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)
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
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
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
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 Health 29: 253-72, Figure 1.
5
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 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
The behavioral indicators profile the extent to which a state’s
population is meeting Healthy People 2010 Fruit and Vegetable
objectives.
• Inform, Influence, and Monitor Change
6
State Indicator Report on Fruits
and Vegetables
• [Insert state indicators, or data to
augment Indicator Report information]
7
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
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 195, 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.h
tm
9
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
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
Summary of Behavioral
Indicators Among Adults
[State] Fruit and Vegetable Daily Frequency
100
US National
State Percentage
Prevalence
75
50
32.8
25
27.4
Note: Change your state percentage!
14.0
• 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”.
0
• Replace the "100"s in the state data with your actual state data.
• Do not change the≥HP2010
numbers as these≥
are
a reference to the
objectives.
2 Fruit
3 providing
Vegetable
≥ HP2010
2 Fruit
&≥3
• Close out of the datasheet. The bar chart should now reflect your state data.
12
Vegetable
•Delete this text box (but not the slide number box)!
Summary of Behavioral
Indicators Among Adolescents
[State] Fruit and Vegetable Daily Frequency
100
US National
State Percentage
Prevalence
75
50
32.2
25
13.2
Note: Change your state percentage!
9.5
• 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”).
0 your state name in the cell entitled “State Percentage”.
• Type
• Replace the "100"s in the state data with your actual state data.
2 Fruit
3providing
Vegetable
2 Fruit
&≥3
• Do not change the≥HP2010
numbers as these≥
are
a reference to the≥HP2010
objectives.
• Close out of the datasheet. The bar chart should now reflect your state data. Vegetable
13
•Delete this text box (but not the slide number box)!
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
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
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
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
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
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
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
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
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
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
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
2
D, 2009
IOM, 2009
24
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.604
2/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/20090508lhcactionstrategies
toolkit.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
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
3
D, 2009
IOM, 2007
26
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/
•
CDC resource on Local Wellness Policy Tools & Resources for
school setting:
http://www.cdc.gov/HealthyYouth/healthtopics/wellness.htm
Council of State Governments, School Wellness Policies,
Legislator Policy Brief:
www.healthystates.csg.org/NR/rdonlyres/C87EB28D-B2F64399-B1BD-BC5617940019/0/SchoolWellnessPoliciesFINAL.pdf
27
State Indicator Report on Fruits
and Vegetables – Call to Action
Food System Support – Potential Action Steps
•
•
1
Organize a Food Policy Council or Coalition.1
Adopt supportive policies for production, distribution, or
procurement from local farms.1
Keener D, 2009.
28
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
State Indicator Report on Fruits
and Vegetables – Call to Action
Action References
1. 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_gui
de.pdf
2. 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%2
0obesity%20report%20brief%20FINAL%20for%20web.pdf
3. 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
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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
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
State Indicator Report on Fruits and
Vegetables – Next Steps
• Discussion of next steps
• [Fill in points for discussion]
33
[STATE] Contact
Information
[NAME]
[e-mail]
[phone]
CDC Contact Information
indicator_reportfv@cdc.gov
• Technical assistance
• Feedback and general
questions
The State Indicator Report on Fruits and Vegetables, 2009
http://www.fruitsandveggiesmatter.gov/indicatorreport
Division of Nutrition, Physical Activity, and Obesity
http://www.cdc.gov/nccdphp/dnpao/index.html
34