1. 1 States’ Capacity for Comprehensive Nutrition and Physical Activity Programming Nutrition and Physical Activity Workgroup (NUPAWG)

2. 2 Presentation Outline Describe the following related to states comprehensive nutrition and physical activity programming 1.The purpose, partners, process and context of the assessment 2.Results: capacity needs barriers for comprehensive nutrition and physical activity programming major successes 3.Implications for professional organizations and states

3. 3 Purpose To better understand states' capacity needs, barriers and successes in accomplishing comprehensive nutrition and physical activity programming.

4. 4 Assessment Questions What are the reported capacity needs of states for comprehensive nutrition and physical activity programming? What are the major state reported barriers for comprehensive nutrition and physical activity programming? What major successes have states experienced with comprehensive nutrition and physical activity programming?

5. 5 Partners The Nutrition and Physical Activity Working Group (NUPAWG), partnering with: National Association of Chronic Disease Directors (NACDD), Association of State & Territorial Public Health Nutrition Directors (ASTPHND), Directors of Health Promotion and Education (DHPE), and the National Society of Physical Activity Practitioners in Public Health (NSPAPPH)

6. 6 Process Working with our partners: Developed and tested an online assessment Identified target audience Distributed assessment via existing infrastructure Provided follow up and reminder support

7. 7 Target Audience Three (3) individuals from every state Obesity funded states Program coordinator Nutrition coordinator Physical Activity coordinator Non-obesity funded states ASTPHND rep. NACDD rep. DHPE or NSPAPPH rep.

8. 8 Assessment This online assessment attempts to assess states’ capacity needs, barriers, and successes in five sections, each a critical component of comprehensive nutrition and physical activity programming. leadership coordination/integration partnerships resources planning/purpose

9. 9 Context The responses to the questions are from the perspective of the state health departments’ nutrition/physical activity programming, not local programming.

10. 10 Definitions For the purpose of this assessment, ‘comprehensive nutrition and physical activity programming’ was defined as, “a planned and systematic approach to promote healthy eating, achieving and maintaining the recommended levels of physical activity, eliminating disparities in diet and physical activity, and increasing access to healthy foods and opportunities for physical activity at all levels of society including; individuals, interpersonal, institutions/organizations, communities and public policy”

11. 11 Results 50 of the 51 states represented (98%) Percent reported being members of: 34% NACDD, 50% of ASTPHND, 16% of DHPE, and 46% of NSPAPPH. Only 2% reported having no membership to any of these organizations. 104 total respondents 60% are coordinators, 12% are managers, and 24% are directors. The majority (70%) possess a Master’s degree, while 4% possess a doctoral degree.

12. 12 State Proxy Determination Step 1: Intrastate ‘objective’ responses were compared—no differences were found Step 2: The most complete response, for that state, was utilized as the state’s response The unit of analysis is at the state/district level 49 states and 1 district = population

13. 13 Assessment Question #1 What are the reported capacity needs of states for comprehensive nutrition and physical activity programming?

14. 14 Leadership 41 states (82%) reported having dedicated FTE’s for nutrition and/or physical activity programming 4 = the average number of FTE’s within these states 28 states reported both nutrition and physical activity FTE’s

15. 15 Importance of staff for effective programming

16. 16 Of those that reported NOT having dedicated nutrition and physical activity programming FTE’s:

17. 17 Needed Resources for More Funding States ranking of resources necessary to obtain increased funding. N=50, (%). Most NeededLeast Needed Ancillary staff 13 (26)11 (22) Technical assistance from national and/or state agencies 4 (8)5 (10) Training 1 (2)9 (18) Key program staff 21 (42)3 (6) State strategic action plan 9 (18)20 (40)

18. 18 Planning / Purpose Percent of states with the following elements included in state plan. N=31. Frequency% Behavior Change2787% Policy Change31100% Environmental Change31100% Evaluation2890% Implementation2374% Data Management1858% Planning1858% 31 (62%) states reported having a written state strategic plan for comprehensive nutrition and physical activity programming

19. 19 Self reported capacity level of states Self reported capacity level of states. n=50, (%). HighMediumLow Compared to other states9 (18)19 (38)20 (40) Own expectations12 (24)18 (36)

20. 20 Assessment Question #2 What are the major state reported barriers for comprehensive nutrition and physical activity programming?

