Healthy People 2020Mission of the Holy Spirit

By: Ashlan Brown, Raul Cardona, Clara Dalton, Melody Piranian, Jalyssa Robles, Amanda Turissini, Leigha Wilson, and Lauren Wynder

Monday, November 10, 2014

Objective Nutrition and Weight

Status - Objective 15: Increase the variety and

contribution of vegetables to the diets of the population aged 2 years and older.1

Vegetable Consumption in Other Nations Malnutrition and infection = #1 cause of death in

children in developing nations.2

People are unable to buy adequate amounts of vegetables due to: Insufficient supply High prices

Lack of storage facilities and delivery infrastructure needed to keep vegetables fresh = lower consumption.

Vegetable Consumption in Other Nations Lack of vegetables in a person’s diet can lead to

malnutrition. Vitamin A deficiency = blindness, anemia, and poor

physical growth. 131 million children worldwide suffer from vitamin A

deficiency. Majority in Asian and African countries

UNICEF and Helen Keller International have implemented vitamin A supplementation programs in these countries.2

Vegetable Consumption in Other Nations In general, developed countries have a more constant

and stable supply of vegetables.3

More resources are available for assistance programs Helps provide vegetables and other healthy foods to

families in need. Higher income nations tend to consume more

vegetables than lower income nations. Parents with more education consume more

vegetables, and so do their children.

Vegetable Consumption in Europe Only 6-24% of European children reach the WHO’s

recommended daily consumption of fruits and vegetables.4

Vegetable Consumption in the United States 92% of youth ages 2-19 consume vegetables daily.5

Children ages 2-5 years are more likely to consume vegetables daily than adolescents.

Increasing the consumption of vegetables, especially dark-green, orange, and red vegetables, among youth is a national public health priority included in the US nutritional guidelines.

Children who consume more nutrient-filled vegetables have a decreased risk of chronic illness.

The majority of under-consumed nutrients among youth come from vegetable and fruit sources.

Vegetable Consumption in the United StatesResearch Study of Vegetable Consumption Among Adolescents.5

US Department of Health and Human Services (2014) conducted a 24-hour dietary recall interview on adolescents in the US.

92% consumed vegetables, of those: 11% - dark green vegetables 75.1% - red/orange vegetables 53% - starchy vegetables 60.1% - other vegetables

Dark green vegetable consumption decreased with age.No differences existed between Hispanic, African American, and

Caucasians in vegetable consumption.

Vegetable Consumption in the United States People in the US eat more starchy vegetables than non-

starchy vegetables.6

Both are very important in ones diet just in different amounts.

Starchy vs. non-starchy vegetables: Starchy vegetables need to be consumed less frequently.

Ex: corn, potatoes, and squash Non-starchy vegetables contain more nutrients and fewer

calories and should be incorporated into everyone’s diets. Ex: spinach, tomatoes, and broccoli

Vegetable Consumption at Mission of the Holy Spirit Based on our observations, the MOHS community, is

not receiving the proper amount of vegetable servings per day. The meals provided include few, if any vegetables

Meals observed = pizza, chicken nuggets, casseroles, and artificially sweetened fruit juice.

Canned green beans were the only vegetables served.

Vegetable Consumption at Mission of the Holy Spirit Limited access to fresh vegetables.

Major grocery stores are not easily accessible without cars. Most people in the area around MOHS rely on corner stores and

gas stations to get their food. Studies have suggested that close proximity to a chain

supermarket is positively correlated with fruit and vegetable intake or overall dietary quality.7

Poor access to supermarkets in African-American neighborhoods = negative implications for residents’ fruit and vegetable intake.

National Trends for the Past 10 Years 2013 – those who consumed vegetables 1 or more times a

day NATIONWIDE – 76.9%; those who did not – 21.4% 2009 – consumed fruits and vegetables 5 or more times a

day – 23.5%; did not – 76.5% 2007 – consumed fruits and vegetables 5 or more times a

day – 24.3%; did not – 75.7% 2005 – consumed fruits and vegetables 5 or more times a

day – 23.2%; did not – 76.8% Vegetable consumption has been relatively constant.8

National Trends for the Past 10 Years

Local Trends for the Past 10 Years CDC Behavioral Risk Factor Assessment of Virginia Beach-Norfolk-

Newport News, VA-NC Metropolitan State Area.9

3 studies were conducted: 2005, 2007, 2009 on adults. Fruits and vegetables were combined in the studies. There has been a steady increase throughout the years. Areas included:

Chesapeake city, VA; Currituck County, NC; Gates County, NC; Gloucester County, VA; Hampton city, VA; Isle of Wight County, VA; James City County, VA; Mathews County, VA; Newport News city, VA; Norfolk city, VA; Poquoson city, VA; Portsmouth city, VA; Suffolk city, VA; Surry County, VA; Virginia Beach city, VA; Williamsburg city, VA; York County, VA

