Report on Fruits and Vegetables
Call to Action

• Food System Support Potential Action Steps
• Organize a Food Policy Council or Coalition.1
• Adopt supportive policies for production,
  distribution, or procurement from local farms.1

1 Keener D, 2009.
28
29
State Indicator Report on Fruits and Vegetables
Call to Action

• Food System Support Resources
• Building local food systems A planning guide.
  Center for Popular Research, Education and Policy
  and New York Sustainable Agriculture Working
  Group, 2006. http//www.nysawg.org/pdf/Local_Food_
  Planning_Guide_v2.pdf
• The North American Food Policy Council site
  http//www.foodsecurity.org/FPC/

29
30
State Indicator Report on Fruits and Vegetables
Call to Action

• Action References
• Keener, D., Goodman, K., Lowry, A., Zaro, S.,
  Kettel Khan, L. (2009). Recommended community
  strategies and measurements to prevent obesity in
  the United States Implementation and measurement
  guide. Atlanta, GA U.S. Department of Health and
  Human Services, Centers for Disease Control and
  Prevention. http//www.cdc.gov/obesity/downloads/c
  ommunity_strategies_guide.pdf
• IOM (Institute of Medicine). 2009. Local
  Government Actions to Prevent Childhood Obesity.
  Washington, DC The National Academies Press.
  http//www.iom.edu/Object.File/Master/72/800/local
  20govts20obesity20report20brief20FINAL20for
  20web.pdf
• IOM (Institute of Medicine). 2007. Nutrition
  Standards for Foods in Schools Leading the Way
  Toward Healthier Youth. Washington, DC The
  National Academies Press. http//www.iom.edu/CMS/3
  788/30181/42502.aspx

30
31
State Indicator Report on Fruits and Vegetables
Call to Action

• General Resources
• State Indicator Report on Fruits and Vegetables,
  2009
• http//www.fruitsandveggiesmatter.gov/indicatorre
  port
• National and state by state data, data sources,
  references
• Maps
• National Action Guide
• CDC Division of Nutrition, Physical Activity,
  and Obesity website
• http//www.cdc.gov/nccdphp/dnpao/
• CDC is part of the National Fruit and Vegetable
  Program (http//www.fruitsandveggiesmatter.gov)
• Goal increase FV consumption for improved
  public health
• Tools, recipes, and other resources

31
32
State Indicator Report on Fruits and Vegetables
Call to Action

• STATE Resources
• Add applicable state resources here
• STATE Partners
• Add applicable state partners here
• Create awareness among
• Add applicable groups

32
33
State Indicator Report on Fruits and Vegetables
Next Steps

• Discussion of next steps
• Fill in points for discussion

33
34

STATE Contact Information NAME e-mail phon
e

• CDC Contact Information
• indicator_reportfv_at_cdc.gov
• Technical assistance
• Feedback and general questions

The State Indicator Report on Fruits and
Vegetables, 2009 http//www.fruitsandveggiesmatter
.gov/indicatorreport Division of Nutrition,
Physical Activity, and Obesity http//www.cdc.gov/
nccdphp/dnpao/index.html
34