CX 3 : Evolution & Accomplishments Presented by: Valerie Quinn, MEd, Health Program Specialist & Alyssa Ghirardelli, RD, MPH, Research Associate
Jan 02, 2016
CX3: Evolution & Accomplishments
Presented by:
Valerie Quinn, MEd, Health Program Specialist &
Alyssa Ghirardelli, RD, MPH, Research Associate
YOU are part of the CX3 evolution…
CX3 Evolution: Grounding
Quick trip back in time
circa 2004-5
Metro Atlanta has Removed 58 acres of forest per day for the last 25 years
Georgia Department of Natural Resources
Bog box store
TOXIC ENVIRONMENT
How do you assess it?
How do you
change it?
CX3 Evolution
• Real world information/data a must for planning nutrition education programs
• Local, Local, Local
• Relevant to surroundings, tailored to issues, persuasive, empowering!
CX3 Evolution: Norm Change
CX3 -- a planning framework that evaluates communities in relation to a variety of benchmarks knows as community indicators and assets. – Standardized indicators
– Community strengths, assets, gaps and weaknesses
– Develop local action plans for promoting policy, systems and environmental change
– Strengthen evaluation of local efforts
Goal: Change Norms
CX3 Evolution: 2005
Indicators organized in6 Community
Environments:– Neighborhood– Preschool– School– After-school– Worksite– Government
• Nutrition and Activity
Assets organized into:
– Health department infrastructure
– Political will
– Community infrastructure
CX3 Evolution: 2005
Neighborhood Focus
Neighborhoods MatterResearch: Clear connection between neighborhood factors and health outcomes
Neighborhoods Matter
= Pilot Sites (2006)
= Group 3 (2008)
Local Health Departments
= Group 2 (2007)
CX3 sites
CX3 Cohorts
2006 -- Pilot sites: Berkeley, Santa Clara, San Bernardino, Riverside, Alameda, Kern
2007 -- Group 2 (G2): Marin, Contra Costa, Solano, Sacramento, Ventura, San Diego*
2008 -- Group 3 (G3): San Mateo, Monterey, Sonoma, Stanislaus, Shasta, Yolo, Santa Barbara, Orange, Pasadena, Butte/CSU Chico
+ CCROP*: Fresno, Kern, Kings, Madera, Merced and Tulare
2009 – Group 4: Tulare, Long Beach
* Not Network funded
Tier 1
Tier 2
Community Assets
CX3 Evolution: Tools, etc.
Pilots • Food store survey -
lengthy– In your face scale; quality on all f/v;
store cleanliness, etc.
• Walkability– Wording refined
• Fast Food– Signs; outside only
• Outdoor• Alternative Healthy
Foods– Assess quality, etc.
• Food banks– Lengthy survey, assessed quality,
etc.
Group 2• Food store survey-
streamlined– Overall quality; reduced items; – Added: PoP; pricing comparison data
• Walkability• Fast Food
– Nutrition information!; menu items
• Outdoor• Alternative Healthy
Foods– Chart only, no assessment
• Food banks and emergency food outlets -- focused
CX3 Evolution: Tools, etc.
Pilots Oodles of data! How
make data easier to understand? Toward what end?
Mapping to mobilization!
Group 2Scoring system
Communications templates
Health dept survey– Tier 1
CX3 Evolution: Scoring system
TOTAL NEIGHBORHOOD FOOD STORE QUALITY (based on access and marketing)
Access and Availability of Healthy Foods: Are local stores offering healthy, affordable foods? Are those stores easily and safely accessible to neighborhood residents?
Sample of stores surveyed in neighborhood (If less than 15 stores, all were surveyed) n=
Percent of stores meeting WIC and food stamp vendor acceptance and signage standards
Percent of stores selling a range of quality fruits
Percent of stores selling a range of quality vegetables
Percent of stores selling a range of quality other healthy foods
Percent of stores with reasonable prices for fruits and vegetables ***
Percent of stores meeting standards for safe, walkable streets
Store Marketing: Are stores actively promoting nutrition information and healthier choices?
Percent of stores participating in in state sponsored retail nutrition programs
Percent of stores offering nutrition information
Percent of stores with exteriors that provide healthy marketing practices
Percent of stores with interiors that provide healthy marketing practices
Total Neigborhood Food Store Quality (% meeting standards)
*** Reasonable Prices=no greater than 10% of the county average price for fresh fruits and vegetables in survey
FAST FOOD: What type of marketing and presence do fast food outlets have near local schools, parks and playgrounds?
Sample of fast food outlets within 1/2 mile of school, park, playground (if less than 15, all were surveyed)
Percent of outlets with school visible
Percent of outlets with park/playground visible
Percent of outlets with exterior healthy marketing practices & limited unhealthy marketing practices
Percent of outlets with limited child-oriented marketing practices
Percent of outlets with Interior healthy food marketing and healthy food options.
Fast Food (% meeting standards)
Food stores
100 pts,
75 pts for
“quality”
standard
Fast food
50 pts;
35 pts for
“quality”
standard
Formulas auto-
calculate scores!
