The CDC Guide to Fruit Vegetable Strategies

The CDC Guide to Fruit & Vegetable Strategies to Increase Access, Availability, and Consumption Division of Nutrition, Physical Activity, and Obesity

F&V Workgroup Members Co-chairs Heidi Blanck (Nutrition Branch) Demia Wright (Program Development and Evaluation Branch) Nutrition Branch Christa Essig (on detail to USDA) Jennifer Foltz Kirsten Grimm Larry Grummer-Strawn Sonia Kim Joel Kimmons Latetia Moore Kelley Scanlon Jenna Seymour (on detail to White House) Obesity Prevention and Control Branch Michele Maynard Physical Activity & Health Branch Melissa Cunningham Program Development and Evaluation Branch Diane Ayers Claire Heiser Kate Thomas Communication Team Reba Griffith Division of Adolescent and School Health Terry O'Toole (on detail to DNPAO) OD/BC Advisory Members Deb Galuska Casey Hannan Rosanne Farris *Alicia Hunter (MOU)

CDC/DNPAO Target Area Guidance Documents – Concept: Based upon “The CDC Guide to Breastfeeding Interventions” • 5 New DNPAO Target Area Guidance Documents being released Spring, 2010 – Fruits & Vegetables – Energy Density – Sugar Sweetened Beverages – Physical Activity – Television Viewing

Guide to Fruit and Vegetable Strategies to Increase Access, Availability, and Consumption: Authors • • • Michele Doucette, former Nutrition Branch fellow Christa Essig, Nutrition Branch (on detail to USDA) Sonia Kim, Nutrition Branch Joel Kimmons, Nutrition Branch Kelley Scanlon, Nutrition Branch Jenna Seymour, Nutrition Branch (on detail to White House) Tara Simpson, former Program Development and Evaluation Branch fellow Judith Tessema, former Nutrition Branch intern Kate Thomas, Program Development and Evaluation Branch The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Strategies to Increase Fruit and Vegetable Access, Availability, and Consumption 1. Promote Food Policy Councils as a Means to Improve the Food Environment at State and Local Level 2. Improve Access to Retail Venues that Sell or Increase Availability of Quality Fruits and Vegetables in Currently Underserved Communities 3. Include or Expand Farm-to-Where-You-Are Programs in All Possible Venues 4. Ensure Ready Access to Fruits and Vegetables in Worksite Foodservice and in Food Offered at Meetings and Events 5. Support and Promote Community and Home Gardens 6. Establish Policies to Incorporate Fruit and Vegetable Activities into Schools 7. Include Fruits and Vegetables in Emergency Food Programs

Guidance Document Components Included for each Strategy • Definition • Rationale • Evidence of Effectiveness • Key Considerations • • Action Steps Program Examples Resources References

1. Promote Food Policy Councils as a Means to Improve the Food Environment at the State and Local Level • Presented by: Kirsten Grimm, Nutrition Branch Food Policy Councils (FPCs): FPCs consist of civic, government, and business stakeholders and approach food issues by working at many levels of the food system to increase economic and environmental sustainability, efficiency, and food access

Promote Food Policy Councils (continued) • Examine how the food system is working and develops policies and programs in response • FPCs are a method to achieving other strategies • Evidence for FPCs is very limited – No current peer-reviewed literature demonstrates an impact on fruit and vegetable consumption – Existing literature does indicate policy changes and program implementation resulting from FPCs

FPC Program Examples

2. Improve Access to Retail Venues that Sell or Increase Availability of Quality Fruits and Vegetables in Underserved Communities • Presented by: Heidi Blanck, Work Group Co-Lead • Intervene in: – Variety of venues (supermarkets, grocery stores, convenience stores, corner stores, and specialty stores) – New and existing stores

Achieving Healthier Food Retail • Financial incentives for new stores in underserved areas • Improving transportation to these venues • Upgrading existing store facilities to carry all forms of fruits and vegetables • Increasing supply of and shelf space dedicated to quality and affordable fruits and vegetables at existing stores

Evidence for Healthier Food Retail Interventions • Evidence is promising but limited: – Body of literature exists on access/health outcomes correlation – Some peer-reviewed literature on intervention success – Several program examples

Healthier Food Retail Program Examples • PA Fresh Food Financing Initiative • The Good Neighbor Program: San Francisco, CA • Healthy Corner Store Initiative: The Food Trust

3. Include or Expand Farm-to-Where-You-Are Programs in All Possible Venues • Presented by: Joel Kimmons, Nutrition Branch • Specific Farm-to-Where-You-Are Strategies: a. Farm-to-institution (schools, hospitals, worksites) b. Farmers markets c. Community supported agriculture (CSA)

Farm-to-Where-You-Are • Support regional fruit and vegetable production and distribution • Promote availability of regionally grown farm produce • Provide a connection with the food & the grower – enhances perception of the food and the willingness of the participant to eat local and regional fruits and vegetables (Joshi and Azuma 2008)

3. a. Farm-to-Institution – schools, hospitals, worksites, other community organizations – Regular and convenient access to fruits and vegetables benefits to employees, others – Complements existing food service programs

