1999 California Healthy Eating and Exercise Practices Survey: Programmatic Implications for the California Children’s 5 a Day–Power Play! Campaign Authors: Angie Keihner 1, Tanya Garbolino 1, Mark Hudes 2 1 Public Health Institute, 2 University of California, Berkeley

The Problem

Diet and Exercise Only 1% of children eat a diet consistent with federal nutrition recommendations ( CSFII). 1 Fewer than half of California children meet the 60 minute PA recommendation, and 14% get fewer than 30 minutes of PA a day. 2 1 Munoz K, et al., Food Intakes of U.S. Children and Adolescents Compared with Recommendations. Pediatrics, (3): p California Department of Health Services, 1999 California Children's Healthy Eating and Exercise Practices Survey: Unpublished data. In press: Sacramento, CA.

Marketing to Children In 1997, U.S. children spent $7.7 billion on foods and beverages –Ranked first among expenditures –Accounted for one-third of the total $23.4 billion spent McNeal JU. The kids market: Myths and realities. Ithaca, NY: Paramount Market Publishing, 1999.

The Child Consumer Median Age Consumer Behavior Primary Stores Primary Products 2 monthsFirst store visitSupermarkets 2 years First in-store gesture/ request Supermarkets Cereals and snacks 3½ years First in-store selections Supermarkets Cereals, toys, and snacks 5½ years First assisted purchases Mass discounters Toys 8 years First independent purchase Convenience stores Snacks

California Children’s Healthy Eating and Exercise Practices Survey (CalCHEEPS)

Survey Purpose Fills a monitoring gap - no comprehensive statewide surveys on nutrition for 9-11 year-old age group Includes dietary and physical activity practices on a typical school day; knowledge, attitudes, beliefs Evaluates knowledge and awareness of 5 a Day–Power Play!

Sample Selection and Administration Market research panel population Demographically diverse, English- speaking sample Conducted April - June 1999 Parent-assisted 2-day food and physical activity diary: Mailed, filled out, and returned Unassisted telephone survey –14 minutes, 44 questions

Sampling and Response Rate Quota sampling –Demographically reflect California households with 9-11 year old children –Pool of 2000 qualified households selected from the market research panel 814 returned food and activity diary –41% response rate 394 completed telephone interview –51% response rate

5 a Day—Power Play! TV Spots and Recall

Paid Advertising and Public Service Announcements (PSA) in 1999 Commercial –Three Wishes FV make you faster, stronger, and learn more FV give you power 5 a Day is important PSA –Shaq’s Secret 5 a Day is important FV give you power

California Children Aware of 5 a Day-Power Play! Campaign TV Spots, 1999, by Gender**, Ethnicity*, and Income* Boys Girls White African American Latino Asian/Other $19,999 or less $20,000-$49,999 $50,000 or more Percent of Children * p<.05; ** p<.01 Source: California Department of Health Services, Preliminary data.

California Children Aware of5 a Day-Power Play! Campaign TV Spots Were More Likely to Know that 5 or More Servings of Fruits and Vegetables Are Needed for Good Health, Servings3-4 Servings5+ Servings Fruits and Vegetables Believed Needed Percent of Children Aware of 5 a Day-Power Play! Yes No/Don't Know p<. 001 Source: California Department of Health Services, Preliminary data.

California Children Aware of5 a Day-Power Play! Campaign TV Spots Were More Likely to Eat 5 or More Servings of Fruits and Vegetables, Servings1-2 Servings3-4 Servings5+ Servings Fruit and Vegetable Intake Percent of Children Aware of 5 a Day-Power Play! Yes No/Don't Know p<. 05 Source: California Department of Health Services, Preliminary data.

Food Preparation

Who Prepares Meals and Snacks? Meals and SnacksWho Fixed Them BreakfastParent, Child, School LunchSchool, Parent, Child DinnerParent After-school snackChild, Parent Evening snackParent, Child

Associations Between Who Makes Meals and Snacks and Fruit and Vegetable Intake, Percent of Children Who Ate a Serving of Fruit or Vegetable Who Made Meal/Snack Child Alone Mom/Dad/Adult School ** p<.01; *** p<. 001 Source: California Department of Health Services, Preliminary data. After-School Snack*** Lunch**Breakfast***

School Environment

California Children Who Participated in School Meals Were More Likely to Eat 5 or More Servings of Fruits and Vegetables, Percent of Children Meeting 5 a Day Goal Participated in School Meals Yes No School Breakfast*** School Lunch** ** p<.01; *** p<. 001 Source: California Department of Health Services, Preliminary data.

California Children's Access to Soda Vending Machines, Candy Vending Machines, and Fast Food on School Campuses, Percent of Children Source: California Department of Health Services, Preliminary data. School Cafeteria Serves Fast Food Vending Machine with Chips and Candy Vending Machine with Soda

Vending Machines Linked to Vegetable Intake Soda vending machines at school –Ate significantly fewer servings of vegetables (0.7 vs. 1.3 servings, p<.001) Vending machines stocked with chips and candy at school –Ate significantly fewer servings of salad (0.1 vs. 0.3 servings, p<.001)

California Children's Participation in Physical Education by Total Minutes of Daily Physical Activity, None1 or Less Times2 Times3-4 Times5 Times Physical Education Per Week Minutes of Physical Activity Source: California Department of Health Services, Preliminary data.

Physical Education Linked to Daily Physical Activity Schools made students exercise (84 vs. 63 minutes of daily PA, p<.01) Children who participated in PE 2 or more times per week (22-30 minutes more daily PA, p<.001)

5 a Day—Power Play! Programmatic Implications

Prioritize Campaign Activities: Food Preparation Meals and Snacks Campaign Efforts Should Target After-school snackParent, Child BreakfastChild, Parent LunchParent Encourage children to participate in school meal programs

Prioritize Campaign Activities: School Environment Address soda vending machines, vending machines stocked with chips and candy, and fast food in schools Replace soda, chips, and candy with more nutritious foods –Promote the voluntary adoption of school nutrition guidelines –Educate legislators

Prioritize Campaign Activities: School Environment Encourage schools to enforce existing PE requirement of 200 minutes of PE every 10 days –Promote the voluntary adoption of school PE guidelines –Educate legislators

Angie Keihner