Measuring
What Matters
Idaho
Obesity Indicators
© 2014 by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association
Foundation for Health, Inc.
PREFACE
Despite access to beautiful outdoor opportunities,
a robust agricultural economy and high-caliber
health care institutions, Idaho faces the same
challenge of rising obesity rates as the rest of the
nation. Childhood overweight and obesity rates
range from 10 to 50 percent in Idaho communities.
Obesity affects some adults and children more
than others; poverty, race and lower educational
attainment are all associated with increased
obesity. Children who are obese face physical
limitations, social stigma, mental health issues and
greater risk for an unhealthy future. Many of the
leading causes of preventable death including heart
disease, stroke, type 2 diabetes and certain types of
cancer are obesity-related.
Obesity is costly to individual health, and it is costly
for Idaho. A 2012 Robert Wood Johnson Foundation
Trust for America’s Health Report predicted that
Idaho spends more than $2.7 billion in costs due to
obesity, which are projected to rise to more than
$3 billion by 2030. The good news in the report
is that with only a five percent decrease in Idaho
obesity the state would save $1.2 billion by 2020
and $3.28 billion by 2030.
Blue Cross of Idaho Foundation for Health, Inc. has
partnered with communities and organizations
across the state to improve healthy eating and
physical activity through their High Five Children’s
Health Collaborative. High Five’s goal is to make
childhood obesity a key public health priority in the
state of Idaho by driving awareness and encouraging
engagement statewide.
The return on this investment looks bright.
Changes are taking place across Idaho to increase
healthy food options, offer more physical activity,
encourage less screen time and to educate about
obesity prevention. Research supports that
investing in obesity prevention pays off. The
American Health Association estimates that for
every dollar spent on building bike trails and walking
paths, the state could save three dollars in health
costs. Likewise, for every dollar spent in wellness
programs, companies could save $3.27 in medical
costs and $2.73 in absenteeism.
The path to obesity prevention will require a broad
approach with multiple sectors collaborating to
make the healthy choice the easy and available
choice. The Blue Cross of Idaho Foundation
for Health funded “Measuring What Matters,
Idaho Obesity Indicators Report” to advance the
conversation on obesity in Idaho. Assessing the
current status of obesity and obesity-related
indicators provides an important step in clarifying
which populations share the greatest obesity burden
and what evidence-based actions Idaho can take to
support every child’s health. It is the hope of the
Blue Cross Foundation for Health that Measuring
What Matters will catalyze stakeholders across
diverse sectors to take on the challenge of targeted
and data driven obesity prevention strategies.
There is an Ethiopian proverb that says, “when spider
webs unite, they can tie up a lion.” The Blue Cross
Foundation for Health hopes that through the High
Five Collaborative, forces will be able to unite to
fight childhood obesity and promote health.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
3
AUTHORS
University of Idaho Movement Science Faculty:
Helen Brown, RD, MPH, Philip Scruggs, PhD, Grace Goc Karp, PhD, Julie S. Son, PhD, Chantal Vella, PhD.
TABLE OF CONTENTS
Introduction...............................................................................................................................................................5
Report Background..............................................................................................................................................5
Methods ..................................................................................................................................................................5
Limitations..............................................................................................................................................................7
Overarching Overweight and Obesity Measures..........................................................................................9
Physical Activity Environment........................................................................................................................ 23
Food and Beverage Environment..................................................................................................................... 35
Health Care and Worksite Environment....................................................................................................... 51
School Environment............................................................................................................................................. 61
Message Environment......................................................................................................................................... 75
Conclusions ............................................................................................................................................................. 77
Appendix 1............................................................................................................................................................... 79
Acronyms.............................................................................................................................................................. 79
Appendix 2............................................................................................................................................................... 81
Tables and Figures............................................................................................................................................ 81
Maps....................................................................................................................................................................... 82
ACKNOWLEDGMENTS
The Blue Cross of Idaho Foundation for Health, Inc.
made this project possible through their generous
contribution of resources, time and talent. The
findings and recommendations of this report are
solely those of the authors and do not represent the
official view of the Blue Cross of Idaho, Foundation
for Health, Inc.
Bureau of Vital Records and Health Statistics
staff, Andy Bourne provided needed data support.
Tenley Burke, Christy Dearien and Debbie Gray,
from the University of Idaho Office of Community
Partnerships, lent their considerable skill and
expertise in the collection and presentation of the
data and thoughtful review of this report. Finally,
thank you to all the many individuals that attended
Special thanks to the Blue Cross of Idaho Foundation meetings, provided information, consented to
Board of Directors and to Kendra Witt-Doyle PhD,
interviews and shared invaluable expertise that
MPH, and staff for their vision and commitment
supported the development of this report. Thank you
to improving the lives of Idaho children and their
for your vision of a healthier, thriving future for Idaho
families. Particular thanks to Idaho Department of
children and adults.
Health and Welfare staff, Joseph Pollard, Angela
Gribble, and Christopher Murphy for their support
supplying data and program information.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
5
INTRODUCTION
Across Idaho, nearly 30% of children, 25% of
adolescents and over 62% of adults live with daily
health and social challenges of overweight and
obesity and face a future with high risk of chronic
disease, disability, social stigma, and a shortened,
lower quality of life. Obesity is costly and all
Idahoans share this burden through increased health
care cost, lower productivity, and concern for the
health of their loved ones.
• What data are readily available to assess obesity
and obesity-related factors?
Experts classify obesity as a disease of epidemic
proportion. This 21st century disease is unlike
communicable diseases of the past with a single,
identifiable agent that given the right science and
resources is containable. Obesity is a complex,
multi-factorial condition requiring a systems
approach. Conditions in utero, early feeding
practices, personal choice, access to adequate
physical activity and affordable healthy food,
healthy enhancing school, work and communities
along with clear and consistent messages create
a web of factors that impact obesity. A systems
approach to preventing obesity requires pulling on
multiple of strings of a complex and interconnected
system that supports our current obesogenic
environment.
• What obesity indicators are most important to
measure to inform interventions and to evaluate
progress toward reducing obesity and impacting
obesity-related factors?
No county or region in Idaho is immune to obesity.
As this report describes, some Idahoans face higher
obesity prevalence, have fewer resources and live in
regions with fewer obesity protections. The regions
facing the greatest risks are the same regions
experiencing increased poverty, food insecurity and
are more likely communities with less education
and employment. Hispanic and American Indian/
Alaska Native children experience the greatest
risk of all. Fortunately, committed Idahoans across
multiple sectors apply resources, time and talent
to prevent obesity. The genesis of this report arose
from a desire to answer four critical questions about
obesity in Idaho:
• Does the available data identify the populations
most impacted by obesity and in need of
strategic actions?
• What obesity prevention data are missing
or exist at some level but are disconnected
from avilable data systems and reporting
mechanisms?
REPORT BACKGROUND
Initially, efforts to identify obesity measures
centered on the Idaho Department of Health
and Welfare Healthy Eating Active Living (HEAL)
Framework. HEAL was developed with input from
over 100 Idaho stakeholders and includes action
for obesity prevention in several domains. The
Framework included an infrastructure and capacity
building goal (Goal 3) to, “Establish a statewide
system to report, monitor and evaluate healthy
eating and active living programs and initiatives,”
with one of the recommended actions to, “Identify
and reduce gaps in healthy eating and active living
surveillance data for children, youth and adults
and share the information with partners and
stakeholders.” 1
The HEAL Framework outlined actions to reduce
obesity, but did not include measureable indicators
for practical and scientific identification of
obesity risk factors and the evaluation of obesity
prevention efforts. University of Idaho, Movement
Sciences faculty approached Blue Cross of Idaho
and proposed a project to work with stakeholders
statewide to share existing data, identity data
gaps and reach some common agreements on data
needs and priorities. Blue Cross of Idaho funded
and worked alongside University of Idaho faculty to
answer the four critical questions posed above.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
7
This work’s framework is grounded in two Institute
of Medicine (IOM) reports: Accelerating Progress
in Obesity Prevention, Solving the Weight of the
Nation, 2012 (APOP)2 and Evaluating Progress of
Obesity Prevention Efforts: A Plan for Measuring
Progress, 2013 (EPOP)3. APOP identified 20
environmental and policy strategies with the best
evidence for preventing obesity and organized these
strategies into five environments: (1) the physical
activity environment; (2) the food and beverage
environment; (3) the message environment; (4) the
health care and worksite environment; and (5) the
school environment (Figure 1). The IOM considers
data collection of obesity measures as foundational
to the work and describes them as “overarching
obesity and overweight data.” As depicted in
Figure 1, the message environment is critical for
making obesity prevention progress in each of
the environments. The IOM documents offered a
conceptual framework, a touchstone for evidencebased practices and a common set of data indicators
to assess current conditions and evaluate obesity
strategies.
Figure 1: Accelerating progress of obesity prevention
environments
Message Environments
School
Environments
Control and Prevention (CDC) guidance in describing
the significance, scope, and limitations of the
indicator measure and the data source. Additionally,
any disparities identified were noted and discussed.
Gathering expert perspectives on available obesityrelated data was accomplished using the following
three methods:
• Idaho State Key Leaders – Two meetings
were held with invited key decision makers
representing health, school, planning,
transportation, education, medical providers,
community-based programs and others. These
leaders offered input of existing data, data gaps,
identification of needed partners and initial
conversations on solutions to data gaps and lack
of systematic surveillance.
• Healthy Eating Active Living (HEAL) Network –
Four sessions were held at regional HEAL
meetings to gather local experts input on the
availability of obesity-related data, data gaps,
opinions on potential data sources and collection
methods. To gather more input, a special session
was conducted for HEAL Network members
attending the annual HEAL meeting.
• Stakeholder Interview – Over 20 interviews
(face-to-face and via phone) were conducted to
gain clearer insight into obesity data availability,
gaps and potential methods to increase data
access.
MEASUREMENT MATTERS ORGANIZATION
Each obesity prevention environment is presented in
the following way:
Physical
Activity
Environments
Food and
Beverage
Environments
Health Care
and Work
Environments
METHODS
Based on APOP and EPOP, the authors set out to
identify the available data indicators for obesity and
overweight as well as indicators for each of the five
environments and followed the Centers for Disease
8
• Key Findings – Highlights of key findings for each
obesity prevention environment.
• Environment Description – A brief description
of the environment with references to scientific
reports supporting the data indicators. These
reports provide a comprehensive review of the
literature so no attempt was made to extensively
cite literature in this report.
• Data Indicator Table – Each environment table
lists national, state, regional and local data
measures, and a summary of data gaps and
opportunities. Abbreviation definitions are found
in the appendix under Acronyms.
Measuring What Matters – Idaho Obesity Indicators
• Obesity Measures – The data measures are first
described in a data summary table followed
by tables, figures and maps of the key data
indicators presented.
• Summary – Information is summarized by:
1) Existing data; 2) Opportunities for expanding
data; and 3) Recommendations to fill data gaps.
IDAHO PUBLIC HEALTH REGIONS
Idaho is divided into seven distinct Public Health
Districts (Districts) (Map 1). Health district
indicators are reported by the District number,
e.g., District 1, and not by the name of the region.
LIMITATIONS
Every effort was made to obtain the most recent
and accurate data readily available. Public agencies
in Idaho can provide more in-depth data analysis
upon request. New sources of data continually
emerge and this report attempts to capture the
obesity-related indicators available based on
IOM recommendations. Strategic actions from
many sectors are needed to impact obesity and
critical measures from partners outside of health
and education are largely missing. The work of
key indicators is nascent across many sectors.
Identification of obesity-related indicators is
in its infancy. A further limitation is the lack of
perspective obtained from key leaders in agriculture,
the food and beverage industry and other private
sectors. The interest in this work is growing and new
partners will expand and improve upon the findings
and recommendations of this report.
Idaho Department of Health and Welfare. (2013). Healthy Eating, Active Living (HEAL) Idaho. Nutrition and Physical Activity Framework Updated 2013. Retrieved
from http://www.healthandwelfare.idaho.gov/Portals/0/Health/IPAN/Healthy%20Eating%20Active%20Living%20(HEAL)%20Idaho%20Framework.pdf
1
IOM (Institute of Medicine). (2012). Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press.
Retrieved from http://www.iom.edu/Reports/2012/Accelerating-Progress-in-Obesity-Prevention.aspx
2
IOM (Institute of Medicine). (2013). Evaluating obesity prevention efforts: A plan for measuring progress. Washington, DC: The National Academies Press.
Retrieved from http://www.iom.edu/Reports/2013/Evaluating-Obesity-Prevention-Efforts-A-Plan-for-Measuring-Progress.aspx
3
Measuring What Matters – Idaho Obesity Indicators
9
Map 1: Idaho Public Health Districts
OVERARCHING OBESITY AND
OVERWEIGHT MEASURES
KEY FINDINGS
• Direct measures of childhood obesity are limited and are only reported on a statewide basis.
• Most obesity data relies on self-reported height and weight.
• Youth BMI is calculated from self-reported height and weight and is not available
by region or school district.
• Direct measures of childhood obesity are limited to third grade.
• Idaho does not require schools to collect or report BMI.
• Pre-pregnant weight status and weight gain in pregnancy is reported regionally.
• Few data exist to identify sub-populations most at risk for obesity.
• No system of statewide obesity surveillances exists.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
11
OVERWEIGHT AND OBESITY DATA INTRODUCTION
ADULT OVERWEIGHT AND OBESITY
The 2010 White House Task Force on Childhood
Obesity Report to the President, Solving the
Problem of Childhood Obesity Within a Generation,
defines obesity as an epidemic with life-threatening
consequences.4 Nationwide, 16.9% of children ages
2-19 are obese. No significant declines in obesity
prevalence have occurred since 2004-2012.5 Many
expert reports in the last ten years have detailed the
human, economic, social and environmental cost of
obesity.
There are no reported population-level direct
measures of obesity and overweight available
in Idaho. The annual Behavioral Risk Factor
Surveillance Survey (BRFSS) calculates BMI from
self-reported height and weights by telephone and
cell phone interviews for each public health district
(District). The majority of Idahoans are overweight
or obese (62.5%) and 26.8% are considered obese
(Table 1). Males are more overweight and obese than
females in every District except District 3 (Table
2). Overweight (Map 2) and obesity (Map 3) varies
between health regions. Idaho matches the nation
for overweight rates (35.8%) and is slightly below
U.S. obesity rates (26.8% vs. 27.6%) (Figure 2).
Rates of overweight and obese are highest among
people who are unemployed, did not graduate
high school and are Hispanic (Table 3). Except
for Washington, Idaho is the most obese among
neighboring states and has higher rates of obesityrelated diseases, diabetes and hypertension, than
Montana, Utah and Colorado (Table 4).
Obesity is defined as excess body fat. Direct
measurements of body fat are not easy to obtain so
obesity is most often estimated by body mass index
(BMI). BMI is a calculation of weight and height
(kg/m2 ) that is used to classify people as
underweight, normal weight, overweight or obese.
Adults with a BMI between 25.0 and 29.9 are
considered overweight and those with a BMI greater
than 30 are considered obese. A BMI of 40 or
more is classified as morbidly obese.6 Childhood
and adolescent obesity takes sex and age into
consideration. BMI is calculated using growth charts
from the Centers for Disease Control and Prevention
(CDC). Children and adolescents with a BMI between
the 85th and 94th percentile are considered
overweight and those with a BMI above the 95th
percentile are considered obese. BMI above the
97th percentile is considered very high or equal to or
above BMI.7
Accelerating Progress in Obesity Prevention (APOP)
discusses the importance of accurate measures for
adult, adolescent, childhood, infant and prenatal
overweight and obesity as well as for weight gain in
pregnancy. Most population-based BMI measures
are calculated from self-reported height and weight.
Studies indicate that self-reported BMI is lower
than technician measured BMI due to underreporting
of weight and over-reporting of height. Direct
measures offer a more precise measure of obesity
prevalence but self-reported measures are
considered useful for population studies of BMI.8
12
ADOLESCENT OBESITY
The 2013 Youth Risk Behavior Surveillance System
(YRBSS) contained 14 questions about body weight
(self-reported height and weight), self-perception
of body weight status, weight control behaviors and
nutrition. In 2013, 15.7% of high school students
were overweight and 9.6% were obese (Table 5).
2013 reported rates of obesity and overweight
were higher than 2011 (25.3% vs. 22.6%) but below
national 2011 rate of 28% (Figure 3). Obesity was
highest among males (Table 5) and over twice as
likely among Hispanics (Figure 4). Idaho Hispanic
obesity in 2011 was higher in Idaho than in the U.S.
(16.3% vs. 14.1%) (Table 6). Between 2011 and
2013, Hispanic obesity increased from 16.3% to
20% (Figure 4). Nationwide, American Indian and
Alaska Native youth have the highest report rates
of overweight and obesity. Females in Idaho report
harmful weight control behaviors: 17% went without
eating for 24 hours, 6% took diet drugs and 5%
vomited or took laxatives to lose weight.
Measuring What Matters – Idaho Obesity Indicators
CHILDHOOD OVERWEIGHT AND OBESITY
The National Survey of Children’s Health (NSCH)
provides the only BMI data for children of all ages
under 17 in Idaho. This indirect measure is only
available statewide. Overall, Idaho children are less
overweight or obese than overall U.S. rates (27.8%
vs. 31.3%) but rates have continued to rise slightly
since 2003 (Figure 5). Idaho Hispanic children are
significantly more obese and overweight than white,
non-Hispanic (37.3% vs. 26.2%) (Figure 6). Data
are not available for American Indian/Alaska Native
children.
IDAHO 3RD GRADE BODY MASS INDEX
ASSESSMENT 2011-2012 SCHOOL YEAR
Idaho does not require schools to collect height
and weight or report body mass index. The Idaho
Department of Public Health, Bureau of Community
and Environmental Health contracted with all
seven Districts to directly assess the BMI of 2,102
3rd graders. Overall, 29.7% of third-graders were
overweight with varying rates of overweight (Map 4)
and obesity (Map 5) across Idaho Districts. Rates of
obesity were slightly higher in 2011-2012 (14.6%)
than in the 2007-2008 study (12.8%). District 3
had the highest obesity rates (22%) and District 4
had the best rate of children with a healthy weight
(75%).
OVERWEIGHT AND OBESITY OF LOW-INCOME
PRESCHOOLERS
All Head Start programs serving low-income
preschoolers (ages 3-5) collect height and weight,
We ignore the early years at our peril
if we want to do something about
conquering this growing epidemic of
obesity in our society. Jack Skonkoff,
MD, The Weight of the Nation
calculate BMI, and report results to the federal Head
Start program. The procedures used for collecting
BMI are site-specific, and BMI protocols are not
Measuring What Matters – Idaho Obesity Indicators
uniform. Aggregate Head Start data are available
from the national Head Start office upon request.
Idaho data from specific regions or programs are
unavailable. Information on Hispanic preschool
obesity is available from the Idaho Migrant and
Seasonal Head Start program. Of the 797 children
enrolled in 2012-2013, 796 were Hispanic. The
2012-2013 Idaho Migrant and Seasonal Head Start
program found that 34.4% of children ages 3-5
were overweight or obese and 18.6% were obese
compared to 13.1% of all Idaho Head Start children
(Table 7). Among the Idaho Head Start population,
15.0% were overweight compared to 13.0%
nationwide. Idaho preschoolers were slightly less
obese (13.1%) than. U.S. rates (15.1%) (Figure 7).
The Pediatric Nutrition Surveillance System
(PedNSS) collected data from low-income children
ages 24-59 months participating in federal
assistance programs. BMI is calculated through
direct measures by trained health professionals. Of
particular concern is the high rate of obesity among
Hispanics (17.5%) and American Indian/Alaska
Natives (20.8%). PedNESS was discontinued in
2012 (Figure 8).
INFANT BIRTHWEIGHT
Low birthweight and high birthweight infants appear
at risk for obesity. In 2011, 6.1% of infants were
born low birthweight (<2500 grams) and 8.5% were
born high birthwheight (>4,000 grams). Idaho Vital
Statistics reports infant birth weights by county and
several demographic indices.
PRENATAL OVERWEIGHT AND OBESITY AND
WEIGHT GAIN DURING PREGNANCY
A life course perspective is essential to prevent
and control early childhood obesity. Women
entering pregnancy overweight and obese are at a
higher risk for cesarean delivery, pre-eclampsia,
gestational diabetes, pregnancy complications
and post-partum weight retention. Obesity among
pregnant women doubles a child’s risk of obesity.
High weight gain and tobacco use in pregnancy are
13
also related to pregnancy and birth complications
and increased childhood obesity risk.9 The 2011
Idaho Vital Statistics reported that 50.1% of
births were to mothers classified as normal weight
while 24.8% of births were to women classified as
overweight and 21.7% of births were to mothers
who were obese.10 Prepregnant obesity is more
common in particular Idaho counties (Map 6).
Prepregnancy obesity is highest among Hispanic
women (27.2%) and American Indian/Alaska Native
women (38.5%) (Figure 9). According to the 2010
CDC Pregnancy Nutrition Surveillance System
(PNSS) 50.2% of Idaho women gained more than
the recommended weight in pregnancy vs. 49.0%
of women nationally (Table 8).11 The Pregnancy Risk
Assessment Tracking System (PRATS) is an annual
survey of new mothers and provides information
on several health behaviors including the mother’s
BMI, prenatal weight gain, exercise, tobacco use, and
other factors.12 Both Vital Statistics and PRATS will
supply data upon request.
KEY INDICATORS FOR OVERWEIGHT AND OBESITY
Key Indicators
Idaho Data
Data Source
Overweight & Obesity
Measures
County
Region
State
No
Yes
26.8%
No
Yes
35.8%
No
9.6% 1
Data Gaps
Opportunities
Self-reported; no region
race/ethnic measures
Direct BMI surveillance and diverse
population data needed
No direct BMI surveillance.
ID BMI Study, (1st- 11th) and
ID PE PA Study (1st-12th)
directly measured BMI.
NCHA indirect, 10-17
Directly measure, track and report
BMI following the American
Academy of Pediatrics Criteria for
successful screening in schools
No direct BMI surveillance.
