CDC-DNPAO Fruit and Vegetable Workgroup

Demia Wright, Co-ChairDivision of Nutrition, Physical Activity, and Obesity

(DNPAO)Centers for Disease Control and Prevention (CDC)

The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

2010 Child Nutrition

Reauthorization

Presentation Outline

• F&V Workgroup Overview• F&V Workgroup Members’ Projects• CDC F&V Guidance Document• Contacting Workgroup Members

F&V Workgroup

• One of DNPAO’s target area workgroups

• Includes staff working on or interested in F&V

F&V Workgroup Members

Co-chairsSonia Kim (Nutrition Branch) Demia Wright (Program Development and Evaluation Branch) Nutrition BranchChrista Essig (on detail to USDA)Jennifer FoltzKirsten GrimmLarry Grummer-Strawn Diane HarrisJoel KimmonsLatetia MooreKelley ScanlonJenna Seymour (on detail to White House)

Obesity Prevention and Control BranchHeidi Blanck (Senior Advisor)Michele Maynard 

Program Development and Evaluation BranchDiane AyersClaire HeiserBarbara LathamKate Thomas

Communication TeamReba Griffith Division of Adolescent and School HealthTerry O'Toole (on detail to DNPAO)

OD/BC Advisory MembersDeb GaluskaCasey HannanRosanne Farris *Alicia Hunter (MOU)

F&V Workgroup Objectives• Identify, adapt, and/or develop surveillance systems to

measure behavior, policy and environmental change • Strengthen the science base related to environment and

policy strategies and interventions • Translate and disseminate effective/promising interventions • Strengthen partnerships and advocacy efforts, strategies, and

activities • Enhance state capacity to implement environmental and

policy interventions • Identify and reduce disparities related to access, availability,

and consumption

Highlights of F&V Workgroup Members’ Projects and Activities

F&V Projects and Activities• Surveillance

– F&V surveillance tools - BRFSS, Healthy People 2020, SHPPS, HealthStyles 2010– Environmental and policy surveillance– Fruit and Vegetable Indicator Report (2009 & 2011), Unhealthy Foods

Indicator Report – Community Based Surveillance Project

• Science Base– Evaluation/Framework projects on farm to school & farmers markets– Reliability and validity testing of the Wisconsin F&V food environment audit

tool – Evaluability Assessments project – i.e. Health bucks

F&V Projects and Activities• Translation and Dissemination

– Center for Excellence in Training and Research Translation (Center TRT) – State Program Highlights -

http://www.cdc.gov/obesity/stateprograms/statestories.html– Healthier Food Retail Action Guide – F&V Guidance Document Executive Summary– Monitoring and Assessment Resource Guide for Healthy Foods – Fruits and Veggies More Matters website

• State Capacity– Sustainable Food Systems and Nutrition Environment Measures Workgroups – Association of State and Territorial Public Health Nutrition Directors

(ASTPHND)/ F&V Coordinators teleconferences– General technical assistance

F&V Projects and Activities (cont’d)• Disparities

– Reducing Dietary Quality Disparities Using Policy and Environmental Approaches - Meeting

– Cross-cutting topic in many F&V projects previously mentioned

• Partnership– ASTPHND & F&V Council – National Fruit and Vegetable Alliance– Produce for a Better Health Foundation– USDA– Many other partners we work with

The CDC Guide to Fruit & Vegetable

Strategies to Increase Access, Availability, and Consumption

CDC/DNPAO Target Area Guidance Documents

– Concept: Based upon “The CDC Guide to Breastfeeding Interventions”

• 4 New DNPAO Target Area Guidance Documents released Spring 2010– Fruits & Vegetables– Energy Density– Sugar Sweetened Beverages– Physical Activity

• 1 more Guidance Document in clearance– Television Viewing

Guide to Fruit and Vegetable Strategies to Increase Access, Availability, and Consumption: Authors

• Michele Doucette, former Nutrition Branch fellow• Christa Essig, Nutrition Branch (on detail to USDA) • Sonia Kim, Nutrition Branch• Joel Kimmons, Nutrition Branch• Kelley Scanlon, Nutrition Branch • Jenna Seymour, Nutrition Branch (on detail to White House)• Tara Simpson, former Program Development and Evaluation Branch

fellow• Judith Tessema, former Nutrition Branch intern• Kate Thomas, Program Development and Evaluation Branch

Strategies to Increase Fruit and Vegetable Access, Availability, and Consumption

1. Promote Food Policy Councils as a Means to Improve the Food Environment at State and Local Level

2. Improve Access to Retail Venues that Sell or Increase Availability of Quality Fruits and Vegetables in Currently Underserved Communities

3. Include or Expand Farm-to-Where-You-Are Programs in All Possible Venues

4. Ensure Ready Access to Fruits and Vegetables in Worksite Foodservice and in Food Offered at Meetings and Events

5. Support and Promote Community and Home Gardens6. Establish Policies to Incorporate Fruit and Vegetable Activities into

