Download State Indicator Report Fruits Vegetables 2013

State Indicator Report
on
Fruits and Vegetables
2013
The State Indicator Report on Fruits and Vegetables can be used to:
•
•
Introduction Fruitsandvegetables(F&V)contributeimportant
nutrientsforthehumanbody.EatingF&Vlowersthe
riskofdevelopingmanychronicdiseasesandcan
alsohelpwithweightmanagement.1Creatinggreater
accesstoqualityandaffordableF&Vnationwideisan
importantsteptoincreaseF&Vconsumption.Whenstate
leaders,healthprofessionals,foodretailowners,farmers,
educationstaff,andcommunitymembersworktogether,
moreAmericanscanlivehealthierlives.
TheState Indicator Report on Fruits and Vegetables, 2013
providesinformationforeachstateonfruitandvegetable
(F&V)consumption,andenvironmentalandpolicy
indicatorsofsupportforconsumption.Thereport,which
canbeusedtoinformdecisionmakers,showsthatF&V
consumptionishigherinsomestatesthanothers,but
overallconsumptionofF&VintheUnitedStatesislow.
AdultsintheUnitedStatesconsumefruitabout1.1times
perdayandvegetablesabout1.6timesperday.The
DietaryGuidelinesforAmericans,2010recommends
thatAmericanseatmoreF&Vaspartofahealthydiet.
TheMyPlatefoodguidancesystememphasizestheneed
to“focusonfruits”and“varyyourveggies”asbuilding
blocksforahealthydiet(www.choosemyplate.gov).
•
IllustratehowstatessupporttheconsumptionofF&V
Monitorprogressandcelebrate
statesuccesses
IdentifyopportunitiesforimprovementinF&Vaccess
ManystatesareattemptingtoincreaseF&Vconsumption
byimprovingaccessandestablishingpoliciesthatmake
iteasiertogetF&Vincommunities,schools,andchild
The State Indicator Report on Fruits
and Vegetables can be used to:
•
Illustrate how states support the
consumption of F&V
•
Monitor progress and celebrate
state successes
•
Identify opportunities for
improvement in F&V access
care.Forexample,28statesnowhaveafarmtoschool/
preschoolpolicy.Twenty-sevenstateshavecreated
state-levelfoodpolicycouncils--coalitionsofprivateand
publicpartnersworkingtogethertoimproveaccessto
healthyfood.
Median Daily Vegetable Intake
Among Adults in the United States Behavioral Risk Factor Surveillance System, 2011
2
ThereisstillmoreworktobedonetoincreaseF&V
accessandconsumption.Forexample,onlyabout70%
ofallcensustractsinthiscountrycurrentlyhaveatleast
onestorethatoffersawidevarietyofaffordableF&V.
Thisratevariesbystate,withCalifornia,NewYork,
Florida,theDistrictofColumbia,andOregonhavingthe
greatestaccesstooneofthesestores.
Farmersmarketsareanadditionalsourceofaffordable
F&Vinthecommunity.Vermont,Wyoming,Iowa,and
NewHampshirehavemorethansevenfarmersmarkets
per100,000stateresidents.Nutritionassistanceprograms
improveaccesstoF&Vforindividualsandfamilieswith
lowerincomes.Thepercentoffarmersmarketsthat
acceptSupplementalNutritionAssistanceProgram
(SNAP)benefitsvariesamongstates;withtheDistrictof
Columbia,Vermont,NewMexico,andOregoncurrently
leadingallothers.Additionally,19statesnowauthorize
farmerstoacceptSpecialSupplementalNutritionProgram
forWomenInfantsandChildren(WIC)CashValue
Vouchers.
Anumberofstateswiththehighestconsumptionof
fruitsandvegetableshavemoreenvironmentalsupports.
Forexample,adultsinOregonandCaliforniaeatmore
vegetablesthanadultsinotherstates.Theyalsoare
amongthehighestinfruitconsumption.Oregonand
Californiaarealsoabovethenationalscoreonaccess
toahealthierfoodretailer,farmersmarketdensity,
andfarmersmarketacceptanceofnutritionassistance
programbenefits.However,manyfactorsplayarole
inimprovingconsumption.Furthermonitoringand
evaluationmayhighlightthosefactorsmostsupportive
ofconsumption.
Stories from the Field
Healthier Food Retail in Communities
New York City
ThroughitsHealthBucksandStellarFarmersMarketprograms,the
NewYorkCityDepartmentofHealthandMentalHygieneishelping
customerslearnaboutandbuyfruitsandvegetables.
z The Health Bucks program distributes $2 Health Bucks coupons to
consumers for the purchase of fresh fruits and vegetables at farmers
markets. SNAP participants who use their benefits at participating markets
receive a $2 coupon for every $5 spent in SNAP benefits, effectively a
40% increase in purchasing power. Since the program began in 2005, the
number of participating markets has grown from about 5 in 2005 to 138
in 2012. Coupon redemption rates have also increased every year; in 2011
93% of the nearly 88,000 coupons distributed to SNAP recipients were
redeemed.
z The Stellar Farmers Market program provides free nutrition workshops
and cooking demonstrations at farmers markets in low-income
neighborhoods. It also offers tips on food safety and shopping on a
budget. In 2011 the program sponsored over 1,300 workshops and
provided Health Bucks coupons to more than 15,000 consumers.
3
Massachusetts
TheMassachusettsDepartmentofTransitionalAssistance
andtheDepartmentofAgriculturalResourcespartnered
in2009toincreaseSNAPrecipients’accesstofarmers
markets.Theyhelpedfinancepoint-of-saleterminalsand
transactionfeesassociatedwithSNAPpurchases,increased
people’spurchasingpowerthroughincentivesthatmatched
SNAPpurchasesatthefarmersmarkets,andpromoted
thesebenefitswidelytoSNAPrecipients.Inthefirstyear,
theseeffortsincreasedthenumberoffarmersmarketsthat
acceptedSNAPfrom30to58andboostedSNAPsales
atthesemarketsbyover500%.Onaverage,marketsthat
offeredincentiveshad$1,700moreinSNAPsalesthan
marketsthatdidnotofferthem.
Schools, Child Care, and Early Education
Vermont
SinceitslaunchinJanuary2011,theVermontWorksfor
WomenFRESHFoodProgramhasservedmorethan68,000
nutritiousmealsfor2to5-year-oldsinearlycareandeducation
centersthroughouttheGreaterBurlingtonarea. FRESHFood
createshealthyanddeliciousmenuitemsthatexceedUSDA
nutritionalstandardsandservesthesemealshome-style. Asa
memberoftheVermontFreshNetwork,FRESHFoodworks
withmorethan20localandregionalvendorsandfarmersto
acquirevegetables,fruits,dairyproducts,herbs,meats,and
honey. FRESHFoodgrewoutofVermontWorksforWomen’s
TransitionalJobsprogram,whichprovidesskillstrainingand
workexperiencetohelpwomenfindpermanentemployment.