21. 21 Capacity Barriers Reported barriers to developing or maintaining states nutrition and physical activity programming capacity. n=50, (%). Largest BarrierSmallest Barrier Leadership 7 (14)12 (24) Coordination 5 (10)2 (4) Partnership 0 (0)17 (34) Resources 34 (68)2 (4) Planning 2 (4)15 (30)

22. 22 Program Funding Sources Proportion of state's overall nutrition and physical activity programming funds from the following funding sources. N=50, (%). Source 0%10-20%30-40%50-60%70-80%90-100% Preventive Health and Health Services Block Grant 28 (56)14 (28)2 (4)3 (6) WIC or other USDA 31 (62)9 (18)2 (4)1 (2)2 (4)3 (6) STEPS 46 (92)3 (6)1 (2) REACH 50 (100) CDC or State Cardiovascular Health Program 46 (92)3 (6)1 (2) CDC or State Cancer Program 44 (88)6 (12) CDC or State Diabetes Program 42 (84)8 (16) CDC's NPAO Program 23 (46)3 (6)2 (4)3 (6)4 (8)15 (30) Foundations 36 (72)10 (20)1 (2)2 (4)1 (2) State Allocations 33 (66)12 (24)1 (2)3 (6)1 (2) Tobacco Settlement Funds 42 (84)4 (8)1 (2)

23. 23 State Allocation 17 (34%) states reported that state funds are allocated and/or used specifically for nutrition and physical activity programming

24. 24 Barriers for Comprehensive Nutrition and Physical Activity Program Coordination/Integration

25. 25 Partnerships % of states reporting having experienced the following in forming or sustaining partnerships

26. 26 Assessment Question #3 What major successes have states experienced with comprehensive nutrition and physical activity programming?

27. 27 Leveraging Funds Did your state's nutrition and physical activity program play a role in leveraging other federal funds. N=50, (%). SourceYesNoNot Sure USDA 17 (34)18 (36)15 (30) Department of Transportation 11 (22)22 (44)17 (34) Parks and Recreation 3 (6)27 (54)20 (40) Department of Education 5 (10)24 (48)21 (42) CDC 13 (26)18 (36)19 (38)

28. 28 Coordination with Chronic Disease Programs What the state’s chronic disease initiatives/programs provides to the state’s nutrition and physical activity programming: 50% reported that leadership was provided 78% reported that disease prevention expertise was provided 84% reported that general support was provided 88% reported that membership on committees was provided

29. 29 Assistance to Local Health Departments

30. 30 Partnering Efforts Reported Activity Level Type of Org.Least ActivityMost Activity Civic Boys/Girl ScoutsYMCA Policy National Council of State Legislatures National Governors Association Public Health SOPHEASTPHND Other Trade Orgs.Universities

31. 31 Partnering Efforts: Civic orgs. YMCAYWCA Boy/Girl Scouts Boys & Girls Club No activity2648 36 Minimal/Fair32203638 Moderate/Extensive30104 N/A - Not sure12221216 Percentage of states reporting extent of partnering with civic organizations

32. 32 Partnering Efforts: Policy orgs. National Governors Association National Council of State Legislatures Council of State Governments No activity284446 Min/Fair302018 Mod/Ext26810 N/A - Not sure162826 Percentage of states reporting extent of partnering with policy organizations

33. 33 Partnering Efforts: Public Health orgs. SOPHEDHPEAPHAASTPHNDNACDDNACCHONASPAPPH No activity 4026208103024 Minimal/Fair 34 5230363018 Moderate/Exten sive 12262260481240 N/A - Not sure 14 6262818 Percentage of states reporting extent of partnering with public health organizations

34. 34 Partnering Efforts: Other orgs. No activityMin/FairMod/Ext N/A - Not sure Insurance Co1458262 Hospitals1056322 Clinics1650304 Medical Ctr.1848304 Universities226702 Gov Council10364410 Business & Industry1050400 Media1254322 Trade Org403612 Foundations14364010 Faith-based Org2252224 Racial/Ethnic Org18502210 Other non-profit6364612 Percentage of states reporting extent of partnering with other organizations

35. 35 Importance of Partnerships 92% of the states reported that partnerships are “very or extremely important” for the success of the nutrition and physical activity programming.

36. 36 Sharing of Assets/Resources What states receive from partners Materials Technical Assistance Expertise* What partners receive from states Technical Assistance* Expertise Funding * Reported as “most important”

37. 37 Take away messages for States Keep doing the following: Partnering Resource management and leveraging Management/Leadership support Need to improve the following: Develop written plan Market written plan

38. 38 Take away messages for Professional Orgs. Physical Activity appears to be advancing: Nutrition paved the way Nutrition can potentially learn and grow with PA Discuss and determine what can be done to help increase states’ capacity as it fits within the orgs. strategic plan Ideas: Case studies of states that have successfully leveraged federal and other funding sources Documenting successful partnerships

39. 39 Questions and (hopefully) Answers

40. 40 Contact Information David Dennison Centers for Disease Control and Prevention Division of Nutrition and Physical Activity 4770 Buford Hwy, NE, MS K-24 Atlanta, GA 30341-3717 Work: (770) 488-5390 Email: ddennison@cdc.gov