Farm to Institution Examples

3. b. Farmers Markets – Rapid increase in the last 15 years – Augment small markets and groceries - fill grocery gap in underserved areas – SNAP, WIC Farmers Market Nutrition Program, and Senior Farmers Market Nutrition Programs • Low-income community participation through use of food and nutrition assistance program funds

Farmers Market Program Examples • Health Bucks (NYC) • Kaiser Permanente Farmers Markets

3. c. Community Supported Agriculture (CSA) – Large increase in last 15 years - variety of structures for fees, delivery – In some communities, CSAs may be only point of access to fresh produce within reasonable distance

Farm-to-Where-You-Are: CSAs • CSA Program Examples – City Fresh: Cleveland, OH – TX: Farm to Work – WI: MACSAC

Farm-to-Where-You-Are: Evidence • Evidence is promising but limited – In all three areas • limited research documenting the relationship of “farm-to” strategies to F&V consumption • some non peer-reviewed evaluations show increase in purchases/intake with programs – WIC FMNP has stronger peer-reviewed data – Many program examples • Some focus on encouraging increased purchases for low-income individuals

Strategies 1 -3: Questions? • Food Policy Councils • Healthier Food Retail • Farm-to-Where-You. Are: – Farm-to-Institution – Farmers Markets – CSAs

4. Ensure Ready Access to Fruits and Vegetables in Worksite Foodservice and in Food Offered at Meetings and Events • Presented by: Christa Essig, Nutrition Branch • Specific Strategies: – Healthy cafeterias – Healthy foods at meetings and events

Worksite Strategies (continued) • Cafeteria policies may include: – requiring availability of appealing, quality and affordable fruits and vegetables – preferential pricing for fruits and vegetables – provision of coupons, discounts, and subsidies – using point-of-sale icons (e. g. nutrition labels) to highlight healthy fruit and vegetable options – establishing a policy that a certain proportion of items be fruits and vegetables

Worksite Strategies (continued) • Meeting and event policies may include: – promotion of fruits and vegetables at meetings, conferences, or other events and gatherings – encouragement to incorporate regionally or locally grown fruits and vegetables in worksite gathering menus

Worksite Strategies (continued) • Evidence is promising but limited – Limited published findings show that worksite health strategies have been effective in increasing fruit and vegetable intake & sales – Some program examples exist

Worksite Program Examples • Healthy Picks: Healthy Cafeteria Initiative • CDC Healthier Worksite Initiative

5. Support and Promote Community and Home Gardens • Presented by: Kate Thomas, Program Branch • Community Gardens: – Definition: Collaborative projects created by community members in which participants share both the maintenance and products of the garden – Some gardening programs including a teaching component

Gardening Strategies (continued) • Home Gardens: – Definition: Located at individual’s residence – Fruits and vegetables grown could be eaten by individuals, their families, neighbors, and friends

Gardening Strategies (continued) • Key Points: – Gardening can occur in institutions (worksite, childcare) – Home production and storage of fruits and vegetables can be important during periods of limited access to these foods – Participating in community/home gardens exposes individuals to fresh produce; they then may be more likely to consume

Gardening Strategies (continued) • Evidence is limited: – Program evaluation data - exposure to fresh fruits and vegetables may lead to/has been associated with more consumption or willingness to consume – Some program examples exist

Gardening Program Examples • P-Patch: Seattle, WA • Common Ground: Los Angeles, CA • City Slicker Farm: Oakland, CA

6. Establish Policies to Incorporate Fruit and Vegetable Activities into Schools • Presented by Terry O’Toole, DNPAO Program Development and Evaluation Branch • Policies to incorporate activities with fruits and vegetables into curricula: – school gardening – agricultural education – fruit and vegetable tasting demonstrations in the classroom

Establish Policies in Schools (continued) • Policies to Incorporate Activities with Fruits and Vegetables into Schools (continued): – Provide students with hands-on experiences with fruits and vegetables – Support policy and environmental changes within the school setting – May be linked with farm-to-school

Establish Policies in Schools (continued) • Evidence is promising but limited: – School Gardening: especially promising • associated with increased fruit and vegetable consumption • Three potential action steps

School Policies: Program Examples • Cooking with Kids • Edible Schoolyard (Berkeley, New Orleans) • CA Head Start

7. Include Fruits and Vegetables in Emergency Food Programs • Presented by: Kelley S. Scanlon, Nutrition Branch • In 2007, 11% of U. S. households food insecure during the year • Emergency food programs provide relief for these families • Emergency food programs have been shown to have an inadequate supply of fruits and vegetables

Emergency Food Programs (continued) • Programs can improve access to fruits and vegetables by: – requesting donations of fresh, frozen, canned, and dried fruits and vegetables – partnering with local grocery retailers, farmers markets, CSA programs, and community, school, and home gardens – acquiring donations of or purchasing unsold and surplus fruits and vegetables from farmers

Emergency Food Programs (continued) • No research evaluating the effectiveness of including fruits and vegetables in emergency food programs • Some program examples exist

Emergency Food Program Examples • Community Food Bank of Arizona • Michigan Agricultural Surplus System • The Emergency Foodshelf Network • Food Bank of Western Massachusetts

Technical Assistance • How to Contact a DNPAO Subject Matter Expert: – Ask your Project Officer to be connected with the appropriate Work Group member – We would be happy to help you answer any future questions

Questions?