State-Specific Trends in Fruit and Vegetable Consumption Among Adults, United States Jennifer Foltz, Kirsten Grimm, Heidi Blanck, Kelley Scanlon, Latetia Moore, Larry Grummer-Strawn State FV Coordinators Presentation September 7,

FV Consumption Trends MMWR Overview and Highlights: Importance Methods Materials and Timeline Implications 2

Importance 3

Importance of FV Reduces the risk of leading causes of death *, ¶, § Important role in weight management † 4 * USDA. Dietary Guidelines for Americans 2005 ¶ He FJ et al. Journal of Human Hypertension 2007; 21: 717–728 § CDC. Deaths: Preliminary Data for National Vital Statistics Reports 2006; 54(19) † Rolls BJ et al. Nutr Rev. Jan 2004;62(1):1-17

Healthy People 2010 Objectives Increase the proportion of adults consuming fruit ≥2 x day –Target 75% of adult residents in the state Increase the proportion of adults consuming vegetables ≥ 3 x day –Target 50% of adult residents in the state 5 Source: Objective 19-5,

Percentage of U.S. adults aged ≥ 18 years who consumed fruit ≥2 times per day, by state Behavioral Risk Factor Surveillance System, 2007 National Average: 32.8% State Range: 20.5% % 10

Percentage of U.S. adults aged ≥ 18 years who consumed vegetables ≥3 times per day, by state Behavioral Risk Factor Surveillance System, National Average: 27.4% State Range: 22.4% %

Purpose 1)To assess states’ progress in meeting HP2010 objectives over the last decade 2)To provide an update on consumption by demographic characteristics 8

Methods 9

Behavioral Risk Factor Surveillance System Ongoing, state-based, telephone survey Non-institutionalized U.S. pop aged >18 years Used to –track the prevalence of health behaviors –monitor progress toward health objectives Multistage design –based on random-digit dialing methods –representative sample from each state's civilian adult residents 10

Behavioral Risk Factor Surveillance System FV module: “These next questions are about the foods you usually eat or drink. Please tell me how often you eat or drink each one, for example, twice a week, three times a month, and so forth. How often do you…” 1)“…drink fruit juices such as orange, grapefruit, or tomato?” 2)“Not counting juice, how often do you eat fruit?” 3)“…eat green salad?” 4)“…eat potatoes, not including FF, fried potatoes, or chips?” 5)“…eat carrots?” 6)“Not counting carrots, potatoes, or salad, how many servings of vegetables do you usually eat?” 11

Materials and Timeline 12

Materials and Timeline August 2010 –CDC ; ASTPHND media release September 9, 2010 – MMWR –Report and results embargoed until release –Maps: 2009 for fruits and for vegetables –Table: prevalence and trends, by state –Table: 2009 national data by demographics Close hold on any info until Thursday –2009 results, trend results, demographics 13

Findings and Implications 14

Implications It will be important for increased efforts and resources to address behavioral and environmental interventions in the next decade –increase FV consumption –improve Americans diets –decrease disease risk 15

Initiatives to promote FV consumption –5 A Day for Better Health –Fruits and Veggies — More Matters * Consumption low despite efforts Demonstrate need for –Awareness campaigns, individual counseling & education interventions –Population-based solutions P&E approaches ¶, § Findings and Implications 16 * ¶ Larson NI et al. Am J Prev Med 2009; 36(1): e10 § McCormack LA et al. J Am Diet Assoc 2010; 110(3):

Major geographic disparities Factors may include differences in –population demographics –access, availability, and affordability State Indicator Report on FV, 2009 † 17 † Findings and Implications

No demographic subgroup meets HP2010 targets –Variation exists –Higher incomes – higher vegetable consumption To improve intake by low-income –Voucher programs, such as “Health Bucks” Attract low-income customers to FM * Increase FV consumption § –Installing EBT machines –Accepting SNAP benefits at FM 18 * § Herman DR et al. Am J Public Health 2008; 98(1):98–105 Findings and Implications

Declining response rates and exclusion of households without landline phones –Young or low-income adults more likely wireless-only * Estimates from abbreviated food frequency module are generally lower §, ¶ Screener does not include fried potatoes Screener asks times per day, national recs in servings per day Limitations 19 * Blumberg SJ et al. NCHS. Dec At: § Thompson FE et al. In: Nutrition in the Prevention and Treatment of Disease. 2001:3–30 ¶ Serdula M et al. Epidemiology 1993; 4(5):455–463

New national initiatives to improve FV consumption –Intensify efforts, especially for P&E changes Strategies to improve FV access in the US –Surgeon General’s Vision for a Healthy and Fit Nation * –WH Task Force on Childhood Obesity Report to the President ¶ First Lady’s Let’s Move! Campaign § Action: What Can Federal Govnt Do? 20 * ¶ § http//

States and communities efforts to change FV consumption –State Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases † State program highlights –Communities Putting Prevention to Work program § –USDA, DASH, others Action: What Can States Do? 21 † § http//

FV Guidance Document provides strategic P&E approaches ¶ 1.Promote Food Policy Councils 2.Improve Access to Retail Venues 3.Include or Expand Farm-to-Where-You-Are Programs 4.Ensure Ready Access to FV in Worksite 5.Support and Promote Gardens 6.Policies to Incorporate FV Activities into Schools 7.Include FV in Emergency Food Programs 22 Action: What Can States Do? ¶ Available at

Implications Intensified, multi-sector and multi-setting approaches are necessary New and continued surveillance of FV consumption and environments and policies are needed –to monitor progress –to target and assess the impact of interventions 23

Acknowledgements Co-authors ASTPHND CDC FV Workgroup BRFSS MMWR editors and staff 24

Thank you! 25