Network for a Healthy California Empowering Change Presented by: Susan Foerster Tanya Garbolino Melanie Hall Sharon Sugerman
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Network for a Healthy CaliforniaEmpowering Change
Presented by:
Susan FoersterTanya GarbolinoMelanie HallSharon Sugerman
Children/Youth• Children’s Power
Play! Campaign• Harvest of the Month• Youth Empowerment• Early Childhood
Children’s Power Play! Campaign
Social Marketing Campaign
Fourth and Fifth Graders
Schools – Youth Organizations – Community
Educator Newsletters
Family and Community Newsletters
Menu Templates
Posters
Youth Empowerment and Early Childhood
Worksite Program
• California Fit Business Kit– 10 tools
Retail Program• Help retailers improve the quality or
quantity of their fresh produce selection.• Help increase produce sales by providing
retail point-of-sale education on produce selection, storage, and preparation.
• Help retailers improve community image and customer loyalty through sponsored events, social responsibility programs, and other innovative partnerships.
Retail Program: Signage
Retail Program: Educational Marketing
Retail Program Retailer/Regional Trainings
• Retailer Training Materials– Produce Handling
Guide– Retailer Marketing Kit– Produce Quick Tips– Food Demonstrations
Guide– Store Tour Guide
Mass Media• Radio Spots• Good Food TV• Direct Mail
Selected Network Research and Evaluation Components
• Surveillance – statewide population-based surveys, internal & external
• Impact/outcome evaluation to evaluate the effect of a given project intervention or to rigorously test a social marketing campaign controlled intervention developed by the State
• Special Tools – CX3 – Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention
• Communications/Media Strategy Benchmark Survey – tracks recall and behavioral determinants
• Process evaluation, includes activity tracking – Semi-annual activity report (SAAR) and Education and Administrative Reporting System (EARS)
• Formative – New project development & feedback• Case Studies – Non-profit LIAs, Regional Networks
Evaluation of Network Projects:Key Behavioral Outcomes
•• Fruit and vegetable consumption Fruit and vegetable consumption and determinants in adults and and determinants in adults and children/youth, ages 9 and older, children/youth, ages 9 and older, to recommended levelsto recommended levels
• Daily physical activity and determinants to at least 30 minutes in adults and 60 minutes in children and youth
• Access to and utilization of appropriate food assistance programs, especially the Supplemental Nutrition Assistance Program (Food Stamps)
Network surveillance surveys developed internally and administered in-house are used to:
…biennially monitor the current dietary and physical activity practices, and related habits, attitudes, and beliefs of Californians– California Dietary Practices Survey
• CDPS Adults > 18 years– California Teen Eating, Exercise, and Nutrition Survey
• CalTEENS Teens age 12 – 17 years– California Children’s Healthy Eating and Exercise
Practices Survey• CalCHEEPS Children age 9 – 11 years
33 32 3438
42
50.1
30 3033 35
38
47.1
35 35 34
4146
53.1
0
10
20
30
40
50
60
1997 1999 2001 2003 2005 2007
Perc
ent Total
Males Females
Network + 5 a Day
Campaigns
5 a Day Campaign
alone
Figure 1. California Adults Who Reported Eating 5+ Servings Fruits and Vegetables, 1997-2007 California Dietary Practices Survey
Sample weighted to the 2000 U.S. Census: N (Male)=12,130,354, N (Female)=12,491,465
3.8 3.8 3.9 4.14.4
5.2
3.7 3.7 3.8 3.9 4.0
5.0
3.9 4.0 4.04.4
4.8
5.4
0
1
2
3
4
5
6
1997 1999 2001 2003 2005 2007
Mea
n se
rvin
gs
Total Males Females
Figure 2. Average Servings of Fruit and Vegetables, California Adults 1997-2007
Sample weighted to the 2000 U.S. Census: N (Male)=12,130,354, N (Female)=12,491,465
Figure 3. California Women by Age Group Who Reported Eating 5+ ServingsFruits and Vegetables, 1997-2007
20
25
30
35
40
45
50
55
60
65
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007Year
Perc
ent
65+25-3435-5051-6418-24
Sample weighted to the 2000 U.S. Census: N (18-24)=1,606,913, N (25-34)=2,535,262 N (35-50)=3,891,682, N (51-64)=2,375,284, N (65+)=2,081,784.
