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State-Specific Trends in Fruit and Vegetable Consumption Among Adults, United States 2000-2009. Jennifer Foltz, Kirsten Grimm, Heidi Blanck, Kelley Scanlon, Latetia Moore, Larry Grummer-Strawn. State FV Coordinators Presentation September 7, 2010. 1. FV Consumption Trends MMWR.
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State-Specific Trends in Fruit and Vegetable Consumption Among Adults, United States 2000-2009 Jennifer Foltz, Kirsten Grimm, Heidi Blanck, Kelley Scanlon, Latetia Moore, Larry Grummer-Strawn State FV Coordinators Presentation September 7, 2010 1
FV Consumption Trends MMWR Overview and Highlights: • Importance • Methods • Materials and Timeline • Implications 2
Importance of FV • Reduces the risk of leading causes of death *, ¶, § • Important role in weight management† * USDA. Dietary Guidelines for Americans 2005 ¶He FJ et al. Journal of Human Hypertension 2007; 21: 717–728 §CDC. Deaths: Preliminary Data for 2004. National Vital Statistics Reports 2006; 54(19) †Rolls BJ et al. Nutr Rev. Jan 2004;62(1):1-17 4
Healthy People 2010 Objectives • Increase the proportion of adults consuming fruit ≥2 x day • Target 75% of adult residents in the state • Increase the proportion of adults consuming vegetables ≥ 3 x day • Target 50% of adult residents in the state Source: Objective 19-5, 19-6. http://www.healthypeople.gov/publications 5
Percentage of U.S. adults aged ≥ 18 years who consumed fruit ≥2 times per day, by stateBehavioral Risk Factor Surveillance System, 2007 National Average: 32.8% State Range: 20.5% - 41.6% 10
Percentage of U.S. adults aged ≥ 18 years who consumed vegetables ≥3 times per day, by stateBehavioral Risk Factor Surveillance System, 2007 National Average: 27.4% State Range: 22.4% - 37.8% 10
Purpose • To assess states’ progress in meeting HP2010 objectives over the last decade • To provide an update on consumption by demographic characteristics 8
Methods 9
Behavioral Risk Factor Surveillance System • Ongoing, state-based, telephone survey • Non-institutionalized U.S. pop aged >18 years • Used to • track the prevalence of health behaviors • monitor progress toward health objectives • Multistage design • based on random-digit dialing methods • representative sample from each state's civilian adult residents 10
Behavioral Risk Factor Surveillance System FV module: “These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth. How often do you…” • “…drink fruit juices such as orange, grapefruit, or tomato?” • “Not counting juice, how often do you eat fruit?” • “…eat green salad?” • “…eat potatoes, not including FF, fried potatoes, or chips?” • “…eat carrots?” • “Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?” 11
Materials and Timeline • August 2010 • CDC email; ASTPHND media release • September 9, 2010 – MMWR • Report and results embargoed until release • Maps: 2009 for fruits and for vegetables • Table: prevalence and trends, by state • Table: 2009 national data by demographics • Close hold on any info until Thursday • 2009 results, trend results, demographics 13
Implications • It will be important for increased efforts and resources to address behavioral and environmental interventions in the next decade • increase FV consumption • improve Americans diets • decrease disease risk 15
Findings and Implications • Initiatives to promote FV consumption • 5 A Day for Better Health • Fruits and Veggies — More Matters* • Consumption low despite efforts • Demonstrate need for • Awareness campaigns, individual counseling & education interventions • Population-based solutions • P&E approaches ¶ , § * www.fruitsandveggiesmatter.gov/index.html; www.fruitsandveggiesmorematters.org ¶ Larson NI et al. AmJ Prev Med 2009; 36(1): 74-81.e10 § McCormack LA et al. J Am Diet Assoc 2010; 110(3): 399-408 16
Findings and Implications • Major geographic disparities • Factors may include differences in • population demographics • access, availability, and affordability • State Indicator Report on FV, 2009 † †http://www.fruitsandveggiesmatter.gov/indicatorreport 17
Findings and Implications • No demographic subgroup meets HP2010 targets • Variation exists • Higher incomes – higher vegetable consumption • To improve intake by low-income • Voucher programs, such as “Health Bucks” • Attract low-income customers to FM * • Increase FV consumption § • Installing EBT machines • Accepting SNAP benefits at FM * http://wholesomewave.org/wp-content/uploads/winch-full.pdf § Herman DR et al. Am J Public Health 2008; 98(1):98–105 18
Limitations • Declining response rates and exclusion of households without landline phones • Young or low-income adults more likely wireless-only * • Estimates from abbreviated food frequency module are generally lower § ,¶ • Screener does not include fried potatoes • Screener asks times per day, national recs in servings per day * Blumberg SJ et al. NCHS. Dec 2009. At: http://www.cdc.gov/nchs/nhis.htm § Thompson FE et al. In: Nutrition in the Prevention and Treatment of Disease. 2001:3–30 ¶Serdula M et al. Epidemiology 1993; 4(5):455–463 19
Action: What Can Federal Govnt Do? • New national initiatives to improve FV consumption • Intensify efforts, especially for P&E changes • Strategies to improve FV access in the US • Surgeon General’s Vision for a Healthy and Fit Nation * • WH Task Force on Childhood Obesity Report to the President ¶ • First Lady’s Let’s Move! Campaign § *http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf ¶http://www.letsmove.gov/tfco_fullreport_may2010.pdf § http//www.LetsMove.gov. 20
Action: What Can States Do? • States and communities efforts to change FV consumption • State Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases † • State program highlights • Communities Putting Prevention to Work program § • USDA, DASH, others † http://www.cdc.gov/obesity/stateprograms/index.html § http//www.cdc.gov/chronicdisease/recomvery/community.htm 21
FV Guidance Document provides strategic P&E approaches ¶ Promote Food Policy Councils Improve Access to Retail Venues Include or Expand Farm-to-Where-You-Are Programs Ensure Ready Access to FV in Worksite Support and Promote Gardens Policies to Incorporate FV Activities into Schools Include FV in Emergency Food Programs Action: What Can States Do? ¶ Available at http://www.cdc.gov/nccdphp/dnpao 22
Implications • Intensified, multi-sector and multi-setting approaches are necessary • New and continued surveillance of FV consumption and environments and policies are needed • to monitor progress • to target and assess the impact of interventions 23
Acknowledgements • Co-authors • ASTPHND • CDC FV Workgroup • BRFSS • MMWR editors and staff 24
Thank you! 25