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Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans January 26, 2012 Nutrition Network Needs Assessment.

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Presentation on theme: "Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans January 26, 2012 Nutrition Network Needs Assessment."— Presentation transcript:

1 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans January 26, 2012 Joan.Agostinelli@azdhs.gov Nutrition Network Needs Assessment

2 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Identifying Need Trend going in wrong direction Disparities among subgroups Comparison to standard or goal Comparison to reference group –AZ vs. U.S. or –County vs. State Partner/stakeholder input

3 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Why Do Needs Assessments? Helps prioritize limited resources Identify gaps –Where are resources going compared to where is the need? Intervene where we can make a difference Required by USDA

4 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Required to Address 1.Description of the target audience 2.Their nutrition-related behavioral and lifestyle characteristics 3.Availability of other programs that target same population 4.Areas where target audience is underserved 5.Implications for planning.

5 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Data Sources U. S. Census, including American Community Survey (ACS) SNAP Utilization data Behavior Risk Factor Surveillance System (BRFSS) Youth Risk Behavior Survey (YRBS) Program evaluation data (quantitative and qualitative) Social marketing studies

6 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Arizona Per Capita Income Tends to be lower than U.S. averages. 91% of national average in 2010

7 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Median Household Income

8 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Unemployment Historic low in 2007 of 3.6% in Arizona. Climbed to over 10% by end of 2010. 36% decrease in construction jobs over last decade –173,600 in 2001 –111,600 in 2010

9 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Unemployment in Arizona 2010 Higher rates in rural areas, Lowest rates in Maricopa and Pima County, However, majority of unemployed people live in Maricopa and Pima County

10 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans

11 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Distribution of Unemployed People

12 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Persons in familyPoverty guideline 1$10,830 214,570 318,310 422,050 525,790 629,530 733,270 837,010 Add $3,740 for each additional person. Federal Poverty Guidelines 2010 Contiguous U. S.

13 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Poverty Rates 2010

14 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Food Insecurity One in five Arizona households (20.8%) reported not having enough money to buy food that they needed during prior 12 months (rank=15) 29% of households with children did not have enough money to buy food (rank=7)

15 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Arizona Poverty Rates 2010 by Age Group 24.4% of children under the age of 18 in poverty

16 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Children Under Age 5 Poverty Rate by Race

17 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Racial Composition of Children Under Age 5 in Poverty

18 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Arizona Resident Incomes 2010 as a Percent of Federal Poverty Level

19 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans SNAP Participation

20 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Target for Nutrition Education Certified Eligible – SNAP participants Likely Eligible –Income below 130% FPL –Location proxies: food banks, food pantries, soup kitchens, public housing, SNAP/TANF job readiness programs Potentially Eligible –Locations where 50% have incomes below 185% FPL –Retail grocery stores with $50,000 average SNAP benefit redemption

21 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans More Recent SNAP Participation (Arizona, July 2011) 477,227 households 1,102,573 people –568,882 adults –533,691 children

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26 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Households with Children Likely Eligible ( =130%FPL) Likely EligibleNot eligible With children under 6 years only12.610.1 With children 6 to 17 years only25.626.2 With children under 6 years and 6 to 17 years 28.812.7 No children33.151.0 100%

27 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Family Composition and Labor Force Participation Likely Eligible ( =130%FPL) Likely Eligible Not eligible Married-couple families48.478.3 Husband and wife in labor force14.542.7 Husband in labor force, wife not21.518.4 Wife in labor force, husband not3.45.4 Neither husband or wife in labor force9.011.8 Other Families51.621.7 Male householder, no wife present, in labor force9.86.2 Male householder, no wife present, not in labor force2.21.2 Female householder, no husband present, in labor force23.411.4 Female householder, no husband present, not in labor force16.22.8 100% 27.4% 100% 15.8%

28 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Among Likely Eligible Population During the last 12 months... 22.6% in families with no workers 51.3% had one worker 21.0% had two workers 5.1% had three or more workers

