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Using CX3 Tools to Assessthe Food Environment
Presented by:County of Orange Health Care Agency – Nutrition Services
Nutrition Education and Obesity Prevention (NEOP)
Neighborhoods MatterResearch: Clear connection between neighborhood factors and health outcomes
What’s in Your Neighborhood?• How many places are providing food?
• Is it easy for your residents to choose healthier foods at nearby grocery stores?
• Are families able to make healthy food choices at fast food restaurants?
Objectives
• Use CX3 tools to assess the food environment
• Describe sample findings from target neighborhoods
• List ways to share the CX3 information
CX3 Nutrition Education & Obesity Prevention BranchCalifornia Department of Public Health
Communities of Excellencein Nutrition, Physical Activity and
Obesity Prevention
2008 & 20124 target neighborhoods• Orange – El Modena• San Juan Capistrano – Mission• Santa Ana – Spectrum/Lacy • Santa Ana – Lyons• La Habra (2012 only)
Maps of Census Tracts
Santa Ana - Spectrum
San Juan Capistrano - Mission
Santa Ana - Lyon
2008 & 2012 ResultsLower scores = healthier, Goal is ≤ 5
(Unhealthy ÷ Healthy)
• Orange – El Modena = 8.7…..6.0Few parks, fair access to grocery stores but none meet healthy standards
• San Juan Capistrano – Mission = 7.2…..6.0Many small & large parks, no major grocery store serving Latinos, 24 fast food
• Santa Ana – Spectrum/Lacy = 6.2…..4.25Fair access to grocery stores meeting standards, 27 fast food outlets (all types)
• Santa Ana – Lyons = 24.0…..15.5No parks, no nearby major grocery store accepting CalFresh/WIC
CX3 Tier 1- Data Mapping
GIS Maps (GIS – Geographical Info System)
Analyze Census Tracts• Income levels• Large/small markets• Fast food sites• Schools• Parks• Other
(State website, internet-based, open to all)
CX3 Tier 2 – Data CollectionWhat did we look at?
Neighborhood food stores: – Price, quality of f/v; marketing cues– Safe, walkable?
Around schools & parks:– Marketing cues on outdoor ads– Fast food: Cues, nutrition
info posted, healthy options?– Convenience markets
and small stores
CX3 Tools
1. Access to healthy food markets– Was it easy & safe to get to the market? (Walkability survey)– What was available? (Grocery Store survey)– Areas for improvement
2. Access to fast food and ads– What was available at restaurants? (Fast food survey)– What advertising was seen? (Outdoor ads survey)
– Areas for improvement
Walkability SurveyIs it safe to cross the street?
No crosswalk
Entrance to the store
What did we see?
Where the sidewalk ends…
Grocery Store Survey – Sample questions
13) Fresh produce displays or bins outside storeCircle “1” Yes
Exterior – What is outside the store?
Exterior – What is in the windows?
21) If store sells alcohol, more than 1/3 total window area covered by ANY type of ads: Circle “1” Yes
Interior – What is by the check out stand?
24) Number of cash registers: Record “2”
Produce – Are healthy messages posted?
27) Health promotion items around the fruit and vegetable display: Circle “1” Yes
Is there a good variety of quality of fruits & vegetables?
Limited quantity
4 3 2 1 1
Quality – Example of color change, yellowing
22) WIC signage displayed: If either old or new logo on WIC vendor sign, circle “1” Yes (could be on interior)
Do stores accept WIC or CalFresh? Food Costs?
Rate the Store:Tally the results
If >75 pts,quality store with
healthy items
If <75 pts, room for
improvement
Santa Ana
1 site was:• Grocery Store• WIC Store• Water Store• Coffee & Donut Shop
Santa Ana – Same site 2014
Grocery Trucks
Produce vendors
Grocery Trucks
Ads & other items on trucks
Where’s the fruit?
