CX 3 Orientation FFY 2012 Presented by: Valerie Quinn & Alyssa Ghirardelli

CX 3 Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention (CX 3 ) C = Communities X = Excellence 3 = 1 (nutrition) + 2 (PA) + 3 (obesity prevention)

Welcome back!!! Alameda, Berkeley, Monterey, Pasadena, Santa Clara, Solano, Ventura, Contra Costa, Orange, SF, Santa Barbara, Shasta Background & Orientation to CX 3 -Overview -History on CX 3 indicators and assets -Data analyses, changes & improvements Strategizing, Lessons Learned Resources & Timeline Agenda

You are what you eat

Neighborhoods Matter

You are what you eat where you live Obesity Poor nutrition Diabetes Cancer Stroke

CX 3 : Project Background Objectives: 1.Collect real-world data that accurately conveys neighborhood conditions 2. Activate consumers to improve food availability in low-income neighborhoods* Focused initiative with local health depts. Began 2006 (6 pilot sites) Collect neighborhood-level data using CX 3 standardized tools & methods Over 100 neighborhoods * >50% 185% FPL

Why local health depts? 10 essential public health services

Your Role Change Agents –Data collection by local health department Involve community members where possible Disseminate and engage: Community groups, neighborhoods actively involved, community leaders

Neighborhood Nutrition Data Look at nutrition in the broadest sense: All about understanding how consumers are influenced in their food choices. –Are healthy food choices available and accessible to residents of low-income neighborhoods? –How many fast food outlets are in neighborhood and around schools? What’s the proportion to large grocery stores? –How much and what are the types of nutrition marketing messages around schools? At stores? –Safely walk to store? Is it accessible? –And more!

Data Uses Expose disparities Resource allocation Engage residents in advancing change Program planning- tailor interventions Real-world data to create healthier neighborhoods –City/Co Planners, Redevelopment agencies, inform General Plan, health impact, etc. Program evaluation

Resources Steps, time, & resources

CX 3 – How does it work? Standardized Indicators Tools & Methods Real world data 4 STEPS 1.Compile localized real world data 2. Set priorities based on data 3. Implement strategic, community-focused action plan 4. Evaluate progress over time

CX 3 Data #1: Mapping (aka Tier 1) GIS, cutting-edge public health tool; Web searches –Time: 1 day training, up to 3 days for mapping –Selecting neighborhoods takes time to ponder & plan (up to 20 hours) * SNAP-Ed eligible: Comprised of census tracts where 50% of residents are at or below 185% FPL

Network GIS Updates Updated buffering with creation of double buffers Ability to show and download data inside buffers Measure tool to gauge distances through streets More frequent retail database updates Revised demographics with ACS (American Communities Survey) data

Use of other data sources Environmental health data Google/Yahoo Google street view City crime data – variable, but emerging Walkscore/Transit Score –walkscore.com Healthy City –healthycity.org –All CA- does not include data about store for points on map

CX 3 Data – Cont. #2: On-the-Ground (aka Tier 2) In-depth look (quality) at nutrition factors 3 – 5 neighborhoods Involve community members/youth Training –Time: 1 day training –Train-the-trainer –2 months for field work –Multiple surveys: Stores & walkability; Fast Food Outdoor Emergency food outlets, Alternative healthy foods

CX 3 Data – Cont. #3: Community Assets (aka Tier 3) Internal look at your department Media coverage – via web search

CX 3 Tools & Methods Innovative –Unique scoring system –GIS, powerful data layers Standardized Local focus Reliability tested* Updated, relevant - New features, analyses * Store survey tool

Key to success: Community involvement

The beginnings

Creating CX – 2005 Model after Tobacco Control Program What makes an excellent community?

Indicators & Assets Indicators- Community Environments: –Neighborhood –Preschool –School –After-school –Worksite –Government - Nutrition and PA Assets : –Health department infrastructure –Political will –Community infrastructure

Indicators Community Indicators: Criteria for including… –Environmental or community level measures (e.g., policies) –Possible to change by community –Addresses an intermediate goal –Items are stated neutrally

Creating CX 3 – cont.

Indicators & Assets Community Indicators Specific, observable characteristics of a community’s environments & norms. Example “Supermarkets and grocery stores offering healthy, affordable food choices are located in low-income neighborhoods and readily accessible to residents.”

Indicators & Assets Assets A community’s “readiness” for addressing environmental change. Example “Extent of local media coverage that is supportive of role of communities and government in addressing obesity prevention, not just a matter of “individual choice.”

