Results of the FY 2009 Needs Assessment Shelley Kuklish Epidemiologist Arizona Nutrition Network

Outline Population Overview Poverty Demographics of Food Stamp Recipients Nutrition Related Behavioral and Lifestyle Characteristics of Food Stamp Eligibles Food Purchasing Attitudes and Behaviors Partner Satisfaction Survey Results

Population Overview

¾ of Arizona’s population is in Maricopa and Pima Counties Source: 2006 Claritas Data Population is relatively young 65% of the population in the state is <44 years of age

Unemployment rate is similar to the national average (4.7% compared to 5.0%) Source: Arizona Department of Economic Security Per capita income is lower than national average ($31,936 compared to $36,714) Navajo County had lowest per capita income ($19,505)

Poverty

PHOENIX TUCSON Source: US Census Data, 2000

Population in Poverty by Age Group, Arizona 2000 Source: US Census, Categories are cumulative

Educational Attainment by Poverty Level Source: Behavior Risk Factor Surveillance System, 2007

Source: US Census, 2000

Children in Poverty Just under half (47%) of children in AZ in 2006 live in low income families. –1 in 5: live in families considered poor have no employed parents –Over half have at least one employed parent –Almost half live in single parent households –% of children living in low income families increases as educational attainment decreases. –% living in low income families varies by race/ethnicity: 72% of American Indian children 68% of Hispanic children 25% of White children Source: National Center for Children in Poverty

Over half (61.5%) of schools in AZ qualify for FSNE Just over half (56%) of eligible schools are currently receiving FSNE through LIA partners Average of 604,559 students receive free and reduced cost lunches per day Source: Arizona Department of Education

Demographics of Food Stamp Recipients

Over a half million (618,447) participants in March 2008 –Average monthly per person benefit was $ –Average monthly household benefit was $ –Total issuance for the month totaled over $62 million Majority (89%) have incomes lower than the FPL Over half (61.3%) are preschool age children 11.3% are elderly One-third (31.1%) of households are single parents with children Source: DES Family Assistance Statistical Bulletin, 2008 USDA Report of Food Stamp Recipients in AZ, 2006

Arizona Food Stamp Recipients by Age and Race/Ethnicity 2007 Source: Arizona Department of Economic Security

Arizona Food Stamp Recipients by Age and Gender 2007 Source: Arizona Department of Economic Security

Geographic Location: Food Stamp Recipients: –Half reside in Maricopa County –Just under one-fifth (17%) reside in Pima County Food Stamp Program Eligibles: –36.7% of the population eligible for food stamps in Yavapai County were receiving food stamps. Pinal, Santa Cruz and Graham counties followed (43%). Source: Arizona Department of Economic Security

Nutrition Related Behavioral and Lifestyle Characteristics of FSP Eligibles

Source: Arizona Health Status and Vital Statistics, 2006

Risk Factors by Poverty Level Source: Behavior Risk Factor Surveillance System, 2007

Fruit and Vegetable Consumption

Fruit and Vegetable Consumption by Poverty Level for Adults, 2007 Source: Behavior Risk Factor Surveillance System, 2007

Fruits and Vegetables: Most (82.9%) high school students ate less than 5 servings of fruit and vegetables per day –American Indians more likely to eat 5 or more servings per day (32% compared to 16% for Whites). Source: Youth Risk Behavior Survey, 2007

Fruits and Vegetables Formative Research Results on FSP Eligibles Aware of the importance of eating fruits and vegetables Reasons for not eating fruits and vegetables: –short shelf life –expensive –no time to prepare –don’t like vegetables –not in the habit of eating vegetables. Believe that frozen and canned fruits and vegetables are not as nutritious as fresh. Source: AzNN Social Marketing Formative Research

Overweight and Obesity

Adult Overweight and Obesity Over half (58.7%) of adults in AZ are overweight or obese. –More likely to be overweight or obese: Hispanics (55.4%) American Indians (64.2%) Adults with incomes % FPL (64.8%). Santa Cruz County (78.7%) Source: Behavior Risk Factor Surveillance System, 2007

Adolescent Overweight and Obesity One in four (25.9%) high school students were at risk for or were overweight. –More likely to be at risk: African Americans (29%) Hispanics (19%) –More likely to be overweight: American Indians (20%) Hispanics (17%) Source: Youth Risk Behavior Survey, 2007

Childhood Overweight and Obesity Children age 2 and older who were overweight: –Inter Tribal Council of Arizona WIC % –Navajo WIC program % –Arizona WIC program - 14% Source: Arizona WIC Program

Physical Activity

Adult Physical Activity Over half (51.6%) of Arizona adults did not meet physical activity recommendations. –Less likely to meet recommendations: Adults with incomes below 185% FPL Maricopa County, across all income groups. Source: Behavior Risk Factor Surveillance System, 2007

Adolescent Physical Activity Two-thirds (68%) of high school students did not meet physical activity recommendations for in the past week. –One quarter (28%) reported spending at least 3 hours watching TV per day. –One fifth (21%) reported spending at least 3 hours playing video games per day. Source: Youth Risk Behavior Survey, 2007

