1Facts for Action: Chronic Diseases and Related Risk Factors in Colorado Fruit and Vegetable Consumption in Colorado

0

10

20

30

40

50

60

Children

Per

cent

High school* Adults

Ate fruit less than once a day Ate vegetables less than once a day

Fruit and Vegetable Consumption

in Colorado

November 2014

• 16%ofchildren,55%ofhighschoolstudentsand36%ofadultColoradansdidnoteatfruitatleastonceaday.

• Fruitjuicesubstantiallycontributestochildren’stotalfruitconsumption.Thepercentofchildrenwhodidnoteatfruitatleastonceadayjumpedfrom16%to24%whenfruitjuicewasexcludedfromconsideration.

• 29%ofchildren,55%ofhighschoolstudentsand19%ofadultColoradansdidnoteatvegetablesatleastonceaday.

Obesity and healthy eating

Percent of children (ages 1-14), high school students (grades 9-12), and adults (ages 18+) who did not eat fruits and vegetables at least once a day, Colorado, 2013.

Many Coloradans do not eat fruits and vegetables every day.

*Highschooldatadonotincludefruitjuice.

56% were overweight or obese.In 2013, 21% of adult Coloradans were obese..

F A acts for ction: Chronic Diseases and Related Risk Factors in Colorado

Colorado data sources: BehavioralRiskFactorSurveillanceSystem,ColoradoChildHealthSurvey,HealthyKidsColoradoSurvey1.CDC.2012.AdultOverweightandObesity:CausesandConsequences.[ONLINE]Availableat:http://www.cdc.gov/obesity/adult/causes/index.html.[Accessed24November14].2.CDC.2012.AdultOverweightandObesity:BasicsAboutChildhoodObesity.[ONLINE]Availableat:http://www.cdc.gov/obesity/childhood/basics.html.[Accessed24November14].3.FinkelsteinEA,TrogdonJG,CohenJW,DietzW.AnnualMedicalSpendingAttributabletoObesity:Payer-andService-SpecificEstimates.HealthAffairs2009;5:w822-w831.4.CDC.2013StateIndicatorReportonFruitsandVegetables.[ONLINE]Availableat:http://www.cdc.gov/nutrition/downloads/State-Indicator-Report-Fruits-Vegetables-2013.pdf.[Accessed24November14].5.USDA.MyPlateFoodGroups[ONLINE]Availableat:http://www.choosemyplate.gov/food-groups/.[Accessed24November14].

• ThedoublingoftheadultobesityprevalenceintheUnitedStates in the past 18 years has multiple causes including genet-ic, behavioral (e.g., diet, physical activity), and environmental factors (e.g., food retail and transportation infrastructure).

• Obesity has been shown to increase the risk of numerous ad-verse health conditions including coronary heart disease, type 2 diabetes, high blood pressure, stroke, and various cancers.1

• Obese children are more likely to become obese adults; If chil-dren are overweight, obesity in adulthood is likely to be more severe.2

• TheestimatedannualmedicalcostofobesityintheU.S.was$147billionin2008U.S.dollars;themedicalcostsforpeoplewho are obese were $1,429 higher than those of normal weight.3

• While no single-factor strategy can solve this complex problem alone, promotion of healthy eating patterns, especially the regular consumption of fresh fruits and vegetables, can help to reduce obesity and alleviate associated health burdens.4

>80%

Overall, 86% of adult Coloradans did not meet recommendations for fruit and vegetable consumption in 2013. Depending upon the age of adults, 4-5 cups of fruits and vegetables is the recommended daily amount for men and 3.5-4.5 cups for women.5

More than 80% of adult Coloradans (ages 18+) who have been diagnosed with a chronic condition did NOTmeetage/sex-specificrecommendationsforfruitandvegetableconsumptionin2013.

Percentage not meeting recommendations relative to other adverse health outcomes:90% of adults with diabetes90% of adults who had a heart attack, angina,

coronary heart disease or stroke89% of adults with high blood pressure

87% of adults with high blood cholesterol86% of adults with a depressive disorder82% of adults who have or had cancer (excluding

skin cancer)

2 Facts for Action: Chronic Diseases and Related Risk Factors in Colorado Fruit and Vegetable Consumption in Colorado

86% of adult Coloradans did not meet recommendations for fruit and vegetable consumption.

• Womenweresignificantlymorelikelytomeetrecommendationscomparedtomen.

• WhitesweresignificantlymorelikelytomeetrecommendationscomparedtoHispanicsandBlacks.

• Adultswithhouseholdincomesabove$50,000weresignificantlymorelikelytomeetrecommendationsthanthoseearning<$35,000.

• Adultswithhighereducationlevelsweresignificantlymorelikelytomeetrecommendations.

