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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