There’s the fruit! (and veggies)
Variety of items
Preliminary ResultsSanta Ana-Spectrum
2008 2012Total # of stores 16 21
Chain/large 3 2Small 4 8Other 3 5
Convenience 6 6
# with >75 pts 6 8 & 1 close
Food Assistance WIC = 5CalFresh = 8
WIC = 11CalFresh = 13
Network Retail F & V partner 7 2 (5 in 2013)
Preliminary ResultsSanta Ana - Lyon
2008 2012Total # of stores 12 13
Chain/large 1 1Small 4 3Other 1 2
Convenience 6 7
# with >75 pts 1 2 & 2 close
Food Assistance WIC = 2CalFresh = 4
WIC = 5CalFresh = 9
Network Retail F & V partner 0 1 (2 in 2013)
Preliminary ResultsSan Juan Cap - Mission
2008 2012Total # of stores 15 16
Chain/large 3 3Small 3 5Other 4 3
Convenience 5 5
# with >75 pts 3 4 & 2 close
Food Assistance WIC = 2CalFresh = 4
WIC = 4CalFresh = 11
Network Retail F & V partner 3 0 (6 in 2013)
CX3 Tools
1. Access to healthy food markets– Was it easy & safe to get to the market? (Walkability survey)– What was available? (Grocery Store survey)– Areas for improvement
2. Access to fast food and ads– What was available at restaurants? (Fast food survey)– What advertising was seen? (Outdoor ads survey)
– Areas for improvement
Fast Food & Outdoor Ad Surveys
Exterior – What ads are seen?
12) Amount of advertising on doors & windows (shown):Unhealthy: 0 Small, 0 Med., 5 LargeHealthy: 0 Small, 0 Med., 0 Large
Marketing – What is targeted to kids?
22) “Yes” to signs/ads kid-oriented24) “Yes” to Kids Meals24a) Yes to toy give-aways, e.g., Bratz and GI Joe
Is nutrition info posted?
26) On the menu board: Minimum of total calories next to each menu item- Circle “1” Yes
Rate the Site:Tally the results
If >37 pts,quality site with healthy items
If <37 pts, room for
improvement
Santa Ana
From grocery store to taco shop
What ads are in the area?
Type/Size: “4” Transit AdProduct/Ad: “4” Unhealthy food items
What ads are in the area?
Type/Size: 2 small billboardsTop - Product/Ad is: Other – Obesity prevention messageBottom - Product/Ad is: Fast food restaurant
Preliminary ResultsSanta Ana - Spectrum
2008 2012# of Fast Food 27 20
Burger/FF 4 chain, 14 not 6 chain, 7 not
Pizza 3 chain, 0 not 2 chain, 1 not
Sandwich/Deli 2 2
Other (not chain) 4 2
# with >37 pts 1 1Exterior healthy ads
score ≤10 pts 15 5
Healthy food option score >5 pts
13 9
Preliminary ResultsSanta Ana - Lyon
2008 2012# of Fast Food 13 20
Burger/FF 5 chain, 7 not 9 chain, 6 not
Pizza 0 chain, 0 not 1 chain, 0 not
Sandwich/Deli 1 1
Other (not chain) 0 3
# with >37 pts 0 2 & 2 close
Exterior healthy ads score ≤10 pts 2 2
Healthy food option score >5 pts
5 16
Preliminary ResultsSan Juan Cap - Mission
2008 2012# of Fast Food 24 18
Burger/FF 10 chain, 8 not 9 chain, 0 not
Pizza 2 chain, 1 not 3 chain, 1 not
Sandwich/Deli 2 1
Other (not chain) 1 4
# with >37 pts 0 1Exterior healthy ads
score ≤10 pts12 3
Healthy food option score >5 pts
13 9
Share CX3 Findings
• Community members
• Grocery vendors
• Fast food vendors
• City and County staff
Any Questions onGrocery or Fast Food
Surveys?
Review Objectives
• Use CX3 tools to assess the food environment
• Describe sample findings from target neighborhoods
• List ways to share the CX3 information
CX3 Communities of Excellencein Nutrition, Physical Activity
& Obesity Prevention
CDPHwww.cdph.ca.gov/programs/cpns/Pages/CX3_Main_Navgation.aspx
Dawn Robinson(714) 834-7984
Elsa Amezcua(714) 834-7842
For CalFresh information, call 1-877-847-3663. Funded by USDA SNAP-Ed, an equal opportunity provider and employer.
Visit www.CaChampionsForChange.net for healthy tips.
County of Orange Health Care Agency
