evaluating sodium initiatives rashon i. lane, m.a. evaluation and program effectiveness team...
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Evaluating Sodium InitiativesEvaluating Sodium Initiatives
Rashon I. Lane, M.A.Evaluation and Program Effectiveness Team
Division for Heart Disease and Stroke Prevention
September 14, 2010
Disclaimer Statement
The information presented here is for training purposes and reflects the views of the presenter. It does not
necessarily represent the official position of the Centers for Disease Control and Prevention.
Overview of Today’s SessionToday’s session will address the following:
Why Sodium Reduction?• Excess sodium intake is a known risk factor for high blood pressure
and CVD events.• Average consumption of sodium in the United States is far greater
than recommended limits.– 2005 Dietary Guidelines recommendation: <2,300 mg/day (1,500 mg
for specific populations)
– Average intake: 3,466 mg/day
• The majority of sodium consumed comes from processed and restaurant foods.
• Policy and environmental changes are needed to speed decreases in sodium intake.
Relative Amounts of Dietary Sodium in the American Diet
Food Processing
77%
Naturally Occurring
12%
At the table6%
During Cooking5%
Source: Mattes RD, Donnelly, D. Relative contributions of dietary-sodium sources. J Am Coll Nutr. 1991 Aug;10(4):383-93.
Similar Foods Have Less Sodium in the U.K.
U.S. sodium/serving
210 mg
U.K. sodium/serving
160 mg
U.S. sodium/serving
220 mg
U.K. sodium/serving
120 mg
Sample Food Label, U.S.
Sodium Reduction Policies and Strategies
ProcurementPolicies designed to make the healthy food more available, affordable, and appealing. They can work to change individual
factors (i.e., knowledge of how to choose healthy options), social factors (i.e., social norms), and environmental factors
(i.e., access to healthy options).
Labeling Studies
• Studies assess:– Awareness– Knowledge– Consumer choices/behavior
• Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City
– http://content.healthaffairs.org/cgi/content/full/28/6/w1110
• Stanford Study Shows Posting Calories on Restaurant Menu Boards Lowers Customers’ Calorie Counts per Visit
– http://www.gsb.stanford.edu/news/starbucks.html
Venue Based Strategies• Worksites
• Schools
• Hospitals
Example Media Evaluation Champlain (Canada) “GIVE YOUR HEAD A SHAKE”
Sodium Reduction Media Campaign
• Evaluation Design
-Telephone survey repeated 6, 12, & 24 months post launch of campaign. -Respondents (n=1,600 per community) of Champlain and control community-Assess attitudes, knowledge and behaviors of related to dietary sodium
2010. Champlain Cardiovascular Prevention Network Annual Report 2009-10
Example Media Evaluation Results • Four-in-ten respondents say the campaign has been instrumental in
getting them to reduce their sodium intake
– Most respondents are concerned about eating too much sodium– 70% are trying to cut back on the amount of sodium they are eating– 50% of respondents were not able to correctly identify many high sodium
foods– Many respondents report regularly eating foods high in sodium
2010. Champlain Cardiovascular Prevention Network Annual Report 209-10
Why Evaluate Now?• Determine if policies or environmental changes are effective in attaining expected
outcomes [e.g., knowledge, attitude, consumer behavior]• Share lessons learned among public health practitioners and other partners.
Logic ModelsMediating Factors
Individual Factors-Increased knowledge of health effects of sodium -Increased knowledge of how to choose low sodium foods
Increased intention to consume low sodium foods
Decreased sodium consumption
Decrease blood pressure
Label sodium content of foods
Health Impact
Biological-Increased sensitive ‘taste of salt” -Decreased sodium preference
Potential Food Procurement Policy Components
Promote healthy low sodium options
Decrease cost of healthy low sodium options
Increase the availability of low sodium options
Social Factors-increase positive social norms around reducing sodium consumptions
Environmental Factors-increase access to low sodium optionsDecrease affordability gap of low sodium options
Example Procurement Evaluation Questions
Process – To what extent have agencies implemented procurement standards?
• Have agencies met standards?• Were manufactures able to meet standards?• What were the resources needed?
Outcome– What is the impact of the policy...
• on cost of certain foods?• on the food or nutrients (such as sodium) that clients consume?• on client health (i.e. blood pressure, weight)?
Indicators and Data Sources• Proportion of procurement policy/standards for foods purchased,
served or sold that are passed• Proportion of agencies adhering to policy/standards• Proportion of meals served that have lower sodium options
• Data Sources– Documentation of policies passed– Purchase records– Point of purchase/sales data– Audits of agency menus– Dietary surveys (consumer level)
Group Activity1. Choose a strategy or intervention
2. Select 2 possible evaluation questions (process and outcome)
3. Determine what indicators will help answer these questions.
4. Determine if there is an existing data source or if one can be developed.
Evaluation Plan TemplateActivity Evaluation Question Data Source Data Collection/Analysis
Implement procurement standards for food nutrients to include sodium
To what extent have agencies complied with new standards?
Purchase records/receipts/menus
Pre/post-purchase records/receipts/menus audit.
Related Workshops
• Reducing Sodium Intake—What Are the Policy Opportunities? (WK-12)
• The BRFSS 2012 Salt Intake Module ─ Possible State-Added Questions in 2011 (19-A)
Q & A