ID BMI Study, (1st- 11th) and
ID PE PA Study (1st-12th)
directly measured BMI
Directly measure, track and report
BMI following the American
Academy of Pediatrics Criteria for
successful screening in schools
Data unavailable by income
and race/ethnicity
Expand surveillance and analysis
Data unavailable by
race/ethnicity
WIC, Head Start and Medicaid
Not readily available
WIC, Early Head Start, Medicaid
Adult
Obes i ty BMI > 30
Overwei ght >= 25 - 29.9
BRFSS, NHANES
Adolescent (12-19yr)
Obes i ty BMI
% BMI >= 95th %i l e
Overwei ght
No
1
2
YRBSS , ID BMI , ID
PE PA3, NCHA4
Yes
No
No
% BMI 85 - 95th %i l e
Yes
Child (6-11yr)
Obes i ty BMI
% BMI >= 95th %i l e
Overwei ght
13.6% 2
11.7%
3
1
15.7%
17.1% 2
14.1% 3
13.27% 2
No
Yes
No
Yes
No
Yes
14.6%
No
Yes
15.1%
PedNSS , WIC,
NHANES
No
No
11.4% 1
No
No
15.3%
WIC, Vi tal
No
No
No
ID BMI 2, ID PE PA3,
NHANES
% BMI 85 - 95th %i l e
14.7% 3
14.67% 2
15.2% 3
3rd Grade
Obes i ty
Overwei ght
ID 3rd Gra de BMI
Pre-School (2-5yr)
Obes i ty
Overwei ght
1
1
Infants (0-2yr)
Obes i ty
Bi rthwei ght > 4000 gra ms
Stati s ti cs 1, NHANES
1
Yes
Yes
8.5%
ID Vi tal Stati s ti cs ,
PRATS
Yes
Yes
24.8%
Yes
Yes
PNSS
No
No
21.7%
50.2%
Available
Perinatal
Prepregna nt Overwei ght
Prepregna nt Obes i ty
> Idea l wei ght ga i n
14
1
1
1
Available
Data dissemination
No postpartum data
Web-based WIC data
Measuring What Matters – Idaho Obesity Indicators
OVERWEIGHT AND OBESITY MEASURES
Table 1: Idaho adult BMI classification, 2012
BMI Classification (BMI)
Percent
Lower 95% CI
Upper 95% CI
Estimated
Adults
Sample Size
Underweight ( < 18.5)
1.8
1.2
2.6
19,700
92
Normal (18.5 - 24.9)
35.7
33.5
38.0
393,100
1,894
Overweight (25.0 - 29.9)
35.8
33.6
38.0
393,800
2,051
Obese I (30.0 - 34.9)
17.2
15.6
19.0
189,900
968
Obese II (35.0 - 39.9)
6.1
5.1
7.3
67,300
356
Obese III (40+)
3.4
2.7
4.2
37,500
217
Source: Idaho Department of Health and Welfare,
Behavioral Risk Factor Surveillance System (BRFSS)
Table 2: Idaho adults: Overweight and obese by sex (%), 2012
Overweight, BMI >= 25
Idaho
District 1
District 2
District 3
District 4
District 5
District 6
District 7
Total
62.5
59.3
61.2
69.1
58.7
67.7
65.0
67.6
Female
54.9
46.4
51.2
62.6
51.0
61.7
55.9
61.9
Male
69.6
71.8
70.9
75.2
66.3
73.6
73.7
73.2
Obese, BMI >= 30
Total
26.8
22.2
26.0
35.8
26.0
29.2
24.9
28.1
Female
26.2
18.2
22.7
38.3
23.5
26.9
24.7
27.3
Male
27.3
26.0
29.2
33.5
28.4
31.5
25.0
28.9
Source: Idaho Department of Health and Welfare,
Behavioral Risk Factor Surveillance System (BRFSS)
Measuring What Matters – Idaho Obesity Indicators
15
ADULT OVERWEIGHT AND OBESITY
INDICATOR
Map 2: Overweight adults in Idaho by Public Health District,
2012
Adult Overweight and Obesity
BACKGROUND
Public health districts in Districts 3 and 5 have the
highest prevalence of adults who are overweight and
obese. District 3 has the highest rate of overweight
middle-aged males (85.0%). This rate includes
overweight and obese individuals
SIGNIFICANCE
Poor health outcomes related to overweight and
obesity (hypertension, diabetes, cardiovascular
disease, disability, etc.) are well established.
DISPARITY
Obesity rates are highest among the state’s
Hispanics, and men. The percent of overweight
Hispanics (BMI >= 25) in 2012 was 70.3% and
non-Hispanics, 61.8%.
Source: Idaho Department of Health and Welfare, BRFSS
Map 3: Obese adults in Idaho by Public Health District,
2012
INDICATOR CHARACTERISTICS
In Idaho, the prevalence of overweight (BMI>=25
kg/m2) was 70.3% in Hispanics and 61.8% in nonHispanics. Data are based on self-reported height
and weight. Data are reported annually for the state
and public health districts.
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Idaho Department of Health and Welfare, Behavioral
Risk Factor Surveillance System, (BRFSS)
http://healthandwelfare.idaho.gov/Health/
VitalRecordsandHealthStatistics/HealthStatisitcs/
BehaviorRiskFactorSurveillanceSystem/tabid/913/
Default.aspx
Source: Idaho Department of Health and Welfare, BRFSS
Figure 2: Obesity measures in adults (%), 2012
35.8
35.8
27.6
26.8
LIMITATIONS OF DATA RESOURCES
BRFSS does not survey enough individuals to
report data by county at this time. More precise
direct measures for a larger number of individuals
would allow for more strategic obesity prevention
approaches.
Idaho
United States
Overweight
Obese
Source: Idaho Department of Health and Welfare, BRFSS
16
Measuring What Matters – Idaho Obesity Indicators
ADULT OBESITY
LIMITATIONS OF DATA RESOURCES
INDICATOR
BRFSS does not survey enough individuals to report
data by county at this time. More precise direct
measures for a larger number of individuals would
allow for more data analysis and strategic obesity
prevention approaches.
Obesity
BACKGROUND
While Idaho’s rates of obesity are similar to national
rates, they vary across the state. Idaho’s highest
rates of obesity are in its southwestern public health
districts: 35.8% in District 3 and 29.2% in District 5.
SIGNIFICANCE
Poor health outcomes related to obesity
(hypertension, diabetes, cardiovascular disease,
disability, etc.) are well established.
DISPARITY
Obesity rates are highest among the state’s men,
and people who are unemployed, low-income or have
low levels of education. Compared with the state’s
average for obesity (26.8%), 33.5% of men ages
35-64, 33.4% of the unemployed, and 30.3% of
those with K-11th grade education were obese. On
the other hand, only 22.6% of those earning $75,000
or more a year were obese.
INDICATOR CHARACTERISTICS
Adults ages 18 and older who have a body mass
index >=30 kg/m2 (obese). Data are based on selfreported height and weight. Data are reported
annually for the state and public health districts.
Table 3: Overweight Idaho
adults (%), 2012
Percent
Age
18-34
35-64
65 and older
Ethnicity
Non-Hispanic
Hispanic
Income
Less than $15,000
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 and higher
Education
K-11
12th grade or GED
Some college
College grad
DATA RESOURCES
Idaho Department of Health and Welfare, Behavioral
Risk Factor Surveillance System, (BRFSS)
http://healthandwelfare.idaho.gov/Health/
VitalRecordsand HealthStatistics/HealthStatisitcs/
BehaviorRiskFactorSurveillance System/tabid/913/
Default.aspx
61.8
70.3
61.6
59.3
65.4
68.3
67.3
60.6
64.9
60.9
63.5
61.5
Source: Idaho Department of Health and Welfare, BRFSS
Table 4: State rankings on obesity and health related indicators
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
47.5
69.7
68.1
Idaho
Colorado
Montana
Nevada
Oregon
Utah
Washington
Wyoming
Obesity
2012
Diabetes
2012
Physical
inactivity
2012
Hypertension
2011
32
51
44
34
28
44
32
42
39
46
49
36
22
49
37
34
39
49
37
33
51
50
43
34
37
50
31
25
35
51
31
43
NOTE: Rankings are valued from 1 to 51 with 1 being the
highest percentage of the indicator and 51 the lowest
percentage.
Source: F as in Fat Final Report, 2013
F as in Fat Final Report, 2013
http://www.fasinfat.org/
Measuring What Matters – Idaho Obesity Indicators
17
ADOLESCENT OBESITY
Table 5: Overweight and obese Idaho
INDICATOR
high school students (%), 2013
Overweight and Obesity by Age Group
BACKGROUND
In 2013, 25.3% of Idaho’s high school students are
either overweight (16%) or obese (10%), this is
lower than the 2011 national rate of 28%. In 2011,
13% of Idaho’s students were overweight and 9%
were obese.
SIGNIFICANCE
Overweight
not obese
Obese
15.7
15.4
16.0
9.6
13.0
5.9
Total
Male
Female
Source: CDC, Youth Risk Behavior Surveillance System
Figure 3: Obesity measures in adolescents
(grades 9-12) (%), 2011
15.2
13.4
13.0
Adolescent obesity is associated with hypertension,
abnormal glucose tolerance, and adverse social and
psychological impacts. In the past 40 years, obesity
has tripled among adolescents 12-19.
9.2
Idaho
DISPARITY
Idaho’s Hispanic high school students are almost
twice as likely as white students to be overweight
and over twice as likely to be obese. This difference
between Hispanic and white students and others is
much greater in Idaho than at the national level.
United States
Overweight
Obese
Source: CDC, Youth Risk Behavior Surveillance System
Figure 4: Obesity measures in adolescents
(grades 9-12) by race in Idaho (%), 2011
20.1
INDICATOR CHARACTERISTICS
High school students in grades 9-12 whose BMI is
>= 85th and < 95th percentile (overweight); and high
school students in grades 9-12 whose BMI is >= 95th
percentile (obese). Data are based on self-reported
height and weight. Data are reported bi-annually for
states, major metropolitan areas and the nation.
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Centers for Disease Control and Prevention, Youth
Risk Behavior Surveillance System (YRBSS), Youth
Online
http://nccd.cdc.gov/youthonline/App/Default.aspx
LIMITATIONS OF DATA RESOURCES
YRBSS data are not reported by county or region
due to the sample size. Greater representation is
needed among Idaho schools and regions.
18
16.3
12.2
7.8
White
Hispanic
Overweight
Obese
Source: CDC, Youth Risk Behavior Surveillance System
Table 6: Overweight and obese U.S. high school students (%), 2011
Total
By sex
Female
Male
By race/ethnicity
White
Black
ByHispanic
sex and
race/ethnicity
White
Black
Hispanic
Overweight
Obese
15.2
13.0
15.4
15.1
9.8
16.1
14.2
16.2
17.4
11.5
18.2
14.1
Female
13.8
19.6
18.0
Male
14.7
12.8
16.9
Female
7.7
18.6
8.6
Source: F as in Fat Final Report, 2013
Measuring What Matters – Idaho Obesity Indicators
Male
15.0
17.7
19.2
CHILDHOOD OVERWEIGHT AND OBESITY
INDICATOR
Figure 5: Overweight or obese children
(ages 10-17) (%), 2011-2012
Obesity by Age, Race and Ethnicity
31.3
27.8
BACKGROUND
Idaho youths, ages 10-17, have slightly lower rates
of overweight and obesity than their national peers:
28%, compared to 31%, respectively.
SIGNIFICANCE
Childhood obesity can progress to adult obesity
and presents serious physical, social, and mental
health impacts. In the past 40 years, obesity has
quadrupled among children ages 6-11.
DISPARITY
In Idaho, Hispanic youths have much higher rates of
overweight and obesity than their peers, while black,
non-Hispanic youth have much lower rates.
INDICATOR CHARACTERISTICS
Youths ages 10-17 whose BMI is >= 85th percentile.
Data are based on parent-reported height and
weight. Data have been gathered by the Centers for
Disease Control three times: 2010-12, 2007-08
and 2003-04. Data are reported for states and the
nation.
Idaho
United States
Source: National Survey of Children’s Health (NSCH)
Figure 6: Overweight or obese children
(ages 10-17) by race and ethnicity (%), 2007
27.5
Overall
31.6
26.2
26.8
White, Non-Hispanic
37.3
Hispanic
Black, Non-Hispanic
7.0
Idaho
41.0
41.1
United States
Source: National Survey of Children’s Health (NSCH)
LIMITATIONS OF THE INDICATOR
Data are reported by parent/guardians, which
introduces potential information bias and error in
estimation.
DATA RESOURCES
National Survey of Children’s Health (NSCH)
http://childhealthdata.org/browse/survey/
results?q=2415&r=14&r2=1
http://childhealthdata.org/browse/snapshots/
nsch-profiles/race-ethnicity?geo=14&i
nd=654,651,655,685
LIMITATIONS OF DATA RESOURCES
NSCH provides the only data overweight and
obesity for children under 17 in Idaho. Data are only
reported statewide, no regional data are available.
Direct measures of height and weight would provide
more valid results and more localized data are
needed.
Measuring What Matters – Idaho Obesity Indicators
19
BMI OF IDAHO 3RD GRADERS 2011-2012 SCHOOL
YEAR
Map 4: Overweight 3rd graders by Public Health District,
2011-2012
INDICATOR
3rd Grade Overweight and Obesity
BACKGROUND
Obesity rates among Idaho’s 3rd graders are highest
in Districts 3 (22%) and 6 (18%), and lower in
district 4 (10%). Overall, 29.7% of Idaho 3rd graders
are overweight (includes obesity).
SIGNIFICANCE
The Idaho 3rd grade BMI study measured height and
weight directly. The first data collection took place
in 2007-2008. These are the only direct BMI data
currently available in the state.
DISPARITY
Variation was seen among Public Health Districts
but neither race/ethnicity nor socio-economic status
were collected. These data do not elucidate BMI
disparities.
Source: Idaho Department of Health and Welfare
INDICATOR CHARACTERISTICS
3rd graders whose BMI is >= 95th percentile.
Students’ height and weight were measured by
a trained health professional. Data have been
collected one time only and are reported for the
state and its public health districts.
Map 5: Obesity in 3rd graders by Public Health District,
2011-2012
LIMITATIONS OF THE INDICATOR
These data have confidence intervals that are quite
large. The range is large since the estimate is for a
small population and therefore not too precise.
DATA RESOURCES
Idaho Department of Health and Welfare
http://www.healthandwelfare.idaho.gov/Portals/0/
Health/IPAN/BMI_report.pdf
LIMITATIONS OF DATA RESOURCES
The primary limitation is that the data obtain only
3rd grade BMI and do not report BMI by income
or race/ethnicity. Ongoing collection at a regular
interval is needed to determine overweight and
obesity trends.
Source: Idaho Department of Health and Welfare
20
Measuring What Matters – Idaho Obesity Indicators
BMI OF LOW-INCOME PRESCHOOLERS
DATA RESOURCES
INDICATOR
U.S. Department of Health and Human Services,
Office of Head Start, Head Start Enterprise System
http://hses.ohs.acf.hhs.gov/pir/reports
Overweight Low-Income Preschoolers
BACKGROUND
In both Idaho and the U.S., 28% of Head Start
preschoolers ages 3-5 are overweight or obese.
However, Idaho preschoolers are slightly more likely
to be overweight than obese.
SIGNIFICANCE
A healthy weight at an early age is a predictor of
healthy adult weight and fewer obesity-related
complications.
DISPARITY
At the national level, there are several disparities
among low-income preschoolers. Native American
and Hispanic preschoolers are more likely to be
overweight or obese, while Asian and Pacific Islander
preschoolers are less likely.
INDICATOR CHARACTERISTICS
Preschoolers in Head Start. Height and weight are
measured by health professional and/or program
staff. Data are available by special request and are
reported annually at various levels: national, state,
region, program and grant.
Preschoolers in federal assistance programs
including the Special Supplemental Nutrition
Program for Women, Infants and Children (WIC),
the Early and Periodic Screening, Diagnosis and
Treatment (EPSDT) program, and the Title V
Maternal and Child Health Progrhham.
(PedNSS) Height and weight are measured by
trained health professionals at public health clinics.
Data are available annually, but data collection was
discontinued in 2012. Data are readily available at
the national level, and at other levels upon request.
LIMITATIONS OF THE INDICATOR
Only measures preschoolers in Head Start. Data
are not consistently collected by professional staff
using professional grade scales and stadiometers/
recumbent measuring boards.
CDC, Pediatric Nutrition Surveillance Service
(PedNSS) http://www.cdc.gov/pednss/pednss_
tables/pdf/national_table16.pdf
LIMITATIONS OF DATA RESOURCES
Head Start program data are submitted to the
Federal program level and are not reported and
tracked for state use. The discontinuation of
PedNSS data presents an important data gap.
Table 7: Idaho Migrant and Seasonal
Head Start (ages 3-5), 2012-2013
Number
Percent
16
291
74
87
3.4
62.2
15.8
18.6
Underweight
Healthy weight
Overweight
Obese
Source: Office of Head Start, Head Start Enterprise
System
Figure 7: BMI of Head Start preschoolers
(ages 3-5) (%), 2012-2013
15.1
15.0
13.1
13.0
Idaho
United States
Overweight
Obese
Source: Office of Head Start, Head Start Enterprise
System
Figure 8: U.S. pediatric nutrition surveillance
(ages 24-59 months), 2011
White, Not Hispanic
15.6
12.1
Black, Not Hispanic
11.5
14.1
17.2
17.5
Hispanic
20.1
20.8
American Indian/Alaska Native
Asian/Pacific Islander
11.3
Overweight
13.5
Obese
Source: CDC, PedNSS
Measuring What Matters – Idaho Obesity Indicators
21
PRENATAL WEIGHT STATUS AND PRENATAL
WEIGHT GAIN
INDICATOR
Prepregnant Obesity and Prenatal Weight Gain
BACKGROUND
In 2011, 46.5% of Idaho’s new mothers were
overweight or obese prior to pregnancy. Rates vary
significantly across the state, from a low of 42.1% in
District 4 to a high of 53.6% in District 3.
SIGNIFICANCE
LIMITATIONS OF DATA RESOURCES
BMI generated from self-reported data are generally
lower than technician obtained data. Vital Statistics
does not link natality data with health risk behaviors
as does the Pregnancy Risk Assessment Tracking
System (PRATS). PRATS is not a continuous survey.
The Pregnancy Nutrition Surveillance System
tracking low-income women pregnant women (PNSS)
is discontinued.
Figure 9: Prepregnancy BMI measures,
Idaho, 2011
Women entering pregnancy overweight and obese
have increased risks for gestational diabetes,
excessive prenatal weight gain and postpartum
weight retention.
DISPARITY
Mothers who are more likely to be obese prior to
pregnancy include those who are Hispanic, American
Indian/Alaska Native, not married, and/or have low
levels of education.
INDICATOR CHARACTERISTICS
Mothers age 18 or older at the time of delivery who
had a live birth in-state and had a BMI >= 30 prior to
becoming pregnant. Data come from supplemental
questions asked when data are gathered for the
state’s Vital Statistics program. Data are selfreported. Data are reported annually for the
counties and state.
Total
24.8
21.7
White
24.6
21.3
Black
33.0
20.2
28.8
27.2
Hispanic
31.0
American Indian/Alaska Native
Overweight
38.5
Obese
Source: Idaho Vital Statistics
Table 8: Maternal health indicators (%), 2010
Idaho
United States
Overweight
53.9
53.4
< Ideal weight gain
17.4
21.5
> Ideal weight gain
50.2
48.0
Source: CDC, Pregnancy Nutrition Surveillance System
Map 6: Prepregnant obesity, 2011
LIMITATIONS OF THE INDICATOR
Data come from Idaho birth certificates, which are
based on the 2003 U.S. Standard Certificate of Live
Birth. Data are reported annually for counties, public
health districts and Idaho State. Prepregnant weight
and prenatal weight gain is self-reported.
DATA RESOURCES
Idaho Department of Health and Welfare, Idaho
Vital Statistics, Bureau of Vital Records and Health
Statistics http://healthandwelfare.idaho.gov/
Portals/0/Health/Statistics/Natality.pdf
CDC, Pregnancy Nutrition Surveillance System
(PNSS) http://www.cdc.gov/pednss/pdfs/2010PNSS-Summary-Report.pdf
Source: Idaho Vital Statistics
22
Measuring What Matters – Idaho Obesity Indicators
OVERARCHING OBESITY DATA SUMMARY
STRENGTHS OF THE DATA
OPPORTUNITIES TO FILL DATA GAPS
• National (BRFSS, YRBSS, NSCH) and state data
resources provide ongoing surveillance.
• Develop a statewide surveillance system of
preK-12th grade BMI.
• All Head Start agencies collect BMI using direct
collection methods.
• Build new opportunities with Medicaid and
insurance plan to collect, track and report direct
measures of BMI.
• Idaho Department of Health and Welfare collects
3rd grade with direct collection methods.
OPPORTUNITIES TO EXPAND DATA
• Increase present data sample size for greater
specificity.
• Expand direct BMI measures to a greater age
range of the school population.
• Collect and report on BMI measures currently
collected by Idaho schools.
• Collect and report Head Start data by state and
region.
• Track infant birth weight, prepregnant weight and
prenatal weight gain as obesity indicators.
• Build new collection systems for BMI such as
driver’s licenses, employee health programs,
hospitals, Medicaid and CHIP.
• Improve systems to collect data from population
groups most at risk of obesity.
• Build capacity of schools, preschools, worksites
and medical practices to collect accurate and
reliable data and create systems for storing and
retrieving data indicators.
• Develop a system to gather county-level prenatal
weight and weight gain data linked to health
behaviors and health outcomes like diabetes,
hypertension, cesarean section, etc.
• Create systems to track and report WIC
participant BMI.
