Enumeration of the Public Health Nutrition Workforce Alexa George, MPH, RD Susanne Gregory, MPH Denise Ferris, RD, LD, DrPH Betsy Haughton, EdD, RD, LDN

Monitoring Trends in the Public Health Nutrition Workforce  Purpose: Workforce enumeration Only comprehensive source of workforce data on nutritionists in state & local public health agencies  6 Previous surveys— In 2000: 10,904 positions surveyed (88% response rate)  Healthy People 2010 Goal 23: Ensure that Federal, Tribal, State, and local health agencies have the infrastructure to provide essential public health services effectively.

Monitoring Trends in the Public Health Nutrition Workforce  Objectives for : Identify workforce trends Determine workforce capacity Assist public health agency planning & evaluation Identify training needs Measure staff qualifications Evaluate use of Web-based survey

Survey Administration  On-line administration Individuals accessed password-protected site with 9-digit unique ID On-line access available from any location (worksite, home, library)  Print administration only as default when on- line not available Entered into on-line format by designated staff within each state

Participation in the Enumeration Survey  State/territory participation: 100% states ITOs were incorporated within states Guam was territory participating  Overall respondent rate = 80.0% (range = %)

WIC’s Presence in the Workforce Table 1. WIC and Non-WIC Job Functions of Filled Positions Job FunctionPositionsPercent Working in WIC Not Working in WIC Total

Agency of Employment Table 2. Agency of Employment of Filled Positions Agency TypeWICNon-WICTotal State government health agency 71.0%68.1%70.8% Local government health agency Indian Health Services, tribal agency or tribal health center Non-profit organization25.5%21.9%25.1% For-profit organization0.4%0.7%0.4% Other3.1%9.3%3.8% Total100%

Job Classifications Population/ System Focus: Admin & Planning Client Focus: Direct Care -Clinical Nutrition -Nutrition -Nutrition Technician -Nutrition Assistant -PH Director (Nutrition) -Assistant PH Director (Nutrition) -PH Supervisor (Nutrition) -PH Nutrition Consultant PH Nutrition Dodds J, Kaufman M. Personnel in Public Health Nutrition for the 1990’s. MacLean Va: Association of State and Territorial Health Officials Foundation; % 71%

Years of Practice  Among those in WIC, 51.6% have >10 years nutrition/dietetics experience 43.5% have >10 years public health nutrition experience (including WIC)  Among those not in WIC, 52.4% have >10 years nutrition/dietetics experience 36.1% have >10 years public health nutrition experience  Overall, 51.8% have >10 years nutrition/dietetics experience 42.7% have >10 years public health nutrition experience

Areas of Practice Table 3. Percent of Time Spent in Direct Services Time in Direct ServicesWICNon-WICTotal None6.2%31.8%9.1% <25%8.4%20.2%9.7% 25-49%6.1%7.7%6.3% 50-74%11.0%13.3%11.2% 75-99%45.1%18.4%42.1% 100%23.3%8.5%21.7% Total100% 52% 27%68% 15%

Employment Status Table 4. Employment Status of Filled Positions WICNon-WICTotal Contracted5.6%12.9%6.4% Employed94.4%87.1%93.6% Total100%

Sources of Funding for Workforce Table 5. Full-time Equivalents Per Funding Source for Filled Positions Funding SourceFTEsPercent USDA State DHHS Local Other Department of Education Total

Academic Preparation  Of those in WIC reporting having earned a degree: 48.9% have Bachelor’s in Nutrition/dietetics 10.5% have Master’s in Nutrition/dietetics  Of those not in WIC reporting having earned a degree: 57.6% have Bachelor’s in Nutrition/dietetics 21.4% have Master’s in Nutrition/dietetics

Table 6. Perceived Training Needs—Top 5 Choices Identified by WIC and Non-WIC Filled Positions Training NeedsTotalWICNon-WIC Breastfeeding11 Prenatal nutrition22 Infant and preschool age nutrition33 Childhood nutrition456 Nutrition counseling, behavioral change, client education 54 Use of information technology, including computers 671 Development of nutrition education materials2 Program evaluation3 Community nutrition assessment4 Communicating with low literacy populations10 5

Table 7. Race/Ethnicity of the Workforce for Filled Positions Race/EthnicityWICNon-WICTotal Hispanic/Latino20.9%9.1%19.6% Not Hispanic/Latino69.0%78.0%70.0% No Response10.1%12.8%10.4% Total100% One race reportedWICNon-WICTotal American Indian or Alaska Native3.4%4.9%3.6% Asian 5.5%4.3%5.3% Black or African American11.6%6.5%11.0% Native Hawaiian or Other Pacific Islander0.7%0.4%0.7% White69.2%75.0%69.9% Two or more races reported2.2%1.8%2.2% No response7.4%6.9%7.3% Total100%

Primary and Secondary Languages as English, Spanish and Other  Among WIC, 88.5% English as primary 19.4% Spanish as secondary  Among Non-WIC 93.3% English as primary 11.6% Spanish as secondary  Overall, 89.0% English as primary 18.5% Spanish as secondary

Table 8. Intend to Retire Within the Next 10 Years for Filled Positions, by WIC/Non-WIC and by Job Classifications CategoryNoYesTotal WIC/Non- WIC WIC76.1%23.3%100% Non-WIC71.0%28.5%100% Total75.6%23.9%100% Job Classification PHN Director55.4%44.6%100% PHN Assistant Director61.5%37.8%100% PHN Supervisor69.5%30.1%100% PHN Consultant68.1%31.7%100% PH Nutritionist78.2%20.8%100% Clinical Nutritionist67.3%32.3%100% Nutritionist78.6%20.8%100% Nutrition Technician70.8%28.6%100% Nutrition Assistant81.6%17.6%100% BF Peer Counselor88.1%11.5%100% Other76.3%22.8%100% Total75.6%23.9%100%

Summary  Enumeration, workforce (followed survey)  On-line survey administration (print optional)  10,683 positions; almost 90% in WIC  Most work in official health agencies  WIC is major funding source  Top training need for those in WIC is breastfeeding vs. information technology use for those not in WIC  High retirement rates expected within the next 10 years

Acknowledgments  ASTPHND state designees  ASTPHND state contacts  ASTPHND Data & Epidemiology Committee  Food and Nutrition Service, USDA