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States’ Capacity for Comprehensive Nutrition and Physical Activity Programming

Nutrition and Physical Activity Workgroup (NUPAWG)

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Presentation Outline

Describe the following related to states comprehensive nutrition and physical activity programming1. The purpose, partners, process and context of the

assessment

2. Results: capacity needs barriers for comprehensive nutrition and physical

activity programming major successes

3. Implications for professional organizations and states

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Purpose

To better understand states' capacity needs, barriers and successes in accomplishing comprehensive nutrition and physical activity programming.

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Assessment Questions

What are the reported capacity needs of states for comprehensive nutrition and physical activity programming?

What are the major state reported barriers for comprehensive nutrition and physical activity programming?

What major successes have states experienced with comprehensive nutrition and physical activity programming?

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Partners

The Nutrition and Physical Activity Working Group (NUPAWG), partnering with: National Association of Chronic Disease Directors

(NACDD), Association of State & Territorial Public Health Nutrition

Directors (ASTPHND), Directors of Health Promotion and Education (DHPE),

and the National Society of Physical Activity Practitioners in

Public Health (NSPAPPH)

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Process

Working with our partners: Developed and tested an online assessment Identified target audience Distributed assessment via existing

infrastructure Provided follow up and reminder support

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Target Audience

Three (3) individuals from every state Obesity funded states

Program coordinator Nutrition coordinator Physical Activity coordinator

Non-obesity funded states ASTPHND rep. NACDD rep. DHPE or NSPAPPH rep.

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Context

The responses to the questions are from the perspective of the state health departments’ nutrition/physical activity programming, not local programming.

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Results

50 of the 51 states represented (98%) Percent reported being members of:

34% NACDD, 50% of ASTPHND, 16% of DHPE, and 46% of NSPAPPH.

Only 2% reported having no membership to any of these organizations.

104 total respondents 60% are coordinators, 12% are managers, and 24%

are directors. The majority (70%) possess a Master’s degree, while

4% possess a doctoral degree.

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State Proxy Determination

Step 1: Intrastate ‘objective’ responses were compared—no differences were found

Step 2: The most complete response, for that state, was utilized as the state’s response

The unit of analysis is at the state/district level 49 states and 1 district = population

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Assessment Question #1

What are the reported capacity needs of states for comprehensive nutrition and physical activity programming?

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Leadership

41 states (82%) reported having dedicated FTE’s for nutrition and/or physical activity programming

4 = the average number of FTE’s within these states

28 states reported both nutrition and physical activity FTE’s

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Importance of staff for effective programming

Importance of Having Dedicated FTEs

010203040506070

Moderately Very Extremely

Importance

Per

cen

tag

e o

f S

tate

s R

epo

rtin

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Reported FTEs

No Reported FTEs

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Of those that reported NOT having dedicated nutrition and physical activity programming FTE’s:

Reported Needs for Creation of Dedicated Nutrition and Physical Activity FTE's

88% 90% 96%

8% 8%

Funding Strategic Plan OrganizationalRestructuring

ManagementSupport

QualifiedPersonnel

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Needed Resources for More Funding

States ranking of resources necessary to obtain increased funding. N=50, (%).

  Most Needed Least Needed

Ancillary staff 13 (26) 11 (22)

Technical assistance from national and/or state agencies 4 (8) 5 (10)

Training 1 (2) 9 (18)

Key program staff 21 (42) 3 (6)

State strategic action plan 9 (18) 20 (40)

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Planning / Purpose

Percent of states with the following elements included in state plan. N=31.

  Frequency %

Behavior Change 27 87%

Policy Change 31 100%

Environmental Change 31 100%

Evaluation 28 90%

Implementation 23 74%

Data Management 18 58%

Planning 18 58%

31 (62%) states reported having a written state strategic plan for comprehensive nutrition and physical activity

programming

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Self reported capacity level of states

Self reported capacity level of states. n=50, (%).

  High Medium Low

Compared to other states 9 (18) 19 (38) 20 (40)

Own expectations 12 (24) 18 (36) 18 (36)

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Assessment Question #2

What are the major state reported barriers for comprehensive nutrition and physical activity programming?

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Capacity Barriers

Reported barriers to developing or maintaining states nutrition and physical activity programming capacity. n=50, (%).