Minnesota
WithCDCfunding,Minnesota’sGreatTrays™Partnership
workedtohelpschoolsservehealthierfoodstostudents.
Formedin2010amongeightstate-levelorganizations—
includingtheStateDepartmentsofAgriculture,Education,
andHealthandHumanServices—GreatTrays™trained
schoolnutritionleaders,promotedtimeandcostsavingsto
allowschoolstobuyhealthierfoods,andsupportedfarm-toschoolprograms.Overthree-quartersofMinnesotapublic
schoolsparticipatedintrainingsandarenowcommittedto
improvingthefoodstheyoffer.Plus,farm-to-schoolefforts
areincreasingaccesstolocalproduceinatleast367schools
and22schooldistrictsacrossthestate,servingmorethan
200,000students.
4
Food System Support
Rhode Island
MarketMobile,whichbeganin2009asapilotprojectofthe
non-profitorganizationFarmFresh,isincreasingRhodeIslanders’
accesstohealthylocalfoods.Byfacilitatingrelationshipsbetween
localfoodproducers,institutions,andotherbuyers,MarketMobile
in2012generatedover$1.5millioninsalesfrom60localfood
producerstomorethan260retailvenues—includingrestaurants,
schools,hospitals,worksites,grocerystores,cornerstores,andfarm
stands.ThroughMarketMobile,about50,000familiesthroughout
RhodeIslandandneighboringareaslikeBostonnowhaveaccessto
locallyproducedfood,includingfruitsandvegetables.
Fruit and Vegetable Indicators
In2011‚twoupdatesoccurredintheBehavioralRiskFactorSurveillanceSystem(BRFSS)thatwillaffectestimationof
fruitandvegetableintake.First,therewasanoverallchangeintheBRFSSmethodologytoadjustsampleweighting
proceduresandaccommodatecellphoneusage.Second,therewerechangestothecorequestionsusedtoassessfruit
andvegetableintake.Becauseofthesechanges,estimatesoffruitandvegetableintakefrom2011forwardcannotbe
comparedtoestimatesfrompreviousyears.DatafromBRFSScollectedin2011willprovideanewbaselineforfruitand
vegetabledatacollectedinsubsequentyears.Anumberofpolicyandenvironmentalindicators,whicharenotbasedon
BRFSS,maybecomparabletofindingsfrompreviousyears.
ThereareeightbehavioralindicatorspresentedinTable
1and13policyandenvironmentalindicatorspresented
inTable2.Theindicators(describedbelow)followthe
orderofthecolumnsinthetables.Thisreportprovides
dataonbehavioral,policy,andenvironmentalindicators
for50statesandtheDistrictofColumbia(hereafter
referredtoasstates).
z Percentage of adolescents in the state who report
Behavioral Indicators
Trackingconsumptionoffruitsandvegetablesovertime
willhelpstatesmonitorprogresstowardsincreasedF&V
consumption,akeyrecommendationoftheDietary
Guidelines for Americans, 2010.1
ThisreportpresentsindicatorsofF&Vconsumptionfor
bothUSadultsandadolescentsfromtheBehavioral
RiskFactorSurveillanceSystem*andYouthRiskBehavior
SurveillanceSystem,respectively,bothsupportedbyCDC.
z Percentage of adults in the state who report
consuming fruits less than one time daily and
vegetables less than one time daily (new)
z Median daily intake of fruits and median daily
intake of vegetables for adults in the state (times
per day) (new)
consuming fruits less than one time daily and
vegetables less than one time daily (new)
z Median daily intake of fruits and median daily intake
of vegetables for adolescents in the state (times per
day) (new)
Policy and Environmental
Indicators
Mostindicatorsarethesameasthoseintroducedinthe
2009report,thoughtwoweredroppedandtwohave
differentdefinitionsordatasources.Inaddition,thereare
sixnewindicators.Thestrategiesrepresentedbythese
indicatorscanoccurorbesupportedatthestatelevel
aswellasincommunitiesacrossthestate.Statesmay
focusonafewormanyoftheindicatorsbasedontheir
existingcapacity,partnerships,andresources.
* Due to changes in the Behavioral Risk Factor Surveillance System, these data cannot be compared to previous reports. See page 10 for more information.
5
Availability of Healthier Food Retail
in Communities
z Percentage of farmers markets that accept WIC
HavingaccesstostoresthatsellF&Vandotherhealthier
foodsmayincreaseF&Vconsumptionamongadults.2,3
ImprovingaccesstoF&Vandotherhealthierfoodscan
includeexpandingaccesstostoresthattypicallystockan
affordableandwideselectionofF&V(i.e.supermarkets,
largergrocerystores,F&Vspecialtystores),improving
availabilityofF&Vinsmallstoresincludingconvenience
andcornerstores,andutilizingfarm-to-consumer
approachessuchasmarketsatwhichfarmerssellF&V
directlytoconsumers.2,4,5
z States that authorize farmers to accept WIC Cash Value
z Percentage of census tracts in a state that have at
least one healthier food retailer located within the
tract or within 1/2-mile of tract boundaries (different
definition or data source)
OnemeasureofaccesstoF&Visthepercentageof
censustractsinstatesthathaveatypicalhealthierfood
retailer(atleastonesupermarket,supercenter,larger
grocerystore,warehouseclub,orF&Vspecialtystore)
locatedwithinthetractorwithina1/2-mileoftract
boundaries.Acensustractisasmallandrelatively
permanentsubdivisionofcountiesthatissimilarin
populationandeconomiccharacteristicsandliving
conditions.Onaveragesupermarkets,supercenters,
largergrocerystores,warehouseclubs,andF&Vspecialty
storesstockawideselectionofaffordableF&V.Other
typesofretailvenuesincommunitiesareoftenless
consistentinwhattheyoffermakingitdifficulttoidentify
whethertheyprovideaccesstoF&V.Residentsmayhave
additionalaccesstoF&Vintheirneighborhoodsthrough
seasonalfarmersmarketsandfarmstands,although
temporaryvenuesmaynotbecapturedinthismetric.
z State-level healthier food retail policy
State-levelpoliciesthatsupporthealthierfoodretail
havethepotentialtoincreaseF&Vaccessandimprove
nutritionamongadultsandchildren.5Suchpolicies
includesupportfor:1)thebuildingand/orplacement
ofnewfoodretailoutlets(e.g.newsupermarketsin
underservedareas);2)renovationandequipment
upgradesofexistingfoodretailoutlets(e.g.purchasing
refrigeratorsforcornerstorestoallowforthesaleof
freshproduce);3)increasesinandpromotionofF&Vat
foodretailoutlets(e.g.,increasedshelfspaceforF&V;
shelf-labeling).
