Strategies for Improving Nutrition Policies & Environments

1. Strategies for Improving Nutrition Policies & Environments Center TRT: 26 Strategies Based on Best Available Evidence CDCs Recommended Nutrition Strategies Media, Access, Point of Decision Information, Price, and Social Support & Services (MAPPS) interventions

2. Center TRT: Intervention Strategies • http://centertrt.org/?p=find_strategies Intervention strategies are broad approaches to address healthy eating, physical activity and obesity prevention. Each of the intervention strategies described in this section can be part of an overall strategy to prevent obesity in states and communities. More often than not, multiple strategies will be combined to create a comprehensive obesity prevention initiative. These intervention strategies answer the question: What are the best available options for taking action to prevent and control obesity?

3. 26 strategies/One Stop Shopping, based on: • CDC’s Community Strategies and Measurements to Prevent Obesity in the U.S. (COCOMO) • CDC’s Guide to Breastfeeding Interventions • The Community Guide by the Community Prevention Services Task Force • IOM’s Early Childhood Obesity Prevention Policies • IOM’s Local Government Actions to Prevent Childhood Obesity • Convergence Partnership’s Promising Strategies for Creating Healthy Eating & Active Living

4. Active Transportation • Changing Access and Availability to Favor Healthy Foods and Beverages • Community-Wide Campaigns to Promote Healthy Eating • Community-Wide Campaigns to Promote Physical Activity • Comprehensive Nutrition Programs in a Single Setting • Decreasing Screen Time and Other Sedentary Behaviors • Education for Mothers about Breastfeeding during Prenatal and Intrapartum Periods • Food and Beverage Marketing to Favor Healthy Foods and Beverages • Increase Purchasing and Use of Foods from Local Farms • Increasing Access to and Number of Places for Physical Activity • Individual Counseling about Healthy Eating • Individually-tailored Health Behavior Change Programs to Increase Physical Activity

5. Maternity Care Practices in the Hospital Setting • Media Campaigns and Social Marketing Promoting Breastfeeding • Peer Support for Breastfeeding • Point-of-Decision Prompts for Stairwell Use • Point-of-Purchase and Point-of-Decision Labeling to Favor Healthy Foods and Beverages • Pricing Strategies (Including Taxation) to Favor Healthy Foods and Beverages • Professional Support for Breastfeeding by Health Professionals • School Nutrition Programs to Promote Healthy Eating • School-Based Physical Activity and Physical Education • Social Support for Healthy Eating • Social Support for Physical Activity • Support for Breastfeeding in the Workplace • Urban Design-Policy and Zoning to Facilitate Physical Activity • Urban Planning-Zoning Approaches to Facilitate Healthy Eating

6. Go to the TRT web site for: • a brief description of the strategy, • the documents that support the strategy, • the setting in which the strategy would be implemented, • several examples of the strategy in action, • the TRT-reviewed interventions that employ the strategy, and • resources and tools related to implementation of the strategy.

7. Recommended Community Strategies and Measurements to Prevent Obesity in the United States “Where people live, work and play affects their health.” http://www.cdc.gov/NCCDPHP/DNPAO/Publications/index.html

8. Recommended Community Strategies & Measurements to Prevent Obesity in the United States http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

9. Recommended Strategies and Associated Measures in 6 Categories • Promote availability of affordable healthy food & beverages • Support healthy food and beverage choices • Encourage breastfeeding • Encourage physical activity or limit sedentary activity among children & youth • Create safe communities that support physical activity • Encourage communities to organize for change

10. Process • Literature search & analysis resulted in 179 policy-level strategies. • Select expert panel rated each strategy: • 47 most promising (26 nutr, 17 pa) • Strategies were matched with appropriate measures & expert review resulted in 25 recommended strategies with measures. • Pilot tested in 20 local settings & modified for a final total of 24 strategies.

11. Criteria used by the Select Expert Panel to rate each proposed strategy

12. 11 nutrition strategies • Healthy foods in public service venues • Affordable food in public service venues • Geographic availability of supermarkets • Incentivize retailers for healthy foods • Mechanisms for purchasing foods from farms • Incentives for food from local farms • Restrict unhealthy foods/bevs in public venues • Smaller portions in public venues • Limit ads for less healthy foods • Discourage consumption of sugar-sweetened bevs • Increase support for breastfeeding

13. 1. Communities Should Increase Availability of Healthier Food and Beverage Choices in Public Service Venus.

