Assessing the Nutritional Health of Populations

1. Assessing the Nutritional Health of Populations

2. Some Definitions Joint Nutrition Monitoring Evaluation Committee, 1986 Expert Panel on Nutrition Monitoring, 1989

3. Dietary Status The condition of a population�s or an individual�s intake of foods and food components, especially nutrients.

4. Nutrition Assessment Measurement of indicators of dietary status and nutrition related health status to identify the possible occurrence, nature, and extent of impaired nutritional status.

5. Nutrition Monitoring Assessment of dietary or nutrition status at intermittent times with the aim of detecting changes in the dietary or nutritional status of a population

6. Nutrition Surveillance Continuous assessment of nutritional status for the purpose of detecting changes in trend or distribution in order to initiate corrective measures

7. Nutrition Monitoring in the United States

8. Brief Chronology

10. Goals of NNMS Provide foundations for improvement of nutritional status and quality and healthfulness of food supply Collect, analyze, and disseminate timely data on nutrition and dietary status, quality of food supply, food consumption patterns, consumer knowledge and attitudes

11. NNMS Goals, cont... ID high risk groups and geographic areas and trends Establish national baseline data and develop standards for monitoring Provide data for evaluating implications of changes in agricultural policy

12. NNMS - Some Agencies USDA Food and Nutrition Service Food Safety and Inspection Service Agricultural Research Service Economic Research Service Extension Service Cooperative State Research Service

13. Department of Health and Human Services National Center for Health Statistics CDC-National Center for Chronic Disease Prevention and Health Promotion Food and Drug Administration Heath Resources and Services Administration Indian Health Services National Institutes of Health Substance Abuse and Mental Health Services Administration

14. Others: Department of Defense Department of Education Agency for International Development Department of Veterans Affairs Census Bureau Bureau of Labor Statistics National Marine Fisheries Service

15. Nutrition and Related Health Measurements National Health and Nutrition Examination Surveys (I-V, and continuous) National Health Interview Survey National Hospital Discharge Survey Pediatric Nutrition Surveillance System

16. Food and Nutrient Composition Nationwide Food Consumption Survey Continuing Survey of Food Intakes by Individuals � now integrated into What We Eat in America

17. Knowledge, Attitudes, and Behavior Behavioral Risk Factor Surveillance System Youth Risk Behavior Survey Diet and Health Knowledge Survey

18. Food Composition and Nutrient Data Bases National Nutrient Data Bank (NNDB)

19. Food Supply Determinations US Food and Nutrition Supply Series

20. Major Surveys with Nutrition Content

21. Behavioral Risk Factor Surveillance System (BRFSS) CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) Annually since 1984 (not all states at first) Telephone interview Data collection is conducted separately by each State. Sample design uses State-level, random-digit-dialed probability samples of the adult (aged 18 years and over) population. State-specific sample sizes ranged from 1,499 to 6,005

22. BRFSS - Questions Behavioral risk factors (for example, alcohol and tobacco use), preventive health measures, HIV/AIDS, health status, limitation of activity, and health care access and utilization Core of questions asked in all States Standardized optional questions on selected topics administered at the State�s discretion Rotating core of questions asked every other year in all States State-added questions developed to address State-specific needs

23. BRFSS - Data National State Smaller units when local agencies pay for additional surveys Data system homepage: http://www.cdc.gov/brfss/

24. BRFSS - Nutrition Self reported height and weight Trying to loose weight? 6 fruit and vegetable intake questions Activity Food security

29. This slide set contains information about and data from the Youth Risk Behavior Surveillance System or YRBSS. It includes national, state, and local data from the 2005 surveys.This slide set contains information about and data from the Youth Risk Behavior Surveillance System or YRBSS. It includes national, state, and local data from the 2005 surveys.

30. Purposes of the YRBSS Focus the nation on behaviors among youth causing the most important health problems Assess how risk behaviors change over time Provide comparable data The purposes of the YRBSS are threefold: To focus the nation on behaviors among youth causing the most important health problems; To assess how risk behaviors change over time; and To provide comparable data.The purposes of the YRBSS are threefold: To focus the nation on behaviors among youth causing the most important health problems; To assess how risk behaviors change over time; and To provide comparable data.