z Number of farmers markets per 100,000 state
residents
z Percentage of farmers markets that accept SNAP
benefits (new)
6
Farmers Market Nutrition Program coupons
Vouchers (new)
Farmersmarketsareamechanismforpurchasingfoods
fromlocalfarmsandcanaugmentaccesstoF&Vfrom
typicalretailstoresorprovidearetailvenueforF&V
inareaslackingsuchstores.5,6Thenumberoffarmers
marketsper100,000stateresidentsprovidesabroad
estimateoftheavailabilityofF&Vfromfarmersmarkets
adjustedforvariationinstatepopulation.Farmers
marketsthatacceptnutritionassistanceprogrambenefits,
suchasSupplementalNutritionAssistanceProgram
(SNAP),SpecialSupplementalNutritionProgramfor
Women,Infants,andChildren(WIC)FarmersMarket
NutritionProgram(FMNP)coupons,andWICCashValue
Vouchers(CVV),improveaccesstoF&Vforindividuals
andfamilieswithlowerincomes.6
Availability of Fruits and Vegetables in Schools,
Child Care, and Early Education Programs
Schools,childcare,andearlyeducationprograms(e.g.,
childcarecenters,daycarehomes,HeadStartprograms,
preschoolandpre-kindergarten)areuniquelypositioned
tomodelandreinforcehealthfuleatingbehaviorsby
includingF&Vatmeals,activitiesandevents,suchas
celebrations,andincorporatingnutritioneducationinto
curricula.
z Percentage of middle and high schools that offer fruits
or non-fried vegetables at school celebrations (new)
TheInstituteofMedicinerecommendsthatschools
limitopportunitiesforfoodandbeveragesobtained
outsidetheUnitedStatesDepartmentofAgriculture
(USDA)schoolmealsprograms.7However,whenthese
opportunitiesarise,schoolscanencourageconsumption
ofhealthierfoods,includingfruitsandvegetables.7Many
middleandhighschoolsofferfoodsorbeveragesat
schoolcelebrationsandthusincreasingthepercentage
ofschoolsthatofferfruitsandvegetablesattheseevents
indicatesschools’supportofafoodenvironmentthat
alignswithcurrentdietaryguidance.7,8
z State child care regulations align with national
standards for serving fruits (new)
z State child care regulations align with national
standards for serving vegetables (new)
Statescansupportincreasedfruitandvegetable
consumptionbyensuringthattheirstatechildcare
regulationsrelatedtonutritioncloselyalignwith
evidence-based,best-practicestandards.9These
standardsspecifythatchildreninearlyeducationand
childcarefacilities(bothcentersandfamily-homes)be
servedavarietyoffruits,especiallywholefruits,and
vegetables,specificallydarkgreen,orange,deepyellow
androotvegetables.
foods.Forexample,somefoodhubsacceptSNAP
benefitsandhaveinitiativesthatsupportfoodbanksand
hungerrelieforganizations.Additionally,foodhubsmay
provideservices,suchasqualitycontrolandprocessing,
thatfacilitatethepurchaseofF&Vbyschools,hospitals,
andsmallstores.13,14
z State-level farm to school/preschool policy
z Percentage of cropland acreage harvested for fruits
(different definition or data source)
Farmtoschoolandfarmtopreschoolprogramscan
supportincreasedfruitandvegetableintakeamong
childrenthroughthepurchaseofproducefromlocal/
regionalfarms,implementationofsaladbars,training
servicesforfoodproviders,teachers,orparents,and
byprovidingexperientiallearningopportunitiessuch
asschoolgardensprogramsandfarmvisitsforyouth
andstaff.10,11Theexistenceofstate-levelfarmtoschool/
preschoolpoliciesshowssupportforcreation,expansion,
ormaintenanceoftheseprograms.
Food System Support
AsystemsapproachtoincreasingaccesstoF&V
considersthemanyfactorsinvolvedingettingfoodfrom
farmtoconsumer,includingaspectsoffoodproduction,
processing,distribution,andretail.12Alsoincludedin
suchanapproacharepartnershipswiththeparticipants
inthatsystem,includingfarmers,industries,workers,
governments,institutionalpurchasers,communities,
andconsumers.
z Number of food hubs in each state (new)
Afoodhub,asdefinedbytheUSDA,isa“business
ororganizationthatactivelymanagestheaggregation,
distribution,andmarketingofsource-identifiedfood
productsprimarilyfromlocalandregionalproducersto
strengthentheirabilitytosatisfywholesale,retail,and
institutionaldemand.”13,14Forretailersandfoodservice
buyerswhowouldliketopurchaselargervolumesof
locallyandregionallygrownproducts,foodhubslower
theprocurementcostsbyprovidingasinglepointof
purchaseforconsistentandreliablesuppliesofsourceidentifiedproductsfromlocalandregionalproducers.
Moreover,foodhubshavethepotentialtoreach
populationswhomightotherwiselackaccesstohealthier
and vegetables
CroplandacreageharvestedforF&Visabroadindicator
ofdomesticF&Vinputstothefoodsystem.When
interpretingthismeasure,itmaybeimportanttoconsider
thetypesofcropsharvestedandtheiryieldsaswellas
growingconditionsacrossstates.State-grownfruitsand
vegetablescanprovideF&Vforinstitutionalbuyersas
wellasretailvenuesthatsourcefromlocalgrowers.
z State-level food policy council
z Number of local food policy councils in each state
Foodpolicycouncils(FPCs)andsimilarcoalitionsbring
togetherdiversestakeholderstoexamineanddevelop
recommendationsforimprovementstoaregional,
state,and/orlocalfoodsystem.15Memberstypically
representawidearrayofinterests,includingnutrition,
health,agriculture,education,communitydesign,
andcommerce.6FPCscansupportimprovedfood
environmentsforhealthyeatingandaidcommunityF&V
accessbyencouragingimprovementofretailstoresand
supportingfarmtoinstitutionprogramsandpracticesby
schools,childcareandearlyeducation,worksites,and
communityorganizations.
For more information or to provide feedback
contact [email protected].
AdditionalmaterialsfortheState Indicator Report
on Fruits and Vegetables, 2013areavailableat
http://www.cdc.gov/nutrition/professionals/data.