Figure 4. Average Servings of Fruit & Vegetables for Women by Age Group, 1997-2007
2.5
3
3.5
4
4.5
5
5.5
6
6.5
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
Serv
ings
65+25-3451-6418-2435-50
Sample weighted to the 2000 U.S. Census: N (18-24)=1,606,913, N (25-34)=2,535,262 N (35-50)=3,891,682, N (51-64)=2,375,284, N (65+)=2,081,784.
Sample weighted to the 2000 U.S. Census: N(<$15,000)=11,602,000, N($15,000-24,999)=4,130,000, N($25,000-34,999)=3,039,000, N($35,000-49,999)=2,917,000, N(>$50,000)=4,795,000.
Figure 5. California Adults Who Reported Eating 5+ Servings Fruits and Vegetables by Income, 1997-2007
20
25
30
35
40
45
50
55
60
65
1997 1999 2001 2003 2005 2007
Year
Perc
ent
>$50,000$35,000-49,999$15,000-24,999<$15,000Food Stamp Participants$25,000-34,999
Sample weighted to the 2000 U.S. Census: N(<$15,000)=11,602,000, N($15,000-24,999)=4,130,000, N($25,000-34,999)=3,039,000, N($35,000-49,999)=2,917,000, N(>$50,000)=4,795,000.
2.5
3
3.5
4
4.5
5
5.5
6
6.5
1997 1999 2001 2003 2005 2007
Year
Serv
ings
$50,000+$15,000-24,000<$15,000Food Stamp Participants$35,000-49,999$25,000-34,999
Figure 6. Average Servings of Fruits & Vegetables by Income, 1997-2007
Figure 7. Californians Who Reported Eating 5+ Servings Fruits and Vegetables by Race/Ethnicity, 1997-2007
20
25
30
35
40
45
50
55
60
65
1997 1999 2001 2003 2005 2007
Year
Perc
ent
Asian/Pacific IslanderWhiteLatinoAfrican American
Sample weighted to the 2000 U.S. Census: N (White)=13,013,000, N (Hispanic)=6,896,000 N (African American)=1,632,000, N (Asian/Other)=3,177,000.
Sample weighted to the 2000 U.S. Census: N (White)=13,013,000, N (Hispanic)=6,896,000 N (African American)=1,632,000, N (Asian/Other)=3,177,000.
Figure 8. Average Servings of Fruit & Vegetables by Race/Ethnicity, 1997-2007
2.5
3
3.5
4
4.5
5
5.5
6
6.5
1997 1999 2001 2003 2005 2007
Year
Serv
ings
Asian/Pacific IslanderLatinoWhiteAfrican American
Process EvaluationNetwork process evaluation:
• Includes activity tracking that encompasses the nine social marketing tools Network emphasizes
• Allows for the merging of similar information from a large variety of programs
• Helps programs and regions to measure their own progress
471,480# attended: HEALTH FAIRS
100,991# attended event: ORGANIZED PA
312,692PA promo w/ nut impressions: CLASSES
51,675# provider training participants: CLASSES
2,497,147# Consumer Nut Ed impressions: CLASSES
12,493other promo consumer impressions: FARMERS MARKET
3,844tour consumer impressions: FARMERS MARKET
9,067taste test consumer impressions: FARMERS MARKET
1,945other promotions consumer impressions: GROCERY STORE 1,394tour of retail outlet consumer impressions: GROCERY STORE 6,309taste test consumer impressions: GROCERY STORE
13,954,500# consumer impressions: OUTDOOR ADS
688,947Total Cumulative Circulation: PAID PRINT ADS
338,700Est. consumer impressions- RADIO
488,200Est. Consumer Impressions: TV and PSA
Total FFY09 ImpressionsCategory of Local Project ActivityNetwork Semi-Annual Activity Report (SAAR)
Network Local Contractor Social Marketing Activities FFY 2009 (partial list)
Summary of SNAP-Ed-Eligible ContactsFFY 2009
1,426,331,84214,495,167Total
6,625,116195,602UC FSNEP
86,381,2423,118,077Regional Networks(Fruit, Vegetable, and
Physical Activity Campaigns)
1,307,847,6038,585,000Network Media (Advertising and Public Relations)
25,477,8812,596,488Local Projects-Network
Total Impressions(Estimate Only)
Total Unduplicated Contacts
(Estimate Only)
Category of Activity
2009 Outcome/Impact Evaluation Findings -Youth
• 29 contractors collected self-reported FV consumption data from 7,067 school-age children using one of four validated instruments
• Matching (same youth) pre-tests and post-tests were provided by 2,689 children using one of four validated instruments.