White House Task Force on Childhood Obesity Report to the President. (2010). Solving the Problem of Childhood Obesity Within a Generation. Retrieved from
http://www.letsmove.gov/white-house-task-force-childhood-obesity-report-president
4
Ogden CL, Carroll MD, Kit BK, Flegal KM. (2014). Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.
doi:10.1001/jama.2014.732. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1832542
5
Centers for Disease Control and Prevention . (2012). Defining Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/adult/defining.html
6
7
Centers for Disease Control and Prevention (2012). Basics About Childhood Obesity. Retrieved from http://www.cdc.gov/obesity/childhood/basics.html
McAdams, M. A., Van Dam, R. M. and Hu, F. B. (2007). Comparison of Self-reported and Measured BMI as Correlates of Disease Markers in U.S. Adults. Obesity, 15(1):
188-96. doi: 10.1038/oby.2007.504
8
9
Walters, M. R. and Taylor, J. S. (2009). Maternal Obesity. Nursing for Women’s Health, 13(6): 486–495. doi: 10.1111/j.1751-486X.2009.01483.x
Idaho Vital Statistics, Bureau of Records and Health Statistics. (2011). Natality. Retrieved from http://www.healthandwelfare.idaho.gov/Portals/0/Health/
Statistics/Natality.pdf
10
Dalenius K, Brindley P, Smith B, Reinold C, Grummer-Strawn L. (2012). Pregnancy Nutrition Surveillance 2010 Report. Atlanta: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/pednss/pdfs/2010-PNSS-Summary-Report-Text%20File.pdf
11
Idaho Department of Health and Welfare. (2010). Idaho’s Pregnancy Risk Assessment Tracking System (PRATS). Retrieved from http://www.healthandwelfare.
idaho.gov/Health/VitalRecordsandHealthStatistics/HealthStatistics/PregnancyRiskAssessmentTrackingSystem/tabid/915/Default.aspx
12
Measuring What Matters – Idaho Obesity Indicators
23
PHYSICAL ACTIVITY
ENVIRONMENT
KEY FINDINGS
• Physical activity measures are limited to self-reported surveys reported
regionally for adults and statewide for high school students.
• Walking and biking measures are limited to census data reporting travel
to work mode.
• No statewide measures describe physical activity environments.
• Only school-based physical activity policies are available.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
25
IMPORTANCE OF PHYSICAL ACTIVITY
The central role of physical activity to health and
obesity prevention is widely accepted. The first
Surgeon General’s report on physical activity and
health was released in 1996.13 Since that time,
numerous reports have been released supporting
the important role physical activity plays in
academic performance, mental and cognitive health,
decreasing disability, improving quality of life and
preventing cardiovascular diseases, type 2 diabetes
and metabolic syndrome, and others.
The Office of Disease Prevention and Health
Promotion (ODPHP) within the U.S. Department of
Health Services (HHS) led the development of the
first Physical Activity Guidelines (PAG) in 2008.14
In 2010, a public-private sector collaborative
developed the National Physical Activity Plan
(NPAP) with the aim to create a national culture
supportive of physically active lifestyles to
improve health, prevent disease and disability,
and to enhance quality of life in order to increase
physical activity in all segments of the American
population. HHS developed the PAG Midcourse
Report Strategies to Increase Physical Activity
Among Youth in 2013 summarizing evidencebased intervention strategies to increase physical
activity.15
The Report Card Research Advisory Committee, a
subcommittee of the National Physical Activity Plan
Alliance (The Alliance), developed the 2014 United
States Report Card on Physical Activity for Children
and Youth to, “assess levels of physical activity
and sedentary behaviors in American children and
youth, facilitators and barriers for physical activity,
and related health outcomes.”16 The Report Card
is mentioned here as an additional resource for
physical activity indicators for both out-of-school
and in-school environments.
PHYSICAL ACTIVITY MEASURES
ADULT MEASURES
The 2008 Physical Activity Guidelines for Americans
recommend that all adults, including those with
disabilities, receive a minimum of 150 minutes
of moderate intensity aerobic activity per week.
26
Direct measures to obtain these data are only
available on a national level through the National
Health and Nutrition Examination Survey (NHANES).
Idaho, like most states, relies on self-reports
through phone survey methods to determine adult
physical activity levels. Idaho adult physical activity
indicators slightly exceed U.S. rates (Figure 10).
Following national trends, higher income Idahoans
were more likely to reach the target of 150 minutes
of physical activity in the past week (65.1 % for
incomes above $50,000 and 48.5 for incomes below
$15,000) (Table 9). Fewer whites than Hispanics met
the target for aerobic and muscle strengthening
exercise (21.7% vs. 27.7%) and those with higher
incomes were almost two times more likely to reach
this exercise target (27.5% vs. 14.4%) (Table 10).
There are no state data readily available for physical
activity levels among adults with disabilities, an
important subgroup that is found to have low levels
of physical activity and increased rates of obesity
and chronic disease. 17
The Behavioral Risk Factor Surveillance Survey
(BRFSS) measures adult participation in leisuretime
physical activity in the past month. Idahoans who
are 65 and older, Hispanic and/or low-income report
lack of leisure time activity most often. College
graduates are nearly four times more likely to have
leisure time activity than those with less than a 12th
grade education (Table 11). Southwestern Idaho
adults (District 3) reported the highest levels of no
leisure time activity (26.0%) compared to adults in
North Central Idaho (District 2) at 19.5% (Map 7).
ACTIVE TRANSPORTATION
There are limited measures for adult active travel
outside of the American Community Survey data on
walking or biking to work. Rates of walking (3.2%)
and biking (1.2%) to work vary across the state (Map
8). Latah County has the greatest number of people
actively commuting to work. The League of American
Bicyclists developed a ranking system, The Bicycle
Friendly StateSM (BFSSM), based on a scoring criteria
including: legislation and enforcement, policies and
programs, infrastructure and funding, education and
encouragement, and evaluation and planning.18 Each
state’s Bicycle Coordinator completes the BFSSM
questionnaire. In 2014, Idaho ranked 20th with a
Measuring What Matters – Idaho Obesity Indicators
score of 41.1 of 100 (an improvement from 34.5
of 100 in 2013). See http://bikeleague.org/sites/
default/files/BFS2014_Idaho.pdf for specific Idaho
ranking.
National data on modes of travel to school are
available from the National Household Travel
Survey (NHTS) and generalized data from the
National Center for Safe Routes to School program
(NCSRTS)19; statewide data are not available. Child
and youth biking and walking to school (travel
behavior) data are not routinely collected on the
school or district level. Safe Routes to School
programs are requested to collect travel behavior
data and school site data are generated by NCSRTS.
States are no longer funded to support a SRTS
program manager.
ADOLESCENT AND CHILD PHYSICAL ACTIVITY
The 2008 Physical Activity Guidelines for Americans
recommend at least 60 minutes of moderate to
vigorous physical activity per day for children and
youths ages 6-15. Two data sources provide needed
data for adolescent and child physical activity
behaviors; the National Survey of Children’s Health
(NSCH) and the Youth Risk Behavior Surveillance
Survey (YRBSS). NSCH is a telephone survey that
provides data on health and physical activity for
children ages 0-17 by state.20 The 2011-2012
NSCH survey reported that 82.7% of children
age 6-17 participated in activities outside of
school (Figure 11) and most neighborhoods were
safe and supportive (Figure 12) with amenities
supporting physical activity (Figure 13). The NSCH
2007 Childhood Obesity Report Card21 reported
that 65.1% of children participated in 4 or more
days of vigorous activity per week. NSCH did not
report on the physical activity level of children with
disabilities.
Adolescent physical activity data rely on self-reports
by 9-12th graders. In 2013, 55.9% of Idaho students
reported they were physically active for at least 60
minutes per day on five or more days of the past
seven days. Male students (66%) were significantly
more active than female students (45%) and
significantly more likely to be active for 60 minutes
on all seven days (38% vs. 17%) (Table 12).
Measuring What Matters – Idaho Obesity Indicators
OUT-OF-SCHOOL ACTIVITY
Organized sports can contribute significantly
toward meeting physical activity recommendations.
2013 YRBSS reported that 61% of Idaho 9-12th
grade students played on one or more sports teams
and watched less television than U.S. counterparts;
21.7% vs. 32.4% watched more than three hours
of TV per day (Figure 14). Hispanic students were
significantly less likely to play on a sports team
(55%) than white students (62%). Fewer Idaho
children get vigorous physical activity every day
than U.S. children overall (25.0% vs. 29.9%). Black
and Hispanic children were least likely to receive
daily vigorous activity (Figure 15).
SEDENTARY BEHAVIOR
The evidence for sedentary behavior as an important
chronic disease risk factor is mounting. There are no
national guidelines to limit sedentary behavior. The
most commonly used proxy measure for sedentary
behavior is television viewing and/or screen time
(video games, computer time). The National Heart,
Lung, and Blood Institute and the American Academy
of Pediatrics (AAP) recommend children limit nonschool related screen time (includes television and
computers) to 2 hours or less per day.22
Television viewing and/or screen time questions are
included in both NSCH and Youth Risk YRBSS and
findings are reported statewide. No local or regional
data are available and distinctions are not easily
made between leisure time sedentary behavior (TV
time) and productive time (school computer use).
2007 NSCH reported that 12% of children ages
1-5 and 8.1% of children ages 6-17 engage in 4 or
more hours of screen time per weekday (Figure 16).
Among Idaho high school students, 20% reported
watching 3 or more hours of TV and 28% reported
using computers for something other than school
work 3 or more hours per day. Hispanic students
reported more TV watching than white students.
NSCH also reports on television in children’s
bedrooms as an important sedentary behavior
indicator.
27
BUILT ENVIRONMENTS SUPPORTIVE OF PHYSICAL
ACTIVITY
The Task Force on Community Preventive Services
recommends, “creating or enhancing access
to places for physical activity combined with
informational outreach activities” as a strategy
for creating more active neighborhoods and
communities.23 The School Health Policies and
Practices Study (SHPSS) reports that 81.1%
of schools have joint use agreements to extend
their facility use. Recreation outlets per 100,000
population are measured by County Business
Patterns (CBP) Idaho has 10/100,000 and the U.S.
Census Bureau reports Idaho has 9.3 fitness and
recreation centers per 100,000 (Figure 17). There
are no available data or criteria for park conditions,
programs or other park characteristics. Park and
playground disparities generally exist by ethnicity
and socio-economic status; these data are not
currently available in Idaho and the potential to use
Geographic Information Systems (GIS) to depict
data spatially is great.
POLICY SUPPORTING PHYSICAL ACTIVITY
The NSCH 2007 Obesity Report Card provides some
physical activity policy comparisons. Idaho does
not have a state Complete Streets Policy (9 states
do), although some local governments have passed
such policies. State childcare center licensing and
afterschool programs do not require vigorous
to moderate activity or any physical activity (8
states do) (Table 13). New voluntary guidelines for
childcare physical activity are under development
and discussion is in process to recommend physical
activity standards for afterschool programs. Schoolbased physical activity and physical education policy
is discussed under the School Environment.
There is a great potential for further geospatial
analysis to better understand links between socioeconomic factors, greenspace, connectivity, parks,
etc. These are key metrics for better understanding
the built environment supportive of physical
activity. The Treasure Valley’s Urban Tree Canopy
Assessment completed in May 2013 can contribute
data of value to support better understanding of
this topic and inform future community planning
decisions in southwest Idaho. Existing data and
collaborative support for further research in the
arena of building healthy communities are available
through the Treasure Valley Canopy Network http://
www.tvcanopy.net.
28
Measuring What Matters – Idaho Obesity Indicators
KEY INDICATORS FOR PHYSICAL ACTIVITY ENVIRONMENT
Measuring What Matters – Idaho Obesity Indicators
29
PHYSICAL ACTIVITY AMONG IDAHO ADULTS
INDICATOR
Physical Activity
BACKGROUND
Idaho adults are slightly more active than their
national peers. While they are more likely to
participate in physical activity and do muscle
strengthening exercises, only one-fifth get enough
aerobic and muscle strengthening exercise to meet
guidelines.
SIGNIFICANCE
Adults are recommended to engage in hat least 150
minutes of moderate-intensity physical activity and
two hours of muscle strengthening activity per week.
DISPARITY
In both Idaho and the U.S., Hispanics and people
with lower incomes are less likely to get at least
150 minutes of exercise per week. However, Idaho’s
Hispanic adults are more likely than white adults to
report aerobic and muscle strengthening exercise:
28% for Hispanics, compared to 22% for whites.
INDICATOR CHARACTERISTICS
Adults ages 18 and older. Data are self-reported.
Data are reported annually for the state and nation.
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Centers for Disease Control and Prevention,
Behavioral Risk Factor Surveillance System (BRFSS)
Prevalence and Trends Data
Source: CDC, BRFSS
Table 9: Adults meeting 150+ minutes of
physical activity in the past week (%), 2011
Idaho
United States
White 57.9
54.1
Hispanic 48.4
44.6
Ethnicity
Income
< $15,000 48.5
43.3
$15,000 - $24,999 50.5
45.0
$25,000 - $34,999 59.6
47.7
$35,000 - $49,999 54.1
51.7
> $50,000 65.1
58.6
Source: CDC, BRFSS
Table 10: Adults meeting aerobic
and muscle strengthening
guidelines (%), 2011
Idaho
United
States
White 21.7
21.0
Hispanic 27.7
18.9
< $15,000 14.4
15.3
$15,000 - $24,999 15.2
15.4
$25,000 - $34,999 25.8
17.9
$35,000 - $49,999 22.0
19.4
> $50,000 27.5
25.0
Ethnicity
Income
Source: CDC, BRFSS
http://www.cdc.gov/brfss/index.htm and http://
apps.nccd.cdc.gov/brfss/
LIMITATIONS OF DATA RESOURCES
The BRFSS is conducted annually using land lines
and in 2012 added cell phones. Current data are
not comparable to data prior to 2012. Currently the
data are reported by health region and metropolitan
areas.
30
Measuring What Matters – Idaho Obesity Indicators
ADULT LEISURE TIME PHYSICAL ACTIVITY
Table 11: Idaho adults
INDICATOR
with no leisure time
Leisure Time Physical Activity
physical activity (%), 2011
Percent
BACKGROUND
Adults in southwestern Idaho are much less likely
than other Idaho adults to participate in leisure time
physical activity. Rates range from 19.5% in District
2 to 26.0% in District 3.
SIGNIFICANCE
Having no leisure time physical activity is a proxy
measure for sedentary behavior, a risk factor for
chronic disease and poor overall health.
DISPARITY
Adults who are less likely to participate in leisure
time physical activity include older adults and adults
who are Hispanic, unemployed, and/or have lower
levels of income and education.
INDICATOR CHARACTERISTICS
Adults ages 18 and older. Data are self-reported.
Data are reported annually for the state and public
health districts.
Age
18-34
17.7
35-64
20.3
65 and older
31.7
Ethnicity
Non-Hispanic
20.4
Hispanic
31.5
Income
Less than $15,000
29.6
$15,000 - $24,999
28.9
$25,000 - $34,999
21.2
$35,000 - $49,999
24.4
$50,000 - $74,999
14.8
$75,000 and higher
10.1
Education
K-11
42.7
12th grade or GED
24.2
Some college
18.3
College grad
11.0
Source: Idaho Department of Health and Welfare, BRFSS
Map 7: Idaho adults with no leisure time physical activity by
Public Health District, 2011
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Idaho Department of Health and Welfare, Behavioral
Risk Factor Surveillance System, (BRFSS)
http://healthandwelfare.idaho.gov/Health/
VitalRecordsandHealthStatistics/HealthStatisitcs/
BehaviorRiskFactorSurveillanceSystem/tabid/913/
Default.aspx
LIMITATIONS OF DATA RESOURCES
The BRFSS is conducted annually using land lines
and in 2012 added cell phones. Current data are
not comparable to data prior to 2012. Currently the
data are reported by health region and metropolitan
areas.
Source: Idaho Department of Health and Welfare, BRFSS
Measuring What Matters – Idaho Obesity Indicators
31
WALKING AND BIKING TO WORK IN IDAHO
INDICATOR
Method of Transport to Work
BACKGROUND
Many people get their exercise by walking or biking
to work. Counties with the highest rates of workers
who walk to work include Latah (3.4%), Madison
(3.2%) and Blaine (2.5%). Counties with the highest
rates of workers who bike to work include Latah
(13.6%), Madison (12.6%), Camas (11.5%) and
Idaho County (11.3%). Idaho has one of the nation’s
highest rates of workers bicycling to work, with only
seven states having higher rates in 2012.
population’s characteristics and replaces the Census
Bureau’s decennial census long form. Especially
in the case of small populations (like Idaho’s rural
counties), ACS data are subject to sampling error,
which occurs as a result of selecting a sample rather
than surveying the entire population.
Map 8: Population walking and biking to work by county,
2008-2012
SIGNIFICANCE
Walking and biking to work is an indicator of physical
activity and also for built environments favorable to
physical activity.
DISPARITY
No data are available.
INDICATOR CHARACTERISTICS
Workers ages 16 and older. Data are reported
annually. Single-year estimates are available
for places with population >= 65,000; three-year
estimates are available for places with population >=
20,000; and five-year estimates are available for all
geographies.
LIMITATIONS OF THE INDICATOR
Walking and biking to work rates are low nationwide
and the indicator does not capture needed data on
the quality of the infrastructure to support walking
and biking. However, upwards trends in walking and
biking reflect increased efforts to improve active
travel.
DATA RESOURCES
U.S. Bureau of the Census, American Community
Survey (ACS)
http://factfinder2.census.gov
Source: U.S. Bureau of the Census, American Community
Survey
LIMITATIONS OF DATA RESOURCES
The ACS is an ongoing survey sent to a sample of
the U.S. population. It provides estimates of the
32
Measuring What Matters – Idaho Obesity Indicators
PHYSICAL ACTIVITY OUTSIDE OF SCHOOL
INDICATOR
http://childhealthdata.org/browse/survey/
results?q=2526&r=14&r2=1
Physical Activity Outside of School
LIMITATIONS OF DATA RESOURCES
BACKGROUND
Data are only reported on a state level, no local or
regional measures exist.
Idaho’s children are more likely than their national
peers to live in safe and supportive neighborhoods,
and more than half live in neighborhoods that have
parks, recreation centers, sidewalks and libraries.
About 8% live in neighborhoods with only one or
none of these amenities. Idaho’s children are slightly
more likely than their national peers to participate in
at least one organized activity outside of school.
Figure 11: Children (ages 6-17) participating
in organized activities outside of school (%),
2011-12
82.7
80.3
SIGNIFICANCE
Participation in physical activity outside of
school time increases the likelihood that students
obtain 60 minutes of physical activity per day.
Environments that are safe and have physical
activity supportive amenities are seen to increase
physical activity.
DISPARITY
Children who live in neighborhoods that are less
safe, less supportive and have fewer amenities,
and children who are less likely to participate in
activities outside of school are more likely to be
Hispanic, have parents with less than a high school
education, live in poverty and lack health insurance.
Idaho
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
National Survey of Children’s Health 2011-2012
(NSCH)
United States
Participate in 1 or more
Do not participate
Source: National Survey of Children’s Health
Figure 12: Safe and supporting neighborhoods
for children (%), 2011-2012
88.1
Children living in supportive
neighborhoods
82.1
94.7
Children living in neighborhoods that are
usually or always safe
Idaho
INDICATOR CHARACTERISTICS
Children ages 6-17 and ages 0-17. Data are based on
parents’ responses to a telephone survey. Data have
been gathered by the Centers for Disease Control
three times: 2010-12, 2007-08 and 2003-04. Data
are reported for states and the nation.
19.2
17.3
86.6
United States
Source: National Survey of Children’s Health
Figure 13: Children who live in neighborhoods
that contain parks, recreation centers, sidewalks
or libraries (%), 2011-2012
all 4 amenities
24.3
24.0
3 amenities
2 amenities
1 amenity
No amenities
4.7
6.1
3.1
3.7
55.8
54.1
12.2
12.0
Idaho
United States
Source: National Survey of Children’s Health
http://www.childhealthdata.org/browse/snapshots/
nsch-profiles?rpt=16&geo=14
Measuring What Matters – Idaho Obesity Indicators
33
ADOLESCENT PHYSICAL ACTIVITY IN IDAHO
DATA RESOURCES
INDICATOR
Centers for Disease Control and Prevention, Youth
Risk Behavior Surveillance System (YRBSS), Youth
Online
Adolescent Physical Activity by Age and Ethnicity
BACKGROUND
Almost 60% of Idaho’s high school students play on
a sports team. Idaho’s high school students are much
less likely than their national peers to watch more
than three hours of television per day (22% in Idaho,
compared to 32% nationally).
Among children ages 6-17, Idaho’s children are
less likely to participate in daily vigorous physical
activity (25% in Idaho, compared to 30% nationally),
and less likely to watch more than four hours of
television per day (8% in Idaho, compared to 11%
nationally).
http://nccd.cdc.gov/youthonline/App/Default.aspx
National Survey of Children’s Health (NSCH)
http://childhealthdata.org/browse/snapshots/
nsch-profiles/race-ethnicity?geo=14&i
nd=654,651,655,685
LIMITATIONS OF DATA RESOURCES
Data are only reported on a state level, no local or
regional measures exist.
Table 12: Physical activity behaviors (grades 9-12)
in Idaho (%), 2013
SIGNIFICANCE
Currently Idaho has no time duration guidelines for
physical activity for children attending elementary,
middle or high school. The national recommendation
is that children receive 150 minutes per week or 30
minutes per day of structured activity in schools.
DISPARITY
Among Idaho’s children ages 6-17, black nonHispanics are much less likely to participate in daily
vigorous activity (13% among black non-Hispanics,
compared to 25% for all Idaho children).
Total
Male
Female
Physically active for 60+
minutes/day for 5+ days in
the past week
55.9
66.4
44.9
Watched 3+ hours/day of TV
on an average school day
19.6
20.9
18.3
Source: CDC, Youth Risk Behavior Surveillance System
Figure 14: Sport teams and TV viewing
(grades 9-12) (%), 2011
59.3
58.4
INDICATOR CHARACTERISTICS
CDC, YRBSS: High school students in grades 9-12.
Data are self-reported. Data are reported biannually for states, major metropolitan areas and
the nation.