7
Table 1: State Indicator Report on Fruits and Vegetables, 2013: Behavioral Indicators
Adults
Percentage who report
consuming fruits and
vegetables less than
one time daily
State
U.S. National
Adolescents
Median intake of
fruits and vegetables
(times per day)
Percentage who report
consuming fruits and
vegetables less than
one time daily
Median intake of
fruits and vegetables
(times per day)
Fruits
Vegetables
Fruits
Vegetables
Fruits
Vegetables
Fruits
Vegetables
37.7
22.6
1.1
1.6
36.0
37.7
1.0
1.3
43.8
24.3
1.0
1.6
44.4
45.7
1.0
1.0
Alabama
38.7
19.7
1.1
1.7
39.1
34.1
1.0
1.3
Alaska
38.0
20.6
1.1
1.7
Arizona
47.5
28.6
1.0
1.5
49.4
43.2
1.0
1.0
Arkansas
30.4
16.5
1.3
1.8
California
35.7
19.1
1.1
1.7
Colorado
32.0
20.6
1.3
1.7
34.6
35.3
1.3
1.3
Connecticut
39.2
23.8
1.0
1.6
46.0
1.0
Delaware
31.7
20.1
1.3
1.8
Dist of Columbia
37.7
22.6
1.1
1.6
37.2
42.1
1.0
1.1
Florida
41.9
23.2
1.0
1.6
42.9
43.1
1.0
1.0
Georgia
39.5
22.6
1.0
1.7
45.1
40.8
1.0
1.1
Hawaii
38.1
20.1
1.1
1.6
33.9
32.2
1.0
1.3
Idaho
36.0
25.2
1.1
1.6
38.7
42.3
1.0
1.1
Illinois
41.6
27.3
1.0
1.5
44.7
42.0
1.0
1.1
Indiana
39.8
26.9
1.0
1.4
36.1
35.1
1.0
1.3
Iowa
41.4
22.2
1.0
1.6
40.4
35.7
1.0
1.3
Kansas
45.9
25.2
1.0
1.5
49.7
43.2
1.0
1.1
Kentucky
46.7
32.5
1.0
1.4
47.8
50.1
1.0
0.9
Louisiana
33.2
18.9
1.2
1.7
37.5
1.0
Maine
36.4
22.8
1.1
1.6
38.7
38.9
1.0
1.3
Maryland
31.6
20.7
1.2
1.7
Massachusetts
37.3
23.2
1.1
1.6
37.8
36.8
1.0
1.3
Michigan
36.2
23.6
1.1
1.5
Minnesota
50.8
32.3
0.9
1.4
39.8
42.4
1.0
1.1
Mississippi
43.9
25.2
1.0
1.5
Missouri
39.2
21.7
1.0
1.6
38.4
33.5
1.0
1.3
Montana
40.1
26.2
1.0
1.5
41.0
38.0
1.0
1.3
Nebraska
36.9
24.4
1.1
1.6
Nevada
30.3
17.6
1.3
1.8
36.8
31.8
1.0
1.3
New Hampshire
33.9
22.2
1.1
1.6
39.1
34.9
1.0
1.3
New Jersey
38.0
21.9
1.1
1.7
40.8
37.1
1.0
1.3
New Mexico
33.9
23.0
1.2
1.6
34.7
1.3
New York
40.8
21.9
1.0
1.6
44.5
39.6
1.0
1.1
North Carolina
39.1
27.1
1.1
1.4
36.4
39.4
1.0
1.1
North Dakota
40.5
26.0
1.0
1.5
42.4
42.2
1.0
1.1
Ohio
50.2
26.8
0.9
1.5
44.3
40.4
1.0
1.1
Oklahoma
32.0
15.3
1.1
1.9
Oregon
36.1
23.9
1.1
1.5
Pennsylvania
32.9
20.7
1.2
1.6
36.5
35.3
1.0
1.3
Rhode Island
44.4
27.3
1.0
1.5
50.6
47.8
0.7
1.0
South Carolina
39.6
26.3
1.0
1.4
41.2
38.8
1.0
1.1
South Dakota
46.3
25.4
1.0
1.6
44.9
41.4
1.0
1.1
Tennessee
40.3
21.8
1.0
1.6
42.1
47.5
1.0
1.0
Texas
34.9
19.8
1.1
1.7
32.5
31.8
1.0
1.3
Utah
31.4
18.1
1.3
1.7
30.7
26.4
1.3
1.6
Vermont
38.4
22.2
1.1
1.7
39.8
41.7
1.0
1.1
Virginia
35.0
18.8
1.1
1.7
Washington
47.2
26.2
1.0
1.5
37.8
34.9
1.0
1.3
West Virginia
35.6
26.0
1.1
1.5
34.1
35.7
1.0
1.3
Wisconsin
38.2
22.4
1.1
1.6
37.9
31.4
1.0
1.3
Wyoming
Data sources: Behavioral Risk Factor Surveillance System, 2011. Youth Risk Behavior Surveillance System, 2011. Some states may not have estimates for F&V intake among
adolescents which may be due to either not collecting survey data, not achieving a high enough overall response rate to receive weighted results, or omitting 1 or more
questionnaire items during administration of the survey.
8
Table 2: State Indicator Report on Fruits and Vegetables, 2013: Policy and Environmental Indicators
Schools, Child Care, and Early
Education
25.8
19
33.63
64.8
No
3.1
4.7
Alabama
48.5
No
4.4
18.8
Alaska
71.1
No
1.3
30.5
Arizona
58.9
No
2.7
8.8
Arkansas
82.4
Yes
2.2
27.4
California
69.9
No
3.2
21.7
Colorado
66.7
No
4.3
10.3
Connecticut
76.2
No
3.5
6.3
Delaware
77.7
Yes
5.7
60.0
Dist of Columbia
78.5
No
1.1
15.7
Florida
70.9
No
1.2
21.5
Georgia
73.5
No
6.4
30.7
Hawaii
67.1
No
4.2
9.0
Idaho
71.4
Yes
2.3
10.6
Illinois
62.3
No
2.5
11.7
Indiana
55.5
No
7.5
12.2
Iowa
57.3
No
3.4
18.6
Kansas
59.6
No
3.7
9.3
Kentucky
67.1
Yes
1.4
12.9
Louisiana
55.3
No
6.3
31.0
Maine
74.0
Yes
2.6
16.3
Maryland
68.6
No
4.4
29.8
Massachusetts
63.9
Yes
3.2
29.5
Michigan
57.6
No
3.2
20.1
Minnesota
61.5
No
2.5
26.7
Mississippi
65.9
No
2.6
14.8
Missouri
52.0
No
6.5
21.5
Montana
60.2
No
4.6
8.2
Nebraska
71.9
Yes
1.5
17.5
Nevada
54.5
No
7.3
16.7
New Hampshire
76.9
No
1.5
13.4
New Jersey
56.4
No
3.3
47.8
New Mexico
78.9
Yes
3.3
29.5
New York
69.9
No
2.2
12.6
North Carolina
49.8
No
9.5
1.5
North Dakota
63.7
No
2.3
21.5
Ohio
51.1
Yes
1.9
14.1
Oklahoma
77.1
No
4.2
45.4
Oregon
69.1
Yes
2.0
20.7
Pennsylvania
67.6
No
5.8
27.9
Rhode Island
66.4
No
2.7
13.6
South Carolina
45.5
No
4.6
31.6
South Dakota
63.1
No
1.5
11.8
Tennessee
66.4
No
0.7
18.5
Texas
66.0
No
1.3
10.8
Utah
43.7
No
15.0
50.0
Vermont
70.3
No
2.8
14.5
Virginia
71.6
No
2.1
35.6
Washington
59.3
No
4.4
19.8
West Virginia
61.1
No
5.2
13.1
Wisconsin
60.3
No
7.6
7.0
Wyoming
1
Indicates states that did not receive WIC FMNP grants in FY2012.