• Contractors representing about 50% of the 2,689 youth reported statistically significant increased consumption of fruit, vegetables, and total consumption of fruit and vegetables from pre- to post-test
• Those representing about 80% of the youth reported increased consumption of fruit from pre- to post-test
2009 Outcome/Impact Evaluation Findings –Adults
• An additional 11 contractors collected FV consumption data from 1,551 adults using one of three validated instruments
• Matching pre-tests and post-tests from intervention and comparison groups were provided by 1,029 adults using one of three validated instruments
• All adult impact evaluations using the “cups” measurement instrument showed statistically significant improvement in vegetable, fruit, and total fruit and vegetable consumption (N = 493)
• Impact evaluations using the “servings” instrument showed increases in vegetables and total fruit and vegetables with a trend towards increased fruit consumption
• Control group participants also showed increases in consumption.
28
Townsend Marilyn S, Kaiser Lucia L, Allen LH, Joy AB, Murphy SP. Selecting items for a food behavior checklist for a limited resourceaudience. Journal for Nutrition Education and Behavior. 2003;35:69-82.
Murphy S, Kaiser LL, Townsend MS, Allen L. Evaluation of Validity of Items in a Food Behavior Checklist. Journal of the American DieteticAssociation. 2001;101:751-756, 761.
Fruit and Vegetable Checklist7-item; Validated; Available in Spanish
30
Banna JC, Vera Becerra LE, Kaiser LL, Townsend MS. Using qualitative methods to improve questionnaires for Spanish speakers: assessing face validity of a food behavior checklist. J Am Diet Assoc. 110:
80-90, 2010.
A Collection of validated survey instruments to measure FV consumption and determinants of consumptionwww.cdph.ca.gov/programs/cpns/Documents/Network-Compendium.pdf
Evaluating Campaign-Level Interventions That Work
Fruit, Vegetable, and Physical Activity Toolbox for Community Educators
• Quasi-experimental study: – African-American women age 18-54;– 156 treatment; 171 control
• Intervention: Six one-hour Toolbox classes • Results:
– After the 6 weeks of classes, significantly higher proportions of women in the treatment group compared to the control group reported that they bought and prepared more fruits and vegetables since the intervention had started
– Women in in the treatment group reported significant change pre- to post- test while control group women did not. They reported significantly higher proportions than controls who were consuming at least 3.5 cups of FV daily and were physically active for 30 min/day in a usual week.
Development of Network Interventions That Work
Fruit, Vegetable, and Physical Activity Toolbox for Community Educators
– Women in the treatment groups were also significantly more likely to report ordering more fruits and vegetables when eating out and eating them more at work.
– Women in the treatment group reported significant changes in nine measures of attitude, compared to one measure in the control group, as well as twelve measures of confidence and five measures of empowerment for which the control group showed no changes.
http://www.network-toolbox.net/en/index.asp
CX3 – Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention
D. PRODUCE SECTION
26) Is produce sold? (Circle one) 1 - Yes 0 - No If yes, continue. If no Go to Question 33.
27) Are there any health promotion items around the fruit and vegetable display?1 - Yes 0 - No If no Go to Question 29.
28) If there are health promotion items around the fruit and vegetable display, circle a number next to the types of healthpromotion items that are present (more than one can be circled).1 - 5 A Day signs (not on packaging)2 - Nutrition information3 - Fruit and Veggies: More matters4- Network for a Healthy California: Champions for Change
29) Circle the number that best describes overall availability of fruits and vegetables inside and outside the store.