• Adultswithahealthyweightweresignificantlymorelikelytomeetrecommendationsthanoverweightandobeseadults.

• BlackandHispanicchildrenwere 1.8 and 2.0 times more likely not to eat vegetables every day compared with White children, respectively.

• 35%ofBlackchildrenand43%ofHispanicchildrendidnoteatvegetables at least once a day.

Data sources:BehavioralRiskFactorSurveillanceSystem,ColoradoChildHealthSurvey.

Terminologyforracial/ethnicgroupsmatchesthatusedduringdatacollection.

Disparities exist in the frequency of fruit and vegetable consumption.

Percent of adults (ages 18+) notmeetingage-andsex-specificrecommendationsforfruitandvegetable consumption, Colorado, 2013.

Percent of children (ages 1-14) who who did not eat fruits and vegetables at least once a day by race/ethnicity, Colorado, 2011-2013.

Byrace/ethnicity Byhouseholdincome

White

Black

Hispanic

Asian

50 60 70 80 90 100Percent

Rac

e/et

hnic

ity

<$15,000

$15-24,999

$25-34,999

$35- 49,999

$50,000+

50 60 70 80 90 100Percent

Inco

me

<High school

High school graduate

Some college

College graduate

50 60 70 80 90 100Percent

Edu

catio

n

Underweight

Healthy weight

Overweight

Obese

50 60 70 80 90 100Percent

Wei

ght s

tatu

s

Byeducation Byweightstatus

Fruit and vegetable consumption by household income and body mass index.• Children from households earning less than $25,000 per year were 1.8 times more likely not to eat vegetables

at least once a day compared with children from households earning $50,000 or more per year.• Consumption of fruits and vegetables did not differ based on children’s body mass index.

0

10

20

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40

50

White BlackRace/ethnicity

Hispanic

Per

cent

Ate fruit less than once a day Ate vegetables less than once a day

3Facts for Action: Chronic Diseases and Related Risk Factors in Colorado Fruit and Vegetable Consumption in Colorado

Access to healthy food in Colorado.Increasing access to quality and affordable fruits and vegetables is an important step to increase fruit and vegetable consumption.1

Policies and programs that promote or enhance access to fruits and vegetables in communities, schools and child care facilities represent an important step to increase fruit and vegetable consumption.1

Increasing access

Percent of Colorado’s census tracts without healthy food retail. DefinitionsByrace/ethnicity Byhouseholdincome

�• CensusTracts are small, relatively permanent statistical

subdivisions that provide a stable set of geographic unitsforthepresentationofCensusdata.Theygenerally have a population size between 1,200 and 8,000 people.

• Tractswithnohealthyfoodretaillackasupermarket,supercenter, large(r) grocery store, warehouse club, or fruit/vegetable specialty store in the tract or within 1/2 mile of the tract boundary.

• Nationally,30%ofCensustractsdonothavehealthyfoodretail(statevaluesvaryfrom17%-56%oftracts).2

• WithinColorado,29%oftracts(367of1,242)donothaveaccesstohealthyfoodretail.2

• Thepercentageofruraltracts(>50%ofresidentsclassifiedasruralbythe2010U.S.Census)thatdonothaveaccesstohealthyfoodretailis2.5 times higherthaninurbantracts(61%vs.24%,respectively).

• Affordability:Roughly1in8Coloradanslivebelowthepovertylineandmaybeunabletoregularlyaffordfruitsandvegetables.3• Public assistance programs: ProgramswithinSNAPthatsupporthealthyfoodpurchasing,suchastheHealthy

IncentivesPilot,canpromotefruitandvegetableconsumption.Overall,7.3%ofColoradohouseholdsparticipateinSNAP;thepercentagevariedfrom0%to21.2%amongthestate’s64counties.3,4

• Distance to healthy food retail:Nearly1in3Coloradansdoesnotlivenearahealthyfoodretailer,andthegreatertraveltimeand/ordistancetoreachtheseretailerslimitstheirabilitytopurchaseandconsumefruitsandvegetables.Onaverage,30%ofColoradansmusttravelrelativelylongdistancestoreachthenearestgrocerystore(>1mileinurbanareas,>10milesinruralareas).5

• Vehicle access:InsomeColoradocounties,over12%ofhouseholdsdonothaveaccesstoavehiclethatcouldbeusedforshopping,highlightingtheimportanceofproximitytoretailandpublictransportation.3

• Farmers markets:Farmer’smarketscanimproveaccesstofruitandvegetableretailandsupportlocalagriculturalproduction.Thereare3.2farmersmarketsper100,000residentsinColoradocomparedwith2.5per100,000nationally.1Farmer’smarketsthatacceptSNAPbenefitscanfurtherpromotefruitandvegetableconsumption.Currently,21.7%offarmersmarketsinColoradoacceptSNAPbenefits,comparedwith21.0%nationally.1