2
Among schools that offer foods or beverages at school celebrations.
3
Median across states.
10 / 4
28
213
2.5
27
150
6.7
37.5
41.5
18.8
39.3
NA1
21.3
NA
71.4
5.4
10.7
NA
NA
10.6
35.0
24.9
NA
20.4
16.1
35.7
66.0
45.0
32.1
21.3
13.3
NA
18.5
7.1
NA
NA
32.1
76.8
42.7
11.7
NA
22.6
NA
47.2
22.7
39.3
15.2
NA
2.2
11.3
NA
25.5
NA
58.2
34.6
36.9
NA
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
No
No
No
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
No
No
Yes
No
No
No
Yes
No
Yes
No
No
Yes
Yes
Yes
No
Yes
Yes
No
No
No
No
No
No
No
No
No
No
34.9
40.9
44.0
22.2
36.9
33.8
44.5
35.4
30.6
35.3
31.5
39.4
34.1
No / No
No / No
No / No
No / No
Yes / No
No / No
No / No
Yes / No
No / No
Yes / Yes
No / No
No / No
No / No
Yes / No
No / No
No / No
No / No
No / No
Yes / No
No / No
No / No
No / No
No / No
No / No
Yes / Yes
Yes / No
No / No
No / No
No / No
No / No
No / No
Yes / No
No / No
No / No
No / No
No / No
No / No
No / No
Yes / Yes
No / No
No / No
Yes / Yes
No / No
No / No
No / No
No / No
No / No
No / No
No / No
No / No
No / No
No
Yes
No
No
Yes
Yes
Yes
No
Yes
Yes
Yes
No
No
Yes
No
Yes
No
Yes
No
Yes
Yes
Yes
Yes
No
No
No
Yes
No
No
No
Yes
Yes
Yes
No
No
No
Yes
Yes
Yes
Yes
No
No
Yes
Yes
No
Yes
Yes
Yes
No
Yes
No
3
0
2
4
10
3
2
0
2
5
2
0
2
8
1
5
2
4
2
3
3
13
5
3
2
3
4
1
0
0
1
4
15
13
0
7
2
8
10
2
2
0
2
6
0
12
18
8
1
8
0
1.2
4.0
18.9
0.2
34.4
1.7
10.8
8.7
Yes
Yes
No
Yes
Yes
Yes
Yes
No
NA
Yes
Yes
Yes
No
Yes
No
Yes
No
No
No
Yes
No
Yes
Yes
No
Yes
No
Yes
No
No
No
No
Yes
Yes
Yes
No
Yes
Yes
No
No
Yes
Yes
No
Yes
No
No
No
Yes
No
Yes
Yes
No
2
0
2
0
22
6
3
0
1
7
2
0
1
7
1
3
1
2
1
3
3
5
6
6
0
4
1
1
2
0
5
4
3
5
1
9
1
4
5
0
1
0
3
6
1
3
1
3
0
3
0
23.5
23.1
17.6
24.0
30.3
48.6
41.6
44.4
28.3
29.5
33.3
24.4
30.6
16.4
39.1
44.7
41.0
44.4
41.7
27.3
28.9
27.6
23.7
42.3
41.6
47.8
37.4
12.5
29.4
27.1
31.6
52.4
37.9
29.8
43.2
25.6
30.1
State child care
regulations align with
national standards
for serving fruits /
vegetables
Number of local food
policy councils
Percentage of middle /
high schools that offer
fruits or vegetables at
celebrations2
21.0
State-level food
policy council
States that authorize
farmers to accept WIC
Cash Value Vouchers
2.5
Percentage of
cropland acreage
harvested for fruits
and vegetables
Percentage of farmers
markets that accept
WIC Farmers Market
Nutrition Program
coupons
10
Number of food hubs
Percentage of farmers
markets that accept
SNAP benefits
69.5
Food System Support
State-level farm to
school / preschool
policy
Number of farmers
markets per 100,000
residents
U.S. National
State-level healthier
food retail policy
State
Percentage of census
tracts with at least one
healthier food retailer
within 1/2 mile of tract
boundary
Healthier Food Retail in Communities
42.9
4.3
27.6
9.1
0.3
0.3
0.1
0.1
0.2
0.6
29.3
3.0
23.2
4.5
1.3
0.8
0.3
0.1
0.1
2.2
6.6
17.9
3.6
7.2
3.3
0.4
0.6
0.3
7.7
2.6
17.1
2.9
0.0
0.8
0.9
1.4
1.6
1.8
14.9
1.4
3.6
0.1
9
Indicator Definitions and Data Sources Behavioral Indicators
Percentage of adults in the state consuming fruits
less than one time daily and vegetables less than
one time daily
Median daily intake of fruits and vegetables among
adults in the state (times per day)
BehavioralRiskFactorSurveillanceSystem(BRFSS)
(adultsaged≥18years),2011.Weighteddata.
TheBRFSSincluded6questionsaboutF&Vintake
askedviaatelephonesurvey,precededbythefollowing
statement:“Thesenextquestionsareaboutthefruits
andvegetablesyouateordrankduringthepast30days.
Pleasethinkaboutallformsoffruitsandvegetables
includingcookedorraw,fresh,frozenorcanned.Please
thinkaboutallmeals,snacks,andfoodconsumedat
homeandawayfromhome.”Respondentswereaskedto
reportconsumptionofthefollowingbeveragesandfoods
duringthepastmonthastimesperday,week,ormonth:
1)100%PUREfruitjuices;2)fruit,includingfresh,
frozen,orcannedfruit(notcountingjuice);3)cookedor
cannedbeans(notincludinglonggreenbeans);4)dark
greenvegetables;5)orange-coloredvegetables;6)other
vegetables(notcountingwhatwasreportedalready).
Totaldailyfruitconsumptionwascalculatedbasedon
responsestoquestions1and2,andtotaldailyvegetable
consumptionwasbasedonquestions3-6.
Survey questions and data are available at:
http://www.cdc.gov/brfss/questionnaires/pdf­
ques/2011brfss.pdfandhttp://www.cdc.gov/brfss/
technical_infodata/surveydata/2011.htm.