  Largest Barrier Smallest Barrier

Leadership 7 (14) 12 (24)

Coordination 5 (10) 2 (4)

Partnership 0 (0) 17 (34)

Resources 34 (68) 2 (4)

Planning 2 (4) 15 (30)

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Program Funding Sources

Proportion of state's overall nutrition and physical activity programming funds from the following funding sources. N=50, (%).

Source 0% 10-20% 30-40% 50-60% 70-80% 90-100%

Preventive Health and Health Services Block Grant 28 (56) 14 (28) 2 (4) 3 (6)   3 (6)

WIC or other USDA 31 (62) 9 (18) 2 (4) 1 (2) 2 (4) 3 (6)

STEPS 46 (92) 3 (6) 1 (2)      

REACH 50 (100)          

CDC or State Cardiovascular Health Program 46 (92) 3 (6) 1 (2)      

CDC or State Cancer Program 44 (88) 6 (12)        

CDC or State Diabetes Program 42 (84) 8 (16)        

CDC's NPAO Program 23 (46) 3 (6) 2 (4) 3 (6) 4 (8) 15 (30)

Foundations 36 (72) 10 (20) 1 (2) 2 (4) 1 (2)  

State Allocations 33 (66) 12 (24) 1 (2) 3 (6) 1 (2)  

Tobacco Settlement Funds 42 (84) 4 (8) 1 (2) 1 (2) 1 (2) 1 (2)

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State Allocation

17 (34%) states reported that state funds are allocated and/or used specifically for nutrition and physical activity programming

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Barriers for Comprehensive Nutrition and Physical Activity Program Coordination/Integration

0% 10% 20% 30% 40% 50% 60% 70% 80%

Limited resources

Program Leadership not Aligned

Separation

Fear of Losing Program

Fear of Losing Funding

Additional Work

Categorical Funding

Grant Requirements

Threat to Prof. Autonomy

Other Priorities

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Partnerships

0% 10% 20% 30% 40% 50% 60% 70%

Unwillingness to dedicate time

Lack of leadership

Lack of understanding

Competition

Risky or lack of big picture view

Key individuals refuse to participate

Adds additional work to staff

Fear of sharing resources

Other priorities take precedence

% of states reporting having experienced the following in forming or sustaining partnerships

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Assessment Question #3

What major successes have states experienced with comprehensive nutrition and physical activity programming?

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Leveraging Funds

Did your state's nutrition and physical activity program play a role in leveraging other federal funds. N=50, (%).

Source Yes No Not Sure

USDA 17 (34) 18 (36) 15 (30)

Department of Transportation 11 (22) 22 (44) 17 (34)

Parks and Recreation 3 (6) 27 (54) 20 (40)

Department of Education 5 (10) 24 (48) 21 (42)

CDC 13 (26) 18 (36) 19 (38)

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Assistance to Local Health Departments

How States Provide Assistance to Local Health Departments

78%

60% 54%

76%

30%

TA Training Funds Providing Infoto Public

Working withMedia

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Partnering Efforts

  Reported Activity Level

Type of Org. Least Activity Most Activity

Civic Boys/Girl Scouts YMCA

PolicyNational Council of State

LegislaturesNational Governors

Association

Public Health SOPHE ASTPHND

Other Trade Orgs. Universities

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Importance of Partnerships

92% of the states reported that partnerships are “very or extremely important” for the success of the nutrition and physical activity programming.

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Sharing of Assets/Resources

What states receive from partners

• Materials• Technical Assistance• Expertise*

What partners receive from states

• Technical Assistance*• Expertise• Funding

* Reported as “most important”

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Take away messages for States

Keep doing the following: Partnering Resource management and leveraging Management/Leadership support

Need to improve the following: Develop written plan Market written plan

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Take away messages for Professional Orgs.

Physical Activity appears to be advancing: Nutrition paved the way Nutrition can potentially learn and grow with

PA Discuss and determine what can be done to

help increase states’ capacity as it fits within the orgs. strategic plan Ideas:

Case studies of states that have successfully leveraged federal and other funding sources

Documenting successful partnerships

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Questions and (hopefully) Answers

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Contact Information

David Dennison

Centers for Disease Control and Prevention

Division of Nutrition and Physical Activity

4770 Buford Hwy, NE, MS K-24

Atlanta, GA 30341-3717

Work: (770) 488-5390

Email: ddennison@cdc.gov