NSCH: Children ages 6-17. Data are based on
parents’ responses to a telephone survey. The survey
has been conducted by the Centers for Disease
Control three times: 2010-12, 2007-08 and 200304. Data are reported for states and the nation.
32.4
21.7
Play on sports teams
Watch > 3 hrs TV per day
Idaho
United States
Source: CDC, Youth Risk Behavior Surveillance System
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation. The
confidence intervals in the NSCH are quite large for
smaller populations.
34
Measuring What Matters – Idaho Obesity Indicators
Figure 15: Daily vigorous activity in past week
(children ages 6-17) (%), 2007
25.0
Overall
Figure 16: Four or more hours daily screen time
(ages 6-17) (%), 2007
29.9
24.2
White, Non-Hispanic
22.3
Hispanic
Idaho
8.1
White, Non-Hispanic
8.0
8.2
10.8
25.1
13.0
Black, Non-Hispanic
31.1
Overall
31.2
10.9
10.3
Hispanic
United States
Idaho
United States
Source: National Survey of Children’s Health
Source: National Survey of Children’s Health
FITNESS AND RECREATION CENTERS IN IDAHO
LIMITATIONS OF DATA RESOURCES
INDICATOR
The data resource does not prohvide needed
specificity to determine access disparities and
requires additional skills to map the data to census
tracks, poverty, etc.
Fitness and Recreation Centers
BACKGROUND
In Idaho, there are 9.3 recreation centers per
100,000 people, nearly identical to the national
number of 9.5 per 100,000.
Figure 17: Fitness and recreation centers per
100,000 population, 2011
9.5
9.3
SIGNIFICANCE
Access to safe and affordable fitness and recreation
centers is associated with greater participation in
physical activity.
DISPARITY
No data available.
INDICATOR CHARACTERISTICS
Business establishments with paid employees.
Business establishments are categorized based on
NAICS industry codes. Data are reported annually at
the national, state, county, metropolitan area and zip
code levels.
LIMITATIONS OF THE INDICATOR
The indicator does not distinguish between private
and public facilities, urban or rural access or other
demographic features.
DATA RESOURCES
U.S. Census Bureau, County Business Patterns, 2011
Idaho
United States
Source: U.S. Census Bureau, County Business Patterns
Table 13: Child care center licensing regulations, 2008
Idaho
National
NO
29 states
NO
2 states
Have policy prohibiting or limiting
foods or low nutritional value
NO
12 states
Have policy on vending machines
NO
4 states
Require vigorous or moderate
physical activity
NO
8 states
Meals and snacks should follow
meal requirements
Meal and snacks should be
consistent with Dietary Guidelines
for Americans
Source: National Initiative on Children’s Healthcare Quality
(NICHQ)
http://censtats.census.gov/cgi-bin/cbpnaic/cbpdetl.pl
Measuring What Matters – Idaho Obesity Indicators
35
OVERARCHING PHYSICAL ACTIVITY DATA SUMMARY
DATA STRENGTHS
• Federally supported adult, youths and children
physical activity behavior surveys report
comparable data at consistent intervals.
• League of American Bicyclists conducts reports
on state bicycle travel capacity and policy.
• NCSRTS provides an easy to use travel behavior
data tracking system; some Idaho SRTS
programs have collected data over several years.
• Newly developed physical activity guidelines
for the Idaho STARS program provide a useful
indicator of physical activity policy and practice.
OPPORTUNITIES TO EXTEND DATA
• Ability to add additional physical activity
questions to BRFSS and YRBSS survey
instruments.
• Gather data on the physical activity of adults and
children with disabilities.
• Expand YRBSS and SHPSS survey sample size to
allow for regional data reporting.
• Expand BRFSS capacity to allow for county-level
data measures.
• Identify common active travel indicators in the
Idaho Transportation Bike and Pedestrian Plan.
DATA GAPS TO FILL
• Collect local or regional physical activity data for
children below the 9th grade.
• Create and track physical activity standards for
childcare and out-of-school time.
• Integrate school travel behavior into school
reporting procedures.
• Establish standardized active travel performance
measures.
• Map and track funding for parks and recreation
infrastructure and programs.
• Create, map and disseminate an inventory of
parks, recreation, fitness and sports facilities to
identify disparities in physical activity access.
• Track physical activity in parks, schools and
recreation settings using validated tools such
as System for Observing Play and Recreation in
Communities and System for Observing Play and
Leisure Activity.
U.S. Department of Health and Human Services. (1996). Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.
13
U.S. Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. Retrieved from http://www.health.gov/paguidelines/
pdf/paguide.pdf
14
Physical Activity Guidelines for Americans Midcourse Report Subcommittee of the President’s Council on Fitness, Sports &Nutrition. (2012). Physical Activity
Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth. Washington, DC: U.S. Department of Health and Human
Services. Retrieved from http://www.health.gov/paguidelines/midcourse/
15
National Physical Activity Plan. (2014). The 2014 United States Report Card on Physical Activity for Children and Youth. Retrieved from http://www.
physicalactivityplan.org/reportcard/NationalReportCard_longform_final%20for%20web.pdf
16
Centers for Disease Control and Prevention. (2014). Inactivity Related to Chronic Disease in Adults with Disabilities. Vital Signs, May 2014. Retrieved from
http://www.cdc.gov/media/releases/2014/p0506-disability-activity.html and http://www.cdc.gov/vitalsigns/disabilities/index.html
17
National Physical Activity Plan. (2014). The 2014 United States Report Card on Physical Activity for Children and Youth. Retrieved from http://www.
physicalactivityplan.org/reportcard/NationalReportCard_longform_final%20for%20web.pdf
18
National Center for Safe Routes to School. (2014). Safe Routes to School Website. Retrieved from http://www.saferoutesinfo.org/
19
Centers for Disease Control and Prevention, National Center for Health Statistics, State and Local Area Integrated Telephone Survey. (2013). 2011-2012
National Survey of Children’s Health Frequently Asked Questions. Retrieved from http://www.cdc.gov/nchs/slaits/nsch.htm
20
Data Resource Center for Child & Adolescent Health. (2007). Idaho State Fact Sheet: Obesity. Retrieved from http://www.childhealthdata.org/docs/nsch-docs/
idaho-pdf.pdf
21
American Academy of Pediatrics Policy Statement. (2011). Children, Adolescents, Obesity, and the Media. Pediatrics: 128(1), 201-208 (doi: 10.1542/peds.20111066). Retrieved from http://pediatrics.aappublications.org/content/128/1/201.full
22
Task Force on Community Preventive Services. (2002). Recommendations to increase physical activity in communities. American Journal of Preventive Medicine,
22(4S), 67-72. Retrieved from http://www.thecommunityguide.org/pa/pa-ajpm-recs.pdf
23
36
Measuring What Matters – Idaho Obesity Indicators
FOOD AND BEVERAGE
ENVIRONMENT
KEY FINDINGS
• Energy intake data are unavailable.
• Nutrient intake data are limited to a few nutrients for adults and youths.
• No state policies exist limiting foods high in sugar or solid fats.
• Childcare facilities have new nutrition recommendations but not requirements.
• Food insecurity and healthy eating access data are available.
• Food and nutrition assistance information is available by county or region.
More data on participant characteristics are needed.
• Idaho food cost and consumption data are not readily available and are needed
to determine access to healthy food.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
37
FOOD AND BEVERAGE ENVIRONMENTS
Establishing healthy eating and maintaining energy
balance early in life is central to maintaining a
healthy body weight. The 2010 Dietary Guidelines
for Americans provide evidence-based nutrition
information and advice for people ages 2 and older
to achieve a healthy body weight.24 Individual food
and beverage choices are shaped by a myriad of
factors, including the availability of food where
people live, work, go to school, and shop. Efforts
to measure and improve healthy eating in Idaho
must consider the flow of foods from agricultural
production, through processing and distribution
channels, to the food that is consumed. This flow
of foods, or the food stream, provides a model
for considering individual food intake influences.
To better understand the barriers and limitations
Idahoans face in making healthy choices, more
information is needed about the food production
(imports and exports), the availability and
affordability of health-enhancing food, and the
processing and manufacturing food environment.
THE FOOD STREAM
Source: Applied Research Program-National Cancer
Institute
GENERAL NUTRITION INDICATORS
The only ongoing collection of dietary intake
in the U.S. is the National Health and Nutrition
Examination Survey (NHANES),25 which measures
dietary intake in conformance to the 2010 Dietary
Guidelines for Americans. NHANES assesses the
health and nutritional status of U.S. adults and
children for an annual national report, but does not
present any data on a statewide basis.
38
Another useful national resource is the Healthy
Eating Index 2010 (HEI-2010). HEI-2010 is a
scoring metric that can be applied to data collected
from a 24-hour recall, a defined menu or a market
basket.26 HEI-2010 measures dietary intake in
conformance with the Dietary Guidelines but it does
not measure energy (calorie) intake. HEI-2010 could
be used to assess changes in diet quality over time,
examine diet cost and food quality relationships,
and to evaluate diets of subpopulations, food
environments, menus, and foods provided through
nutrition assistance programs available in Idaho.
ADULT INDIVIDUAL CONSUMPTION
Accessible information about Idahoan’s dietary
behaviors is limited to survey data collected for
the bi-annual Behavioral Risk Factor Surveillance
Survey (BRFSS) (fruit and vegetable intake) and the
bi-annual Youth Risk Behavior Surveillance System
(YRBSS) (fruit, vegetable and sugar-sweetened
beverage intake). Dietary indicators are limited
and self-reported by phone (BRFSS) and a schoolbased paper survey (YRBSS). Regional BRFSS
information is reported and Hispanic data are
reported statewide. YRBSS is reported statewide
only. Fewer than 20% of Idaho adults consume five
fruit and vegetables per day. Adults eating less
than 5 servings of fruit and vegetables range from
a high of 86.7% in District 2 to a low of 80.5% in
District 6 (Map 7). No district reports consumption
significantly different than the state rate of 82.5%
consuming less than 5 fruit and vegetable servings.
While still far below dietary recommendations
Hispanics (73.7%), women (78.2%) and college
graduates (78.3%) reported eating these foods
more often (Table 14) but they reported consuming
less than 5 fruits and vegetables per day.
ADOLESCENT INDIVIDUAL CONSUMPTION
Idaho youths report eating less fruit, slightly more
vegetables and drinking less soda than U.S. youths
overall (Figure 18). Hispanic Idaho youths reported
eating more fruit but fewer vegetables than white
youth. Rates for drinking more than one soda pop
per day for Idaho white youths (16.9%) and Hispanic
youth (21.4%) were considerably lower than the U.S.
rate of 27.8% (Figure 19).
Measuring What Matters – Idaho Obesity Indicators
OTHER FOOD CONSUMPTION INFORMATION
SOURCES
The University of Idaho Extension is funded by
the United States Department of Agriculture
(USDA) to provide nutrition education through
the Supplemental Nutrition Assistance Program
Education (SNAP-Ed) and the Expanded Food and
Nutrition Education Program (EFNEP). The two
programs are now administered and coordinated
as Eat Smart Idaho. Both programs collect pre- and
post- food behavior survey data to measure program
impacts. These data are not made available for
public consumption.
PRIVATE INDUSTRY
Private businesses track food and eating
consumption patterns. The NDP Group (formerly
National Purchase Diary) is the self-purported
industry authority for in-home and away-from-home
food and beverage consumption and for market
trends such as restaurant caloric intake. NDP Group
produces and sells an annual report, Eating Patterns
in America, which analyzes trends and forecasts
changes in food choices and preparation methods.27
Research methods used by NDP Group (e.g., bar code
surveys, receipt harvestry, web-based interceptions)
could inform efforts to gather more precise
consumption information in Idaho. For example, a
recent article, The Future of Eating,28 discussed the
impact the younger generation and Hispanics will
have on the country’s eating behaviors over the next
5-10 years.
COST AND AVAILABILITY OF HEALTHY FOOD
The cost and consumption of fruit, vegetables and
low-fat milk as collected by the Quarterly Foodsat-Home Price Database (QFAHPD)29 supplies the
national information on availability and cost of
food needed to meet federal dietary guidelines.
These data are not readily available for individual
states and would require additional research and
funding to gain greater insight into the cost and
consumption of healthy food in Idaho. Measures for
fruit, vegetable, legume and whole grain production
are other important and needed indicators.
Measuring What Matters – Idaho Obesity Indicators
FOOD DENSITY AND ACCESS TO HEALTHY FOOD
Strategies to improve food intake simply through
education and encouragement presume that a
variety of acceptable and affordable food is readily
available. For some Idahoans and particularly in rural
communities, access to healthy foods is limited due
to income, distance to grocery stores, and access
to a vehicle. The cost of healthy food and the effort
required to obtain it can contribute to poor dietary
choices and food insecurity. The lack of full-service
stores can also impact participation in USDA food
assistance programs like SNAP and WIC. Census
tract information coupled with two store directories
provide information on access to healthy food. Idaho
has fewer full service grocery stores per 1,000
population than the U.S. (7.0 vs. 9.1) and fewer fast
food options (11.6 vs. 13.2) (Figure 20 and Map 10).
Consistent with national findings, access to healthy
food is more difficult in rural areas and particularly
in low-income areas.30
POVERTY
Understanding the prevalence and geography of
poverty is vital to improving the food and beverage
environment. Idaho’s poverty rate has climbed
each year since 2007. In 2012, 16% of Idahoans
were below the federal poverty threshold. Rates
were lowest in Blaine County (11%) and highest in
Madison County (27%) (Map 11).
FOOD INSECURITY
Although APOP did not include food insecurity as
an obesity prevention indicator, the research links
increased food insecurity with obesity.31 BRFSS
reports on the percent of adults who worry most
or all the time about being able to afford nutritious
meals. Overall, 11.1% of Idahoans worry about
affording food compared to 6.3% in District 2 and
15.7% in District 6 (Map 12). Other food security
data are available from a statewide phone survey
by the USDA Economic Research Service (Figure 21
and Table 15) and from Feeding America, Map the
Meal Gap overall by county (Map 13) and child food
insecurity by county (Map 14). Hispanics (double the
rate for non-Hispanic), children and rural Idahoans
were most food insecure. No food security data are
available for other ethnic/racial groups.
39
PARTICIPATION IN SUPPLEMENTAL FOOD
PROGRAMS
The Supplemental Nutrition Assistance Program
(SNAP) is the nutrition safety net for one out of
six Idahoans. The main purpose of SNAP is, “to
permit low-income households to obtain a more
nutritious diet… by increasing their purchasing
power” (Food and Nutrition Act of 2008). In January
2014, 13.7% of Idahoans received SNAP benefits
with great variation across the state (Map 15). The
percent of SNAP participants in Idaho mirrors U.S.
participation (Figure 22). Idaho’s SNAP participation
rate (of those eligible) (81%) exceeds the U.S.
participation rate of 75%. Idaho does not have
a state SNAP outreach plan. Another important
indicator of healthy food access is availability of
Farmers Markets and redemption of SNAP benefits
(electronic benefit transfer-EBT). There are 48
markets in Idaho and 15 accept SNAP benefits.
Farmers Markets and SNAP benefit processing is
not evenly distributed across the state (Map 16).
The Special Supplemental Nutrition Program for
Women, Infants and Children (WIC) assists lowincome mothers and their children from birth up to
age 5 to have a healthy start through nutritious food,
nutrition education, and breastfeeding education
and support. In 2011, 44.2% of all mothers who
gave birth participated in WIC and participation by
county ranged from a low of 12.5% to 76.5% (Map
17). Recent changes in the WIC food packet provide
healthier food choices, including fresh fruits and
vegetables. Data from 2009 estimated that ~50.7%
of Idahoans eligible for WIC participated compared
to 60.9% nationwide.
40
The WIC Farmers’ Market Nutrition Program
(FMNP) is associated with the WIC program and
provides fresh, unprepared, locally grown fruits
and vegetables to WIC participants, along with
raising awareness of farmers markets.32 Currently
46 states, U.S. territories, and federally recognized
Indian Tribal Organizations provide the WIC FMNP.
Idaho does not currently participate in FMNP or the
Seniors Farmer’s Market Nutrition Program.
FOOD AND BEVERAGE POLICY
The Healthy, Hunger-Free Kids Act of 201033
requires all schools participating in the National
School Lunch Program (NSLP) to develop and
implement school wellness polices. Idaho does not
have laws or policies to restrict food and beverages
or to promote access to clean drinking water
beyond NSLP guidelines. Idaho schools can and do
develop food and beverage policies, but these data
are not currently tracked or reported. There are
no workplace vending restrictions in government
facilities. Childcare food, beverage and meal time
eating behavior guidelines were recently developed
through the Idaho State Training and Registry
(STARS) program to link healthy eating and meal
time environment standards34 with the childcare
Quality Rating Improvement System (QRIS). Cities
and counties have developed food and beverage
standards for licensed childcare facilities. This
information is not tracked currently.
Measuring What Matters – Idaho Obesity Indicators
KEY INDICATORS FOR FOOD AND BEVERAGE ENVIRONMENT
Measuring What Matters – Idaho Obesity Indicators
41
FRUITS AND VEGETABLE CONSUMPTION AMONG
IDAHO ADULTS
Map 9: Adults who do not eat 5 servings of fruits and
vegetables daily by Public Health District, 2011
INDICATOR
Adult Healthy Food Choices
BACKGROUND
Less than 20% of Idaho adults consume at least five
fruits and vegetables on a daily basis. While there
are only slight variations across the state, adults
in District 6 are most likely to get enough fruit and
vegetables in their diet.
SIGNIFICANCE
The 2010 U.S. Dietary Guidelines recommend
an increase in fruit and vegetable intake and
consumption of a variety of vegetables, especially
dark-green and red and orange vegetables and peas
and beans.
DISPARITY
Males, non-Hispanics and individuals with lower
rates of education consumed less fruit and
vegetables.
Source: Idaho Department of Health and Welfare, BRFSS
Table 14: Idaho adults who do not
eat 5 servings of fruits and
vegetables daily (%), 2011
INDICATOR CHARACTERISTICS
Adults age 18 and older. Data are self-reported.
Data are reported annually for the state and public
health districts.
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Idaho Department of Health and Welfare, Behavioral
Risk Factor Surveillance System, (BRFSS)
http://healthandwelfare.idaho.gov/Health/
VitalRecordsandHealthStatistics/HealthStatisitcs/
BehaviorRiskFactorSurveillanceSystem/tabid/913/
Default.aspx
Percent
Total population
82.5
Sex
Male
86.9
Female
78.2
Education
College grad
78.3
Not a college grad
83.7
Ethnicity
Hispanic
73.7
Non-Hispanic
83.4
Source: Idaho Department of Health and Welfare, BRFSS
LIMITATIONS OF DATA RESOURCES
BRFSS includes fruit and vegetables consumption
questions every other year. The data are limited to
District level reporting. No other dietary measures
are reported.
42
Measuring What Matters – Idaho Obesity Indicators
FOOD AND BEVERAGE CONSUMPTION AMONG
IDAHO YOUTH
INDICATOR
Figure 18: Daily food behaviors
(grades 9-12) (%), 2011
71.2
66.0
70.8
71.7
Adolescent Healthy Food Choices
BACKGROUND
Over 70% of Idaho’s high school students eat fruit
and vegetables less than twice daily.
Idaho students drink hless pop than their national
peers: only 18% drink pop more than once daily in
Idaho, compared to 28% nationally.
SIGNIFICANCE
The 2010 Dietary Guidelines recommend persons
5-18 years consume 2 1/2 - 6 1/2 cups of fruit and
vegetables each day depending on age and calorie
requirements. The guidelines recommend reducing
sugar intake.
27.8
17.9
Ate fruit <2x/day
Ate vegetables <2x/day
Idaho
Drank pop >1x/day
United States
Source: CDC, Youth Risk Behavior Surveillance System
(YRBSS)
Figure 19: Daily food behaviors by race in Idaho
(grades 9-12) (%), 2011
72.0
66.4
69.7
76.8
16.9
21.4
DISPARITY
In Idaho, male students and Hispanic students are
more likely to drink pop more than once daily.
INDICATOR CHARACTERISTICS
Ate fruit <2x/day
Ate vegetables <2x/day
White
Drank pop >1x/day
Hispanic
Source: CDC, Youth Risk Behavior Surveillance System
(YRBSS)
High school students in grades 9-12. Data are selfreported. Data are reported bi-annually for states,
major metropolitan areas and the nation.
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Centers for Disease Control and Prevention, Youth
Risk Behavior Surveillance System (YRBSS), Youth
Online
http://nccd.cdc.gov/youthonline/App/Default.aspx
LIMITATIONS OF DATA RESOURCES
YRBSS data are reported only on a statewide basis.
No regional data are reported and no other food and
beverage assessment or surveillance methods are
used statewide.
Measuring What Matters – Idaho Obesity Indicators
43
ACCESS TO FOOD IN IDAHO
INDICATOR
Limited Access to Healthy Food
BACKGROUND
Low store access refers to residents who live more
than 1 mile from a supermarket or large grocery
store in urban areas and more than 10 miles from a
supermarket or large grocery store in rural areas.
Counties in which more than 90% of residents have
low store access include: Boise (90%), Lincoln
(97%), Camas (100%) and Clark (100%). While
these are all very rural counties, the counties with
the lowest percentage of residents with low access
are also rural: Shoshone (4%), Franklin (7%) and
Teton (9%).
At the state level, Idahoans have less access to fullservice grocery stores: 7.0 stores per 1,000 people
in Idaho, compared to 9.1 per 1,000 in the U.S. The
state also has less access to fast food restaurants:
11.6 restaurants per 1,000 in Idaho, compared to
13.2 per 1,000 in the U.S.
SIGNIFICANCE
A lack of grocery stores is associated with reduced
access to fresh fruits and vegetables and less
healthy food intake.
DISPARITY
Access to healthy food is most challenging for
individuals living in rural communities.
Data are reported annually at the national, state,
county, metropolitan area and zip code levels.
LIMITATIONS OF THE INDICATOR
Healthy food access only considers proximity to full
service grocery stores and does not consider small
stores selling healthy affordable food or, farmers
markets, or other access to healthy food.
