Nutrition, Physical Activity, and Obesity

1. Nutrition, Physical Activity, and Obesity Looking Back – Moving Forward Claire Heiser Acting Team Lead and Project Officer Program Advancement Team

2. Today’s presentation • Looking back: Lessons learned from the past 5 years • Moving forward: DP08-805 cooperative agreement

3. What can we learn from the past 5 years? Cooperative Agreement 03022 State Progress Monitoring Reports

4. Partnerships Percent of Partners Engaged in Activities Supporting the State Program Source: PMR C3 – C25 Time Pd: July 1, 2007 - December 31, 2007

5. State Plan Development • State Plan Index • General Public • Guide to Community Preventive Services

6. State Plan Objectives Strategies Targeted by States’ Objectives Source: PMR PL24 Time Pd: July 1, 2003 - December 31, 2007

7. Legislation 2005-07 Total Number of Bills Enacted by Focus Area Source: PMR PO11, PO13

8. Legislation 2005-07 Total Number of Bills Enacted by Setting Source: PMR PO11, PO13

9. Policy Changes 2005-07 Total Number of Policy Changes by Setting Source: PMR PO3, PO5

10. Interventions Number of Interventions by Setting Source: PMR IM34 Time Pd: July 1, 2003 - December 31, 2007

11. States successfully leveraged funds

12. Looking Forward Overview of DP08-805 cooperative agreement

13. State Programs in Nutrition, Physical Activity, and Obesity www.cdc.gov/nccdphp/dnpa/obesity/state_programs

14. Program Outcome Objectives • Decrease prevalence of obesity • Increase physical activity • Improve dietary behaviors related to population burden of obesity and chronic diseases

15. Program Impact Objectives • Increase the number, reach and quality of policies and standards set in place to support healthful eating and physical activity in various settings. • Increase access to and use of environments to support healthful eating and physical activity in various settings. • Increase the number, reach and quality of social and behavioral approaches that complement policy and environmental strategies to promote healthful eating and physical activity.

16. State Program Activities • Coordinate program infrastructure and strategic partnerships • Develop a comprehensive NPAO state plan • Implement the plan throughout the state • Identify data sources and monitor outcomes • Evaluate progress and impact of the state plan

17. Target Areas • Increase breastfeeding initiation, duration, and exclusivity • Increase physical activity • Increase consumption of fruits and vegetables

18. Target Areas • Decrease consumption of sugar-sweetened beverages • Reduce consumption of high-energy-dense foods • Decrease television viewing

19. Settings for the Prevention and Control of Obesity • Community • Health Care • School • Work Site

20. New Activities with 805 • Give priority to policy and environmental approaches • Ensure emphasis on reducing health disparities • Develop and use an annual implementation plan • Develop surveillance measures of policy and environmental changes

21. New Activities with 805 (cont) • Develop surveillance data and reporting plans • Evaluate the state partnership • Use an evaluation advisory group • Develop success stories to share

22. Relationships Among the Various Plans Within the DP08-805 Cooperative Agreement State Plan Sustainability Plan Annual Implementation Plan Evaluation Plan Annual Work Plan For CDC Cooperative Agreement Partner “X’s” Work Plan Surveillance Data and Reporting Plans

23. Program Philosophy

24. Program Philosophy • Commit to long-term accomplishments

25. Program Philosophy 2. Address factors needed for social change

26. Program Philosophy 3. Decrease health disparities Forming and maintaining diverse partnerships is critical

27. Program Philosophy 4. Emphasize policy and environmental changes

28. Environment Making Healthy Choices Easier Environment • Affordability • Price/ Economic • Access • Policy • Legislation • Advertising Individual • Culture • Skills • Knowledge • Time 6 target areas

29. Key Elements of Community-Based Health Promotion Programs • Active participation • Multiple intervention settings • Multiple individual level strategies • Environmental interventions • Policy initiatives Merzel C. D’Afflitti, J. Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health. 2003; 93(4):557-574.

30. Program Philosophy 5. Use Social Ecological Model to design state plan and activities

31. Social Ecological Model Social Norms and Values • Home and Family • School • Community • Work Site • Healthcare • Food and Beverage Industry • Agriculture • Education • Media • Government • Public Health Systems • Healthcare Industry • Business and Workers • Land Use and Transportation • Leisure and Recreation Sectors of Influence Behavioral Settings • Genetics • Psychosocial • Other Personal Factors Individual Factors Food and Beverage Intake Physical Activity Energy Intake Energy Expenditure Energy Balance Prevention of Overweight and Obesity Among Children, Adolescents, and Adults Note: Adapted from “Preventing Childhood Obesity.” Institute of Medicine, 2005.

32. Obesity Prevention Requires All Sectors of Influence Working Together Science Base For Obesity Prevention Medical System Food & Beverage Industry Land Use Trans- portation Agriculture Active Living and Healthy Eating Schools Community Media Work Site

33. Program Philosophy 6. Use social marketing planning approach to design activities

34. Social Marketing Advertising “The application of commercial marketing technologies to the analysis, planning, execution, and evaluation of programs designed to influence voluntary behavior of target audiences in order to improve their personal welfare and that of society.” Andreasen, A. Marketing Social Change. 1995.

35. Program Philosophy 7. Develop evidence- based portfolio of policies and intervention strategies

36. Evidence Action “ To get more evidence-based practice, we need more practice-based evidence. ” Lawrence W. Green, DrPH

37. UNC Center of Excellence for Training and Research Translation (Center TRT) http://www.center-trt.org

38. Program Philosophy 8. Build and sustain partnerships and resources • Integration • Opportunities for collaboration

39. Moving Forward Together Moving Forward Together

40. Thank You