CX3 Evolution: Communications pieces
CX3 Evolution: Tools, etc.
Group 3• Tools refined
– Food store survey• New WIC food items
covered• Changed exterior
marketing approach
– Fast Food • Nutrition info refined
– Outdoor• E-boards
• Scoring refined! – School score
created
Group 4 -- ??• Neighborhood
score?
• Survey mobile vendors?
Accomplishments
70+ low-income neighborhoods in CA Pilots: 22 neighborhoods
Group 2: 18 neighborhoods
Group 3: 30+ neighborhoods
310 food stores surveyedPilots: 180 food stores
Group 2: 138 food stores
Group 3: TBD, field work wrapping up
Accomplishments (Cont.)
• Show some charts & graphs from pooled data
• Identify patterns, issues
• Limitations: – Not representative sample for CA– Data for local use
CX3 Sample: Food Store Types
SupermarketChain
Small Chain
Grocery Other
Convenience
Other
Other: Warehouse, Health Food, WIC Only,
Specialty, Fruit and Vegetable Market
SupermarketChainLarge Grocery
Small Market
Convenience
Other
Other: Discount, Drug Stores, Health Food,
Ethnic
Pilots Sites Group 2
WIC Vendor/Not FS n = 9
WIC/FS Vendor n = 28
CX3 Pilot Findings: Food Assistance Programs Available
23% of Store Sample are WIC
Vendors
Store Size Among Food Assistance Programs
0
57
127
100
43
8893
0
10
20
30
40
50
60
70
80
90
100
WIC VendorNot FS
WIC/FS FS Only Not WIC orFS
Pe
rce
nt
of
Sto
res
Large stores ≥ 4 Registers
Small Stores < 4 Registers
FS Only n= 78
Not WIC or FS Vendor n=44
CX3 Group 2 Findings: Food Assistance Programs Available
18% of Store Sample are WIC
Vendors
Store Size Among WIC and FS Vendors
50
60
50
9097
04 3
0
10
20
30
40
50
60
70
80
90
100
WIC/FS Vendor Food Stamp OnlyVendor
No WIC or FS
Perc
ent of S
tore
s
Large stores≥ 4 Registers
Small Stores< 4 Registers
Other
WIC/FS Vendor n=24, Food Stamp Only n=79, No WIC or FS n=29
CX3 Pilot Findings: Fruit Availability
Overall Availability of Fruits by Store Size
0%
16%
0%
55%
8% 6%
92%
23%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Large Stores Fruit(≥ 4 Registers)
Small Stores Fruit (< 4 Registers)
None Limited (1-3 types)Moderate Variety (4-6 types) Wide Variety (≥ 7 types)
Large Stores
n=25
Small Stores
n=83
CX3 G2 Findings: Fruit Availability
Overall Availability of Fruits by Store Size
0%8%
0%
38%
0%
18%
100%
36%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Large Stores Fruit(≥ 4 Registers)
Small Stores Fruit (< 4 Registers)
Per
cen
t o
f S
tore
s
None Limited (1-3 types)Moderate Variety (4-6 types) Wide Variety (≥ 7 types)
Large stores n=11
Small stores n=73
CX3 Pilot Findings: Fruit Quality
Quality of Fruits by Store Size
0%
9%8%
29%32%
46%
60%
17%
0%
10%
20%
30%
40%
50%
60%
70%
Large Stores Fruit(≥ 4 Registers)
Small Stores Fruit (< 4 Registers)
Per
cent
of
Sto
res
All or most poor quality Mixed quality; more poor than goodMixed quality; more good than poor All or most of good quality
Large Stores n=25
Small Stores n=70
CX3 G2 Findings: Fruit QualityQuality of Fruits by Store Size
0%
8%
0%
26%27%
35%
73%
29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Large Stores Fruit(≥ 4 Registers)
Small Stores Fruit (< 4 Registers)
Pe
rce
nt
of
Sto
res
All or most poor quality Mixed quality; more poor than goodMixed quality; more good than poor All or most of good quality
Large stores n=11
Small stores n=72
Mean Price per Pound of Common Produce Items by CX3 Group
$0.00
$0.20
$0.40
$0.60
$0.80
$1.00
$1.20
$1.40
$1.60
Apple Banana Orange Tomatoes Cabbage
Pri
ce P
er P
ound
Pilot Jun-Aug2006
Group 2 May-Jul 2007
CX3 Pilot and G2 Findings: Store Prices
40% of G2 StoresMet the standard for reasonable prices
CX3 Findings: F&V Prices
12% of Pilots 16% of G2Stores that sell produce have
health promotions
around fruit and vegetable displays
CX3 Findings: F&V Promo
% of Stores that Have Unhealthy Marketing around Checkout by Store Size
63
92
0
20
40
60
80
100
Large Stores (≥ 4Registers)
Small Stores (<4Registers)
% o
f Sto
res
CX3 Findings: Checkout
Pilots:
CX3 Findings: Safety45% of Pilot 43% of G2 stores surveyed
have bars on windows
G2 Store Scoring
• Store score = 100 possible pts
• “quality standard” > 75 pts
• Total of 132 stores
not quality76%
close14%
made the "cut"10%
CX3 Findings: Fast Food Ratio
• Both Pilots and G2
• Range for # of FF outlets