DATA RESOURCES
U.S. Census Bureau, County Business Patterns
http://censtats.census.gov/cgi-bin/cbpnaic/cbpdetl.pl
USDA, Economic Research Service
http://www.ers.usda.gov/data-products/
food-environment-atlas/data-access-anddocumentation-downloads.aspx
LIMITATIONS OF DATA RESOURCES
There are limited data resources to evaluate the
quality, affordability and acceptability of local food
options in Idaho.
Figure 20: Food store and fast food access, 2011
ERS: Data are a compilation of two store directories
(2010 STARS directory of stores authorized to
accept SNAP and 2010 Trade Dimension TDLinx
directory of stores) and 2010 block level population
data from the U.S. Census of Population and
Housing. The data sites were combined using
geocoding and GIS. Rural and urban status are
based on Census Bureau definitions. To meet the
criteria for a supermarket or large grocery store,
stores had to have at least $2 million in annual sales
and offer all of the major food departments found in
a traditional supermarket (fresh meat and poultry,
dairy, dry and packaged goods, and frozen foods).
CENSUS: Business establishments with paid
employees. Business establishments are
categorized based on NAICS industry codes.
44
9.1
11.6
Limited-service eating places (fast food)
per 1,000 population
Idaho
INDICATOR CHARACTERISTICS
7.0
Full-service grocery stores per 1,000
population
13.2
United States
Source: U.S. Census Bureau, County Business Patterns
Map 10: Idaho counties with low store access, 2010
Source: USDA, Economic Research Service
Measuring What Matters – Idaho Obesity Indicators
POVERTY IN IDAHO
LIMITATIONS OF DATA RESOURCES
INDICATOR
Poverty data are readily available from the U.S.
Census Bureau. Lack of specificity of most health
data in Idaho limits in-depth analysis of the impacts
of poverty on health.
Poverty Rate
BACKGROUND
In 2012, 16% of Idahoans had income below the
federal poverty threshold. The poverty threshold in
2012 was $23,050 for a family of four. Rates were
lowest in Blaine (11%), Caribou (12%) and Camas
(12%) counties, and highest in Canyon (21%), Latah
(22%) and Madison (27%) counties.
Map 11: Poverty in Idaho by county, 2012
SIGNIFICANCE
Poverty is associated with poorer diet quality and
increased obesity.
DISPARITY
Poverty is more prevalent among individuals with
lower education attainment, disability, Hispanics,
American Indian/Alaska Natives and single femaleheaded households.
INDICATOR CHARACTERISTICS
Model-based estimates are calculatedh on a
regression model that predicts the number of people
in poverty. The model uses county-level data from
the Census Bureau’s American Community Survey
as a dependent variable and administrative records
and census data as predictors. Data are available
annually for states, counties and school districts.
Source: U.S. Bureau of the Census, Small Area Income and
Poverty Estimates
LIMITATIONS OF THE INDICATOR
Using the federal poverty threshold to identify
people in poverty has several drawbacks.
Income used to determine poverty status does
not include non-cash government benefits such as
home energy assistance or food stamp benefits. It
does not take into account geographic variability in
the cost of living or variation of medical expenses
related to health insurance coverage.
DATA RESOURCES
U.S. Census Bureau, Small Area Income and Poverty
Estimates
http://www.census.gov/did/www/saipe/index.html
Measuring What Matters – Idaho Obesity Indicators
45
ABILITY TO AFFORD NUTRITIOUSH MEALS IN
IDAHO
Map 12: Adults worried about affording nutritious meals
most or all of the time by Public Health District, 2012
INDICATOR
Social Context
BACKGROUND
The percent of adults who worry most or all of the
time about being able to afford nutritious meals
varies widely across the state, from a low of 6.3% in
District 2 to a high of 15.7% in District 6.
SIGNIFICANCE
Food insecurity is associated with lower nutrient
diets and increased overweight and obesity.
DISPARITY
Regional differences reported. Statewide, food
insecurity is higher among Hispanics.
INDICATOR CHARACTERISTICS
Adults age 18 and older. Data are self-reported.
Data are reported annually for the state and public
health districts.
Source: Idaho Department of Health and Welfare, BRFSS
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
DATA RESOURCES
Idaho Department of Health and Welfare, Behavioral
Risk Factor Surveillance System, (BRFSS)
http://healthandwelfare.idaho.gov/Health/
VitalRecordsandHealthStatistics/HealthStatisitcs/
BehaviorRiskFactorSurveillanceSystem/tabid/913/
Default.aspx
LIMITATIONS OF DATA RESOURCES
Data are reported by District only. Greater
specificity is not possible at this time. Further
analysis is possible upon request from BRFSS.
46
Measuring What Matters – Idaho Obesity Indicators
HOUSEHOLD FOOD SECURITY IN IDAHO
DATA RESOURCES
INDICATOR
USDA, Economic Research Service (ERS)
Household Food Security
http://www.ers.usda.gov/data-products/state-factsheets/state-data.aspxhttp://
BACKGROUND
Household food insecurity rates in Idaho are similar
to national rates. Over the period 2010-2012, 14%
of Idaho households were food insecure, and 5% had
very low food security. A household is food insecure
if at any point in the previous year it was difficult
to provide enough food for all members of the
household due to a lack of resources. A household
has very low food insecurity if one or more members
of the household reduced food intake due to a lack
of resources or access.
LIMITATIONS OF DATA RESOURCES
Due to limited sample sizes of the national food
security survey, there are no direct measures of
food insecurity on a county or regional level.
Figure 21: Household food insecurity (%),
2010-2012
14.3
14.7
5.3
5.6
SIGNIFICANCE
The data are mixed on the associations between
food insecurity and obesity. Food insecure
individuals report eating fewer fruits, vegetables,
whole grains and lean meats.
DISPARITY
Food insecurity rates are highest among children,
Hispanics, and single female-headed households.
Food insecurity rates among Hispanics is double the
state rate.
INDICATOR CHARACTERISTICS
In collaboration with USDA, the U.S. Census Bureau
conducts a supplemental survey to assess the
food security of the nation’s households as part
of its annual Current Population Survey. A few
questions assess the household as a whole, and
the rest are divided between adults and children
in the household. Unlike individual estimates from
Feeding America, USDA estimates are reported for
households. Single-year national estimates and
3-year state estimates are reported annually.
Food insecure households
Idaho
Households with very low food security
United States
Source: USDA, Economic Research Service
Table 15: Idaho food security by ethnicity (%), 2007-2011
Food Secure
Low food
security
Very low food
security
Idaho
86.4
9.5
4.2
Non-Hispanic
87.7
8.2
4.1
Hispanic
75.1
19.7
5.2
Source: USDA, Economic Research Service, calculations by
University of Idaho
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation.
Measuring What Matters – Idaho Obesity Indicators
47
FOOD INSECURITY IN IDAHO
DATA RESOURCES
INDICATOR
Map the Meal Gap, Feeding America
Food Insecurity estimates
http://feedingamerica.org/hunger-in-america/
hunger-studies/map-the-meal-gap.aspx
BACKGROUND
Idaho’s highest rates of overall food insecurity are in
Adams (18.0%), Latah (18.2%), Shoshone (18.5%)
and Madison (20.9%) counties. Rates are highest
in northern and central Idaho and lowest in the
southeastern part of the state.
Idaho’s children experience food insecurity at much
higher rates than adults. In 2012, 22% of Idaho’s
children (91,730 children) were food insecure,
compared to 14% of Idaho’s adults. The highest
rates of child food insecurity were in Owyhee
(24.7%), Shoshone (25.1%) and Lemhi (27.2%)
counties, all of which are rural.
LIMITATIONS OF DATA RESOURCES
Due to limited sample sizes of the national food
security survey, there are no direct measures of
food insecurity on a county or regional level.
Map 13: Food insecurity by county, 2011
SIGNIFICANCE
The data are mixed on the associations between
food insecurity and obesity. Food insecure
individuals report eating fewer fruits, vegetables,
whole grains and lean meats.
DISPARITY
Disparities are not reported for this data resource.
INDICATOR CHARACTERISTICS
Feeding America estimates start with the
USDA’s state-level rates of food insecurity for
households and then analyzes the relationship
between food insecurity and variables such as
income, unemployment and poverty. The resulting
relationships are modeled and used to generate
estimates of food insecurity at the state and county
level for the total population and for children.
Unlike household estimates from USDA, Feeding
America estimates are reported for individuals.
Data are reported annually for the nation, states and
counties.
Source: Map the Meal Gap, Feeding America
Map 14: Child food insecurity by county, 2011
LIMITATIONS OF THE INDICATOR
The indicator is an estimate and not a direct
measure of food insecurity.
Source: Map the Meal Gap, Feeding America
48
Measuring What Matters – Idaho Obesity Indicators
SNAP PARTICIPATION IN IDAHO
DATA RESOURCES
INDICATOR
USDA, Food and Nutrition Service
Supplemental Nutrition and Assistance Program
(SNAP) Participation Rate
http://www.fns.usda.gov/pd/16SNAPpartHH.htm
BACKGROUND
SNAP participation rates in Idaho are very similar
to national rates, as 15% of Idahoans received
food stamps in 2012. There were pockets of high
participation in both northern and southern Idaho in
January 2014. Participation rates were highest in
Power (18%), Payette (18%), Shoshone (18%) and
Canyon (21%) counties and lowest in Blaine (5%),
Teton (6%), Custer (7%) and Franklin (7%) counties.
SIGNIFICANCE
SNAP is the largest food assistance program in the
U.S. Participation in SNAP provides access to food
as well as nutrition education.
Idaho Department of Health and Welfare
http://healthandwelfare.idaho.gov/
FoodCashAssistance/FoodStamps/tabid/90/
Default.aspx
LIMITATIONS OF DATA RESOURCES
Rates provided report on participation not
eligibility. Ready access to this information was not
found. Data on SNAP education rates by region were
not found.
Map 15: SNAP participation by county, January 2014
DISPARITY
Program requirements limit the participation of
some individuals who may be in need of nutrition
support, i.e., undocumented persons and their
families.
INDICATOR CHARACTERISTICS
Persons participating in SNAP as a percentage of
the total population. To be eligible for SNAP, income
must be below 130% of the poverty level. Data are
reported annually for states and the nation, and
monthly for Idaho shtate and its counties.
LIMITATIONS OF THE INDICATOR
Comparing participation rates to the percent of
people eligible for SNAP is difficult because income
data from the U.S. Census Bureau’s American
Community Survey are not reported for income
below 130% the poverty level.
Source: Idaho Department of Health and Welfare
Figure 22: SNAP participation (%), 2012
19.4
17.4
14.6
14.8
People participating in SNAP
Idaho
Households participating in SNAP
United States
Source: USDA, Food and Nutrition Service
Measuring What Matters – Idaho Obesity Indicators
49
FARMERS MARKETS THAT PROCESS SNAP
BENEFITS IN IDAHO
Map 16: Farmers market density and SNAP benefit
processing, 2014
INDICATOR
Farmers Markets
BACKGROUND
The number of farmers markets that process SNAP
benefits continues to increase in Idaho. By 2014, 15
such markets could be found throughout the state.
SIGNIFICANCE
SNAP participants’ consumption of fruit and
vegetables increases when SNAP benefits are
processed at farmers markets.
DISPARITY
Many counties do not even have a farmers market,
limiting many Idahoans’ access to fresh, locally
grown produce. With only 15 of the state’s 48
farmers markets accepting SNAP benefits, many
low-income persons’ access to fresh, locally-grown
produce is even more limited.
Source: Idaho State Department of Agriculture, Farmers
Market Guide
INDICATOR CHARACTERISTICS
The Idaho Department of Agriculture produces a
directory of the state’s farmers markets.
LIMITATIONS OF THE INDICATOR
The current indicator does not track sales of SNAP
benefit redemption by county or region.
DATA RESOURCES
Idaho State Department of Agriculture, Farmers
Markets and Direct Marketing, Farmers Market
Guide, 2014
http://www.agri.idaho.gov/Categories/Marketing/
Documents/2014FarmersMarketGuide.pdf
LIMITATIONS OF DATA RESOURCES
Data from the Idaho Farmers Market Guide were
inconsistent with USDA data. It is unclear which
source provides the most recent and accurate data.
50
Measuring What Matters – Idaho Obesity Indicators
WIC PARTICIPATION RATES IN IDAHO
LIMITATIONS OF DATA RESOURCES
INDICATOR
Data are needed to determine the percentage
of WIC eligible women and children that are not
receiving WIC program benefits.
Special Supplemental Nutrition Program for Women,
Infants and Children (WIC) Participation
BACKGROUND
Map 17: Mothers who participated in WIC during
pregnancy, by county, 2011
In 2011, 44% of all mothers who gave birth that
year participated in WIC while pregnant. WIC
participation rates were highest in Cassia (68%),
Benewah (68%), Power (69%) and Minidoka (77%)
counties. Participation rates were lowest in Camas
(13%), Latah (27%), Blaine (29%) and Adams (31%)
counties.
SIGNIFICANCE
Participating in the WIC program improves the diets
of pregnant and breastfeeding women and their WIC
eligible children. WIC provides lactation support and
nutrition education.
DISPARITY
Significant disparities exist for this indicator.
Participation rates were especially high among
mothers under the age of 20 — 81% participated,
compared to 41% of mothers ages 20 and older —
and among unmarried mothers — 72% participated,
compared to 34% of married mothers.
Source: Idaho Department of Health and Welfare, Bureau of
Vital Records and Health Statistics
INDICATOR CHARACTERISTICS
The number of mothers who participated in WIC
during pregnancy as a percentage of mothers with
live births. Data come from Idaho birth certificates,
which are based on the 2003 U.S. Standard
Certificate of Live Birth. Data are reported annually
for counties, public health districts and Idaho.
LIMITATIONS OF THE INDICATOR
Data supply rate of participation by birth and not
rate of participation by income eligibility. The
indicator reflects enrollment in the WIC program but
does not consider program dropout.
DATA RESOURCES
Idaho Department of Health and Welfare, Bureau of
Vital Records and Health Statistics
http://healthandwelfare.idaho.gov/Portals/0/
Health/Statistics/Natality.pdf
Measuring What Matters – Idaho Obesity Indicators
51
OVERARCHING FOOD AND BEVERAGE DATA SUMMARY
STRENGTHS OF THE DATA
OPPORTUNITIES TO FILL DATA GAPS
• Food intake behaviors monitored with BRFSS
and YRBSS. Both surveys have the ability to add
questions.
• Systematically assess and report on healthy food
and beverage polices in government facilities,
hospitals, childcare, out-of-school and school
facilities.
• Idaho School Health Education Profiles Survey
report on food and beverage policies and health
and nutrition education offerings.
• WIC, SNAP and other USDA food programs track
participation.
• Food security data are available for the state and
by county.
OPPORTUNITIES TO EXPAND DATA
• Analyze and report existing dietary intake
information (e.g., EFNEP) using a standardized
metric such as the Healthy Eating Index 2010.
• Assess and track healthy eating environments in
school, afterschool and childcare programs using
validated tools.
• Develop systematic nutrition surveillance system
for children and adolescents.
• Use validated instruments to measure the
nutrition environment of stores, restaurants
and convenience stores to assess healthy eating
access.
• Assess older adult food security and access to
healthy food.
• Add additional food and beverages intake
questions to existing statewide surveys.
• Expand WIC data availability.
• Create a system to report childcare nutrition
standards.
U.S. Department of Agriculture and U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). Dietary
Guidelines for Americans, 2010. 7th ed. Washington, DC: U.S. Government Printing Office. Retrieved from http://www.health.gov/dietaryguidelines/2010.asp
24
enters for Disease Control and Prevention, National Center for Health Statistics (NCHS). (2014). National Health and Nutrition Examination Survey (NHANES).
C
Retrieved from http://www.cdc.gov/nchs/nhanes.htm
25
.S. Department of Agriculture. Center for Nutrition Policy and Promotion. (2010). CNPP Fact Sheet No. 2. 2010. Retrieved from http://www.cnpp.usda.gov/
U
Publications/NutritionInsights/Insight52.pdf
26
NPD Group (2014). Eating Patterns in America. Ordering information available from https://www.npd.com/latest-reports/eating-patterns-america-consumerconsumption-behavior/
27
NPD Group (2013). The Future of Eating Report. Ordering information available from https://www.npd.com/latest-reports/the-future-of-eating-report/
28
.S. Department of Agriculture, Economic Research Service. (2012) Quarterly Food-at-Home Price Database. Retrieved from http://www.ers.usda.gov/dataU
products/quarterly-food-at-home-price-database.aspx#.U1792lc8CCg
29
er Ploeg, M., V. Breneman, P. Dutko, R. Williams, S. Snyder, C. Dicken, and P. Kaufman. (2012). Access to Affordable and Nutritious Food: Updated Estimates
V
of Distance to Supermarkets Using 2010 Data, ERR-143, U.S. Department of Agriculture, Economic Research Service. Retrieved from http://ers.usda.gov/
publications/err-economic-research-report/err143.aspx#.U3KHXvldW7O
30
ood Action Research (FRAC). (2011). Food Insecurity and Obesity: Understanding the Connections. Retrieved from http://frac.org/pdf/frac_brief_understanding_
F
the_connections.pdf
31
U.S. Department of Agriculture, Food and Nutrition Service. (2013). WIC Farmers’ Market Nutrition Program (FMNP). Retrieved from http://www.fns.usda.gov/
fmnp/wic-farmers-market-nutrition-program-fmnp
32
U.S. Department of Agriculture, Food and Nutrition Service. (2014). School Meals Healthy Hunger-Free Kids Act. Retrieved from http://www.fns.usda.gov/schoolmeals/healthy-hunger-free-kids-act
33
letcher, J.F. & Branen, L.J. (2010). Building Mealtime Environments and Relationships: An Inventory for Feeding Young Children in Group Settings. Retrieved from
F
http://www.cals.uidaho.edu/feeding/pdfs/BMER.pdf
34
52
Measuring What Matters – Idaho Obesity Indicators
HEALTH CARE AND WORKSITE
ENVIRONMENT
KEY FINDINGS
• Overall, few obesity-related indicators are available in health and work environments.
• Public supported health care provides an important opportunity for the collection,
tracking and reporting of obesity indicators.
• Electronic health records offer great potential for routine BMI collection and tracking.
• Employee wellness programs often assess obesity-related biometrics.
• Initiation of breastfeeding is well documented.
• Exclusive breastfeeding, breastfeeding duration and worksite support for breastfeeding
data are needed.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
53
INTRODUCTION TO THE HEALTH CARE AND WORK
PLACE ENVIRONMENT
Great opportunity exists in the health care
and worksite environment to influence obesity
prevention knowledge, behaviors and healthy
environments. The Institute of Medicine
Accelerating Progress in Obesity Prevention (APOP)
recommends four primary strategies in the health
care and worksite environments and suggests
indicators to measure progress.
• Health care providers should adopt standards of
practice for screening, diagnosis and treatment
of obesity to help all achieve a healthy body
weight.
• Insurers should provide coverage of, access to
and incentives for routine obesity prevention,
screening, diagnosis and treatment.
• Worksites should encourage active living and
healthy eating.
• Health care providers and employers should
encourage healthy weight gain in pregnancy,
and support breastfeeding and breastfeeding
friendly environments.
STANDARDIZED OBESITY MEASURES IN HEALTH
CARE SETTING
The Institute of Medicine recommends that
pediatricians and other health care professionals
measure weight and height or length in a
standardized way and also assess obesity risk
factors such as rate of weight gain and the weight
of parents and siblings during routine pediatric
visits.35 The transition to and higher utilization of
As health care continues to evolve
and as new forms of health systems
emerge such as patient-centered
medical homes, accountable care
organizations, and other new
systems of care), attention to obesity
prevention, screening, diagnosis, and
treatment must be considered.
electronic health records (EHRs) allows for easier
BMI screening, assessment, tracking and public
54
health reporting. BMI is also a useful measure for
quality improvement efforts and measures. APOP
recommends that practice level data be fed into
health information exchanges (HIEs), a system of
aggregating health care information electronically.
The Idaho Health Data Exchange is in process
of designing a system that will supply, analytics
and have the capacity to report obesity-related
public health data like BMI, nutrition behaviors and
physical activity. 36
Two national surveys provide information on the
practice of standardized obesity measures and care
practice: the National Survey on Energy BalanceRelated Care Among Primary Care Physicians
(NSEBRCPCP) and the National Ambulatory Medical
Care Survey (NAMCS). These two surveys provide a
useful prototype for collecting this information in
Idaho.
COVERAGE OF, ACCESS TO, AND INCENTIVES FOR
ROUTINE OBESITY PREVENTION, SCREENING,
DIAGNOSIS AND TREATMENT
APOP cites numerous research studies that support
the need for adequate coverage and reimbursement
for obesity-related services as an important
component of obesity prevention. With 91% of
Idaho children (Map 18) and 82% of Idaho adults
(Map 19) covered by private or public insurance,
Idaho health insurers and federally qualified health
centers are poised to provide routine obesity
prevention, screening, diagnosis and treatment.
Idaho Medicaid has initiated steps to incorporate
and encourage preventive care among participants.
The Idaho Prevenative Health Assistance (PHA)
Program began in 2006 and has helped to increase
preventive screening rate among CHIP children and
increased reimbursement to Medicaid providers.
An analysis of the PHA Program Conducted by Dr.
Jessica Greene in 2010 is available at: http://www.
academyhealth.org/files/2010/sunday/greene.pdf.
Idaho Medicaid implemented a full patient-centered
medical home (PCMH) model of care in 2013 as their
Health Homes Program. Quality measures for weight
assessment are optional measures that Health
Homes Providers can report on and this may allow
Measuring What Matters – Idaho Obesity Indicators
for the reporting of BMI data for some Medicaid
recipients.
The new health care legislation includes preventive
and wellness services as “essential benefits”.
Measuring reimbursement for obesity-related
services in through private insurance and public
programs like Medicaid and the Children’s Health
Insurance Program (CHIP) is a feasible option.
Tracking the availability and utilization of health
professionals (e.g., Registered Dietitians, physical
activity practitioners) trained to provide preventive
and therapeutic obesity services is also important.