14. Overview • Limited availability of healthier food and beverage options can be a barrier to healthy eating and drinking. Healthier food and beverage choices include, but are not limited to, low energy dense foods and beverages with low sugar, fat, and sodium content (11). Schools are a key venue for increasing the availability of healthier foods and beverages for children. Other public service venues positioned to influence the availability of healthier foods include after-school programs, child care centers, community recreational facilities (e.g., parks, playgrounds, and swimming pools), city and county buildings, prisons, and juvenile detention centers. Improving the availability of healthier food and beverage choices (e.g., fruits, vegetables, and water) might increase the consumption of healthier foods.

15. Evidence • CDC's Community Guide reports insufficient evidence to determine the effectiveness of multicomponent school-based nutrition initiatives designed to increase fruit and vegetable intake and decrease fat and saturated fat intake among school-aged children (22,23). However, systematic research reviews have reported an association between the availability of fruits and vegetables and increased consumption (24,25). Farm-to-school salad bar programs, which deliver produce from local farms to schools, have been shown to increase fruit and vegetable consumption among students (12). A 2-year randomized control trial of a school-based environmental intervention that increased the availability of lower-fat foods in cafeteria à la carte areas indicated that sales of lower-fat foods increased among adolescents attending schools exposed to the intervention (26).

16. Suggested measurement • A policy exists to apply nutrition standards that are consistent with the Dietary Guidelines for Americans to all food sold (e.g., meal menus and vending machines) within local government facilities in a local jurisdiction or on public school campuses during the school day within the largest school district in a local jurisdiction.

17. MAPPS • Media, Access, Point of Decision Information, Price, and Social Support & Services (MAPPS) interventions • List of strategies put together in 2009 by CDC to support applications from states and local health departments for prevention initiatives for nutrition, physical activity and tobacco. • Each strategy has some evidence for effectiveness. http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for_N_and_PA_MAPPS_strategies_cleared.pdf

18. Media • Media and advertising restrictions consistent with federal law • Promote healthy food/drink choices • Counter-advertising for unhealthy choices

19. Access • Healthy food/drink availability (e.g., incentives to food retailers to locate/offer healthier choices in underserved areas, healthier choices in child care, schools, worksites) • Limit unhealthy food/drink availability (whole milk, sugar sweetened beverages, high-fat snacks) • Reduce density of fast food establishments • Eliminate transfat through purchasing actions, labeling initiatives, restaurant standards • Reduce sodium through purchasing actions, labeling initiatives, restaurant standards • Procurement policies and practices • Farm to institution, including schools, worksites, hospitals, and other community institutions

20. Point of Purchase/Promotion • Signage for healthy vs. less healthy items • Product placement & attractiveness (e.g. as part of healthy corner store) • Menu labeling

21. Price • Changing relative prices of healthy vs. unhealthy items (e.g. through bulk purchase/ procurement/competitive pricing)

22. Social and Support Services • Support breastfeeding through policy change and maternity care practices

23. MAPPS Evidence and Resources • Evidence for the MAPPS interventions: http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for_N_and_PA_MAPPS_strategies_cleared.pdf • “Example: “9.Procurement policies and practices establish mechanisms and guidelines for obtaining healthier foods, including fresh fruits and vegetables. They can be used to promote healthier foods, including fruits and vegetables, at workplace cafeterias; in workplace vending machines; and at meetings, events, and conferences. Examples of such practices might include the modification of food and beverage contracts at schools or the identification of vending suppliers who carry healthier vending items at worksites.” • Document lists 4 resources

24. Resources for Procurement Policies • Strategy 6: Provide incentives for the production, distribution, and procurement of foods from local farms. From: Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. This guide provides 24 recommended strategies to encourage and support healthy eating and active living along with measures to help communities track their progress over time. http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf • CDC’s Lean Works! offers interactive tools and evidence-based resources to design effective worksite obesity prevention and control programs. http://www.cdc.gov/leanworks/index.html • Growers' Collaborative is a program organized by Community Alliance with Family Farmers (CAFF). The collaborative organizes small, family farms into a single marketing unit. This lightens the marketing and distribution burden from farmers and provides a more unified delivery option for purchasers, such as public and private grade schools, colleges, hospitals, and corporate cafeterias. http://www.caff.org/programs/growerscollaborative.shtml • Making it Happen! School Nutrition Success Stories provides a collection of success stories describes approaches that schools, districts, or states have used to improve the nutritional quality of foods offered at school. www.cdc.gov/HealthyYouth/MIH http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for_N_and_PA_MAPPS_strategies_cleared.pdf

25. In Class Groups • Select one strategy to address your priority issue from one of these: • Center TRT • CDC Recommended Community Strategies • MAPPS list • Using the ideas presented about this strategy in the document, start to lay out your approach to applying the strategy in Delridge/White Center.