29 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Educational Attainment Arizona Adults Age 25 and Older Likely Eligible ( =130%FPL) Highest Level of Education Completed Likely Eligible Percent Not eligible Percent CumulativePercentCumulative Graduate or Professional Degree1.5 7.6 Bachelor’s degree4.76.213.821.4 Some College20.426.628.650.0 High School Diploma or GED19.746.320.070.1 High school-no diploma17.563.89.679.7 Grades 1-823.787.513.993.6 Less than First Grade12.5100.06.4100.0

30 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Overall Health Ratings

31 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Likely eligible population is also more likely to report... Health problems that limit their activities (32% vs. 19%) No health insurance (28% vs. 13%) Needed a doctor within last year but did not see one because of cost (vs. 31% vs. 7%)

32 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Fruits and Vegetable Consumption Among Target Population

33 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Adults Consuming 5 or More Fruits and Vegetables Daily by Income AZ 2010 = 25.2%

34 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Daily Intake of Fruits and Vegetables Among Likely Eligible Adults

35 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Trans-Theoretical Model  Not thinking about it  Thinking about it and plan to start within 6 months  Definitely planning to start in next month  Trying to do it now  Already doing it

36 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Post Campaign Report: Adult Readiness to Eat More Fruits and Vegetable 46% said they already ate 5+ servings 42% said they were trying to eat more 10% said they definitely planned to eat more in the next month 2% said they are thinking about eating more and plan to start in the next six months Less than half of 1% said they were not thinking about eating more fruits and vegetables

37 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Before Implementation of Fruits and Veggies – More Matters TM* Most students already... Could pick at least one food that was a fruit (96%) and one that was a vegetable (91%) Knew which foods had a lot of vitamin C (64%) Said they ate fruits and vegetables as snacks (86%) *Curriculum administered to elementary students age 7 through 10

38 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Before Implementation of Fruits and Veggies – More Matters TM* Among Elementary Students 15% knew how many grams of fiber were needed to stay healthy 37% knew which foods had fiber 27% knew which foods had a lot of vitamin A *Curriculum administered to elementary students age 7 through 10 *

39 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Milk/Calcium Among Target Population

40 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Adult Milk Drinking (from Food Behavior Checklist Survey) Over past three years, findings have not changed significantly: One in three eligible adults drink milk every day One-fourth said they drink milk often 15% do not drink milk

41 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Adult Milk Drinking – Fat Content (from Food Behavior Checklist Survey) 5% drank fat-free milk 24% drank 1% milk 38% drank 2% milk 28% drank whole milk

42 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Adult Milk Drinking Habits Prior to Launch of Go Low Campaign 31% in maintenance stage 18% action stage - trying to switch 9% preparation stage - definitely planning to change in the next month. 9% contemplating changing to low fat or fat free milk in the next six months (half drank 2%, 25% drank whole milk). 33% in pre-conceptualization stage – not thinking about changing, or did not perceive or personalize risks.

43 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Beliefs about Milk (Adults) Drinkers of 2% milk: –Say it is not as thick as whole milk, but not watery like 1% low fat milk (“happy medium”). –Many switched from whole milk and now feel they have made the healthy choice. Drinkers of 1% milk: –Talk mainly about fewer calories and less fat, although a few described liking the taste. Drinkers of Fat-free milk: –talked almost exclusively about the health benefits.

44 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Post Go-Low Social Marketing Campaign 46% of moms and 56% of children drank 2% milk. 23% of moms and 32% of children drank whole milk. 64% of moms believed lot fat and fat free milk have same amount of vitamins and minerals as whole milk. 82% agreed that drinking low fat or fat-free milk is an important part of a healthy diet.

45 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Adolescents Milk Consumption (YRBS 2009)* 14% of high school students reported drinking three glasses of milk or more per day during the week before the survey: –8% of girls –19%of boys 28% drank a soda at least once per day in the previous week *Includes all high school students, statistics specific to low-income youth not available.

46 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Building Better Bones Pretest – 5 th Graders 67% knew which fast foods had the most calcium and least fat 47% could identify foods without calcium 37% knew how many daily servings of dairy they should have, and the age at which 90 percent of bone density is built 15% knew percent daily value for calcium needed for students their age 20% knew what osteoporosis was 23% had at least 3 servings of milk the day before.