Physical Activity Formative Research Results on FSP Eligibles Believe that getting regular exercise is key to a healthy lifestyle. Reasons for not being physically active: –laziness –too tired –not enough will power –too busy Common physical activities participated in: –Walking –Bicycling –Cleaning –Going to the park with the kids –Walking with kids to and from school –Yard work Source: AzNN Social Marketing Formative Research

Physical Activity Formative Research Results on FSP Eligibles Common physical activities for kids: –Soccer –Walking to the park –Running –Swimming –Basketball –Kick ball –Tennis Source: AzNN Social Marketing Formative Research

Food Purchasing Attitudes and Behaviors

Shopping Behaviors/Food Resource Management: Food accounted for 13.4% of total household expenditures in the Phoenix Area. –Families and single consumers spent almost half (46.8% ) of their food budgets on food prepared away from home –Just 9.4% of the food budget was spent on fruits and vegetables Source: Consumer Expenditure Survey,

Shopping Behaviors/Food Resource Management: AzNN Evaluations from 2006 and 2007 indicated that of the 339 people surveyed: –Just under half (42%) planned meals ahead of time –Over half (58%) compare prices before buying food –Over half (62%) look for specials when grocery shopping –Almost all (97%) shop for fruits and vegetables in supermarkets

Food Resource Management Formative Research on FSP Eligibles Purchases influenced by preferences of children and husband Number of healthy foods purchased limited by financial constraints Use coupons, sales and inexpensive food items Limit purchase of new and unfamiliar foods Purchase dairy at practically every grocery trip Agree that if they like a recipe from a food demo and know how to prepare the recipe, they will prepare it for their families Want food demos in familiar locations such as WIC and food banks by WIC counselors or promoters Source: AzNN Social Marketing Formative Research

Where and how FSP Eligibles Eat 71% of FSP eligibles reported eating meals as a family at least 5 days per week. Eating behaviors of high school students in the past week: –10% consumed 3 or more servings of milk –17% ate 5 or more servings of fruits and vegetables Source: Social Marketing Demographic Surveys Youth Risk Behavior Survey, 2007

Where and how FSP Eligibles Eat School environment (middle and high schools): –Two-thirds (69%) of schools had snacks or beverages available for purchase on school grounds. 39% had low fat or fat free milk available for purchase 37% had fruits or vegetables available for purchase 66% had 100% fruit and vegetable juice available for purchase Three quarters (73%) of schools had a required physical activity class. Source: Arizona Department of Education, School Health Profiles

Food Stamp Redemption A national analysis of food stamp redemption patterns conducted by the USDA found : –used the EBT system frequently –left very little unspent at the end of the month –Households had an average of 8 transactions per month ~$25 per transaction Over the past 5 years, food stamp EBT transactions at Arizona farmers’ markets have increased from less than $500 in 2003 to over $4,000 for the first half of 2006 (based on a convenience sample of 6 markets). Source: USDA/AZFMNP

Summary Population Overview –¾ of population in Maricopa and Pima Counties –Relatively young –Unemployment rate comparable with national average Some counties have higher unemployment rates Poverty –High percentage of the state population at or below 185% FPL –Children and elderly are more likely to be in poverty –Single parent households more likely to be in poverty –Poverty increases as education level decreases

Summary Demographics of Food Stamp Recipients –Over a half million participants in March 2008 –Total issuance for March = $62 million –Over half are preschool age children –11.3% are elderly –One-third of households are single parents with children Nutrition Related Behavioral and Lifestyle Characteristics of Food Stamp Eligibles –Adults with incomes <185% FPL Less likely to meet recommendations for physical activity and fruit and vegetable consumption More likely to be overweight or obese

Summary Food Purchasing Attitudes and Behaviors –2/3 of FS eligibles surveyed reported eating meals as a family at least 5 days per week –Phoenix consumers spent: Almost ½ of their food budgets on food prepared away from home Just under 10% of the food budget was spent on fruits and vegetables –National food stamp redemption patterns: Left very little unspent at the end of the month Avg. of 8 transactions per month at $25 per transaction

Partner Satisfaction Survey Results, FY 2008

Network Strengths Diversity of network members. Design of the Fun Food News, posters and recipe cards. Television ads for social marketing campaigns. The website.

Areas of Improvement The planning process used to prepare the network’s objectives. Utilization of partner input. Opportunities for network members to take leadership roles. Communication among members of the network. Communication between the network and the broader community.

Next Steps: Network management and staff are committed to addressing the identified concerns and improving program relationships. Several changes have already taken place and many more are in the planning stages. The LIA partners are the heart of this program and their feedback is critically important.

The Nutrition Network sincerely thanks you for your time and commitment to this program and to the Food Stamp Population of Arizona.

Both reports are available at: stats.php

Thank You! Shelley Kuklish Epidemiologist Arizona Nutrition Network Arizona Department of Health Services