Local Trends for the Past 10 Years In 2005, adult vegetable consumption

5 or more times a day—26.3% Less than 5 a day—73.5%

In 2007, adult vegetable consumption 5 or more times a day—28.5% Less than 5 a day—71.5%

In 2009, adult vegetable consumption 5 or more times a day—30% Less than 5 a day—70%

Programs to Increase Vegetable Consumption in Norfolk: Community Gardens Norfolk Redevelopment and Housing Authority distributes

grant money from State Farm Youth Advisory Board to NHRA assisted-rental communities.10

Young residents use grant money to start new gardens within the neighborhoods. Residents sow seeds for community gardens that improve

land-use, grant access to fresh produce and healthier lifestyles.

Most recent neighborhood to start community garden is Calvert Square Apartments.

Programs to Increase Vegetable Consumption in Norfolk: Farm Markets Markets in the community where local farmers sell fresh

produce. St. Paul’s Downtown Farm Market.11

Runs from May-November Five Points Community Farm Market. 12

Runs year round Reflects local culture and economy – helps connect people. Not just a time for shopping, but a time for community. Cheaper prices.

Programs to Increase Vegetable Consumption in Norfolk: Community Supported Agriculture Allows city residents to obtain fresh produce grown by regional

farmers. Winter and Summer subscriptions, prices range from $190-250.

Paid in advance Produce is picked up weekly or bi-weekly. Enough produce for a family of 2-3, with options for smaller

portions. 7-10 types of seasonal vegetables. Mattawoman Creek Farms.13

Five Points Community Supported Agriculture Program.12

Other programs: USDA Fresh Fruit and Vegetable Program Federally funded program aimed at improving the health of

students in schools with high free/reduced lunch enrollments.14

Began as a pilot program in 2002, but became available nationwide in 2008.

Food is served at times other than lunch and breakfast at least twice a week.

Schools encouraged to partner with local universities and grocery stores.

Total funding for 2013/14 school year: 165.5 million.

Other programs: Farm to School Program Aim: to get fresh produce from local farms to schools,

as well as educate children on nutrition, food, and agriculture.15

Food served at breakfast, lunch, or snack time. Incorporate school gardens into lessons. Trips to farm or farmer presentations. Promotes healthy eating habits and decreases risk of

childhood obesity.

Other programs: Hospital Gardens On-site gardens that grow produce to serve to patients

as well as visitors in the cafeteria.16, 17

Gardens have support of local farming community. Hospital employees can volunteer to help with garden

and receive a portion of produce for their labors. Some hospitals make compost from kitchen waste to

use for the garden. The goal of hospital gardens is to model healthy eating

for their patients.

Recommendations for Addressing Gaps in Service Service that brings produce to their neighborhood – lack of

transportation. Establishing local food pantries, or branches of existing food

pantries – increase their access to vegetables. Education about ways to increase consumption and variety of

vegetables on a limited budget. Build meal plans that can be made on a budget with a variety of

vegetables. On a national level, more education and programs can be directed

towards increasing the variety of vegetables as well as promoting the consumption of vegetables.

Recommendations for Program Improvements Increased investment in community gardens. Community Supported Agriculture programs.

More pick-up locations Education on how to use seasonal vegetables

Advertisement of farm markets. Local schools could be encouraged to invest in a farm to

school program similar to the one in Minnesota. Local hospitals could put resources towards establishing

hospital vegetable gardens.

Additional Research Needed Contribution and variety of vegetables in the diet Hamel & Robbins (2013).18

Aim: to determine the effectiveness of using technology to increase vegetable consumption among children and adolescents.

Method: systematic review, compared the results of 15 studies. Findings: using technology is an effective way to promote vegetable

intake in these populations and nurses should utilize web-based interventions when providing education.

Other studies have been conducted linking low vegetable consumption to hypertension, metabolic syndrome, and even asthma.19, 20, 21

Additional Research Needed What are effective ways to increase vegetable consumption in

the adult population? What are effective ways to increase the variety of vegetables

consumed in all population groups? How do different cooking methods affect the nutritional

content of vegetables? How does vegetable consumption in Norfolk compare to the

rest of Virginia and the rest of the United States? What are the main barriers preventing people from increasing

the variety and contribution of vegetables to their diet?

Questions?

References 1. Healthy People 2020. (2014, September 18). Nutrition and weight status.

Retrieved from http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives

2. Neumann, C. G., Gewa, C., & Bwibo, N. O. (2012). Child nutrition in developing countries: critical role in health. Retrieved from UCLA School of Public Health.