Percentage of adolescents in the state consuming
fruits less than one time daily and vegetables less
than one time daily
Median daily intake of fruits and vegetables among
adolescents in the state (times per day)
YouthRiskBehaviorSurveillanceSystem(adolescentsin
grades9–12),2011.Weighteddata.
TheYouthRiskBehaviorSurveyquestionnaireincludes6
questionsaboutF&Vintakeaskedviaclassroomsurvey,
precededbythefollowingstatement:“Thenextquestions
askaboutfoodyouateordrankduringthepast7days.
Thinkaboutallthemealsandsnacksyouhadfrom
thetimeyougotupuntilyouwenttobed.Besureto
includefoodyouateathome,atschool,atrestaurants,or
anywhereelse.”Respondentswereaskedaboutintakeof
thefollowing:1)100%fruitjuices;2)fruit;3)greensalad;
4)potatoes;5)carrots;6)othervegetables.Totaldaily
fruitconsumptionwascalculatedbasedonresponsesto
questions1and2,andtotaldailyvegetableconsumption
wasbasedonresponsestoquestions3-6.
Thenationalestimatewasderivedfromthenational
YouthRiskBehaviorSurvey,conductedamonga
nationallyrepresentativesampleofstudentsingrades
9–12.ThestateestimateswerederivedfromYouthRisk
BehaviorSurveysconductedamongrepresentative
samplesofstudentsingrades9–12ineachstate.Some
statesmaynothaveestimatesforF&Vintakeamong
adolescents.Thismaybeduetoeithernotcollecting
surveydata,notachievingahighenoughoverall
responseratetoreceiveweightedresults,oromitting
1ormorequestionnaireitemsduringadministrationof
thesurvey.
Survey questions and data are available at:
http://www.cdc.gov/healthyyouth/yrbs/pdf/
questionnaire/2011_hs_questionnaire.pdfandhttp://
www.cdc.gov/healthyyouth/yrbs/data/index.htm.
10
Policy and Environmental
Indicators
1. ChronicDiseaseStatePolicyTrackingSystem.Date
accessedJune1,2012.Availableat
http://apps.nccd.cdc.gov/CDPHPPolicySearch.
Percentage of census tracts in a state that have at
least one healthier food retailer located within the
tract or within 1/2-mile of tract boundaries*
2. NationalConferenceofStateLegislaturesHealthy
CommunityDesignandAccesstoHealthyFood
LegislationDatabase.DateaccessedAugust11,2009.
Availableathttp://www.ncsl.org/?tabid=13227.
Numerator:Numberofcensustractsthathaveatleast
onehealthierfoodretailerwithinthetractorwithin
one-halfmileofthetractboundary.Twoseparate
national-leveldirectoriesonretailfoodstoreswere
usedtodevelopacomprehensivelistofhealthierfood
retailersintheU.S.:3,16InfoUSA,aproprietarysourceof
individualstorelistings,currentasofJune2011,anda
listofstoresauthorizedtoacceptSupplementalNutrition
AssistanceProgram(SNAP)benefitsasofJanuary2012.
Thefollowingtypesofstoresweredefinedashealthier
foodretailers:largergrocerystores,supermarkets,
supercenters,warehouseclubs,andfruitandvegetable
specialtyfoodstores.GeneraldescriptionsoftheseFood
andBeverageandGeneralMerchandiseStores(North
AmericanIndustryClassificationSystem(NAICS)codes
445and452,respectively)canbefoundathttp://www.
census.gov/eos/www/naics.DateaccessedJune1,2012.
Furtherdetailsonmethodologyforidentifyinghealthier
foodretailersareavailableuponrequest.
Denominator:Totalnumberofcensustractsinthestate.
CensusTractBoundaries,2010U.S.CensusBureau.
Availableathttp://www.census.gov/geo/www/tiger/
tgrshp2010/tgrshp2010.html.DateaccessedJune1,2012.
State-level healthier food retail policy
State-levelhealthierfoodretailpoliciesincludestate
legislationenactedbetweenJanuary1,2001,and
December31,2011thatsupportedanyofthefollowing
goals:a)thebuildingand/orplacementofnewfood
retailoutlets(e.g.newsupermarketsinunderserved
areas,loanfinancingprogramforsmallbusiness
development);b)renovationandequipmentupgradesof
existingfoodretailoutlets(e.g.purchasingrefrigerators
forcornerstorestoallowforthesaleoffreshproduce);
c)increasesinandpromotionoffoodsencouragedby
theDietary Guidelines for Americans, 2010stockedor
availableatfoodretailoutlets(e.g.increaseshelfspace
forF&V;assistanceinmarketingofthesefoodssuchas
throughpointofdecisioninformation).
3. TheFoodTrust.DateaccessedAugust11,2009.
Availableathttp://www.thefoodtrust.org/php/
programs/super.market.campaign.php#FFFIcreation.
4. PatriciaL.Smith,TheReinvestmentFund,personal
communication,May21,2009.
5. Nguyen,L.,Kong,J.,Barnhart,K.,Eyler,A.,&
Brownson,R.(2011).StateLegislativeSearch
Guide.Availableathttp://prcstl.wustl.edu/
Documents/2011%20State%20Legislative%20
Search%20Guide.pdf.(Sourceofstatelegislative
websites;usedtofindstatebills.)
Number of farmers markets per 100,000
state residents
Numerator:Totalfarmersmarketsperstate.United
StatesDepartmentofAgriculture,AgriculturalMarketing
Service.USDANationalFarmersMarketDirectory.
ReleasedAugust2012.DateaccessedAugust23,2012.
Availableathttp://apps.ams.usda.gov/FarmersMarkets.
Denominator:PopulationEstimatesUnitedStates
CensusBureau.July1,2011.DateaccessedJuly23,2012.
Availableathttp://www.census.gov/popest/.
Percentage of farmers markets that accept
SNAP benefits
Numerator:Numberoffarmersmarketsthataccept
SNAPbenefits.UnitedStatesDepartmentofAgriculture,
AgriculturalMarketingService.USDANationalFarmers
MarketDirectory.ReleasedAugust2012.Dateaccessed
August23,2012.Availableathttp://apps.ams.usda.gov/
FarmersMarkets.
(Note:Thisisthenumberoffarmersmarketswith
oneormorevendoracceptingSNAPbenefitsbased
onsurveyresponsesreceivedbyUSDA’sAgricultural
MarketingService(AMS).Thisnumberwilldiffer
fromtheofficialnumberusedbyUSDA’sFoodand
NutritionService(FNS),whichisbasedonthenumber
oforganizationsandvendorswhoareauthorizedto
acceptSNAPbenefits.)
11
Denominator:Totalnumberoffarmersmarkets.United
StatesDepartmentofAgriculture,AgriculturalMarketing
Service.USDANationalFarmersMarketDirectory.