Schools7. Include Fruits and Vegetables in Emergency Food Programs

Guidance Document Components Included for Each Strategy

• Definition• Rationale• Evidence of

Effectiveness• Key Considerations

• Action Steps• Program Examples• Resources• References

1. Promote Food Policy Councils as a Means to Improve the Food Environment at the State and Local Level

• Food Policy Councils (FPCs) consist of civic, government, and business stakeholders and approach food issues by working at many levels of the food system to increase economic and environmental sustainability, efficiency, and food access

• FPCs are a method to achieving other strategies

Promote Food Policy Councils: Evidence & Programs • Evidence for FPCs is very limited

– No current peer-reviewed literature demonstrates an impact on fruit and vegetable consumption

– Existing literature does indicate policy changes and program implementation resulting from FPCs

• Program Examples

Food Policy Councils: Sample Action Steps• Sponsor a summit and invite key players in your local food system. This

summit can provide information and training about the benefits of FPCs.

• Promote the benefits of FPCs to state legislators, city and local level government officials, or your governor’s office, and offer to help establish state and local FPCs in your area.

• Establish links between local or state FPCs and groups promoting fruit and vegetable consumption.

2. Improve Access to Retail Venues that Sell or Increase Availability of Quality Fruits and Vegetables in Underserved Communities

• Intervene in variety of venues (supermarkets, grocery stores, convenience stores, corner stores, and specialty stores); new and existing stores

• Ways to achieve:– Financial incentives for new stores in underserved areas– Improving transportation to these venues– Upgrading existing store facilities to carry all forms of fruits and

vegetables– Increasing supply of and shelf space dedicated to quality and

affordable fruits and vegetables at existing stores

Access to Retail Venues with F&V: Evidence & Programs

• Evidence is promising but limited– Body of literature exists on access/health outcomes correlation– Some peer-reviewed literature on intervention success

• Several program examples– PA Fresh Food Financing

Initiative– The Good Neighbor

Program: San Francisco, CA– Healthy Corner Store

Initiative: The Food Trust

Access to Retail Venues with F&V: Sample Action Steps

• Provide training to small store owners in your area on how to select, store, and maintain F&V.

• Sponsor a summit with urban and transportation planners and local officials to discuss and plan for transportation routes that offer better access to healthier food.

• Assist small store owners to equip their locations to accept SNAP and WIC coupons.

• Support and promote legislation and state policies that offer retailers incentives like a streamlined development process, tax exemptions and credits, and assistance in land acquisition. Include incentives to locate in underserved areas.

3. Include or Expand Farm-to-Where-You-Are Programs in All Possible Venues

• Support regional fruit and vegetable production and distribution

• Promote availability of regionally grown farm produce • Provide a connection with the food & the grower

– enhances perception of the food and the willingness of the participant to eat local and regional fruits and vegetables (Joshi and Azuma 2008)

Farm-to-Where-You-Are

• Specific Farm-to-Where-You-Are Strategies:

a. Farm-to-institution (schools, hospitals, worksites, other community organizations)

b. Farmers markets

c. Community supported agriculture (CSA)

Farm-to-Where-You-Are: Evidence & Programs• Evidence is promising but limited in all three areas

– limited research documenting the relationship of “farm-to” strategies to F&V consumption

– some non peer-reviewed evaluations show increase in purchases/intake with programs

– WIC FMNP has stronger peer-reviewed data

• Many program examples– Some focus on encouraging increased purchases for low-

income individuals

Farm to Institution CSAsFarmers Markets• Cleveland, OH: City Fresh• TX: Farm to Work• WI: MACSAC

• OK: Farm to School• PA: The Kindergarten Initiative

• NYC: Health Bucks • Kaiser Permanente

Farmers Markets

Program Examples

Farm-to-Where-You-Are: Sample Action Steps

• Establish links between farmers and community institutions, vendors, and distributors. Allow for information sharing between farmers and institutions.

• Promote policies that support farm-to-institution programs and farmers markets.

• Assist existing or newly formed farmers markets, especially those serving low-income populations, in accepting WIC and SNAP benefits (including taking EBT).

• Establish links between existing CSA programs within your state and those regions of existing need and interest in purchasing from a CSA.

4. Ensure Ready Access to Fruits and Vegetables in Worksite Foodservice and in Food Offered

at Meetings and Events

• Healthy cafeterias - policies may include:– requiring availability of appealing, quality and affordable F&V– preferential pricing for F&V– establishing a policy that a certain proportion of items be F&V

• Healthy foods at meetings and events - policies may include:– promotion of F&V at meetings, conferences, or other events and

gatherings– encouragement to incorporate regionally or locally grown F&V in

worksite gathering menus

Worksite Strategies: Evidence & Programs• Evidence is promising but limited

– Limited published findings show that worksite health strategies have been effective in increasing fruit and vegetable intake & sales

• Program examples:– Healthy Picks: Healthy Cafeteria

Initiative– CDC Healthier Worksite Initiative

Worksite Strategies: Sample Action Steps

• Create or expand a healthy cafeteria or healthy food at meetings and events policy or program in your own worksite.