The National Association of County and City Health
Officials provides Profile-IQ to assess the local
workforce capacity in public health departments. 37
HEALTHY WORKSITES
Worksites represent an important avenue for
obesity prevention efforts. The Rand Workplace
Wellness Programs Study found that half of U.S.
employers with over 50 employees offer wellness
promotion initiatives.38 Employers most commonly
offered wellness screenings to identify health risks
and interventions to promote healthy lifestyles. Half
of the employees surveyed reported using incentives
to encourage healthy behaviors and to participate
in wellness offerings. Although popular with
employers, the Rand study found that few wellness
programs were formally evaluated for effectiveness.
The Idaho Department of Health and Welfare is
currently assessing workplace wellness programs
in each of the public health districts using
standardized CDC tools. This work lends itself to
Measuring What Matters – Idaho Obesity Indicators
the development and reporting of worksite wellness
measures at the state and District level.
ENCOURAGING BREASTFEEDING AND BREASTFEEDING FRIENDLY ENVIRONMENTS
Increasing evidence links breastfeeding, particularly
exclusive breastfeeding and longer duration with
decreased overweight and obesity, along with
the many other health benefits conferred by
breastfeeding. Idaho women surpass national
rates in breastfeeding initiation (90.3% vs. 74.6%).
Breastfeeding initiation rates vary widely in Idaho
(Map 20). At six months, 53% of Idaho women
breastfeed with a range of 46% in District 5 to 58%
in District 2 (Map 21).
Hospital breastfeeding support data are collected
by Maternity Practices in Infant Nutrition and Care
(mPINC). Idaho hospitals receive high scores for
breastfeeding initiation, breastfeeding assistance
and mother child contact and lower scores for staff
education and discharge care (Table 18). These
data are reported for Idaho hospitals overall and
scoring and reporting for local and regional hospital
practices are needed to identify disparities in
breastfeeding initiation and support. No data are
available measuring worksite policies and practices
that support breastfeeding.
Additional breastfeeding outcomes and
breastfeeding process data are available
from the CDC Breastfeeding Report Card
(http://www.cdc.gov/breastfeeding/
pdf/2013breastfeedingreportcard.pdf).
55
KEY INDICATORS FOR HEALTH CARE AND WORKSITES ENVIRONMENT
56
Measuring What Matters – Idaho Obesity Indicators
HEALTH INSURANCE IN IDAHO
DATA RESOURCES
INDICATOR
U.S. Census Bureau, Small Area Health Insurance
Estimates
Health Insurance
BACKGROUND
In 2012, 9% of children under age 19 had no health
insurance coverage. Counties with the highest rates
of no health insurance coverage among children
included Camas (15%), Teton (16%) and Clark (18%)
counties. Counties with the lowest rates among
children included Ada (7%), Latah (8%), Bannock
(8%) and Bonneville (8%).
In 2012, 18% of Idahoans under the age of 65 had
no health insurance coverage. Coverage rates vary
widely across the state. Counties with the highest
rates of no health insurance coverage included
Jerome (27%), Owyhee (29%) and Clark (32%)
counties. Counties with the lowest rates included
Madison (14%), Latah (15%), Ada (15%) and Caribou
(15%) counties.
https://www.census.gov/did/sahie/
LIMITATIONS OF DATA RESOURCES
Data from 2008 forward are not comparable to data
prior to 2008, due to using 1) a different data source
for the population base and 2) a different definition
of health insurance coverage.
Map 18: Population under age 19 with no health insurance,
by county, 2012
SIGNIFICANCE
Healthcare Reform supports early detection,
screening and counseling for obesity. Individuals
without private or public health insurance are
unlikely to access these services.
DISPARITY
Working-age adults have lower rates of health
insurance coverage than children. Other groups
likely to have lower rates of health insurance
coverage include males, minorities and those with
lower incomes. Idaho has not expanded Medicaid,
leaving many Idahoans without insurance.
Source: U.S. Bureau of the Census, Small Area Health
Insurance Estimates
Map 19: Population under age 65 with no health insurance,
by county, 2012
INDICATOR CHARACTERISTICS
Persons under the age of 65 who are not covered
by any type of health insurance for the entire year.
Model-based estimates are based on a regression
model that predicts the number of people without
health insurance coverage. The model uses countylevel data from the Census Bureau’s American
Community Survey along with administrative
records and Census 2010 data. Data are available
annually for states and counties.
LIMITATIONS OF THE INDICATOR
Types and coverage of insurance are not specified.
More detailed insurance access data are available on
the U.S. Census website
Source: U.S. Bureau of the Census, Small Area Health
Insurance Estimates
Measuring What Matters – Idaho Obesity Indicators
57
RATES OF BREASTFEEDING INITIATION IN IDAHO
INDICATOR
Breastfeeding Initiation
BACKGROUND
In 2011, 90% of Idaho mothers breastfed their
infants at the time of birth. Rates vary considerably
across the state. Breastfeeding initiation rates
are highest in Adams (97%), Blaine (97%), Madison
(97%) and Camas (100%) counties. There were
only 8 babies born in Camas County in 2011. Rates
are lowest in Power (78%), Franklin (78%) and Gem
(81%) counties.
SIGNIFICANCE
LIMITATIONS OF DATA RESOURCES
Breastfeeding initiation rates present a limited
view on breastfeeding practices. Infants put to
breast after birth are counted as having initiated
breastfeeding. Exclusive breastfeeding upon
discharge or at the first well child checkup would
provide more accurate data.
Table 16: Idaho infants breastfed
at birth (%), 2011
Percent
90.3
Total
Increasing evidence associates breastfeeding,
particularly exclusive breastfeeding for six months
with healthier body weight and reduced obesity.
Mothers aged < 20
85.3
Mothers aged >= 20
90.7
Mothers, married
92.5
DISPARITY
Mothers, unmarried
84.4
Mothers who are less likely to breastfeed their
infants at the time of birth include mothers under
the age of 20 (85%) and unwed mothers (84%).
Source: Idaho Department of Health and Welfare, Bureau of
Vital Records and Health Statistics
INDICATOR CHARACTERISTICS
The number of infants breastfed at the time of birth
as a percentage of live births. Data come from Idaho
birth certificates, which are based on the 2003 U.S.
Standard Certificate of Live Birth. Data are based
on the infant being breastfed at the time of birth
through the time the birth certificate is completed.
Data are reported annually for counties, public
health districts and Idaho State.
LIMITATIONS OF THE INDICATOR
Breastfeeding initiation is not a sensitive measure
of breastfeeding exclusivity or duration.
DATA RESOURCES
Idaho Department of Health and Welfare, Bureau of
Vital Records and Health Statistics
http://healthandwelfare.idaho.gov/Portals/0/
Health/Statistics/Natality.pdf
58
Map 20: Breastfeeding initiation rates, 2011
Source: Idaho Department of Health and Welfare, Bureau of
Vital Records and Health Statistics
Measuring What Matters – Idaho Obesity Indicators
BREASTFEEDING DURATION IN IDAHO
INDICATOR
Breastfeeding Duration
BACKGROUND
While 92% of Idaho mothers ever breastfed their
infants, only 53% of mothers breastfeed their
infants for at least 6 months. Rates range from 46%
in District 5 to 58% in District 2.
SIGNIFICANCE
The American Academy of Pediatrics recommends
exclusive breastfeeding for six months and
breastfeeding for at least one year with appropriate
complementary feeding.
DISPARITY
Mothers who are college graduates are the most
likely to breastfeed their infants for at least 6
months: 65.2%, compared to 42.6% of mothers who
aren’t high school graduates and 40.0% of mothers
whose highest level of education is a high school
diploma. Hispanic mothers and unmarried mothers
are less likely to breastfeed their infants for at least
6 months.
INDICATOR CHARACTERISTICS
Females ages 18 or older who had an in-state live
birth in 2010 were surveyed. Data were gathered
in 2011 when the babies were between 5 and 20
months old. Surveys were sent to 4,200 randomly
selected mothers from across the state. Weighting
procedures were used to account for health districts
with small populations. Data are reported annually
for the state and public health districts.
LIMITATIONS OF DATA RESOURCES
Data are reported for breastfeeding only up to six
months. Information is needed for rates of exclusive
breastfeeding at six months and the age of the
infant when complementary foods were introduced.
Table 17: Idaho mothers
who breastfed for at least
6 months (%), 2010
Percent
Age
18-19
20-24
25-29
30-34
35+
Ethnicity
Non-Hispanic
Hispanic
Marital Status
Not Married
Married
Income
Less than $15,000
$15,000 - $24,999
$25,000 - $34,999
$35,000 - $49,999
$50,000+
Education
K-11
12th grade or GED
Some college
College grad
28.6
44.3
55.9
60.3
57.9
54.2
45.0
34.7
58.9
41.0
49.4
52.4
54.4
64.6
42.6
40.0
54.2
65.2
Source: Idaho Department of Health and Welfare, PRATS
Map 21: Mothers who breastfed for 6+ months, by Public
Health District, 2010
LIMITATIONS OF THE INDICATOR
Data are self-reported, which introduces potential
information bias and error in estimation. In some
cases, data are gathered more than a year after
an infants’ birth, so some details may be forgotten
or not recalled correctly. Other biases may have
been introduced based on respondents’ willingness
to report answers that would indicate risky
behavior, confidentiality concerns, and whether
the respondent answered questions in a mail or
telephone survey.
DATA RESOURCES
Idaho Department of Health and Welfare, Pregnancy
Risk Assessment Tracking System
http://healthandwelfare.idaho.gov/Portals/0/
Users/074/54/1354/2010%20PRATS%20
Report%20FINAL.pdf
Measuring What Matters – Idaho Obesity Indicators
Source: Idaho Department of Health and Welfare, PRATS
59
MODEL HOSPITAL BREASTFEEDING POLICIES IN
IDAHO
INDICATOR
Model Hospital Breastfeeding Policies
BACKGROUND
One-third of Idaho’s hospitals had model
breastfeeding policies in 2011. Idaho’s strengths
include provision of breastfeeding advice
and counseling, and availability of prenatal
breastfeeding instruction. Needed improvements
include: appropriate use of breastfeeding
supplements, inclusion of model breastfeeding
policy elements, adequate assessment of staff
competency, and protection of patients from
formula marketing.
SIGNIFICANCE
From report: “Data from this survey can be used to
establish evidence-based, breastfeeding-supportive
maternity practices as standards of care in hospitals
and birth centers across the U.S. Improved care
will help meet Healthy People 2020 breastfeeding
objectives and will help improve maternal and child
health nationwide.”
DISPARITY
Because data are reported statewide, disparities in
local hospital practices are not reported.
60
INDICATOR CHARACTERISTICS
Every hospital and birth center in the U.S. that
provides maternity services is given the Maternal
Practices in Infant Nutrition and Care (mPINC)
survey. The person most knowledgeable about the
facility’s maternity care practices completes either
a paper or Web-based version of the questionnaire
with input from other knowledgeable staff. Data are
reported for states and the nation bi-annually.
LIMITATIONS OF THE INDICATOR
Data are self-reported and reporting error or bias is
unknown.
DATA RESOURCES
Centers for Disease Control and Prevention,
Maternity Practices in Infant Nutrition and Care
(mPINC)
http://www.cdc.gov/breastfeeding/pdf/mpinc/
states/mpinc2011idaho.pdf
http://www.cdc.gov/breastfeeding/data/mpinc/
data/2011/tables8_1b-8_2b.htm
LIMITATIONS OF DATA RESOURCES
Reporting is done statewide and information is not
available on specific hospital practice ratings. This
information is necessary to target hospitals serving
women less likely to breastfeed successfully.
Measuring What Matters – Idaho Obesity Indicators
Table 18: mPINC Quality Practice scores for Idaho, 2011
mPINC
Dimension of
Care
Labor and
Delivery Care
Feeding of
Breastfed
Infants
Breastfeeding
Assistance
Contact
Between
Mother and
Infant
Facility
Discharge Care
Staff Training
Structural &
Organizational
Aspects of
Care Delivery
ID Quality
Practice
Subscore
82
82
87
Ideal Response to mPINC Survey Question
‐
‐
Initial skin to skin contact is ≥30 m in w /in 1 hour (vaginal
‐ ‐
births)
Initial skin to skin contact is ≥30 m in w /in 2 hours
(cesarean births)
Initial breastfeeding opportunity is w /in 1 hour (vaginal
births)
Initial breastfeeding opportunity is w /in 2 hours (cesarean
‐ ‐
births)
56
23
68
6
63
17
72
7
Routine procedures are perform ed skin to skin
37
16
Initial feeding is breast m ilk (vaginal births)
85
11
Initial feeding is breast m ilk (cesarean births)
80
11
Supplem ental feedings to breastfeeding infants are rare
26
23
Water and glucose w ater are not used
68
42
Infant feeding decision is docum ented in the patient chart
96
‐‐‐
Staff provide breastfeeding advice & instructions to
patients
100
‐‐‐
Staff teach breastfeeding cues to patients
85
27
Staff teach patients not to lim it suckling tim e
42
32
Staff directly observe & assess breastfeeding
96
‐‐‐
Staff use a standard feeding assessm ent tool
‐
Staff rarely provide pacifiers to breastfeeding infants
82
7
41
22
67
20
82
15
70
7
5
16
84
28
33
17
37
31
New staff receive appropriate breastfeeding education
8
34
Current staff receive appropriate breastfeeding education
26
14
Staff received breastfeeding education in the past year
48
27
Assessm ent of staff com petency in breastfeeding
m anagem ent & support is at least annual
44
37
Breastfeeding policy includes all 10 m odel policy elem ents
33
9
Breastfeeding policy is effectively com m unicated
82
14
Facility docum ents infant feeding rates in patient
population
67
34
Facility provides breastfeeding support to em ployees
56
43
Facility does not receive infant form ula free of charge
11
29
Breastfeeding is included in prenatal patient education
100
‐‐‐
Facility has a designated staff m em ber responsible for
coordination of lactation care
78
17
Mother infant pairs are not separated for postpartum
‐
‐
transition
‐
Mother infant pairs room in at night
86
48
57
72
ID Facilities
with Ideal ID Item Rank
Response
Mother infant pairs are not separated during the hospital
stay
Infant procedures, assessm ent, and care are in the patient
‐
‐
room
Non room ing in infants are brought to m others at night for
feeding
‐
Staff provide appropriate discharge planning (referrals &
other m ulti m odal support)
Discharge packs containing infant form ula sam ples and
m arketing products are not given to breastfeeding
patients
Measuring What Matters – Idaho Obesity Indicators
61
OVERARCHING HEALTH CARE AND WORKSITE DATA SUMMARY
STRENGTHS OF THE DATA
OPPORTUNITIES TO FILL IN DATA GAPS
• Breastfeeding initiation data are available by
county.
• Add BMI as a health care quality measure that is
tracked and reported statewide for public and
private insurance.
• PRATS provides state level data on
breastfeeding duration and exclusivity.
• Insurance data are readily available.
OPPORTUNITIES TO EXPAND DATA
• Increase accessibility of WIC breastfeeding data.
• Adopt continuous sampling for PRATS versus one
time a year for better data validity.
• Use existing national tools to track availability
of preventive nutrition services and physical
activity professional services.
• Assess medical providers obesity standards
of practice (e.g., screening, diagnosis and
treatment).
• Assess insurance companies obesity prevention
and care coverage.
• Evaluate insurance companies’ practice of
incentivizing routine obesity prevention and
treatment practices.
• Consider an Idaho Registry for BMI and
chronic diseases associated with obesity, i.e.,
hypertension and diabetes.
Institute of Medicine. (2011). Early Childhood Obesity Prevention Policies. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/
Reports/2011/Early-Childhood-Obesity-Prevention-Policies.aspx
35
Idaho Health Data Exchange. (2014). Idaho Health Data Exchange [website]. Retrieved from http://www.idahohde.org/what-is-health-information-exchange/
36
National Association of County and City Health Officials. (2014). Profile-IQ [online data system]. Retrieved from http://profile-iq.naccho.org/
37
Mattke S, Liu H, Caloyeras JP, et al. (2013). Workplace Wellness Programs Study: Final Report. RAND Health. Retrieved from http://www.rand.org/content/dam/
rand/pubs/research_reports/RR200/RR254/RAND_RR254.pdf.
38
62
Measuring What Matters – Idaho Obesity Indicators
SCHOOL
ENVIRONMENT
KEY FINDINGS
• State standards do not exist for required physical education time.
• Physical education standards exist but are not assessed.
• Idaho does not require fitness testing and statewide data are not available.
• Physical education and health education policies and practices are reported
voluntarily. Local or regional data are unavailable.
• All data collected for physical education is voluntary.
• Studies conducted by Idaho universities and colleges have bridged important data gaps.
• Participation in USDA school nutrition program data are readily available by state,
but not by district or region.
• New voluntary childcare standards include physical activity and healthy eating guidelines.
• Head Start programs collect nutrition information. The data are not standardized or
aggregated and reported.
Foundation for Health, Inc.
Measuring What Matters – Idaho Obesity Indicators
63
INTRODUCTION
Schools play a crucial role in protecting the health
of large numbers of children on a regular basis
with healthy food and enjoyable physical activity.
The Task Force on Community Preventive Services
(2008)39 strongly recommends longer physical
education classes and increased time in moderate to
vigorous activity to increase physical fitness. With
increased pressure for student achievement and
limited resources, many schools no longer provide
physical education or allow time for students to be
active. Most schools receive no support outside
of the school nutrition program to offer nutritious
foods or healthy eating education. With few state
requirements for physical education, physical
activity, or health education, few data exist to track
important obesity indicators outside of measures
tied to funding by the federal government.
PHYSICAL EDUCATION, PHYSICAL ACTIVITY AND
FITNESS
Schools provide a logical and impactful setting for
offering students opportunities for daily physical
activity and to augment students’ knowledge and
capacity to enjoy regular, safe, and developmentally
appropriate physically active lifestyles. There is no
federal law mandating the requirement of physical
education in schools and there are no incentives
for states or schools to establish requirements.
Physically active and fit children are more likely
to perform better academically, attend school
Quality physical education programs
for all of our children are the
foundation for healthy, physically
active lifestyles as adults. The vision
is that every student will become
physically educated and thus possess
the knowledge, skills and confidence
to be physically active and healthy for
a lifetime. –NASPE 2012 Shape of the
Nation
more regularly and have less discipline issues.
An increasing body of research shows that more
64
time in physical education does not detract from
academic achievement and may result in improved
grades and standardized test scores.40 Researchers
have shown that student fitness matters. Research
using a standard fitness test, FITNESSGRAM™
found more physically fit students had better
attendance and fewer reports of drugs, alcohol,
violence or truancy.41 In 2012, NHANES developed
and conducted a Youth Fitness Survey Plan (YFSP).
Incorporating physical activity breaks in the school
day has shown to increase concentration and
to improve classroom behaviors. A summary of
these important research findings is available at:
http://activelivingresearch.org/files/ALR_Brief_
ActiveEducation_Summer2009.pdf
The first NHANES National Youth Fitness Survey
(NNYFS) was conducted in 2012 for children ages
3-15. The NNYFS will provide national fitness data
and standardized fitness indicators useful for state
and local fitness comparisons.
NATIONAL INDICATORS FOR PHYSICAL EDUCATION
REQUIREMENTS
To reach the recommendations for physical activity
for children set forth by the U.S. Department
of Health and Human Services, the National
Association for Sport and Physical Education
(NASPE) recommends that schools provide 150
minutes per week of instructional physical education
for elementary school children and 225 minutes
per week for middle and high school students. Of
this time, NASPE recommends that 33% and 50%
of physical education activity level be moderate
to vigorous for elementary and secondary school
students, respectively.42 NASPE reports on the
status of physical education indicators across the
nation and provides benchmarks for important
physical education indicators.
IDAHO PHYSICAL EDUCATION AND PHYSICAL
ACTIVITY DATA SOURCES
School and childcare-centered physical education
and physical activity data are available from a
variety of sources. The key sources include:
• 2012 Idaho School Health Education Profiles
Survey43 (Profiles) – The Profiles are funded and
Measuring What Matters – Idaho Obesity Indicators
supported by the Centers for Disease Control
and Prevention (CDC) and based on School
Health Policies and Practices Study (SHPPS).
The 2012 School Profiles utilized three surveys,
one for principals, one for lead health education
teachers and one for lead physical education
teachers from 6-12th grade schools. All data are
aggregated and reported statewide every other
year. CDC is discontinuing support for the Lead
Physical Education Teacher survey.
• Youth Risk Behavior Surveillance System – CDC
also funds YRBSS; this voluntary survey is given
to students in grades 9-12 every other year. No
local or regional data are available. Students
report on participation in physical education and
other out-of-school physical activity.
• Shape of the Nation – NASPE interviews state
physical education coordinators on measures
comparable between states. This source is
helpful for acquiring information on state
policies, regulations and practices.
• Independent Research – The University of
Idaho has led investigations in partnership with
Boise State University, Idaho State University
and Lewis and Clark State College to research
BMI for 1st, 3rd, 5th, 7th, 9th and 11th grade
students, and to assess the physical education
quality and quantity of Idaho schools. The
University of Idaho recently conducted research
on the degree of moderate to vigorous physical
activity in Idaho physical education programs.
IDAHO PHYSICAL EDUCATION AND PHYSICAL
ACTIVITY INDICATORS
Idaho last updated and adopted state physical
education standards in 2012 but does not assess
standards nor require local districts to comply with
the standards. Student assessment in physical
education is not required. Certification of physical
education teachers is required only at the high
school level.
PHYSICAL EDUCATION REQUIREMENTS
Idaho requires that schools offer physical education
and only requires physical education for elementary
and middle school/junior high students but does
not mandate the quantity (time) or the quality of
the physical education program. Many Idaho school
districts do set school standards above and beyond
Measuring What Matters – Idaho Obesity Indicators
state minimums. Overall, 87.8% of Idaho schools
require some physical education at some grade.
Most Idaho schools require physical education
between grades 6-9. By 12th grade, only 35% of
Idaho schools require physical education (Figure 23).
