State Indicator Report on Fruits and Vegetables, 2009

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 (F&V), as part of a healthy diet, are important for: • Optimal child growth • Weight management F&V have a protective role in: • Diabetes • Heart disease • Stroke • Some cancers • Hypertension Source: http://www.health.gov/DietaryGuidelines/dga2005/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 state’s surveillance plan • Identify current successes & opportunities for growth and improvement in environmental and policy supports for making F&V more available and affordable within the state • Provide data for advocacy for change 4

5. Approaches for increasing supportive environments for F&V • 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 Health29: 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 state’s population is meeting Healthy People 2010 Fruit and Vegetable objectives. • The policy and environmental indicators measure elements of supportive policies and environments for F&V consumption. • The indicators show where a state has been successful in supporting the F&V 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 F&V • 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 F&V 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 F&V: • 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 F&V • 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.5137405/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/modelpolicies.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/20090508lhcactionstrategiestoolkit.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.org/ • Council of State Governments, School Wellness Policies, Legislator Policy Brief: www.healthystates.csg.org/NR/rdonlyres/C87EB28D-B2F6-4399-B1BD-BC5617940019/0/SchoolWellnessPoliciesFINAL.pdf • CDC resource on Local Wellness Policy Tools & Resources for school setting: http://www.cdc.gov/HealthyYouth/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/community_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%20govts%20obesity%20report%20brief%20FINAL%20for%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/3788/30181/42502.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/indicatorreport • 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 F&V 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] [phone] CDC Contact Information indicator_reportfv@cdc.gov • Technical assistance • Feedback and general questions The State Indicator Report onFruits and Vegetables, 2009http://www.fruitsandveggiesmatter.gov/indicatorreport Division of Nutrition, Physical Activity, and Obesity http://www.cdc.gov/nccdphp/dnpao/index.html 34