Strategies for Improving Nutrition Policies & Environments

•Washington State Nutrition & Physical Activity Plan•CDCs Recommended Nutrition Strategies• Media, Access, Point of Decision Information, Price, and Social Support & Services (MAPPS) interventions

Washington State’s Nutrition Washington State’s Nutrition & & Physical Activity PlanPhysical Activity Plan

Criteria for Objectives & Criteria for Objectives & RecommendationsRecommendations

Related to obesity and chronic disease Related to obesity and chronic disease prevention prevention

Population based, potential to affect a Population based, potential to affect a large portion of the populationlarge portion of the population

Evidence based, theoretically sound, Evidence based, theoretically sound, or recommended by nationally or recommended by nationally recognized authorities or expertsrecognized authorities or experts

Measurable objectivesMeasurable objectives

Plan Revision ProcessPlan Revision Process

Literature/document review Literature/document review Indentify new research, evidence-based interventions Indentify new research, evidence-based interventions and national guidelinesand national guidelines

Key informant interviewsKey informant interviewsInput from members of original advisory Input from members of original advisory committee and others who have used the Plancommittee and others who have used the Plan

Three stage review processThree stage review processInternal and external partners including selected experts Internal and external partners including selected experts and project coordinatorsand project coordinators

The Six ObjectivesThe Six Objectives

ObjectivesObjectives

Access to Health Promoting FoodsAccess to Health Promoting Foods

Food InsecurityFood Insecurity

Proportion of Mothers Who Breastfeed Proportion of Mothers Who Breastfeed Their Infants & Toddlers Their Infants & Toddlers

Free and Low-Cost Opportunities forFree and Low-Cost Opportunities for Recreation and Physical Activity Recreation and Physical Activity

Physical Activity Opportunities for ChildrenPhysical Activity Opportunities for Children

Active Community EnvironmentsActive Community Environments

Reduce Food Insecurity in Reduce Food Insecurity in Washington Washington

Strengthen food assistance programs and Strengthen food assistance programs and improve economic security for low-income improve economic security for low-income families and individuals families and individuals

Improve access to and awareness of food Improve access to and awareness of food assistance programs assistance programs

Increase Access to Health Increase Access to Health Promoting FoodsPromoting Foods

Assure that communities provide access Assure that communities provide access to healthy foods and beveragesto healthy foods and beverages

Assure that worksites, including healthcare Assure that worksites, including healthcare services and schools, provide healthy services and schools, provide healthy foods and beverages foods and beverages

Assure that schools provide healthy foods Assure that schools provide healthy foods and and

Continue to advance/sustain successful Continue to advance/sustain successful initiatives such as Healthy Communitiesinitiatives such as Healthy Communities

Increase the proportion of mothers Increase the proportion of mothers who breastfeed their infants and who breastfeed their infants and toddlers toddlers

Assure that health care settings, child care Assure that health care settings, child care facilities, and worksite environments facilities, and worksite environments support breastfeeding support breastfeeding

ResourcesResources

Partners inPartners inAction SiteAction Site Web-based version Web-based version

of the Planof the Plan Increased access Increased access

to resourcesto resources

Recommended Community Strategies and Measurements to

Prevent Obesity in the United States

http://www.cdc.gov/NCCDPHP/DNPAO/Publications/index.html

“Where people live, work and play affects their health.”

Recommended Community Strategies & Measurements to Prevent Obesity in the United

States

MMWR. Recommendations & Reports. July 24, 2009/

58(RR)&);1-26.

Recommended Strategies and Associated Measures in 6 Categories

1. Promote availability of affordable healthy food & beverages

2. Support healthy food and beverage choices

3. Encourage breastfeeding

4. Encourage physical activity or limit sedentary activity among children & youth

5. Create safe communities that support physical activity

6. Encourage communities to organize for change

Process

• Literature search & analysis resulted in 179 policy-level strategies.

• Select expert panel rated each strategy:– 47 most promising (26 nutr, 17 pa)

• Strategies were matched with appropriate measures & expert review resulted in 25 recommended strategies with measures.

• Pilot tested in 20 local settings & modified for a final total of 24 strategies.

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

Criterion Description

ReachThe strategy is likely to affect a large percentage of the

target population.