• School-based programs:InColorado,morethan560,000studentsbenefitfromfarm-to-schoolactivities.Associatedprograms,includingschoolgardens,encouragestudentstotrynewfruitsandvegetables,thuspromotinghealthyeatinghabitsthroughincreasedconsumptionoffruitsandvegetables.Agreaterpercentageofschools(6.1%)inColoradoalwaysofferfruitsornon-friedvegetablesinvendingmachines,schoolstores,canteensorsnackbarsandduringcelebrationswherefoodandbeveragesareofferedcomparedtothenationalaverage(2.1%).6

29%

71%

61%39%

24%

76%

All tracts

Percent of Colorado’s Census tracts without healthy food retail.

Urban tracts Rural tracts

Byeducation Byweightstatus

Datasources:1. CDC.2013StateIndicatorReportonFruitsandVegetables.[ONLINE]Availableat:http://www.cdc.gov/nutrition/downloads/

State-Indicator-Report-Fruits-Vegetables-2013.pdf.[Accessed24November14].2. GrimmKA,MooreLV,ScanlonKS.Accesstohealthierfoodretailers-UnitedStates,2011.MMWR2013;62(03):20-26.3. USCensus.2012AmericanCommunitySurvey5-yearestimates.[ONLINE]Availableat:http://factfinder2.census.gov.[Accessed

24November14].4. PersonalcommunicationwithJenniferFern.ColoradoHealthInstitute.September18,20145. USDA.FoodEnvironmentAtlas.[ONLINE]Availableat:http://www.ers.usda.gov/data-products/food-environment-atlas.aspx.

[Accessed24November14].6. CDC,DivisionofAdolescentandSchoolHealth.2012ChronicDiseasePreventionProfiles–ColoradoSecondarySchools[ONLINE]

Availableat:http://www.cdc.gov/healthyyouth/profiles/pdf/facts/co_chronic_profiles.pdf.[Accessed24November14].

4 Facts for Action: Chronic Diseases and Related Risk Factors in Colorado Fruit and Vegetable Consumption in Colorado

*Users(blue):numberofhouseholdsusingfreshfruitsandvegetablesinpastmonthper100householdsinthatCensustract.*Consumption(red):poundsoffreshfruitsandvegetablesusedinpastmonthperhouseholdusingfreshfruitsandvegetablesinthepastmonthinthatCensustract.

Data sources: NielsenHomescandata(2013)linkedtopovertydatafromU.S.Census2012AmericanCommunitySurvey5-yearestimates(availablefromhttp://factfinder2.census.gov/).

AccessdatafromUSDAFoodEnvironmentalAtlas(availablefromhttp://www.ers.usda.gov/data-products/food-environment-atlas.aspx).

Census tracts that have low fresh fruit and vegetable consumption and/or do not have healthy food retail represent potential areas to enhance access to quality and affordable fruits and vegetables.

Householdsusingfreshfruitsandvegetablesinpastmonth(per100households).

Consumption of fresh fruits and vegetables by Census tract poverty, access to healthy food retail, and access to vehicles.

• Asthepercentageoftractresidentslivingbelowpovertyincreased,thereweredecreasesinboththenumberofusersandconsumptionoffreshfruitsandvegetables.

• Boththenumberofusersandconsumptionoffreshfruitsandvegetablesdecreasedasaccesstovehiclesdecreased.

• Intractswithagreaternumberofindividualslivingamileormorefromfoodretailers,therewasanincreaseinboththenumberofusersandconsumptionoffreshfruitsandvegetables.

27

28

29

30

31

32

33

34

64

66

68

70

72

74

76

78

80

<10% 10% -19.9% 20%- 29.9% 30%+

Consum

ption (lb per month)

Use

rs (

# pe

r 10

0 ho

useh

olds

)

Percent of residents per tract living below the poverty line

Users*Consumption*

27

28

29

30

31

32

33

34

64

66

68

70

72

74

76

78

80

0% .1% - 4.9% 5%-9.9% 10%+

Consum

ption (lb per month)

Use

rs (

# pe

r 10

0 ho

useh

olds

)

Percent of workers (aged 16+) per tract in households with no vehicle access

Users*Consumption*

27

28

29

30

31

32

33

34

64

66

68

70

72

74

76

78

80

<10% 10 -39.9% 40-79.9% 80%+

Consum

ption (lb per month)

Use

rs (

# pe

r 10

0 ho

useh

olds

)

Percent of individuals per tract living at least 1 mile from the nearest supermarket, supercenter, or large grocery store

Users*Consumption*