ReleasedAugust2012.DateaccessedAugust23,2012.
Availableathttp://apps.ams.usda.gov/FarmersMarkets.
Percentage of farmers markets that accept WIC
Farmers Market Nutrition Program coupons
Numerator:NumberoffarmersmarketsthatacceptWIC
FMNPcoupons.UnitedStatesDepartmentofAgriculture,
AgriculturalMarketingService.USDANationalFarmers
MarketDirectory.ReleasedAugust2012.Dateaccessed
August23,2012.Availableathttp://apps.ams.usda.gov/
FarmersMarkets.
Denominator:Totalnumberoffarmersmarketsinstates
thatreceiveWICFMNPgrants.UnitedStatesDepartment
ofAgriculture,AgriculturalMarketingService.USDA
NationalFarmersMarketDirectory.ReleasedAugust2012.
DateaccessedAugust23,2012.Availableathttp://apps.
ams.usda.gov/FarmersMarkets.
WICFarmersMarketNutritionProgram.GrantLevels
byStateFY2008-2012.DateaccessedAugust30,
2012.Availableathttp://www.fns.usda.gov/wic/FMNP/
FMNPgrantlevels.htm.
States that authorize farmers to accept WIC Cash
Value Vouchers
UnitedStatesDepartmentofAgriculture,Foodand
NutritionService.SFMNP/FMNPmap.Released
September2012.DateaccessedSeptember27,2012.
Availableathttp://www.fns.usda.gov/wic/SFMNP-FMNP­
Map.pdf.
Percentage of middle and high schools
that offer fruits or non-fried vegetables at
school celebrations
Numerator:Numberofmiddleandhighschoolsthat
responded(viaprincipalsurvey)“(e)alwaysoralmost
always”toQ.33“Whenfoodsorbeveragesareoffered
atschoolcelebrations,howoftenarefruitsornon-fried
vegetablesoffered?”Stateswithestimatesarethose
withweighteddata(atleast70%oftheprincipalsin
thesampledschoolscompletedthesurvey).CDC2010
SchoolHealthProfiles,SchoolPrincipalSurvey.Available
athttp://www.cdc.gov/healthyYouth/profiles/2010/
QuestionnaireP.rtf.
Denominator:Totalnumberofmiddleandallhigh
schoolssurveyedwiththeexceptionofschoolsthat
12
responded“(a)foodsorbeveragesarenotofferedat
schoolcelebrations”toQ.33“Whenfoodsorbeverages
areofferedatschoolcelebrations,howoftenarefruitsor
non-friedvegetablesoffered?”.CDC2010SchoolHealth
Profiles,SchoolPrincipalSurvey.Availableathttp://www.
cdc.gov/healthyYouth/profiles/2010/QuestionnaireP.rtf.
State child care regulations align with national
standards for serving fruits / vegetables
DatawerederivedfromtheNationalResourceCenter
forHealthandSafetyinChildCareandEarlyEducation’s
(NRC)analysisofthedegreetowhichstatechildcare
regulations(forlicensedchildcarecenters,largeor
groupfamilychildcarehomes,andsmallfamilychild
carehomes)reflectednationalnutritionstandards
forservingfruitsandvegetablesasdescribedin3rd
Caring for Our Children: National Health and Safety
Performance Standards for Early Care and Education
Programs.Thestandardsspecifythatchildrenbeserved
avarietyoffruits,especiallywholefruitsandvegetables,
specificallydarkgreen,orange,deepyellowandroot
vegetables.Stateswhoseregulationsweregivenascore
of4(regulationfullyaddressesstandard)acrossall3
childcaretypesweredesignatedas“yes”whereasstates
thatreceivedascoreoflessthan4inanychildcaretype
weredesignatedas“no.”
NationalResourceCenterforHealthandSafetyinChild
CareandEarlyEducation(NRC).2012.Achievinga
StateofHealthyWeight:2011update.Aurora,CO:
NRC.Availableat:http://nrckids.org/ASHW/ASHW%20
2011-Final-8-1.pdf.
State-level farm to school/preschool policy*
State-levelfarmtoschool/preschoolpoliciesinclude
statelegislationenactedbetweenJanuary1,2001,and
December31,2011thatsupportedanycomponentofa
farmtoschoolprogramorinitiativeandtargetedgrades
K-12orchildcareandearlycareandeducation.10
Componentscaninclude:servingF&Vpurchasedfrom
local/regionalfarms;providingagricultureandnutrition
educationopportunities;andsupportinglocaland
regionalfarmers.
1. ChronicDiseaseStatePolicyTrackingSystem.Date
accessedJune1,2012.Availableathttp://apps.nccd.
cdc.gov/CDPHPPolicySearch.
2. NationalConferenceofStateLegislaturesHealthy
CommunityDesignandAccesstoHealthyFood
LegislationDatabase.DateaccessedAugust11,2009.
Availableathttp://www.ncsl.org/?tabid=13227.
3. NationalFarmtoSchoolNetworkandCommunity
FoodSecurityCoalition.StateFarmtoSchool
Legislation,Updated8/17/11.Availableathttp://www.
farmtoschool.org/files/policies_114.pdf.
4. Nguyen,L.,Kong,J.,Barnhart,K.,Eyler,A.,&
Brownson,R.(2011).StateLegislativeSearch
Guide.Availableathttp://prcstl.wustl.edu/
Documents/2011%20State%20Legislative%20
Search%20Guide.pdf.(Source of state legislative
websites; used to find state bills.)
Number of food hubs in each state
Thenumberoffoodhubsbystatewasbasedonthelist
availableontheUSDA,AgriculturalMarketingService
websiteasoftheaccesseddate.Multiplemodelsoffood
hubsareincludedinthelist:farmtoconsumer,farmto
business/institution,andacombinationofthetwo.Food
hubsmaybecooperative,nonprofit,publiclyheld,or
privatelyheldbusiness.
UnitedStatesDepartmentofAgriculture,Agricultural
MarketingService.WorkingListofFoodHubs.Updated
September1,2012.DateaccessedSeptember1,2012.
Availableathttp://www.ams.usda.gov/AMSv1.0/foodhubs.
Percentage of cropland acreage harvested for fruits
and vegetables
Table32Fruits(excludingnuts),page543;Table33
Berries,page560.NationalAgriculturalStatisticsService,
UnitedStatesDepartmentofAgriculture.2007.Censusof
Agriculture.Availableathttp://www.agcensus.usda.gov/
Publications/2007/Full_Report/usv1.pdf.
Denominator:Totalcroplandharvestedinthestate
foundin:Table1,StateSummaryHighlights:2007,page
276.NationalAgriculturalStatisticsService,UnitedStates
DepartmentofAgriculture.2007.CensusofAgriculture.
