Update on CDC Strategic Planning Efforts for Fruits and Vegetables

1. Update on CDC Strategic Planning Efforts for Fruits and Vegetables Association of State & Territorial Public Health Nutrition Directors, June 11, 2008 Laurence Grummer-Strawn, Chief, Nutrition Branch Casey Hannan, Acting Chief, Program Development & Evaluation Branch Division of Nutrition, Physical Activity and Obesity

2. DNPAO Goals • Increase health-related physical activity through population-based approaches. • Improve those aspects of dietary quality most related to population burden of chronic disease and unhealthy child development. • Decrease prevalence of obesity through prevention of excess weight gain and maintenance of healthy weight loss.

3. Nutrition targets • Increase the consumption of fruits and vegetables • Decrease the consumption of sugar-sweetened beverages • Reduce the consumption of high-energy-dense foods • Increase breastfeeding initiation, duration, and exclusivity • Eliminate micronutrient deficiencies around the world

4. F&V focus area • Influencing the influencers to make policy and environmental changes • Why “influencing the influencers”? • To impact 300 million Americans, we must work through others • Expect multiplier effect • Who are the “influencers”? • School administrators, employers, state legislatures, planning commissions, U.S. Congress, farmers, grocery manufacturers

5. Why focus on policy & environment? Low High Reach Cost Specialty Care Primary Care Activities no feedback Health Systems Activities w/ feedback, follow-up Community & Neighborhood Collaboration Health Communication Environment/ecological approaches Policies Low High

6. Nutrition targets • Identify, adapt, and/or develop surveillancesystems to measure behavior, policy and environmental change • Strengthen the science base related to environment and policy strategies and interventions • Translate and disseminate effective/promising interventions • Strengthen partnerships and advocacy efforts, strategies, and activities • Enhance state capacity to implement environmental and policy interventions • Identify and reduce disparities related to access, availability, and consumption

7. F&V Objectives Identify, adapt, and/or develop surveillance systems to measure behavior, policy and environmental change

8. Fruit Consumption

9. Vegetable Consumption

10. BRFSS Screener BRFSS 6-item F&V Frequency Screener Module in rotating core, asked in odd years with PA • How often do you drink fruit juices such as orange, grapefruit, or tomato? • Not counting juice, how often do you eat fruit? • How often do you eat green salad? • How often do you eat potatoes not including French fries, fried potatoes, or potato chips? • How often do you eat carrots? • Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?

11. BRFSS Screener • Strengths: • Short, moderate validity in most groups, lowest in Hispanic mothers enrolled in WIC • Created in 1989:No change overtime has allowed for trend analysis • Limitations: • Lacks text about forms: Fresh, frozen, canned, as well as cooked versus raw forms • Juice question does not specify 100% juice and thus lemonade and other fruit-flavored added sugar drinks (Hi-C, Sunny Delight) might be included • Legumes, dried beans not included as vegetable • Frequency only, new recommendations in Cups

12. BRFSS Revisions • Catalogued concerns from state coordinators and CATI staff • Adapted NHIS/CHIS questions • Analyzed of NHANES 2003-2004 data on top F&V contributors • Conducting two rounds of cognitive interviews • In 2009, MA, TX & WA will test in parallel with current screener • Working with NCI to estimate median portion size by age/sex/race-ethnicity • Roll-out planned in 2011

13. Options for Environmental Surveillance • Perceptions of physical access to F&V • Community checklists: • Farmer’s markets, grocery & food stores, restaurants • Nutrition Environment Measures Survey (NEMS) • School Health Policies and Programs Study (SHPPS)

14. F&V Objectives Strengthen the science base related to environment and policy strategies and interventions

15. Nutrition Policy Research • Adapted the 2006 Physical Activity Policy Research Network to create a Nutrition Policy Research Framework • Identification of relevant policies • Determinants of establishing policies • Development and implementation of policy • Examination of policy outcomes

16. Identify F&V Policies Source: DNPAO State Legislation Database Source: DNPAO State Legislation Database

17. Identify F&V policies

18. State Legislation for F&V, 2001-2007

19. Determinants • Determinants of enactment • Type of bill (appropriations, authorization, rules) • Sponsors • Partners • Evaluation component

20. HealthStyles, 2008 • How likely would you be to support changes to local or state rules or policies that would do each of the following: • Create local community markets or farmers markets? • Create a program that helps small food stores have fresh fruits and vegetables? • Create community gardens or plots for raising fruits and vegetables? • Create farm-to-school programs to provide locally grown fruits and vegetables in schools for breakfast, lunch, and snacks? • Require city/county government agencies to favor the purchase of locally grown fruits and vegetables to serve in cafeterias and at meetings?