Among all Idaho students, only 46.1% of students
attend daily physical education compared to 51.8%
nationally. Idaho does not prohibit using physical
activity as a punishment for misbehavior. Nearly one
in five (17.7%) teach physical education only in an
online format.
Exemptions for physical education are allowed in
Idaho. The primary reason students are exempted
from physical education is due to long-term or
medical disability (72.5%) and exempting students
with a cognitive disability is the second reason given
(41.7%) (Figure 24). Recent Idaho legislation will
allow for the exemptions for sport participation.
Currently, no standards for physical activity exist
for early childhood education, afterschool or outof-school time programs. Without standards or
recommended guidelines, no evaluative measures
are required or collected.
PHYSICAL ACTIVITY INTENSITY
An important determinant of high quality physical
education is the proportion of time spent in
moderate to vigorous physical activity (MVPA).
The majority of Idaho schools report that teachers
allocate at least 50% of time in physical education
for students to be physically active (Figure 25).
University of Idaho researchers, led by P. Scruggs,
evaluated MVPA and determined that 52.0% of
primary students met the recommended MVPA
of 33% of the physical education class time while
19.4% of secondary students met the standard of
50% MVPA (Table 19). Findings included that boys,
non-overweight, and primary students were most
likely to meet MVPA. Direct measures of MVPA are
needed to inform physical education practice and
policy.
65
Other physical education quality measures are
reported and available in the 2012 Shape of the
Nation Report. Ongoing collecting, reporting and
tracking of this information is key to improving
physical education and physical activity in Idaho
schools.
PHYSICAL ACTIVITY OPPORTUNITIES
Most Idaho schools provide opportunities for
physical activity outside of the school day, most
notably through sports. Half of Idaho schools have
intramural activities or physical activity clubs;
less than half reported offering physical activity
breaks in classrooms (Figure 26). Fitness testing is
conducted in about 80% of Idaho schools (Figure
27) but no testing requirements exist and no fitness
data are collected or reported. The state does not
require schools to provide daily recess and daily
recess is not reported.
CHILD NUTRITION PROGRAMS
All child nutrition programs are administered
through the Idaho State Department of Education.
Idaho’s Child Nutrition Program has received many
accolades and recognitions for having an exemplary
child nutrition program which includes the National
School Lunch Program (NSLP), the Child and Adult
Care Food Program, the Summer Food Service
Program, the Fresh Fruit and Vegetable Program,
and other programs that provide milk and nutrition
education and support school gardens and local
food access. The Healthy, Hunger-Free Kids Act of
201044 provided the USDA the authority to set new
standards for food sold in schools, including vending
machines. It also provided resources for schools and
communities to develop Farm to School and School
Garden programs and set standards for school
wellness policies. The Act increased access to school
meals and streamlined the application process.
Idaho has not yet adopted nutrition standards for
competitive foods nor limited when and where
competitive foods could be sold that exceed federal
standards. By the 2014-15 school year, all schools
participating in NSLP will have to comply with new
standards for all food served on school grounds.
66
FREE AND REDUCED PRICE LUNCH PARTICIPATION
During the 2011-12 school year, 95% of Idaho
schools participated in the NSLP and 45% of Idaho
students received free or reduced-price lunches.
County and district participation varied across the
state. Eligibility for free and reduced-price lunches
ranged from 74% in Power County to 27% in Latah
County (Map 22). Among school districts, Wilder
School District had the highest rate of eligibility at
94%. Other school nutrition programs (e.g. the Fresh
Fruit and Vegetable Program) base school eligibility
on at least 50% free and reduce-price eligibility.
SCHOOL BREAKFAST
Nationwide, 28% students participate in free or
reduced-price breakfast program and 29% of
Idaho students participate. Almost 95% of Idaho
schools offering NSLP also offer school breakfast,
compared to 88.1% of schools nationwide (Figure
28). Schools are given the choice to serve school
breakfast in a variety of formats to increase
participation.
SCHOOL FOOD AND BEVERAGE AVAILABILITY
The School Health Profiles provide important
information on school food and beverage practices,
policies and regulations. Across the nation, the
trend is to decrease access to sugar-sweetened
beverages and solid fats. According to Bridging
the Gap,45 a nationwide survey of school nutrition
and physical activity practices, the availability of
vending machines and student stores is decreasing
significantly. In Idaho, 81% of schools allow
students to purchase snack foods and beverages
at vending machines, school stores or snack bars.
Few schools report offering non-fried vegetables
(12.8%), fruit (21%) and milk (30%) as snacks.
(Figure 29). Offering fruit and non-fried vegetables
at school celebrations is an important policy and
practice to encourage healthy choices; 25% of Idaho
6-12th grade schools always offer these healthy
choices (Figure 30). One out of five Idaho schools
rarely to never offer fruit or vegetables for school
celebrations. Bridging the Gap tracks important
Measuring What Matters – Idaho Obesity Indicators
school food and beverage practices and policies
worthy of consideration for obesity prevention
indicators.
The Idaho School Health Education Profiles provide
important bench marks for progress made to
improve food and nutrition in schools. The leading
change (66.9%) schools made was to place fruit and
vegetables near the cashier for easy access. The
action least taken was pricing nutritious food more
favorably (13.6%) (Figure 30).
National entities gather information on school
standards and policies related to obesity. The
2008 National Initiative on Children’s HealthCare
Quality46 compared state policies believed helpful
in preventing obesity. At that time, over half of the
states set regulation about limiting competitive
food and about 40% of states collected BMI or
health information. Many Idaho schools do collect
BMI (%) and fitness levels but this information is
not required by state standards and the information
resides at the school level.
OTHER USDA CHILD NUTRITION PROGRAM DATA
SOURCES
SUMMER FOOD SERVICE PROGRAM
USDA provides nutritious meals to children in the
summer through the Summer Food Service Program
(SFSP). The 2012 SFSP Overview reported that
Idaho had 66 SFSP sponsors and 284 sites that
served 19% of eligible participants, compared to the
U.S. rate of 10%. Expanding access to SFSP would
help support healthy eating for Idaho children.
IDAHO FARM TO SCHOOL PROGRAM
Farm to School describes a broad array of efforts
to connect local food and agriculture with schools,
students, teachers and families. Nationwide, 43%
of schools participate. The Idaho Child Nutrition
Program and the Idaho State Department of
Agriculture, Idaho Preferred Program partner
to support Farm to School Programs in 73 Idaho
schools.47 A 2011 survey reported that 77% of Idaho
school districts serve local food at least seasonally
but do not have the elements of a comprehensive
Farm to School program that includes serving locally
grown foods throughout the school year, a food/
agriculture education program, school gardens, or
marketing efforts supporting the Farm to School
Program.
CHILD AND ADULT CARE FOOD PROGRAM (CACFP)
The goal of CACFP is to provide nutritious meals
for children enrolled in childcare or outside of
school hours centers, afterschool “at risk” snack
programs, homeless shelters, or family daycare
homes and adults enrolled in daycare centers.
Idaho serves 23,000 children and infants through
CACFP in nearly 250 childcare centers and 300
sponsored family daycare homes.48 Potential CACFP
tracking measures include number of childcare
centers, family childcare homes and average daily
attendance.
FRESH FRUIT AND VEGETABLE PROGRAM
Schools with at least 50% eligibility for free and
reduced price lunch are eligible to apply for the
Fresh Fruit and Vegetable Program. Eligible schools
receive at least $50 and up to $75 per student
per year. USDA recommends that fresh fruit and
vegetable snacks are provided as many times as
possible during the week to all enrolled children and
that the program offers nutrition education. In the
2013-2014 school year, 113 Idaho schools received
Fresh Fruit and Vegetable grants.
Measuring What Matters – Idaho Obesity Indicators
67
68
Da i l y PA
% Meeti ng MVPA
SHPPS, BTG
SHPPS, BTG
ID PE PA
PA Informa tion
% Student PA
Nutri tion Informa ti on
% Frui t a nd Vegetabl e
University
Hea l th food opti ons
Frt/Veg req.
Brea kfa s t Progra m
Lunch pa rti ci pa tion
Fa rm to School
NCHA
Col l ege
Col l ege
Yes
Yes
No
ID CNP, SNDA, BTG
ID CNP, SNDA, BTG
ID CNP
NCHA
No
SHPPS, SNDA, BTG
No
No
No
No
No
No
Yes
Yes
No
No
No
No
No
Yes
No
No
YRBSS , SHPPS
1
No
No
Region
No
No
County
Idaho Data
PETQ*
No Source
Data Source
School and Child Nutrition Programs
% Requi re
Amount of Ti me
% Requi re
# of States /Di s tri cts
Recess
Hea l thy fi tnes s zone
Phys i ca l Fi tnes s
MVPA
% Students
Da i l y PE A
% School s Requi re
Da i l y PE B
Physical Education
School Da y PA
School PA
School Environment
Key Indicator
1
No
No
Yes
Yes
Yes
N/A
N/A
N/A
No
19.2%
25.6%
18.8%
No
State
Opportunities
Collected at ID colleges; not
reported or tracked
statewide
No ID policy/regulation; BTG
national
Universal breakfast
School/state has data
Data not readily available
No required time; SHHPS
reports recess > 90% K-6th
Compile and report NCHA data
statewide. Add needed questions.
Report student PA classes
School wellness policy as source of
data on local districts
Report on participation & venue
Expand data access
Participation, contribution to meals
Surveillance with ID PETQ
Surveillance with ID PETQ
Physical educators in Idaho collect
Fitnessgram fitness data
Fitness data is not reported
and or collected.
State and district level data
needed
Expand pilot physical education
physical activity study statewide
Surveillance with ID PETQ
Physical education physical
activity data not collected
Data limited to YRBSS
Daily PE enrollment
Two cycles of the ID PETQ have been
unknown; CDC Lead PE Survey
administered, 2009 and 2011
Physical educators plan, provide
No valid assessment or
professional development for leadership, and track Comprehensive
School Physical Activity
school PA
Data Gaps
KEY INDICATORS FOR SCHOOL ENVIRONMENT
Measuring What Matters – Idaho Obesity Indicators
REQUIREMENTS FOR DAILY PHYSICAL EDUCATION
DATA RESOURCES
INDICATOR
2012 Idaho School Health Profiles in Health and
Physical Education
Daily Physical Education Requirements
BACKGROUND
Idaho requires physical education in elementary
and middle school but only requires it to be taught
by a certified physical educator teacher at the high
school level. Physical education is not required to
graduate high school. In 2012, 88% of Idaho schools
required students to take PE at some point between
6th and 12th grade. The percentage of Idaho
schools requiring PE courses for each grade is much
greater in middle and junior high school than in high
school: 83% of schools require PE courses in 7th
grade while only 35% require PE during a student’s
senior year. Among Idaho schools, 87.8% require
physical education in any grade.
http://www.sde.idaho.gov/site/csh/docs/
Profile%20Survey%202012%20Final.pdf
LIMITATIONS OF DATA RESOURCES
SHPPS is conducted on a voluntary basis every six
years. Representation is not uniform across the
state. The 2012 survey provided important data
provided by the lead physical education teacher. This
survey is discontinued.
SIGNIFICANCE
Expert bodies recommend 150 minutes of physical
education per week for elementary students
and 225 minutes per week for middle and high
school students. “The percentage of schools that
require physical education for students decreased
significantly from 92.4% in 2002 to 87.8% in 2012”
(SHPPS).
DISPARITY
SHPPS data are not reported by district or region.
Data on disparities for access to physical education
are not readily available. With increased obesity
risks among particular populations, these data are
most important.
INDICATOR CHARACTERISTICS
The Idaho School Health Education Profile Survey is
administered to all principals, lead health education
teachers and lead physical education teachers in
the state’s public middle and high schools every six
years. Data are reported bi-annually at the state
level.
LIMITATIONS OF THE INDICATOR
Daily physical education alone does not provide
needed information on the quality of the instruction,
the minutes of physical education provided or the
intensity of the activity.
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
Figure 24: Percentage of time allocated for
physical activity in Idaho schools (%), 2012
75 to 100%
54.8
50 to 74%
25 to 49%
22.1
4.6
0 to 24%
9.4
No allocation
9.1
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
Table 19: Moderate to vigorous
activity in Idaho schools (%), 2013
Percent
MVPA 50% of class time
Grades
1 to 2
3 to 5
6 to 8
9 to 12
MVPA 33% of class time
Grades
1 to 2
3 to 5
6 to 8
9 to 12
23.6
28.9
14.0
11.8
53.4
54.9
42.7
48.4
Source: 2013 Report to the Idaho State Department of
Education Coordinated School Health, Scruggs, et. al.
Measuring What Matters – Idaho Obesity Indicators
69
DAILY PHYSICAL EDUCATION PARTICIPATION AND
EXEMPTIONS
INDICATOR CHARACTERISTICS
Profiles—The Idaho School Health Education Profile
Survey is administered to all principals, lead health
education teachers and lead physical education
teachers in the state’s public middle and high
schools. Data are reported every six years at the
state level.
INDICATOR
Daily Physical Education Attendance
Daily Physical Education Exemptions
BACKGROUND
YRBSS—High school students in grades 9-12. Data
are self-reported. Data are reported bi-annually for
states, major metropolitan areas and the nation.
In 2011, only 46% of Idaho’s public school students
attended daily PE classes, compared to 52% at the
national level. Top reasons for exempting Idaho
students from PE class include a long-term physical
or medical disability (73%), cognitive disability
(42%), enrollment in other courses (36%) and
religious reasons (29%).
LIMITATIONS OF THE INDICATOR
YRBSS—Data are self-reported, which introduces
potential information bias and error in estimation.
The data are collected only for students in grades
9-12.
SIGNIFICANCE
Expert bodies recommend daily physical activity for
all students grades K-12 and limiting exemptions
from physical activity and physical education.
DATA RESOURCES
2012 Idaho School Health Profiles in Health and
Physical Education
DISPARITY
http://www.sde.idaho.gov/site/csh/docs/
Profile%20Survey%202012%20Final.pdf
State-allowed physical education exemptions
permit for the exclusion of physical education and
physical activity for many Idaho students who are
not receiving the benefit of regular physical activity.
Students with disabilities are most often exempted
from physical education.
Centers for Disease Control and Prevention, Youth
Risk Behavior Surveillance System (YRBSS), Youth
Online
http://nccd.cdc.gov/youthonline/App/Default.aspx
LIMITATIONS OF DATA RESOURCES
Neither data source provides specific information
for local, county or regional data. Limited data are
reported for minority populations and no data are
reported by socio-economic status.
Figure 25: Reasons why Idaho schools exempt students from
physical education (%), 2012
Long-term physical or medical disability
72.5
Cognitive disability
41.7
Enrollment in other courses
35.5
Religious reasons
29.2
Participation in school activities (band, chorus, JROTC)
17.4
Participation in school sports
13.3
Participation in vocational training
Participation in community sports activities
12.1
5.1
Positive, passing or high physical fitness test scores
4.4
Participation in community service activities
4.1
Source: 2012 Idaho School Health Profiles in Health and Physical Education
70
Measuring What Matters – Idaho Obesity Indicators
PHYSICAL ACTIVITY OPPORTUNITIES AND
FITNESS ASSESSMENT IN IDAHO SCHOOLS
INDICATOR
Physical Activity Opportunities
Required Fitness Assessments
BACKGROUND
Idaho schools provide a variety of physical activity
opportunities. Most schools provide interscholastic
sports (74%), and most have a joint use agreement
for shared use of school or community physical
activity facilities (73%). Just over half (51%) of
Idaho schools offer intramural activities or physical
activity clubs to their students, and some (42%)
make use of non-PE physical activity breaks in
the classroom. About 80% of Idaho schools also
conduct some sort of physical fitness testing. The
most commonly used test is the Physical Fitness
Test from the President’s Challenge.
SIGNIFICANCE
With the lack of physical education requirements
and offerings, additional physical activity
opportunities are essential to meet physical
activity recommendations. Fitness assessment
is fundamental to assessing student health.
Nationwide, 73.7% of states require fitness
measures. Most Idaho schools do test fitness
but these data are not reported or used to direct
resources.
DISPARITY
Because the available data are only statewide,
nothing is known about gaps of physical activity
opportunity among sub-populations. Nationwide,
disparities exist between fitness levels and these
needed data are unavailable in Idaho.
INDICATOR CHARACTERISTICS
The Idaho School Health Education Profile Survey is
administered to all principals, lead health education
teachers and lead physical education teachers in
the state’s public middle and high schools. Data are
reported bi-annually at the state level.
Measuring What Matters – Idaho Obesity Indicators
LIMITATIONS OF THE INDICATOR
No plans are in place to continue the collection of
the physical education profile. It is unclear what
other fitness assessment measures are collected.
Fitness data are unavailable.
DATA RESOURCES
2012 Idaho School Health Profiles in Health and
Physical Education (Profiles)
http://www.sde.idaho.gov/site/csh/docs/
Profile%20Survey%202012%20Final.pdf LIMITATIONS OF DATA RESOURCES
The Profiles Survey are conducted on a voluntary
basis every six years. Representation is not uniform
across the state. CDC is discontinuing the School
Health Physical Education Profile, and there are
no plans to collect important physical activity
indicators in the future.
Figure 26: Idaho schools providing physical
activity opportunities (%), 2012
Interscholastic sports
74.1
Schools that have a joint use agreement
for shared use of school or community
physical activity facilities
72.6
All students offered intramural activities
or physical activity clubs
51.4
Physical activity breaks in classroom,
outside of PE
41.5
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
Figure 27: Idaho fitness testing
in schools (%), 2012
Physical Fitness Test from President's
Challenge
46.2
Other fitness test
30.0
No fitness testing
Fitnessgram
19.4
4.3
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
71
SCHOOL NUTRITION PROGRAMS– FREE AND
REDUCED PRICE MEALS
INDICATOR
Free and Reduced-Price Meals Participation
BACKGROUND
The National School Lunch Program provides free
and reduced price school lunches to students who
qualify based on the student’s family size and
income. Children from families with incomes at or
below 130 percent of the poverty level are eligible
for free meals. Those with incomes between 130
and 185 percent of the poverty level are eligible for
reduced price meals. During the 2010-11 school
year, 45% of Idaho students were eligible for free
and reduced-price school lunch. Participation rates
among counties range from 27% in Latah County to
74% in Power County. School district rates range
from 24% in the Genesee School District to 94%
in the Wilder School District. More and more Idaho
schools are now offering the School Breakfast
Program. While the program is open to all students,
low-income students can qualify for free or reduced
price breakfast. During the 2011-12 school year,
95% of Idaho schools that participated in the
National School Lunch Program offered breakfast
and 29% participated.
SIGNIFICANCE
The percent of students eligible for free or reduced
price lunches is often used as a measure of children’s
economic well-being. Higher percentages mean more
children live in low-income families, and vice versa.
Increasing school breakfast participation is an
important goal for Idaho schools.
DISPARITY
Participation in free or reduced price school
breakfast is higher in districts with higher Hispanic
populations. Increasing participation of school
breakfast, snack and summer nutrition programs
is important improve nutrition intake and decrease
food insecurity.
LIMITATIONS OF THE INDICATOR
Available data measures participation and not
participation by eligibility. Data are not reported by
grade level and little is known about participation
in higher grades when participation normally
decreases.
DATA RESOURCES
National Center for Education Statistics (NCES),
Elementary/Secondary Information System
http://nces.ed.gov/ccd/elsi/tableGenerator.aspx
Food Research and Action Center (FRAC)
http://frac.org/wp-content/uploads/2010/07/
id.pdf
LIMITATIONS OF DATA RESOURCES
Must generate data from NCES. School nutrition
data are also available in periodic reports
(e.g. USDA Western Wave) and via advocacy
organizations such as the Food Research Action
Council (FRAC). http://frac.org/about/
Figure 28: School breakfast participation (%),
2011-2012
94.6
29.0
88.1
28.0
Participating students eligible for free or
reduced-price school breakfast
Idaho
Schools participating compared to
number of schools serving lunch
United States
Source: Food Research and Action Center (FRAC)
Map 22: Free and reduced price lunch participation (%),
2010-2011
Source: National Center
for Education Statistics
(NCES)
INDICATOR CHARACTERISTICS
The percentage of public school students eligible
for the National School Lunch Program. The percent
is calculated by dividing the number of eligible
students (based on the criteria listed above) by
the number of students enrolled. Not all schools
participate in the program.
72
Measuring What Matters – Idaho Obesity Indicators
IDAHO SCHOOL FOOD AND BEVERAGE
AVAILABILITY
INDICATOR
School Food and Beverage Availability
BACKGROUND
About 81% of Idaho schools allow students to
purchase snack foods and beverages at vending
machines, school stores or snack bars. Many
schools offer sports drinks (56%), pop or fruitflavored drinks (50%), caffeinated beverages
(47%) and candy and/or salty snacks (more than
40%). Few schools provide healthy choices like
non-fried vegetables (13%), fruit (21%) and milk
(30%).
When schools offer food or beverages at school
celebrations, only 26% always, or almost always,
include fruit or non-fried vegetables among the
choices.
healthy options such as fresh fruit, vegetables,
water, low fat dairy and whole grains.
DATA RESOURCES
2012 Idaho School Health Profiles in Health and
Physical Education
http://www.sde.idaho.gov/site/csh/docs/
Profile%20Survey%202012%20Final.pdf
LIMITATIONS OF DATA RESOURCES
The data are limited to 6-12th grade schools and
are collected every six years. Expanded data
collection would allow for regional data reporting.
Figure 29: Idaho schools food and
beverage choices (%), 2012
Sports drinks, such as Gatorade
55.6
Soda pop or fruit drinks, not 100% juice
49.8
Foods or beverages containing caffeine
47.0
Other kinds of candy
46.6
Salty snacks, not low in fat
43.5
Chocolate candy
SIGNIFICANCE
Intake of fruit, non-fried vegetables, whole grains
and low fat protein is below national guidelines.
Intake of sugars (especially sugar-sweetened
beverages) and solid fats exceed recommended
guidelines. Availability of food and beverages at
schools impacts consumption.