31. Behaviors That Contribute to the Leading Causes of Morbidity and Mortality Behaviors that contribute to unintentional injuries and violence Tobacco use Alcohol and other drug use Sexual behaviors Unhealthy dietary behaviors Inadequate physical activity The YRBSS measures behaviors that contribute to the leading causes of morbidity and mortality among youth and adults. These are behaviors that contribute to� Unintentional injuries and violence; Tobacco use; Alcohol and other drug use; Sexual behaviors; Unhealthy dietary behaviors; and Inadequate physical activity. The YRBSS measures behaviors that contribute to the leading causes of morbidity and mortality among youth and adults. These are behaviors that contribute to� Unintentional injuries and violence; Tobacco use; Alcohol and other drug use; Sexual behaviors; Unhealthy dietary behaviors; and Inadequate physical activity.

32. Characteristics of the National, State, and Local School-Based YRBS 9th � 12th grade students Probability samples of schools and students Anonymous Self-administered, computer-scannable questionnaire or answer sheet Completed in one class period (45 minutes) Conducted biennially usually during the spring The national, state, and local Youth Risk Behavior Surveys are administered to 9th through 12th grade students drawn from probability samples of schools and students. The questionnaire is anonymous and self-administered. The questionnaire booklet or answer sheet is computer-scannable. The surveys are completed in one 45-minute class period, and are conducted biennially usually during the spring.The national, state, and local Youth Risk Behavior Surveys are administered to 9th through 12th grade students drawn from probability samples of schools and students. The questionnaire is anonymous and self-administered. The questionnaire booklet or answer sheet is computer-scannable. The surveys are completed in one 45-minute class period, and are conducted biennially usually during the spring.

33. 2005 National YRBS National probability sample of public and private schools Total sample size = 13,917 School-level response rate = 78% Student-level response rate = 86% Overall response rate = 67% The 2005 National YRBS survey was administered to a national probability sample of public and private schools. The sample size is 13,917 students. The school-level response rate is 78% and the student-level response rate is 86%. The school response rate multiplied by the students response rate produces an overall response rate of 67%.The 2005 National YRBS survey was administered to a national probability sample of public and private schools. The sample size is 13,917 students. The school-level response rate is 78% and the student-level response rate is 86%. The school response rate multiplied by the students response rate produces an overall response rate of 67%.

34. Policy and Program Applications Describe risk behaviors Create awareness Set program goals Develop programs and policies Support health-related legislation Seek funding YRBS data are used at the national, state, and local levels in a variety of policy and program applications. YRBS data can be used to do the following: Describe risk behaviors; Create awareness; Set program goals; Develop programs and policies; Support health-related legislation; and Seek funding.YRBS data are used at the national, state, and local levels in a variety of policy and program applications. YRBS data can be used to do the following: Describe risk behaviors; Create awareness; Set program goals; Develop programs and policies; Support health-related legislation; and Seek funding.

35. Describe Risk Behaviors Overall and among subgroups of youth How risk behaviors are interrelated The YRBSS describes risk behaviors that affect youth, including select subgroups of youth that may be of interest. YRBS data also are used to demonstrate how risk behaviors are interrelated.The YRBSS describes risk behaviors that affect youth, including select subgroups of youth that may be of interest. YRBS data also are used to demonstrate how risk behaviors are interrelated.

36. Create Awareness Among: Legislators, boards of education, and school administrators Parents Community members School staff Students Media YRBS data are useful for creating awareness about health challenges and successes for youth among such varied audiences as Legislators, boards of education, and school administrators; Parents; Community members; School staff; Students; and Media.YRBS data are useful for creating awareness about health challenges and successes for youth among such varied audiences as Legislators, boards of education, and school administrators; Parents; Community members; School staff; Students; and Media.

37. Set Program Goals Strategic plans for school health programs Healthy People 2010 objectives CDC�s Performance Plan YRBS data also are used often to set program goals. Examples of how YRBS data have been used are to establish and monitor strategic plans for school health programs; to monitor progress toward national Healthy People 2010 objectives; and to evaluate components of CDC�s Performance Plan. YRBS data also are used often to set program goals. Examples of how YRBS data have been used are to establish and monitor strategic plans for school health programs; to monitor progress toward national Healthy People 2010 objectives; and to evaluate components of CDC�s Performance Plan.

