CX 3 : Evolution & Accomplishments

1. CX3:Evolution & Accomplishments Presented by: Valerie Quinn, MEd, Health Program Specialist & Alyssa Ghirardelli, RD, MPH, Research Associate

2. YOU are part of the CX3 evolution…

3. CX3 Evolution: Grounding Quick trip back in time circa 2004-5

4. Bog box store TOXIC ENVIRONMENT Metro Atlanta has Removed 58 acres of forest per day for the last 25 years Georgia Department of Natural Resources

6. How do youassessit? How do youchange it?

7. CX3 Evolution • Real world information/data a must for planning nutrition education programs • Local, Local, Local • Relevant to surroundings, tailored to issues, persuasive, empowering!

8. 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

9. CX3 Evolution: 2005 Indicators organized in Assets organized into: • Health department infrastructure • Political will • Community infrastructure 6 Community Environments: • Neighborhood • Preschool • School • After-school • Worksite • Government • Nutrition and Activity

10. CX3 Evolution: 2005

12. Neighborhood Focus

13. Neighborhoods Matter Research: Clear connection between neighborhood factors and health outcomes

14. Neighborhoods Matter

15. CX3 sites Local Health Departments = Pilot Sites (2006) = Group 2 (2007) = Group 3 (2008)

16. 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

17. Tier 1 Tier 2 Community Assets

18. 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.

19. Pilots Oodles of data! How make data easier to understand? Toward what end? Mapping to mobilization! Group 2 Scoring system Communications templates Health dept survey– Tier 1 CX3 Evolution:Tools, etc.

20. CX3 Evolution: Scoring system Formulas auto-calculate scores! Food stores 100 pts, 75 pts for “quality” standard Fast food 50 pts; 35 pts for “quality” standard

21. CX3 Evolution: Communications pieces

22. 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? CX3 Evolution:Tools, etc.

24. Accomplishments 70+ low-income neighborhoods in CA Pilots: 22 neighborhoods Group 2: 18 neighborhoods Group 3: 30+ neighborhoods 310 food stores surveyed Pilots: 180 food stores Group 2: 138 food stores Group 3: TBD, field work wrapping up

25. Accomplishments (Cont.) • Show some charts & graphs from pooled data • Identify patterns, issues • Limitations: • Not representative sample for CA • Data for local use

26. CX3Sample: Food Store Types Group 2 Pilots Sites Other: Warehouse, Health Food, WIC Only, Specialty, Fruit and Vegetable Market Other: Discount, Drug Stores, Health Food, Ethnic

27. CX3Pilot Findings: Food Assistance Programs Available 23% of Store Sample are WIC Vendors FS Only n= 78 Not WIC or FS Vendor n=44 WIC Vendor/Not FS n = 9 WIC/FS Vendor n = 28

28. CX3 Group 2 Findings: Food Assistance Programs Available 18% of Store Sample are WIC Vendors WIC/FS Vendor n=24, Food Stamp Only n=79, No WIC or FS n=29

29. CX3 Pilot Findings:Fruit Availability Large Stores n=25 Small Stores n=83

30. CX3 G2 Findings:Fruit Availability Large stores n=11 Small stores n=73

31. CX3 Pilot Findings: Fruit Quality Large Stores n=25 Small Stores n=70

32. CX3 G2 Findings:Fruit Quality Large stores n=11 Small stores n=72

33. CX3 Pilot and G2 Findings: Store Prices

34. CX3 Findings:F&V Prices 40% of G2 Stores Met the standard for reasonable prices

35. CX3 Findings:F&V Promo 12% of Pilots 16% of G2 Stores that sell produce have health promotions around fruit and vegetable displays

36. CX3 Findings: Checkout Pilots:

37. CX3 Findings:Safety 45% of Pilot 43% of G2stores surveyed have bars on windows

38. made the "cut" 10% close 14% not quality 76% G2 Store Scoring • Store score = 100 possible pts • “quality standard” > 75 pts • Total of 132 stores

39. 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)

40. CX3 Findings: Toys in Kid Meals Pilot Chains n =44 G2 Chains n= 27 Pilot Not Chain n= 83 G2 Not Chain n= 75

41. 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)

42. CX3 Findings: Nutrition Info Group 2 Fast Food Chain Outlets n=27 Non-Chain n=75

43. 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

45. You are Change Agents • Add branding architecture • Change Agents

47. TV Spot • Our Neighborhood, Our Rules

48. “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

49. 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