1. 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

2. Washington State’s Nutrition & Physical Activity Plan

3. Criteria for Objectives & Recommendations  Related to obesity and chronic disease prevention  Population based, potential to affect a large portion of the population  Evidence based, theoretically sound, or recommended by nationally recognized authorities or experts  Measurable objectives

4. Plan Revision Process  Literature/document review Indentify new research, evidence-based interventions and national guidelines  Key informant interviews Input from members of original advisory committee and others who have used the Plan  Three stage review process Internal and external partners including selected experts and project coordinators

5. The Six Objectives  Objectives  Access to Health Promoting Foods  Food Insecurity  Proportion of Mothers Who Breastfeed Their Infants & Toddlers  Free and Low-Cost Opportunities for Recreation and Physical Activity  Physical Activity Opportunities for Children  Active Community Environments

6. Reduce Food Insecurity in Washington  Strengthen food assistance programs and improve economic security for low-income families and individuals  Improve access to and awareness of food assistance programs

7. Increase Access to Health Promoting Foods  Assure that communities provide access to healthy foods and beverages  Assure that worksites, including healthcare services and schools, provide healthy foods and beverages  Assure that schools provide healthy foods and  Continue to advance/sustain successful initiatives such as Healthy Communities

8. Increase the proportion of mothers who breastfeed their infants and toddlers  Assure that health care settings, child care facilities, and worksite environments support breastfeeding

9. Resources Partners in Action Site Web-based version of the Plan Web-based version of the Plan Increased access to resources Increased access to resources

10. 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.”

11. Recommended Community Strategies & Measurements to Prevent Obesity in the United States MMWR. Recommendations & Reports. July 24, 2009/ 58(RR)&);1-26.

12. 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

13. 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.

14. Criteria used by the Select Expert Panel to rate each proposed strategy CriterionDescription Reach The strategy is likely to affect a large percentage of the target population. MutabilityThe strategy is in the realm of the community's control. Transferability The strategy can be implemented in communities that differ in size, resources, and demographics. Effect size The 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.

15. Criteria used by content area experts to rate suggested measurements for each strategy CriterionDescription Utility The 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.

16. 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

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

18. 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.

19. 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).

20. 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.

21. 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.

22. Media Media and advertising restrictions consistent with federal law Promote healthy food/drink choices Counter-advertising for unhealthy choices

23. 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

24. Point of Purchase/Promotion Signage for healthy vs. less healthy items Product placement & attractiveness (e.g. as part of healthy corner store) Menu labeling

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

26. Social and Support Services Support breastfeeding through policy change and maternity care practices

27. 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

28. 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

29. 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.