47 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Whole Grains Among Target Population

48 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Whole Grains (Westgroup) Mothers understand that whole grain foods are supposed to be good for you –Some say more nutrients, others say good source of fiber –Know little about specific vitamins and minerals and why they are good for you. –Could identify some ultimate benefits, such as improving digestion, helping with heart health, and helping to control weight. –Some believe whole grains give you energy and lower cholesterol. –Messages about fiber resonated more than vitamins and minerals, especially with Hispanics.

49 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Confusion about Whole Grain, Whole What, Multigrain, and Stone-Ground Use whole grain and whole wheat interchangeably Uncertain whether multigrain is a whole grain Unclear about whether products that don’t say “100% whole grain” or “100% whole wheat” are truly whole grain or whole wheat. Some look for “lowers cholesterol” or the Heart Healthy or red heart logo, or the wheat stalk on the package.

50 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Eating Whole Grains Most say they have whole grain foods at home, with whole grain/whole wheat bread and oatmeal being named most often. Some moms who eat whole grain still serve white bread to their children (“tastes better”), although... Some serve whole wheat bread to children so they will develop healthy eating habits.

51 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Barriers to Whole Grains Not liking the taste (themselves or someone in family) Not understanding what whole grains are, or how to prepare them Not liking to try new things Cost – belief that whole grains cost two or three times more than white bread Many include corn tortillas, but pasta seems to be a more difficult transition.

52 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Healthy Proteins Among Target Population

53 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans WestGroup Study on Proteins Mothers agreed that lean proteins are those that have less fat. –Most listed skinless chicken, fish and ground beef as examples of lean protein. –Fewer listed eggs, low fat dairy, beans, or lean pork when asked which foods are considered lean proteins. Some mentioned –cooking differently to maintain lean quality – baking instead of frying, using less butter or grease. –using more seasoning to add back flavor lost from removing fat from lean chicken and beef.

54 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans WestGroup Study on Proteins Spanish-speaking mothers were unfamiliar with the Spanish word for “lean” – “magra”. They used the English word “lean.” Most agreed with statements about health benefits (good for heart, don’t clog arteries, help build muscle, give energy.) Most mothers look for the “% fat” designation on a package of ground beef, as well as a sticker that says “lean,” although some look at amount of marbling. Almost none said they look for the grams of protein per serving, or any other information that is included on the package.

55 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Lean Proteins (from FBCL) American Heart Association recommends eating fish at least two times per week 60% had eaten no fish in the past week. 35% said they always take the skin off of chicken, or use skinless chicken.

56 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Physical Activity Among Target Population

57 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Moderate Physical Activity Includes brisk walking, bicycling, vacuuming, gardening,... or anything that causes some increase in breathing or heart rate 40.5% adults in Arizona met the recommendation to get at least 30 minutes on 5 or more days per week.

58 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Vigorous Physical Activity Examples include running, aerobics, heavy yard work,... or anything that causes large increase in breathing or heart rate 34.2% of adults in Arizona got at least 20 minutes of vigorous activity on 3 or more days per week

59 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Physical Activity by Income Group among Adults 54.0%

60 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Adults Meeting Recommendations for Either Moderate or Vigorous Physical Activity Among Target Population

61 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Among Fifth Graders* 66% knew how much physical activity they should get 69% reported spending 60 minutes or more being physically active on previous day *Source: Building Better Bones Pretest

62 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Media Connectivity and Messaging

63 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Media Usability Among Target Population* 66% of mothers have access to the internet (nearly always high speed) –Half go online every day, 15% go online most days –63% use it to seek health, nutrition, or disease related information, finding it easier, faster, and more convenient than calling a number, going to the library, or using some other method. 86% of children go on the internet, with 87% of them using it weekly * Westgroup Media Usability Study

64 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans What are Three Best Sources for Health and Nutrition Information?*

65 Bureau of Nutrition and Physical Activity Health and Wellness for all Arizonans Implications for Planning What strikes you as new/most important? What was not mentioned that you think should be addressed? What should we be continuing or doing differently because of what we have learned?


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