• Assist local worksites to establish healthy food environment policies.

• Provide resources and training for food service vendors and staff and those who order catering for meetings and events on nutrition guidelines, how to select healthy options, and sources for procuring food that fits within the guidelines.

5. Support and Promote Community and Home Gardens

• Community Gardens -created by community members, shared maintenance and products

• Home Gardens - located at individual’s residence

• Generally:– Gardens can occur in institutions (worksite, childcare)– Home production and storage of F&V can be important

during periods of limited access

Gardening Strategies: Evidence & Programs

• Evidence is limited– Program evaluation data - exposure to

fresh F&V may lead to/has been associated with more consumption or willingness to consume

• Program examples:– P-Patch: Seattle, WA– Common Ground: Los Angeles, CA– City Slicker Farm: Oakland, CA

Gardening Strategies: Sample Action Steps• Identify communities that need and are interested in starting a community

garden. Establish relationships among these communities and existing community programs or local businesses that can support their efforts.

• Examine existing zoning regulations relevant to community and home gardening. Develop new regulations or modify existing ones as necessary.

• Provide resources and trainings for community and home gardeners or set up a program for state extension agents, Master Gardeners, or other knowledgeable gardeners to train community and home gardeners.

• Invite local community garden operators to participate in state and local level food policy councils.

6. Establish Policies to Incorporate Fruit and Vegetable Activities into Schools

• F&V activities than can be incorporated into curricula through policy change:– School gardening– Agricultural education– F&V tasting demonstrations in the classroom

• Curriculum approaches and activities– Provide students with hands-on experiences with F&V– Support policy and environmental changes within the school setting– May be linked with farm-to-school

School Policies: Evidence & Programs

• Evidence is promising but limited: – School Gardening associated with

increased F&V consumption

• Program Examples– Cooking with Kids– Edible Schoolyard (Berkeley, New Orleans)– CA Head Start

School Policies: Sample Action Steps

• Plan a meeting with school officials to discuss the integration of experiential curricula on F&V into school wellness policies.

• Identify and form relationships between schools that want to start gardening programs and schools that have existing programs.

• Identify resources for school gardens. Funding or supplies may come from state grants, nonprofit organization grants, community organizations, local businesses, or local garden retailers.

7. Include Fruits and Vegetables in Emergency Food Programs

• In 2007, 11% of U.S. households food insecure during the year• Emergency food programs provide relief, but have been

shown to have an inadequate supply of F&V• Programs can improve access to F&V by:

– Requesting donations of fresh, frozen, canned, and dried fruits and vegetables

– Partnering with local grocery retailers, farmers markets, CSA programs, and community, school, and home gardens

– Acquiring donations of or purchasing unsold and surplus fruits and vegetables from farmers

Emergency Food Programs: Evidence & Programs

• No research evaluating the effectiveness of including fruits and vegetables in emergency food programs

• Program examples:– Food Bank of Western Massachusetts– Michigan Agricultural Surplus System– Community Food Bank of Arizona– The Emergency Foodshelf Network

Emergency Food Programs: Sample Action Steps• Examine existing policies and regulations relevant to the acquisition of F&V

by emergency food programs and develop or modify as necessary.

• Invite emergency food program operators to participate in state and local level food policy councils.

• Encourage partnerships between emergency food programs and local grocery retailers; farmers markets; CSA programs; community, home, and school gardens; and individual farmers to acquire donations of or purchase unsold and surplus F&V.

Fruits and Veggies More Matters® (FVMM) in the Guidance Document

• Marketing F&V through branding can be used in conjunction with policy & environmental change strategies. – Exposing people to a brand, especially when it is

connected to positive experiences, builds brand equity.

• Several examples specified in the guidance document’s action steps

Examples of Marketing through Branding from F&V Guidance Document

• Retail Venues: Posters, static clings for freezer doors, reusable grocery bags • Farmers Markets & CSAs: large weather resistant posters, recipes, or aprons, hats,

or drinking cups for those selling produce or distributing boxes• Healthy Cafeterias: aprons and hats for the staff, branded reusable cups, or

nutrition education materials for tables or service lines• Healthy Foods at Meetings and Events: branded tote bags, reusable cups, lanyards • Community and Home Gardens: hats for gardeners, bags for gardening supplies,

aprons, recipes • School Policies: recipes, tee-shirts, bags for gardening supplies

– Educational materials promoting F&V for teachers and students can be used in conjunction with a school garden, cooking classes, or tastings

Building the Evidence

Evaluate your programs and policies

Contacting F&V Workgroup Members

Technical Assistance

• Contacting a DNPAO Subject Matter Expert:– Ask your Project Officer (PO) to be connected with

the appropriate Work Group member• Tell us if you don’t know your PO!

– Let us know of questions, technical assistance needs

• Thank you for feedback from qualitative assessment

Contact Information

• Fruit & Vegetable Workgroup Co-Chairs– Demia Wright, dswright@cdc.gov, 770-488-5506– Sonia Kim, skim3@cdc.gov, 770-488-5156

Questions,Comments,

Ideas?