DISPARITY
School food and beverage availability data are
reported statewide. Lack of local or regional data
does not allow for comparisons on disparities.
Low-income children are often reported to have
decreased access to healthy food options.
42.5
Baked goods, not low in fat
37.9
2% or whole milk (plain or flavored)
30.3
Fruits (not fruit juice)
21.0
Non-fried vegetables (not vegetable juice)
12.8
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
Figure 30: Idaho schools offering fruit or nonfried vegetables at school celebrations when
foods or beverages are offered (%), 2012
Always or almost always
25.5
Sometimes
56.8
Rarely
Never
Foods or beverages not offered at
school celebrations
14.3
0.5
3.0
INDICATOR CHARACTERISTICS
The Idaho School Health Education Profile Survey is
administered to all principals, lead health education
teachers and lead physical education teachers in
the state’s public middle and high schools. Data are
reported every six years at the state level.
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
LIMITATIONS OF THE INDICATOR
By August 2014, all competitive food sold on
school grounds must meet nutritional standards
making this indicator less important. A better
indicator would be the availability of specific
Measuring What Matters – Idaho Obesity Indicators
73
IDAHO SCHOOL FOOD AND BEVERAGE NUTRITION
IMPROVEMENTS
2012 Idaho School Health Profiles in Health and
Physical Education
INDICATOR
Improvements in School Nutrition
http://www.sde.idaho.gov/site/csh/docs/
Profile%20Survey%202012%20Final.pdf
BACKGROUND
LIMITATIONS OF DATA RESOURCES
While Idaho has no formal obesity-related school
standards, many schools are taking steps to improve
school nutrition. For example, 67% of schools
placed fruits and vegetables near the cashier so
students could have easy access, 61% displayed
fruit and vegetables in an attractive way in the
cafeteria and 61% provided a self-serve salad
bar for students. Other actions included helping
students learn more about the food they are eating,
getting feedback from students, and increasing
availability of locally grown foods.
Table 20: Obesity-related school standards, 2008
SIGNIFICANCE
School nutrition environments and policies impact
food consumption and attitudes toward healthy
eating. Measuring environmental and policy change
strategies is important for a multi-level approach to
obesity prevention.
DISPARITY
School nutrition environment and policy data are
reported statewide. Lack of local or regional data
does not allow for comparisons on disparities.
Nothing is known about low resource schools’
ability to make important food environmental
improvements.
INDICATOR CHARACTERISTICS
The Idaho School Health Education Profile Survey
(Profiles) is administered to all principals, lead
health education teachers and lead physical
education teachers in the state’s public middle and
high schools. Data are reported bi-annually at the
state level.
LIMITATIONS OF THE INDICATOR
All data are self-reported and are not evaluated by
an outside party. Verifying data with a systematic
review of School Wellness Policies would provide
important information about school food
environments.
Expanded data collection would allow for regional
data reporting. Surveys are completed by the school
building principal and the lead Health Education
teacher and may not reflect actual school practices
accurately.
Idaho
National
Nutritional standards for school
meals and snack that go beyond
existing USDA requirements
NO
19 states
Nutritional standards for
competitive food products sold a la
carte, in vending machines, school
stores or at bake sales
NO
27 states
Limited access to competitive food
NO
28 states
BMI or health information collected
NO
21 states
Source: National Initiative on Children’s Healthcare Quality
(NICHQ)
Figure 31: Idaho schools' actions to improve
food and nutrition in the past year (%), 2012
Easy access for fruit and vegetables
Fruit and vegetable displays
Self-serve salad bars
Nutrition and calorie information
Stakeholder healthy eating input
Appealing names for healthy food
Conduct taste tests
Students visit and learn in cafeteria
Serve local and regional food
Plant school gardens
Favorably priced nutritious items
66.9
61.0
60.9
41.8
37.2
23.8
23.4
23.3
23.3
20.8
13.6
Source: 2012 Idaho School Health Profiles in Health and
Physical Education
Map 23: Blue Cross of Idaho Foundation for Health, Inc.
healthy eating and physical activity support, 2012-2014
Source: 2014 Blue
Cross of Idaho
Foundation for
Health, Inc.
DATA RESOURCES
National Initiative on Children’s Healthcare Quality
(NICHQ)
http://www.nichq.org/pdf/Idaho.pdf
74
Measuring What Matters – Idaho Obesity Indicators
OVERARCHING SCHOOL DATA SUMMARY
STRENGTH OF THE DATA:
• School Health Profiles and YRBSS provide
benchmarks and longitudinal data for physical
activity and healthy eating behaviors, policies
and practices.
• Idaho universities and colleges have the capacity
and interest to research physical activity and
healthy eating in schools and childcare settings.
• USDA Child Nutrition Program participation data
are available and periodic reports (e.g., Western
Wave and Food Research Action Center) track
rates and offer state comparisons.
OPPORTUNITIES TO EXPAND DATA
• Expand collection of School Health Profiles and
YRBSS to provide larger sample sizes for robust
regional and demographic comparisons.
• Build on current Idaho Department of Health and
Welfare efforts to identify, attack and evaluate
performance measures for physical activity and
healthy eating in schools and childcare settings.
• Aggregate existing school fitness data and
report on statewide fitness levels of Idaho
students.
• Track newly developed Child Care
implementation guidelines.
• Continue to administer the Lead Physical
Education Teachers Survey.
OPPORTUNITIES TO FILL DATA GAPS
• Conduct research on youth fitness using a
nationally-normed standard and develop a
system to record and track fitness measures
over time.
• Build capacity of physical educators to evaluate
and report on levels of moderate to vigorous
physical activity in their classes.
• Develop a system to collect time spent in
physical activity, benchmarking to national
standards.
• Develop ongoing statewide policy surveillance
systems to mark progress in healthy eating and
physical activity practices in preschools, schools,
and in afterschool and out-of-school programs.
• Standardize School Wellness Policy Assessment
procedures across the state to provide
comparable statewide data to plan for strategic
improvements.
• Assess the impact of the new Community Eligibly
Provision (CEP) on free and reduced price meal
participation.
Task Force on Community Preventive Services. (2002). Recommendations to increase physical activity in communities. American Journal of Preventive Medicine,
22(4S), 67-72. Retrieved from http://www.thecommunityguide.org/pa/pa-ajpm-recs.pdf and http://www.thecommunityguide.org/pa/Physical-Activity.pdf
39
Trost S. (2009). Active Education: Physical Education, Physical Activity and Academic Performance. A Research Brief. Princeton, NJ: Active Living Research, a
National Program of the Robert Wood Johnson Foundation. Retrieved from www.activelivingresearch.org
40
Welk G. (2009). Cardiovascular Fitness and Body Mass Index are Associated with Academic Achievement in Schools. Dallas, Texas: Cooper Institute.
41
National Association for Sport and Physical Education & American Heart Association. (2012). 2012 Shape of the Nation Report: Status of Physical Education in
the USA. Reston, VA: American Alliance for Health, Physical Education, Recreation and Dance. Retrieved from http://www.shapeamerica.org/advocacy/son/
42
Idaho Preferred. (2014). Idaho Preferred [website]. Retrieved from http://idahopreferred.com/
43
U.S. Department of Agriculture, Food and Nutrition Service. (2014). School Meals: Healthy Hunger-Free Kids Act. [website]. Retrieved from http://www.fns.usda.
gov/school-meals/healthy-hunger-free-kids-act
44
Johnston, L.D., P.M. O’Malley, Y.M. Terry-McElrath, N. & Colabianchi. (2013). School Policies and Practices to Improve Health and Prevent Obesity: National
Secondary School Survey Results: School Years 2006–07 through 2010–11.Volume 3. Bridging the Gap Program, Institute for Social Research, University of
Michigan. Retrieved from http://www.bridgingthegapresearch.org/_asset/gqq408/SS_2013_report.pdf
45
National Initiative on Children’s Healthcare Quality (NICHQ), Childhood Obesity Action Network., 2007 Idaho State Fact Sheet. Retrieved from http://www.nichq.
org/pdf/Idaho.pdf
46
Idaho Department of Education, Child Nutrition Programs. Growing Farm to School: Results from the Idaho Farm to School Pilot. Retrieved from https://www.sde.
idaho.gov/site/cnp/farmToSchool/docs/Growing%20Farm%20to%20School%20PRINT.pdf
47
Idaho Department of Education, Child Nutrition Programs. (2014). Child and Adult Care Food Program: Statewide List. Retrieved from https://www.sde.idaho.
gov/site/cnp/cacfp/statewideSiteList.htm
48
Measuring What Matters – Idaho Obesity Indicators
75
MESSAGING ENVIRONMENT
The Institutes of Medicine APOP report
recommends that obesity prevention messaging is
wide-reaching, robust, targeted and research-based.
Successful tobacco control mass media campaigns
provide a helpful guide for obesity prevention
messaging.49 In addition to sustained social
marketing campaigns promoting physical activity
and healthy eating, APOP recommends restricting
marketing of unhealthy foods to children and
adopting laws and regulations to provide consumers
with nutrition information (e.g., calories, sugar and
solid fats).
The Blue Cross of Idaho Foundation for Health has
supported grant monies to communities across
Idaho (Map 23) and most recently awarded grant
monies to seven cities, known as the High Five Cities.
The Blue Cross Foundation developed the High Five
Children’s Health Collaborative and joined forces
with associations, businesses and communities to
make childhood obesity a top priority in Idaho and
to reverse its effects. The Daily Do program was
launched to deliver tips about eating well, staying
active and living better using popular social media,
(e.g., texts, email and Facebook). A television
campaign aired in the fall of 2013 in support of this
initiative.
Colorado’s successful messaging efforts (Live Well
Colorado), messaging works best when public and
private partners join resources and disseminate
clear and actionable messages. A few measurable
messaging indicators could include:
• Reach and impact of messaging.
• Dollars allocated to healthy eating and active
living messages.
• Changes in healthy eating, active living attitudes,
knowledge and practices.
Map. 23 Blue Cross of Idaho Foundation for Health, Inc.
healthy eating and physical activity support, 2012-2014
The Blue Cross of Idaho Foundation also supports
obesity prevention messaging efforts through
smaller grants and programs like Unplug and Be
Outside and the Blue Cruise.
Idaho has not had funding for a sustained statewide
obesity prevention campaign. As is seen from
.S. Health and Human Services, Preventing Tobacco Use Among Youth and Young Adults, A Report of the Surgeon
U
General, 2012 http://www.cdc.gov/Features/YouthTobaccoUse/
49
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Measuring What Matters – Idaho Obesity Indicators
77
CONCLUSION
Using the framework provided by the Institute of
Medicine, Measuring What Matters, Idaho Obesity
Indicators identifies existing state, regional, and
local obesity-related measures and suggests
the expansion of existing measures and the
development of new measures to guide obesity
prevention efforts across interconnected systems
throughout the state.
For each of the five Institute of Medicine
environments, there are helpful data indicators
available, at least at the state level. Working across
the state with diverse partners to impact these
readily available and measurable indicators will
provide useful information on the effectiveness of
current obesity efforts. Expanding current data
collections by increasing the population sampled for
more localized results and adding data measures
will offer a clearer picture of the obesity prevention
work that is needed in Idaho. The report draws
from obesity indicators used across the nation and
suggests solutions for closing data gaps by working
across agencies and organizations and in rarer
cases, to create new data measures.
Key state, regional and local obesity prevention
leaders generated suggestions for potential data
resources. The potential for data resource sharing
and development across a diverse group of Idaho
partners is rich and largely untapped. As new
partners join forces around the central concepts
of healthy and affordable food and opportunities
supporting daily physical activity, significant data
indicators will emerge and new, more integrated
obesity strategies will result.
At the core, preventing obesity must focus on
actions that address obesity at the earliest and
most preventable levels and target Idahoans facing
the greatest health inequities.
A necessary starting point for evaluating obesity
efforts in Idaho is the development of key indicators
and a system for tracking progress. Evaluating
and tracking obesity progress requires the active
engagement of leaders in government, industry,
schools, philanthropies, non-profit organizations,
and the health care system as well as parents,
teachers, students and more. One promising
approach is the use of web-based, interactive data
indicators. Communities throughout the nation
are developing health indicators that are readily
available, easily updated, and track progress over
time. The capacity for mapping and interacting with
data grows daily. The development of this type of
system will increase Idaho’s ability to more precisely
define where obesity prevention is needed, and
offer a clearer picture of what works. This level of
specificity and accountability is required to assure
external funders that investing in Idaho obesity
prevention is a wise and profitable endeavor.
Measuring What Matters, Idaho Obesity Indicators
is offered as a complement to the existing obesity
preventions efforts across the state and hopes to
provide a useful framework for assessing needed
interventions, evaluating existing efforts and as a
springboard to reach shared agreements for ongoing
obesity monitoring and surveillance in Idaho.
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Measuring What Matters – Idaho Obesity Indicators
79
APPENDIX 1
AAP-American Academy of Pediatrics
HIE-Health Information Exchanges
ACA-Patient Protection and Affordable Care Act
HP2020-Healthy People 2020
ACS-American Community Survey
HRSA-Health Resources and Services Administration
APOP-Accelerating Progress in Obesity Prevention:
Solving the Weight of the Nation (2012 IOM report)
IOM-Institute of Medicine
BFS-Bicycle Friendly State
MCHB-Maternal and Child Health Bureau
BLS-Bureau of Labor Statistics
mPINC-National Survey of Maternity Practices in Infant
Nutrition and Care
BMI-Body Mass Index
MVPA-Moderate to Vigorous Physical Activity
BRFSS-Behavioral Risk Factor Surveillance System
NAICS-North American Industry Classification System
CACFP-Child and Adult Care Food Program
NAMCS-National Ambulatory Medical Care Survey
CDC-Centers for Disease Control and Prevention
NASPE-National Association for Sport and Physical
Education
CEP - Community Eligibility Provision
CHIP-Children’s Health Insurance Program
CMMS-Centers for Medicaid and Medicare Services
CTG-Community Transformation Grants
CZCBP - County and ZIP Code Business Patterns
DHHS-U.S. Department of Health and Human Services
DOT-Department of Transportation
EBT-Electronic Benefit Transfer
EFNEP-Expanded Food and Nutrition Education Program
EHR-Electronic Health Record
EPOP-Evaluating Progress of Obesity Prevention Efforts:
A Plan for Measuring Progress (2013 IOM report)
EPSDT-Early Periodic Screening, Diagnosis, and Treatment
Program
ERS-Economic Research Service
FHWA-Federal Highway Administration
FMNP-Farmers’ Market Nutrition Program
GIS-Geographic Information Systems
NCHS-National Center for Health Statistics
NCSRTS-National Center for Safe Routes to School
NDP Group-National Diary Purchase Group
NHANES-National Health and Nutrition Examination
Survey
NNYFS-NHANES National Youth Fitness Survey
NHIS-National Health Interview Survey
NHTS-National Household Travel Survey
NPAP-National Physical Activity Plan
NPLHD-National Profile of Local Health Departments
NRPA-National Recreation and Parks
NSCH-National Survey of Children’s Health
NSEBRCPCP-National Survey on Energy Balance-Related
Care Among Primary Care Physicians
NSLP-National School Lunch Program
NYPANS-National Youth Physical Activity and Nutrition
Survey
HEAL-Healthy Eating Active Living Framework
ODPHP-Office of Disease Prevention and Health
Promotion
HEDIS-Healthcare Effectiveness Data and Information Set
PA-Physical Activity
HEI-Healthy Eating Index
PAG-Physical Activity Guidelines for Americans
HHS-U.S Department of Health and Human Services
PCMH-Patient-Centered Medical Home
HIA-Health Impact Assessment
PedNSS-Pediatric Nutrition Surveillance System
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81
PHA - Idaho Preventive Health Assistance
Communities
PNSS-Pregnancy Nutrition Surveillance System
SOPLAY - System for Observing Play and Leisure Activity
in Youth
PRATS-Pregnancy Risk Assessment Tracking System
QFAHPD-Quarterly Foods-at-Home Price Database
QRIS-Quality Rating Improvement System
SFSP-Summer Food Service Program
SHPPS-School Health Policies and Practices Study
SNAP-Supplemental Nutrition Assistance Program
SNAP-ED-SNAP Education
SNDA-School Nutrition Dietary Assessment Study
SOPARC - System for Observing Play and Recreation in
SRTS-Safe Routes to School
STARS-Idaho State Training and Registry
USDA-U.S. Department of Agriculture
USPSTF-U.S. Preventive Service Task Force
WIC-Woman, Infants, and Children Special Supplemental
Nutrition Program
YRBSS-Youth Risk Behavior Surveillance System
YFSP-Youth Fitness Survey Plan
APPENDIX 2
TABLES
FIGURES
Table 1. Idaho adult BMI classification, 2012
Figure 1. Accelerating progress in obesity prevention
environments
Table 2. Idaho adults: Overweight and obese by sex (%)
2012
Table 3. Overweight Idaho adults (%), 2012
Table 4. State rankings on obesity and health related
indicators
Table 5. Overweight and obese, Idaho high school students
(%), 2013
Table 6. Overweight and obese U.S. high school students
(%), 2011
Table 7. Idaho Migrant and Seasonal Head Start (ages 3-5),
2012-2013
Table 8. Pregnancy weight indicators (%), 2010
Table 9. Adults meeting 150+ minutes of physical activity
in the past week (%), 2011
Table 10. Adults meeting aerobic and muscle strengthening
guidelines (%), 2011
Figure 2. Obesity measures in adults, 2012
Figure 3. Obesity measures in adolescents (grades 9-12)
(%), 2011
Figure 4. Obesity measures in adolescents (grades 9-12) by
race in Idaho (%), 2011
Figure 5. Overweight or obese children (ages 10-17) (%),
2011-2012
Figure 6. Overweight and obese children (ages 10-17) by
race and ethnicity (%), 2007
Figure 7. BMI of Head Start preschoolers (ages 3-5) (%),
2012-2013
Figure 8. U.S. pediatric nutrition surveillance (ages 24-59
months), 2011
Figure 9. Prepregnancy BMI measures, Idaho, 2011
Figure 10. Adult physical activity indicators, 2012
Table 11. Idaho adults with no leisure time physical activity,
2011
Figure 11. Children (ages 6-17) participating in organized
activities outside of school (%), 2011-12
Table 12. Physical activity behaviors (grades 9-12) in Idaho
(%), 2013
Figure 12. Safe and supporting neighborhoods for children
(%), 2011-12
Table 13. Child Care center licensing regulations, 2008
Figure 13. Children who live in neighborhoods that contain
parks, recreation centers, sidewalks or libraries (%), 20112012
Table 14. Idaho adults who do not eat 5 servings of fruits
and vegetables daily (%), 2011
Table 15. Food security by ethnicity (%), 2007-2011
Table 16. Idaho infants breastfed at birth (%), 2011
Table 17. Idaho mothers who breastfed for at least 6
months (%), 2010
Figure 14. Sport teams and TV viewing (grades 9-12) (%),
2011
Figure 15. Daily vigorous activity in past week, (ages 6-17)
(%), 2007
Table 18. mPINC Quality Practice scores for Idaho, 2011
Figure 16. Four or more hours daily screen time (ages 6-17)
(%), 2007
Table 19. Moderate to vigorous activity in Idaho schools
(%), 2013
Figure 17. Fitness and recreation centers per 100,000
population, 2011
Table 20. Obesity-related school standards, 2008
Figure 18. Daily food behaviors (grades 9-12) (%), 2011
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Measuring What Matters – Idaho Obesity Indicators
83
FIGURES CONTINUED
Figure 19. Daily food behaviors by race in Idaho (grades
9-12) (%), 2011
Figure 20. Food store and fast food access, 2011
Figure 21. Household food insecurity (%), 2010-2012
Figure 22. SNAP participation (%), 2012
Figure 23. Idaho schools with required physical education
courses (%), 2012
Figure 24. Percentage of time allocated for physical
activity in Idaho schools (%), 2012
Figure 25. Reasons why Idaho schools exempt students
from physical education (%), 2012
Figure 26. Idaho schools providing physical activity
opportunities (%), 2012
Map 5. Obese 3rd graders by Public Health District, 20112012
Map 6. Prepregnant obesity, 2011
Map 7. Idaho adults with no leisure time physical activity by
Public Health District, 2011
Map 8. Population walking and biking to work by county,
2008-2012
Map 9. Adults who do not eat 5 servings of fruits and
vegetables daily by Public Health District, 2011
Map 10. Idaho counties with low store access, 2010
Map 11. Poverty in Idaho by county, 2012
Map 12. Adults worried about affording nutritious meals
most or all of the time by Public Health District, 2012
Map 13. Food insecurity by county, 2011
Figure 27. Idaho fitness testing in schools (%), 2012
Map 14. Child food insecurity by county, 2011
Figure 28. School breakfast participation (%), 2011-2012
Map 15. SNAP participation by county, January 2014
Figure 29. Idaho school food and beverage choices (%),
2012
Map. 16. Mothers who participated in WIC during
pregnancy, 2011
Figure 30. Idaho schools offering fruit or non-fried
vegetables at school celebrations when foods or beverages
are offered (%), 2012
Map 17. Farmers market density and SNAP benefit
processing, 2014
Figure 31. Idaho schools’ action to improve food and
nutrition in the past year (%), 2012
Map 18. Population under age 19 with no health insurance,
by county, 2012
MAPS
Map 19. Population under age 65 with no health insurance,
by county, 2012
Map 1. Idaho Public Health Districts
Map 20. Breastfeeding initiation rates, 2011
Map 2. Overweight Adults in Idaho by Public Health
District, 2012
Map. 21 Mothers who breastfed for 6+ months, by Public
Health District, 2010
Map 3. Obese Adults in Idaho by Public Health District,
2012
Map 22. Free and reduced price lunch participation (%),
2010-2011
Map 4. Overweight 3rd graders by Public Health District,
2011-2012
Map. 23 Blue Cross of Idaho Foundation for Health, Inc.
healthy eating and physical activity support, 2012-2014
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Measuring What Matters – Idaho Obesity Indicators
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Measuring What Matters
Idaho Obesity Indicators
Foundation for Health, Inc.