Availableathttp://www.agcensus.usda.gov/
Publications/2007/Full_Report/usv1.pdf.
State-level food policy council
Stateswithstate-levelcouncilslistedinthisreporthavea
namedpointofcontactontheCommunityFoodSecurity
Coalitionwebsiteasoftheaccesseddate.Recognized
statefoodpolicycouncilsexisttoinfluencestatefood
policyandtocoordinatetheworkoftheareafood
systemstakeholders.Thoselistedincludecouncilsof
varioustypesatdifferentstagesofdevelopment.
CommunityFoodSecurityCoalition.2012.FoodPolicy
CouncilProgram.DateaccessedJuly16,2012.Available
athttp://www.foodsecurity.org/FPC/council.html.
Number of local food policy councils in each state
EveryfiveyearstheCensusofAgriculturecollects
comprehensiveagriculturaldatafromU.S.farmsand
ranchesproducing$1000ormoreofagricultural
products.Cropproductionismeasuredforthecalendar
year,exceptforavocados,citrus,andolivesforwhichthe
productionyearoverlapsthecalendaryear.Harvested
croplandincludeslandfromwhichcropswereharvested,
landusedtogrowshort-rotationwoodycrops,and
landinorchards,citrusgroves,vineyards,nurseries,and
greenhouses.Landfromwhichtwoormorecropswere
harvestedwascountedonlyonce.
Localcouncilsenumeratedinthisreporthaveanamed
pointofcontactontheCommunityFoodSecurity
Coalitionwebsiteasoftheaccesseddate.Recognized
localfoodpolicycouncilsexisttoinfluencelocal,
countyorregionalfoodpolicyandtocoordinatethe
workoftheareafoodsystemstakeholders.Thoselisted
includecouncilsofvarioustypesatdifferentstagesof
development.
Numerator:Totalcroplandharvestedforfruitsand
vegetablesincludes:Table29Vegetables,page508;
*Indicatordefinitionordatasourcevariesfrom
2009indicator,thereforedirectcomparisonsarenot
recommended.
CommunityFoodSecurityCoalition.2012.FoodPolicy
CouncilProgram.DateaccessedJuly16,2012.Available
athttp://www.foodsecurity.org/FPC/council.html.
Links to non-Federal organizations are provided solely as a service to our users. These links do not constitute an
endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred.
CDC is not responsible for the content of the individual organization Web pages found at these links.
13
References 1. U.S.DepartmentofAgricultureandU.S.DepartmentofHealthandHumanServices.Dietary Guidelines for
Americans, 2010.7thEdition,Washington,DC:U.S.GovernmentPrintingOffice,December2010.http://health.gov/
dietaryguidelines/dga2010/DietaryGuidelines2010.pdf.AccessedMay1,2012.
2. LarsonMI,StoryM,NelsonMC.NeighborhoodenvironmentsdisparitiesinaccesstohealthyfoodsintheU.S.
AmericanJournalofPreventiveMedicine2009;36(1):74–81.
3. UnitedStatesDepartmentofAgricultureEconomicResearchService.AccesstoAffordableandNutritiousFood:
MeasuringandUnderstandingFoodDesertsandTheirConsequences.2009.http://www.ers.usda.gov/Publications/
AP/AP036/AP036.pdf.AccessedJuly2,2012.
4. SeymourJD,FenleyMA,YarochAL,KhanLK,SerdulaM.Fruitandvegetableenvironment,policy,andpricing
workshop:introductiontotheconferenceproceedings.PrevMed2004;39(2)S71–4.
5. StoryM,KaphingstKM,Robinson-O’BrienR,GlanzK.Creatinghealthyfoodandeatingenvironments:policyand
environmentalapproaches.AnnuRevPublicHealth2008;29:253–72.
6. CentersforDiseaseControlandPrevention.StrategiestoPreventObesityandOtherChwvronicDiseases:TheCDC
GuidetoStrategiestoIncreasetheConsumptionofFruitsandVegetables.Atlanta:U.S.DepartmentofHealthand
HumanServices;2011.http://www.cdc.gov/obesity/resources/recommendations.html.
7. IOM(InstituteofMedicine).2007.NutritionStandardsforFoodsinSchools:LeadingtheWayTowardHealthier
Youth.Washington,DC:TheNationalAcademiesPress.http://www.iom.edu/CMS/3788/30181/42502.aspx.
8. CentersforDiseaseControlandPrevention.SchoolHealthGuidelinestoPromoteHealthyEatingandPhysical
Activity.MMWR2011;60(5):1-76.
9. NationalResourceCenterforHealthandSafetyinChildCareandEarlyEducation(NRC).2011.AchievingaStateof
HealthyWeight:ANationalAssessmentofObesityPreventionTerminologyinChildCareRegulations2010.Aurora,
CO:NRC.Dataupdatedfor2011byNRCJune,2012;updateavailableuponrequest.
10. JoshiA,AzumaAM,FeenstraG.DoFarm-to-SchoolProgramsMakeaDifference?FindingsandFutureResearch
Need.JournalofHunger&EnvironmentalNutrition2008;3:(2)229–246.
11. JoshiA,AzumaAM.Bearingfruit:FarmtoSchoolProgramevaluationresourcesandrecommendations.Los
Angeles:CenterforFoodandJustice,OccidentalCollege;2008.
12. SobalJ,KhanLK,BisogniC.Aconceptualmodelofthefoodandnutritionsystem.SocSciMed1998;47(7):853–63.
13. Barham,James,DebraTropp,KathleenEnterline,JeffFarbman,JohnFisk,andStaciaKiraly.RegionalFoodHub
ResourceGuide.U.S.DepartmentofAgriculture,AgriculturalMarketingService.Washington,DC.April2012.
14. U.S.DepartmentofAgriculture,AgriculturalMarketingService.FoodHubs:BuildingStrongerInfrastructurefor
SmallandMid-SizeProducers.DateaccessedJuly16,2012.www.ams.usda.gov/foodhubs.
15. CommunityFoodSecurityCoalition.NorthAmericanFoodPolicyCouncil.DateaccessedJuly16.2012.http://www.
foodsecurity.org/FPC.
16. AuchinclossAH,MooreKAB,MooreLV,DiezRouxAV.Improvingcharacterizationofthefoodenvironmentfora
largeregionintheUnitedStatesduringahistorictimeperiod.Health&Place,InPress.
14
CentersforDiseaseControlandPrevention.State Indicator Report on Fruits and Vegetables, 2013.Atlanta,GA:
CentersforDiseaseControlandPrevention,U.S.DepartmentofHealthandHumanServices;2013.
For more information please contact
Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone: 1-800-CDC-INO (232-4636/TTY: 1-888-232-6348
www.cdc.gov/info http://www.cdc.gov/nutrition/professionals/data/
Publication date: May 2013