Trail Markers: Tracking Course Direction through Surveillance

1. Trail Markers:Tracking Course Direction through Surveillance Deb Galuska On behalf on the DNPAO surveillance working group Disclaimer: The conclusions of this presentation represent those of the speaker and not necessarily those of CDC

2. Definition of surveillance “The ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice” (Thacker 1988)

3. The Program Map

4. Change policy Change environment Change individual knowledge, skills, and attitudes Change behavior Change health condition

5. Key trail markers for the DNPAO program

6. The Tools for States: Health Conditions and Behaviors

7. Tools for children

8. Tools for adults

9. Change policy Change environment Change individual knowledge, skills, and attitudes Change behavior Change health condition

10. Health conditions for children

11. Health Conditions for Adults

12. Change policy Change environment Change individual knowledge, skills, and attitudes Change behavior Change health condition

13. Nutrition behaviors for children

14. Nutrition behaviors for adults

15. Physical activity and sedentary behaviors for children

16. Physical activity and sedentary behaviors for adults

17. Change policy Change environment Change individual knowledge, skills, and attitudes Change behavior Change health condition

18. Inventory questions • What federal systems collect state specific data on environment and policy? • What models have states used to collect environmental and/or policy information for their state programs?

19. Key components • Setting • School • Medical • Worksite • Community • Indicator(s) • Methodology

20. Methods of assessing environments or policy • Direct • Individuals in the environment • Decision makers in the environment • Direct measurement • Indirect (data collected for other reasons) • Written documents • Web • Publicly accessible dataset

21. The Tools for States: Environment and Policy

22. Maternity Practices in Infant Nutrition and Care Survey Target behavior: Breastfeeding Setting: Medical care (hospitals and birth centers that provide intrapartum care) Method: Report of most knowledgeable staff Examples of environment or policy measures (or domains): Labor and delivery care Breastfeeding assistance Contact between mother and infant Feeding of breastfeeding infants Facility discharge Staff training Structural and organizational aspects of care delivery Other information: Done in 2007 – repeat planned All states

23. School Health Profiles Target behavior: Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods) Setting: Secondary public schools (Grades 6 through 12) Method: Report principal and teacher Examples of environment or policy measures (or domains): Curriculum Competitive foods Advertising of foods Training of staff Other information: Done biannually State and local data for select states

24. School Health Policies and Program Study Target behavior: Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods) Setting: Schools (Education agency for the state -elementary, middle, high school) Method: Report of most knowledgeable person Examples of environment or policy measures (or domains): Curriculum Competitive foods Food service foods Advertising Training of staff Other information: Done every six years Data on all states

25. National Survey of Children’s Health Target behavior: Physical activity, television Setting: Community (physical activity) and home (television) Method: Telephone survey – parental report Examples of environment or policy measures (or domains): Perceptions of safety and places for physical activity in community Family practices related to television Other information: Done 2003 and 2007 Data on all states

26. DNPAO Legislative Database Target behavior: Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods), television, breastfeeding Setting: All settings possible Method: Multiple outside data sources (e.g. legislative websites, National Counsel of State Legislators) Examples of environment or policy measures (or domains): Legislation for physical education Legislation that supports farmer’s markers Legislation for school vending policy Other information: Need to do additional analyses State data

27. Examples of local trail markers: What are states doing?

28. State examples Individuals in the environment • Addition of parental attitude toward PE policy to CHAMP survey (NC) • Addition of questions related to supports for physical activity in work environment to Minnesota Physical Activity (MN) Decision makers in the environment • Restaurant Heart Healthy Survey (NC) • Worksite Survey and Health Care Site Survey (MA) • New York State Worksite Wellness Survey (NY) External data sources • Monitoring miles of trials (NE)

29. Conclusions • Limited information on environmental and policy in worksites, communities, and medical care • Need for indicators • Need for methodology • Need to share state experiences

30. Proposed next steps • Community setting • Explore feasibility of developing module for assessing individual perceptions of environmental/policy supports • Explore the feasibility of using the Common Measures for Obesity Prevention for community level surveillance • Worksite • Identity relevant indicators • Work with state partners • Needs • How to be engaged

31. Common Community Measures for Obesity Prevention • Multi-partner project • Identify core set of data elements that can be used by communities for self-assessment • Identify strategies • Identify single measure • Next steps • Internal and external review • Pilot • Add to International City and County Management data collection tool • Planned release – summer 2009

32. Surveillance working group members • Heidi Blanck • Patricia Brindley • Susan Carlson • Karen Dalenius • Janet Fulton • Deb Galuska • Laura Kettel Khan • Liping Pan • Barb Polhamus

33. Questions for Large Group Discussion • What are your biggest barriers to conducting surveillance for environment and policy? • What could CDC do to help you address these barriers: • In the next year? • In the next five years? • How do we best use your expertise: • In the development of the CDC plan? • To guide activities in other states?