4321Fresh vegetables4321Fresh fruit
Wide variety (7 or more
types)
Moderate variety (4-6 types)
Limited (1-3 types)
None
30) Circle the number that best describes the overall quality of the fresh fruit.
All or most of fruit is of good quality (very fresh, no soft spots, excellent color)
Mixed quality; more good than poor
Mixed quality; more poor than good
All or most of fruit is of poor quality (brown, bruised, overripe, wilted)
None sold
43210
31) Circle the number that best describes the overall quality of the fresh vegetables.
All or most of vegetable is of good quality (very fresh, no soft spots, excellent color)
Mixed quality; more good than poor
Mixed quality; more poor than good
All or most of vegetable is of poor quality (brown, bruised, overripe, wilted)
None sold
43210
CX3 – Communities of Excellence in Nutrition, Physical Activity, and Obesity Prevention
32) Record if the fresh fruit or vegetable is available and the price if possible. If more than one variety of a fruit (e.g. Gala or Red Delicious apples) or vegetable is available, please record the lowest price option. Record the pricing if available (per pound is preferred). If the fruit or vegetable is available by the bag or bunch, record the price only if you can record a weight for the bag (marked on the bottom) or bunch. If a weight is not on the bag or bunch, weigh the item if a scale is present.
Price per Available? (circle one)
Price posted? (circle one) Pound
(preferred if available)
Piece Package/Bunch
(only record if weight is available or can weigh)
If package/bunch, record weight
in pounds and/or ounces
Fruits Apples 1 - Yes 0 - No 1 - Yes 0 - No
Bananas 1 - Yes 0 - No 1 - Yes 0 - No Oranges 1 - Yes 0 - No 1 - Yes 0 - No
Vegetables Carrots 1 - Yes 0 - No 1 - Yes 0 - No
Tomatoes 1 - Yes 0 - No 1 - Yes 0 - No Broccoli 1 - Yes 0 - No 1 - Yes 0 - No Cabbage 1 - Yes 0 - No 1 - Yes 0 - No
Nutrition information score: subtotal Q9, Q20. Max score of 5Any health promo items around fruit & veg display 0 = none, 2 = anyQ20Participates in 5-a-day 0=no, 3=yesQ9
Supermarkets, grocery stores, and neighborhood food stores serve as a place for nutrition information including information about food assistance programs. NF3
Supermarkets, grocery stores and neighborhood food stores in low income neighborhoods actively participate in the Network for a Healthy California Retail Program NF4
Store sells range of foods: subtotal Q22, Q23, Q24, Q25, Q26, price score. Max score of 50
Price: mean price of all 6. If above mean = 0, if below mean = 3
Availability of other healthy food (0 to 7) - 1pt for any food in dairy category (milk- any type, soy milk, mozzarella cheese), 1 pt for any food in meat protein category (ground beef/turkey, whole chicken, fish), 1 pt for any food in grain category (WWbread, high fiber cereal, oatmeal), 1 pt for any food in non-meat protein category (beans, tofu), 1 pt if any canned fruit or vegetable category, 1 pt if any frozen fruit or vegetable category, 1 pt if skim milk is available.Q26
Quality of vegs 0=poor, 0=mixed/poor, 6=mixed/good, 8=goodQ25
Availability of fresh vegetables: 0=none, 4=limited, 8=moderate, 12=wide varietyQ24
Quality of fruit: 0=poor, 0=mixed/poor, 6=mixed/good, 8=good overallQ23Availability of fresh fruit: 0=none, 4=limited, 8=moderate, 12=wide varietyQ22
Small neighborhood food stores, including convenience stores, offer affordable, quality fruits, vegetables, and other healthy foods.NF2
For more information• Susan Foerster
– [email protected]– (916) 449-5385
• Tanya Garbolino– Fruit, Vegetable, and Physical Activity Campaigns and
Programs– [email protected]– (916) 449-5413
• Melanie Hall– Retail Program– [email protected]– (916) 552-9926
• Sharon Sugerman– Research and Evaluation– [email protected]– (916) 449-5406
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