CX 3 Focus: Neighborhood But, other CX 3 environments soon ?

CX 3 Sites 25 Network funded Local Health Departments and more with other funding All types: Urban dense, suburban, rural, remote CX 3 LOCAL HEALTH DEPARTMENTS Alameda (2006) ▲ San Diego (2007) Berkeley (2006) ▲ San Francisco (2012) Contra Costa (2007)San Joaquin (2009) Humboldt (2011)San Mateo (2009) Kern (2006) ▲ Santa Barbara (2008) Long Beach (2009)Santa Clara (2006) ▲ Marin (2007)Shasta (2008) Monterey (2008)Solano (2007 Orange (2008)Sonoma (2008) Pasadena (2008)Stanislaus (2008) Riverside (2006/2011) ▲ Tulare (2009) Sacramento (2007)Ventura (2007) San Bernardino (2006) ▲ Yolo (2011) ▲ Pilot sites

Mountain of data!

CX 3 : Localized Data Analysis

CX 3 Data Analyses Neighborhood level Store level

Neighborhood level: Retail Food Environment * Percent of neighborhood stores offering predominately healthy food vs. those offering predominately high fat/sugar food. Healthy food sources include supermarkets or large grocery stores, small markets meeting quality standards, farmers markets & fruit/vegetable markets. High fat/sugar food sources include fast food outlets, convenience stores, & small markets not meeting quality standards. HEALTHY vs. UNHEALTHY FOOD SOURCES*

Store level Scores automatically Formulas

CX 3 Communications pieces

After Data Collection Compare with previous data collected –Were there changes? –CX 3 Team working on way to make data comparison easy Share data with department leadership, community groups, neighborhood residents, etc. Get input! Prioritize actions –Network interventions vs. other groups pursue Implement strategic SoW activities based on data findings

Of CX 3 neighborhoods, which ones did you implement interventions? As program evaluation: – Required to reassess any neighborhood where conducted intervention work. – Comparison CX 3 neighborhood if possible (and no intervention work) – Data complexities, expecting more precise federal data in early 2012 (Race/ethnicity data layers by 185% FPL) Reassessing

How did they do it? From the Field… # of Census tracts How Neighborhoods selected Tier 1 – Who mapped? Ease of use? Tier 2 – Who organized? Foot work? Key advise? Suggested resources Top benefit? Key local health department staff

CX 3 Success Stories Solano: Findings presented to several community groups & local action, used for several grants. Santa Clara: Data helped mobilize the community, guide focused activities and interventions. Experience from CX 3 resulted in CHiN-uP! (Coalition for Health, Nutrition & Physical Activity) creating a one-year work plan. Shasta: Findings indicated none of the restaurants surveyed met the CX 3 criteria for a healthy restaurant. Led to adoption of the Healthy Kids Choice (HKC) restaurant partnership program to increase and promote healthy kids menu options.

CX 3 Success Stories (cont.) San Mateo: YO! Mateo youth interviewed about the Healthy Neighborhood Stores campaign and the Friday Night Live Network on "Beyond the Headlines" with Cheryl Jennings on ABC7 news (The segment can be found exactly at the 18:22 mark of the video if you would like to fast forward to the interview.)

Finalizing new GIS layer and method to include coffee shops, ice cream, donuts and other types of restaurants within ½ mile of schools A “retail exposure scale” will be provided to help compare and identify schools Also a neighborhood “school score” will be available to look at stores, fast food, outdoor marketing and mobile vending around schools

Timeline… accelerated Tier 1/Mapping Training: -Oct 12, Nov 7, Dec 12, Jan 6 Tier 2 Training: TBD -Late Jan/early Feb 2012 Field Work: Mar – Jun Share data, community forums, etc.: Jul – Sept Monthly conference calls – for strategizing, reviewing tools, etc. Webinars used also.

Timeline & Next Steps (Cont.) Thinking ahead: –Which neighborhoods? Reassess vs. new ones? –Field work-people power How can the Network help?

Questions? Strategizing…

CX 3 Benefits Advances local change – Proven! Puts local groups at forefront for obesity prevention Standardized indicators, methods, tools Appealing to funders

Thank you! This material was produced by the California Department of Public Health’s Network for a Healthy California with funding from USDA SNAP, known in California as CalFresh (formerly Food Stamps). These institutions are equal opportunity providers and employers. CalFresh provides assistance to low-income households and can help buy nutritious foods for better health. For CalFresh information, call For important nutrition information, visit