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Using CX 3 Tools to Assess the Food Environment Presented by: County of Orange Health Care Agency – Nutrition Services Nutrition Education and Obesity Prevention (NEOP)
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Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Mar 14, 2020

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Page 1: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Using CX3 Tools to Assessthe Food Environment

Presented by:County of Orange Health Care Agency – Nutrition Services

Nutrition Education and Obesity Prevention (NEOP)

Page 2: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Neighborhoods MatterResearch: Clear connection between neighborhood factors and health outcomes

Page 3: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

What’s in Your Neighborhood?• How many places are providing food?

• Is it easy for your residents to choose healthier foods at nearby grocery stores?

• Are families able to make healthy food choices at fast food restaurants?

Page 4: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Objectives

• Use CX3 tools to assess the food environment

• Describe sample findings from target neighborhoods

• List ways to share the CX3 information

Page 5: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

CX3 Nutrition Education & Obesity Prevention BranchCalifornia Department of Public Health

Communities of Excellencein Nutrition, Physical Activity and

Obesity Prevention

Page 6: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

2008 & 20124 target neighborhoods• Orange – El Modena• San Juan Capistrano – Mission• Santa Ana – Spectrum/Lacy • Santa Ana – Lyons• La Habra (2012 only)

Page 7: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Maps of Census Tracts

Santa Ana - Spectrum

San Juan Capistrano - Mission

Santa Ana - Lyon

Page 8: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

2008 & 2012 ResultsLower scores = healthier, Goal is ≤ 5

(Unhealthy ÷ Healthy)

• Orange – El Modena = 8.7…..6.0Few parks, fair access to grocery stores but none meet healthy standards

• San Juan Capistrano – Mission = 7.2…..6.0Many small & large parks, no major grocery store serving Latinos, 24 fast food

• Santa Ana – Spectrum/Lacy = 6.2…..4.25Fair access to grocery stores meeting standards, 27 fast food outlets (all types)

• Santa Ana – Lyons = 24.0…..15.5No parks, no nearby major grocery store accepting CalFresh/WIC

Page 9: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

CX3 Tier 1- Data Mapping

GIS Maps (GIS – Geographical Info System)

Analyze Census Tracts• Income levels• Large/small markets• Fast food sites• Schools• Parks• Other

(State website, internet-based, open to all)

Page 10: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

CX3 Tier 2 – Data CollectionWhat did we look at?

Neighborhood food stores: – Price, quality of f/v; marketing cues– Safe, walkable?

Around schools & parks:– Marketing cues on outdoor ads– Fast food: Cues, nutrition

info posted, healthy options?– Convenience markets

and small stores

Page 11: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

CX3 Tools

1. Access to healthy food markets– Was it easy & safe to get to the market? (Walkability survey)– What was available? (Grocery Store survey)– Areas for improvement

2. Access to fast food and ads– What was available at restaurants? (Fast food survey)– What advertising was seen? (Outdoor ads survey)

– Areas for improvement

Page 12: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Walkability SurveyIs it safe to cross the street?

No crosswalk

Entrance to the store

Page 13: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

What did we see?

Where the sidewalk ends…

Page 14: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Grocery Store Survey – Sample questions

Page 15: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

13) Fresh produce displays or bins outside storeCircle “1” Yes

Exterior – What is outside the store?

Page 16: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Exterior – What is in the windows?

21) If store sells alcohol, more than 1/3 total window area covered by ANY type of ads: Circle “1” Yes

Page 17: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Interior – What is by the check out stand?

24) Number of cash registers: Record “2”

Page 18: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Produce – Are healthy messages posted?

27) Health promotion items around the fruit and vegetable display: Circle “1” Yes

Page 19: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Is there a good variety of quality of fruits & vegetables?

Page 20: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Limited quantity

Page 21: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

4 3 2 1 1

Quality – Example of color change, yellowing

Page 22: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

22) WIC signage displayed: If either old or new logo on WIC vendor sign, circle “1” Yes (could be on interior)

Do stores accept WIC or CalFresh? Food Costs?

Page 23: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Rate the Store:Tally the results

If >75 pts,quality store with

healthy items

If <75 pts, room for

improvement

Page 24: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Santa Ana

1 site was:• Grocery Store• WIC Store• Water Store• Coffee & Donut Shop

Page 25: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Santa Ana – Same site 2014

Page 26: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Grocery Trucks

Produce vendors

Page 27: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Grocery Trucks

Page 28: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Ads & other items on trucks

Page 29: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Where’s the fruit?