21. F&V Objectives Translate and disseminate effective/promising interventions

22. F&V Resource Guide • CDC Resource Guide to Strategies and Programs for Increasing Fruit & Vegetable Consumption • “How To” resources on promising approaches • Primarily web-based with active links • Includes overview, program description, rationale, evidence of effectiveness, and implementation guidance

23. F&V Resource Guide • Community • Worksite • School • Healthcare

24. F&V Resource Guide • Strategies: Single tactics that can be employed alone or with other strategies • Programs: Package of several strategies

25. F&V Objectives Strengthen partnerships and advocacy efforts, strategies, and activities

26. F&V Partnerships • National Fruit and Vegetable Alliance • State, Regional and Community Workgroup • Council of State Fruit and Vegetable Coordinators • States

27. National Fruit & Vegetable Alliance National Council of Fruit & Vegetable Nutrition Coordinators NANA

28. NFVA • Co-chaired by Bill Dietz (CDC) and Elizabeth Pivonka (PBH) • Term agreement in place for health authority role and brand support brand • National Action Plan

29. SRC • Co-chaired by Claire Heiser (CDC) and Joan Atkinson (Council) • SRC membership survey re: future priority topics • Goal: realign SRC work to member needs • Previous topics: restaurants, low income and special populations

30. F&V Advocacy • Integrated and coordinated program efforts supported by integrated and coordinated advocacy efforts through partners • Full debrief with ASTPHND, NACDD, DPHE, NANA re: FOA review process • Partners develop advocacy strategy(ies), with info/facts/stats and estimates from DNPAO

31. F&V Objectives Enhance state capacity to implement environmental and policy interventions

32. Enhance State Capacity • Providing technical assistance and consultation is the “final common pathway” • Majority of division’s efforts and functions are designed for public health application and enhancing public health practice.

33. Provide technical assistance and consultation With Division-wide input, we: • Define audiences, constituencies • Determine needs • Design process (eye towards innovative approaches) • Implement • Evaluate

34. Technical Assistance Manual

35. Worksite Vending Machines • CDC is conducting a vending pilot project with 10 machines across 8 campuses in Atlanta • The program is about to enter the Marketing stage • A toolkit will be published on the HWI website

36. Worksite Garden Market • Garden markets improve access to fruits and vegetables by bringing fruits and vegetables to the work place • Garden Market toolkit is available on the CDC website • The tool-kit includes: • Assessing the need and interest • Planning • Promotion • Implementation • Evaluating Success

37. Child Care SettingNAP SACC • Nutrition and Physical Activity Self-Assessment for Child Care • The purpose is to promote healthy eating and physical activity in young children in preschools and child care settings. • The NAP SACC components include: • self-assessment instrument, • continuing education workshops, • collaborative action planning and technical assistance materials, • extensive resource manual which includes copy ready materials.

38. Health Care SettingResearch to Practice

39. September 2008Fruits & Veggies – More Matters Month Get Smart! • On the Go • As You Shop • In Your Family Dinner • On a Budget • Entertaining • Back to School Materials for Low-income audiences coming soon!

40. Enhance State Capacity • Program evaluation strategies to build “practice-based evidence” • COCOMO (Common Community Measures for Obesity) • Evaluability Assessments (EA)

41. F&V Objectives Identify and reduce disparities related to access, availability, and consumption

42. Disparities in BRFSS, 2005

43. Disparities in BRFSS, 2005

44. F&V Disparities Expert Panel • Meeting planned for late 2008 • Review of current knowledge • Agenda setting for addressing disparities

45. F&V Disparities Efforts • NFVA-SRC workgroup on special populations • Slides, other resources shared on yesterday’s conference call

46. F&V Strategic Planning Group F&V Working Group • Jenna Seymour • Heidi Blanck • Joel Kimmons • Genevieve Polk • Reba Griffith • Claire Heiser • Jenny Kohr • Tara Simpson* • Laura Tanase* State POCs • Claire Heiser • Sarah Kuester • Carol MacGowan • Annie Carr • Susan Anderson • Chris Reinold • Barbara Polhamus • Genevieve Polk • Jenny Kohr OD/Management • Jude McDivitt • Deb Galuska • Alicia Hunter • Casey Hannan • Becky Payne • Laurence Grummer-Strawn * Recently left the group

47. THANK YOU!