3. Agudo, A. (2005). Measuring intake of fruit and vegetables. Retrieved from Catalan Institute of Oncology.

4. European Food Information Council. (2012). Fruit and vegetable consumption in Europe – do Europeans get enough? Retrieved from http://www.eufic.org/article/en/expid/Fruit-vegetable-consumption-Europe/

5. Nielsen, S. J., Rossen, L. M., Harris, D. M., & Ogden, C. L. (2014, July 1). Fruit and vegetable consumption of U.S. youth, 2009–2010. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db156.pdf

References 6. Coffman, M. A. (2014, January 1). Starchy vs non-starchy vegetables. Retrieved

from: http://healthyeating.sfgate.com/starchy-vs-nonstarchy-vegetables-1764.html 7. Zenk, S. N., Schulz, A. J., Hollis-Neely, T., Campbell, R. T., Holmes, N., Watkins, G.,

& ... Odoms-Young, A. (2005). Fruit and vegetable intake in African Americans: income and store characteristics. American Journal Of Preventive Medicine, 29(1), 1-9. doi:10.1016/j.amepre.2005.03.002

8. Centers for Disease Control and Prevention. (2014). Behavioral risk factor surveillance system: prevalence and trends data (Fruits and vegetables). Retrieved from http://apps.nccd.cdc.gov/brfss/index.asp

9. Centers for Disease Control and Prevention. (2014). Behavioral risk factor surveillance system: city and county data (Fruits and vegetables). Retrieved from http://apps.nccd.cdc.gov/BRFSS-SMART/index.asp

References 10. Branham, J. (2012, October 15). State farm and Norfolk Redevelopment and

Housing Authority sow seeds for community gardens initiative. Retrieved from http://www.nrha.us/newsandevents/pressreleases/state-farm-and-norfolk-redevelopment-and-housing-authority-nrha-sow-seed

11. Saint Paul's Episcopal Church. (n.d.). St. Paul’s Downtown Farm Market. Retrieved from http://www.stpaulsnorfolk.org/outreach-2/downtown-market/

12. Reese, K. (2014, September 25). Five Points Community Farm Market newsletter. Retrieved from http://www.5ptsfarmmarket.org/newsletters/

13. Mattawoman Creek Farms. (2014, January 1). Our CSA programs. Retrieved from https://www.mattawomancreekfarms.com/CSA.htm

14. United States Department of Agriculture, Food and Nutrition Service. (2014, August 20). Fresh fruit and vegetable program. Retrieved from http://www.fns.usda.gov/ffvp/fresh-fruit-and-vegetable-program

References 15. University of Minnesota. (2014). Farm to School in Minnesota. Retrieved from

http://www.extension.umn.edu/food/farm%2Dto%2Dschool/in%2Dminnesota/ 16. Mad River Community Hospital. (n.d.). Mad River Community Hospital is out to

change the way you think about hospital food! Retrieved from http://www.madriverhospital.com/about/Vegetablegarden.htm

17. Doiron, R. (2010, December 15). South African hospital uses kitchen garden to grow healthy vegetables and financial savings. Retrieved from http://kgi.org/blogs/roger-doiron/south-african-hospital-uses-kitchen-garden-grow-healthy-vegetables-and-financial-

18. Hamel, L. M., & Robbins, L. B. (2013). Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. Journal of Advanced Nursing, 69(1), 16-30. doi:10.1111/j.1365-2648.2012.06086.x

References 19. Damasceno, M. C., De Araújo, M. M., De Freitas, R., De Almeida, P. C., & Zanetti,

M. L. (2011). The association between blood pressure in adolescents and the consumption of fruits, vegetables and fruit juice - an exploratory study. Journal of Clinical Nursing, 20(11/12), 1553-1560. doi:10.1111/j.1365-2702.2010.03608.x

20. Høstmark, A. (2010). The Oslo Health Study: A dietary index estimating high intake of soft drinks and low intake of fruits and vegetables was positively associated with components of the metabolic syndrome. Applied Physiology, Nutrition & Metabolism, 35(6), 816-825. doi:10.1139/H10-080

21. Seyedrezazadeh, E., Pour Moghaddam, M., Ansarin, K., Reza Vafa, M., Sharma, S., & Kolahdooz, F. (2014). Fruit and vegetable intake and risk of wheezing and asthma: a systematic review and meta-analysis. Nutrition Reviews, 72(7), 411-428. doi:10.1111/nure.12121

22. Di Noia, J., & Byrd-Bredbenner, C. (2014). Determinants of fruit and vegetable intake in low-income children and adolescents. Nutrition Reviews, 72(9), 575-590. doi:10.1111/nure.12126