Fruit and Vegetable Report Card September 2009

1. Fruit and Vegetable Report Card, United States - 2009 Division of Nutrition, Physical Activity & Obesity NCCDPHP, CDC Report Card: Heidi Blanck, Sonia Kim, Kirsten Grimm, Latetia Moore, Diane Harris Advisory Members: Larry Grummer-Strawn, Joel Kimmons, Jenna Seymour, Claire Heiser, Casey Hannan, Laura Kettel Khan, Demia Wright, William Dietz Fruit and Vegetable Report Card September 2009

2. Teleconference Objectives • Describe purpose of Fruit and Vegetable (F&V) Report Card • Discuss process of choosing indicators • Identify and describe key components • Behavioral indicators • Policy and environmental indicators • Share project status and timeline • Describe application of F&V Report Card – Call to Action The results and findings in this presentation are those of the authors and do not represent the official views of the CDC.

3. Fruit and Vegetable Report Card Fruit and Vegetable Report Card modeled after the DNPAO Breastfeeding Report Card (2007, 2008, 2009) Fruit and Vegetable (F&V) Indicators can be used: • As a surveillance tool, part of a state surveillance plan. • Identify opportunities for growth and improvement in environmental and policy supports for making F&V easier choices within each state. • Monitor progress and celebrate state successes.

4. 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. Fruit and Vegetable Report Card Reports information for each state on two categories of indicators. • The behavioral indicators profile the extent to which adults & adolescents in a state meet HP2010 goals. • The policy and environmental indicators measure elements of supportive policies and environments for F&V consumption. • Each indicator can be measured in the majority of states, allowing easy state-by-state comparisons. • The indicators show where a state is at currently and where more work is needed. • Goal: publish periodically throughout decade

6. Process: Fruit and Vegetable Report Card • April 28, 2009 – Sustainable Food System State Workgroup Teleconference • June 2, 2009 – ASTPHND, State F&V Nutrition Coordinators Teleconference Call • September 2009 • Release: part of MoreMatters Promotion Month • Sept 1 ASTPHND, State F&V Nutrition Coordinators Teleconference • Sept 10 DNPAO Teleconference

7. Fruit and Vegetable Report Card • Criteria for inclusion of an indicator included: • Promising area for SE model approach for F&V • Data measurable and available for most states • Data from reputable source: .gov, .org, .edu; transparent methodology in obtaining information • When possible data allows for density and percentages for comparability among states of different geographic and population size • Sets a high bar

8. Fruit and Vegetable Report Card Behavioral Indicators Monitor the Healthy People 2010 F&V objectives • >2 fruit daily, increase proportion to 75% • >3 vegetables daily, increase proportion to 50%

9. Behavioral Indicators • Adult fruit and vegetable consumption • Proportion of adults (age > 18 years) consuming daily: • >2 fruit • >3 vegetables • Both >2 fruit and >3 vegetables • Source: Behavioral Risk Factor Surveillance System (BRFSS 2007, odd year data collection)

10. Behavioral Indicators • Youth fruit and vegetable consumption • Proportion of youth (adolescents in grades 9-12) consuming daily: • >2 fruit • >3 vegetables • Both >2 fruit and >3 vegetables • Source: Youth Risk Behavioral Surveillance Survey (YRBS 2007, odd year data collection)

11. Fruit and Vegetable Report Card 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 and nutrition services in schools • Food systems support

12. 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, 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 data; legislative databases (DNPAO, NCSL)

13. 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

14. 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 • Farm to School programs • Public and private schools, K-12 • Policy for Farm to School, 2001-2009 [y/n] • 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; National Farm to School Program, National Center for Education Statistics; legislative databases

15. 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, Community Food Security Coalition

16. Policy and environmental indicators • Availability of healthier food retail in communities • Availability of healthier foods and nutrition services in schools • Food system support Current Gaps No worksite No childcare No medical care No restaurants, vending, cafeteria 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.

17. Other indicators Assessed other indicators - either insufficient data or inability to obtain state-specific information: • Gardens (community, school) • USDA Programs - Senior FM, Specialty Crop Grants, Fresh FV Program, SNAP Education (EARS) • CSA programs

18. Summary of behavioral indicators HP 2010 objectives • >2 fruit daily, increase proportion to 75% • >3 vegetables daily, increase proportion to 50% • >2 fruit and >3 vegetables daily increase proportion to 50%

19. Summary of behavioral indicators

20. Summary of behavioral indicators

21. Summary of policy and environmental indicators • Availability of healthier food retail in communities • % census tracts: 72% nationally; state range: 56% – 84% • FM availability: 1.5 / 100,000 nationally; range 0.2 – 9 / 100,000 • 6.9% of FM accept EBT nationally; range: 0-49% • 32.6% of FM accept WIC FMNP nationally; range: 0-89% • 8/51 have supportive state policies

22. Summary of policy and environmental indicators • Availability of healthier foods and nutrition services in schools • 21% of schools offer F&V as competitive foods; range: 0-39% • 21 have supportive state policies for Farm to School

23. Summary of policy and environmental indicators • Food system support • 20 have state level Food Policy Councils • 59 local Food Policy Councils across the country; range: 0-14

24. Next Steps • Data Dissemination plan • Sept 1 • Sept 4 • Planned cleared individual state data and national data sent to each state (Excel) • FAQs • Sept 10 – DNPAO Teleconference • Sept 21 • Launch on website • Web, PDF Print Friendly • 15 glossy hard copies to each state

25. Next Steps • Translation of F&V Report Card – Purpose • Broadly communicate message • Provide documents for state use • Translation of F&V Report Card – Products • National press release – launch planned 9/21 • State press release template – planned 9/4 • State F&V Report Card Ppt slides – planned 9/10 • Overview of Report Card • Components to educate state and local audiences • Place-holders for your state’s data • State action document template • State-level indicator data • Action items for each topic area

26. Next Steps Action Document Sample (Draft)

27. Next Steps • Evaluation • General usability and utility • Example questions: • Is the Report Card filling gaps in your surveillance needs? • Have you updated your state surveillance plan or inventory with this surveillance data source? • How have you used it to inform others? • Has it been useful in supporting or initiating state or local policy? • Can you write a success story of the impact of the Report Card? • Multiple venues over next year, e.g. • Correspondence with project officers • NPAO quarterly calls • F&V Nutrition Coordinators Teleconference

28. Report Card Call to Action • Incorporate into state plans • Surveillance • Select priority strategies to work on • Advocate for improvement • Use as a baseline for program evaluation • Evaluate progress over time • Identify success stories • Broaden community support for FV • Strengthen legislative action and support

29. Report Card Call to Action Create awareness within your states among… • Public Health professionals • Local coalitions and advocates • Policy makers • Education • Agriculture • Government and community partners • Media

30. Thank You! Contact Information: Sonia Kim skim3@cdc.gov 770-488-5156 Heidi Blanck hblanck@cdc.gov 770-488-5638 Division of Nutrition, Physical Activity, and Obesity http://www.cdc.gov/nccdphp/dnpao/index.html