to population– Low: 1:127 – High: 1:8185
• Ratio of <1:1000 15 of 37 neighborhoods (45%)Most impacted: Solano (4 of 4), Berkeley (3 of 4); Santa Clara (2 of 3); Riverside (2 of 3)
CX3 Findings: Toys in Kid Meals
Fast Food Outlet with Toys in Kids Meals
2 1
54
74
0
10
20
30
40
50
60
70
80
Fast Food -Chain
Fast Food - AllOther
% o
f O
utl
ets Pilot
G2
Pilot Chains n =44
G2 Chains n= 27
Pilot Not Chain n= 83
G2 Not Chain n= 75
CX3 Findings: Fast Food Marketing
Ads on roof/walls…
77% of Pilot Fast Food chains (n=44)
54% of Pilot Other Fast Food Outlets (n=41)
39% G2 Fast Food Chains (n=26)
12% of G2 Other Fast Food Outlets (n=74)
CX3 Findings: Nutrition Info
Nutrition Information Available in Chain vs. Non-Chain Outlets
0
26 26
12
0
5
10
15
20
25
30
Menu
Boa
rd
Poste
r/Kio
sk
Broch
ure/
Pamph
let
Avail U
pon
Reques
t
Per
cen
t o
f O
utl
ets
Chain
Not Chain(all types)
Fast Food Chain
Outlets n=27
Non-Chain n=75
Group 2
Index of Unhealthy to Healthy Food Sources: G2
C-Stores + Fast Food____________
Supermarket/lg grocery + Farmers Market
Index of 0 = Food desert• 5 neighborhoods (28%) • NO healthy food sources at all
Index of 5 or higher = Poor/toxic?• 10 neighborhoods (55%) • Index range from 2.5 to 18
– Low score is better; 0 means can’t calculate-NO healthy food sources– CCPHA REFI index: CA average = 4.48, similar but not directly comparable
You are Change Agents
• Add branding architecture– Change Agents
TV, Radio, Outdoor, Direct Mail
TV Spot
• Our Neighborhood, Our Rules
“Now that is a real commercial! I like it! There is no suburban greenery in this one. It talks about my community…get involved…time’s are changing. That spoke to me as a low income African American woman in the ‘hood! It makes me take a second look. More importantly, it made me think deeper about the whole issue.”– Oakland African-American mother
Sacramento Bee (circulation: 279,000)
“Study links ‘food environment’ to diabetes,
obesity”
http://www.sacbee.com/101/story/897193.html
Los Angeles Times (circ.: 816,000)
“UCLA study links poor health to fast-food
neighbors”
http://www.latimes.com/news/local/la-me-
fastfood29apr29,0,6657131.story
Central Valley Business Times (circ.: ~
30,000)
“Would You Like Fries with that Heart Attack?”
http://www.centralvalleybusinesstimes.com/
stories/001/?ID=8570
Bakersfield Californian (circ.: 71,000)
“Study: Kern No. 3 for fast-food, convenience
stores”
http://www.bakersfield.com/102/story/
429993.html
The Press Enterprise (circ.: 189,000)
“Neighborhood's food options affect obesity
rates, study finds”
http://www.pe.com/localnews/inland/stories/
PE_News_Local_D_obesestudy29.3cf0c48.html
San Bernardino Sun (circ.: 196,000)
“Food Choices Limited”
http://www.pe.com/localnews/inland/stories/
PE_News_Local_D_obesestudy29.3cf0c48.html
Inland Valley Daily Bulletin (circ.: 185,000)
“In SB County, too much bad food”
http://www.dailybulletin.com/ci_9090193
Fresno Bee (circ.: 158,000)
Fresno’s Fast-Food proximity harms health,
study says
http://www.fresnobee.com/263/story/558500.html
Challenges
• No comparison (high-income) neighborhoods
• 1 local health department for many cities & communities– Selective investment– Policy change is local; walk fine line
• Community work takes time. – When evaluate? 2 years, 3 years, 4 years? – Familiar vs. new/risk
• Flexibility a must (bureaucracy, rules)
Challenges (cont.)
• Dynamic Marketplace
• Economic downturn• FSNE restrictions (where, what said, etc.)
– Partner with community organizations– Other funding sources
Positive shifts?
• FARM BILL 2008 – Shift in sight?– Renames the Food Stamp Act and
Program • Supplemental Nutrition Assistance Program
(SNAP); Food & Nutrition Act of 2008
– Findings of Congress: • Directs USDA Secretary…
– “to support the most effective interventions for nutrition education under the FSA,
including public health approaches and traditional education, to increase the likelihood that recipients and potential recipients of benefits under the SSNAP program choose diets and physical activity practices that are consistent with the Dietary Guidelines for Americans.
YOU • Your dedication, passion, vision
• In-depth data/picture neighborhood nutrition
Thank you!
CX3 Team: Valerie Quinn, Alyssa Ghirardelli, Ellen Feighery & Lynn Moreno