1. Healthy People 2020 Mission 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

2. 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

3. 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.

4. 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

5. 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.

6. Vegetable Consumption in Europe  Only 6-24% of European children reach the WHO’s recommended daily consumption of fruits and vegetables. 4

7. 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.

8. Vegetable Consumption in the United States  Research 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.

9. 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

10. 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.

11. 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.

12. 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

13. National Trends for the Past 10 Years

14. 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

15. 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%

16. 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.

17. 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.

18. 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

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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

25. 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?

26. Questions?

27. 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

28. 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

29. 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

30. 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

31. 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