Page 30: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

There’s the fruit! (and veggies)

Page 31: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Variety of items

Page 32: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Preliminary ResultsSanta Ana-Spectrum

2008 2012Total # of stores 16 21

Chain/large 3 2Small 4 8Other 3 5

Convenience 6 6

# with >75 pts 6 8 & 1 close

Food Assistance WIC = 5CalFresh = 8

WIC = 11CalFresh = 13

Network Retail F & V partner 7 2 (5 in 2013)

Page 33: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Preliminary ResultsSanta Ana - Lyon

2008 2012Total # of stores 12 13

Chain/large 1 1Small 4 3Other 1 2

Convenience 6 7

# with >75 pts 1 2 & 2 close

Food Assistance WIC = 2CalFresh = 4

WIC = 5CalFresh = 9

Network Retail F & V partner 0 1 (2 in 2013)

Page 34: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Preliminary ResultsSan Juan Cap - Mission

2008 2012Total # of stores 15 16

Chain/large 3 3Small 3 5Other 4 3

Convenience 5 5

# with >75 pts 3 4 & 2 close

Food Assistance WIC = 2CalFresh = 4

WIC = 4CalFresh = 11

Network Retail F & V partner 3 0 (6 in 2013)

Page 35: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

CX3 Tools

1. Access to healthy food markets– Was it easy & safe to get to the market? (Walkability survey)– What was available? (Grocery Store survey)– Areas for improvement

2. Access to fast food and ads– What was available at restaurants? (Fast food survey)– What advertising was seen? (Outdoor ads survey)

– Areas for improvement

Page 36: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Fast Food & Outdoor Ad Surveys

Page 37: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Exterior – What ads are seen?

12) Amount of advertising on doors & windows (shown):Unhealthy: 0 Small, 0 Med., 5 LargeHealthy: 0 Small, 0 Med., 0 Large

Page 38: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Marketing – What is targeted to kids?

22) “Yes” to signs/ads kid-oriented24) “Yes” to Kids Meals24a) Yes to toy give-aways, e.g., Bratz and GI Joe

Page 39: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Is nutrition info posted?

26) On the menu board: Minimum of total calories next to each menu item- Circle “1” Yes

Page 40: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Rate the Site:Tally the results

If >37 pts,quality site with healthy items

If <37 pts, room for

improvement

Page 41: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Santa Ana

From grocery store to taco shop

Page 42: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

What ads are in the area?

Type/Size: “4” Transit AdProduct/Ad: “4” Unhealthy food items

Page 43: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

What ads are in the area?

Type/Size: 2 small billboardsTop - Product/Ad is: Other – Obesity prevention messageBottom - Product/Ad is: Fast food restaurant

Page 44: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Preliminary ResultsSanta Ana - Spectrum

2008 2012# of Fast Food 27 20

Burger/FF 4 chain, 14 not 6 chain, 7 not

Pizza 3 chain, 0 not 2 chain, 1 not

Sandwich/Deli 2 2

Other (not chain) 4 2

# with >37 pts 1 1Exterior healthy ads

score ≤10 pts 15 5

Healthy food option score >5 pts

13 9

Page 45: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Preliminary ResultsSanta Ana - Lyon

2008 2012# of Fast Food 13 20

Burger/FF 5 chain, 7 not 9 chain, 6 not

Pizza 0 chain, 0 not 1 chain, 0 not

Sandwich/Deli 1 1

Other (not chain) 0 3

# with >37 pts 0 2 & 2 close

Exterior healthy ads score ≤10 pts 2 2

Healthy food option score >5 pts

5 16

Page 46: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Preliminary ResultsSan Juan Cap - Mission

2008 2012# of Fast Food 24 18

Burger/FF 10 chain, 8 not 9 chain, 0 not

Pizza 2 chain, 1 not 3 chain, 1 not

Sandwich/Deli 2 1

Other (not chain) 1 4

# with >37 pts 0 1Exterior healthy ads

score ≤10 pts12 3

Healthy food option score >5 pts

13 9

Page 47: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Share CX3 Findings

• Community members

• Grocery vendors

• Fast food vendors

• City and County staff

Page 48: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Any Questions onGrocery or Fast Food

Surveys?

Page 49: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

Review Objectives

• Use CX3 tools to assess the food environment

• Describe sample findings from target neighborhoods

• List ways to share the CX3 information

Page 50: Using CX3 Tools to Assess the Food Environmentoc-apa.org/.../2013/12/Using-CX3-Tools-to-Assess-the-Food-Environment.pdf · Using CX3 Tools to Assess the Food Environment Presented

CX3 Communities of Excellencein Nutrition, Physical Activity

& Obesity Prevention

CDPHwww.cdph.ca.gov/programs/cpns/Pages/CX3_Main_Navgation.aspx

Dawn Robinson(714) 834-7984

[email protected]

Elsa Amezcua(714) 834-7842

[email protected]

For CalFresh information, call 1-877-847-3663. Funded by USDA SNAP-Ed, an equal opportunity provider and employer.

Visit www.CaChampionsForChange.net for healthy tips.

County of Orange Health Care Agency