Mutability The strategy is in the realm of the community's control.

TransferabilityThe strategy can be implemented in communities that

differ in size, resources, and demographics.

Effect sizeThe potential magnitude of the health effect for the

strategy is meaningful.

Sustainability of health impact

The health effect of the strategy will endure over time.

Criteria used by content area experts to rate suggested measurements for each strategy

Criterion Description

UtilityThe measurement serves the information needs of communities

enabling them to plan and monitor community-level programs and strategies.

Construct validity

The measurement accurately assesses the environmental strategy or policy that it is intended to measure.

Feasibility

The measurement can be collected and used by local government (e.g. cities, counties, towns) without the need for surveys, access to proprietary data, specialized equipment, complex analytical techniques and expertise, or unrealistic resource expenditure.

11 nutrition strategies

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

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

Overview• Limited availability of healthier food and beverage options

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

Evidence• CDC's Community Guide reports insufficient evidence to

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

Suggested measurement

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

MAPPS

• Media, Access, Point of Decision Information, Price, and Social Support & Services (MAPPS) interventions

• List of strategies put together in 2009 by CDC to support applications from states and local health departments for prevention initiatives for nutrition, physical activity and tobacco.

• Each strategy has some evidence for effectiveness.

Media

• Media and advertising restrictions consistent with federal law

• Promote healthy food/drink choices

• Counter-advertising for unhealthy choices

Access

• Healthy food/drink availability (e.g., incentives to food retailers to locate/offer healthier choices in underserved areas, healthier choices in child care, schools, worksites)

• Limit unhealthy food/drink availability (whole milk, sugar sweetened beverages, high-fat snacks)

• Reduce density of fast food establishments • Eliminate transfat through purchasing actions, labeling

initiatives, restaurant standards • Reduce sodium through purchasing actions, labeling

initiatives, restaurant standards • Procurement policies and practices • Farm to institution, including schools, worksites,

hospitals, and other community institutions

Point of Purchase/Promotion

• Signage for healthy vs. less healthy items

• Product placement & attractiveness (e.g. as part of healthy corner store)

• Menu labeling

Price

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

Social and Support Services

• Support breastfeeding through policy change and maternity care practices

MAPPS Evidence and Resources

• Evidence for the MAPPS interventions: http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for_N_and_PA_MAPPS_strategies_cleared.pdf

• “Example: “9. Procurement policies and practices establish mechanisms and guidelines for obtaining healthier foods, including fresh fruits and vegetables. They can be used to promote healthier foods, including fruits and vegetables, at workplace cafeterias; in workplace vending machines; and at meetings, events, and conferences. Examples of such practices might include the modification of food and beverage contracts at schools or the identification of vending suppliers who carry healthier vending items at worksites.” – Document lists 4 resources

Resources for Procurement Policies

• Strategy 6: Provide incentives for the production, distribution, and procurement of foods from local farms. From: Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. This guide provides 24 recommended strategies to encourage and support healthy eating and active living along with measures to help communities track their progress over time. http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

• CDC’s Lean Works! offers interactive tools and evidence-based resources to design effective worksite obesity prevention and control programs. http://www.cdc.gov/leanworks/index.html

• Growers' Collaborative is a program organized by Community Alliance with Family Farmers (CAFF). The collaborative organizes small, family farms into a single marketing unit. This lightens the marketing and distribution burden from farmers and provides a more unified delivery option for purchasers, such as public and private grade schools, colleges, hospitals, and corporate cafeterias. http://www.caff.org/programs/growerscollaborative.shtml

• Making it Happen! School Nutrition Success Stories provides a collection of success stories describes approaches that schools, districts, or states have used to improve the nutritional quality of foods offered at school. www.cdc.gov/HealthyYouth/MIH

http://www.cdc.gov/chronicdisease/recovery/docs/Additional_information_for_N_and_PA_MAPPS_strategies_cleared.pdf

In Class Groups

• Select one strategy to address your priority issue from one of these:– WA state Nutrition and Physical Activity plan– CDC Recommended Community Strategies– MAPPS list

• Using the ideas presented about this strategy in the document, start to lay out your approach to applying the strategy in Delridge/White Center.