38. Develop Programs and Policies School health programs and policies Programs and policies for youth in high risk situations Instructional guides and materials Professional development programs for teachers YRBS data have proven useful to help develop programs and policies, including School health programs and policies; Programs and policies for youth in high risk situations; Instructional guides and materials; and Professional development programs for teachers.YRBS data have proven useful to help develop programs and policies, including School health programs and policies; Programs and policies for youth in high risk situations; Instructional guides and materials; and Professional development programs for teachers.

39. Support Health-Related Legislation School health program requirements School health council requirements Drug-free or weapon-free school zone laws Minors� access laws Drinking and driving laws Bans on billboards and other advertising Competitive food policies Data from the YRBS also are cited often to support health-related legislation. Examples include School health program requirements; School health council requirements; Drug-free or weapon-free school zone laws; Minors� access laws; Drinking and driving laws; Bans on billboards and other advertising; and Competitive food policies.Data from the YRBS also are cited often to support health-related legislation. Examples include School health program requirements; School health council requirements; Drug-free or weapon-free school zone laws; Minors� access laws; Drinking and driving laws; Bans on billboards and other advertising; and Competitive food policies.

40. Seek Funding Support funding requests to federal, state, and private agencies and foundations YRBS data are a valuable resource to support funding requests to federal, state, and private agencies and foundations.YRBS data are a valuable resource to support funding requests to federal, state, and private agencies and foundations.

41. 2005 YRBS ResultsNutrition The following slides highlight results from the 2005 YRBS.The following slides highlight results from the 2005 YRBS.

42. YRBS - Nutrition Self reported weight and height Dieting behaviors Eating disorder behaviors Fruit and vegetable intake Fat intake

43. Percentage of High School Students Who Ate Fruits and Vegetables = 5 Times/Day,* by Sex** and Race/Ethnicity,*** 2005 Nationwide in 2005, 20.1% of high school students had eaten fruits and vegetables (100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables) = 5 times/day during the seven days preceding the survey. Overall, the prevalence of having eaten fruits and vegetables = 5 times/day was higher among male than female students and higher among black and Hispanic than white students.Nationwide in 2005, 20.1% of high school students had eaten fruits and vegetables (100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables) = 5 times/day during the seven days preceding the survey. Overall, the prevalence of having eaten fruits and vegetables = 5 times/day was higher among male than female students and higher among black and Hispanic than white students.

44. Percentage of High School Students Who Ate Fruits and Vegetables = 5 Times/Day,* 1999 � 2005 This slide shows the percentage of high school students over time who had eaten fruits and vegetables (100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables) = 5 times/day during the seven days preceding the survey. During 1999 to 2005, a significant linear decrease was identified. This slide shows the percentage of high school students over time who had eaten fruits and vegetables (100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables) = 5 times/day during the seven days preceding the survey. During 1999 to 2005, a significant linear decrease was identified.

45. Percentage of High School Students Who Drank > 3 Glasses/Day of Milk,* by Sex**and Race/Ethnicity,*** 2005 Nationwide in 2005, 16.2% of high school students had drunk three or more glasses/day of milk during the seven days preceding the survey. Overall, the prevalence of having drunk three or more glasses/day of milk was higher among male than female students, higher among white than black and Hispanic students, and higher among Hispanic than black students.Nationwide in 2005, 16.2% of high school students had drunk three or more glasses/day of milk during the seven days preceding the survey. Overall, the prevalence of having drunk three or more glasses/day of milk was higher among male than female students, higher among white than black and Hispanic students, and higher among Hispanic than black students.

46. Percentage of High School Students Who Drank > 3 Glasses/Day of Milk,* 1999 � 2005 This slide shows the percentage of high school students over time who had drunk three or more glasses/day of milk during the seven days preceding the survey. During 1999 to 2005, no significant change was identified. This slide shows the percentage of high school students over time who had drunk three or more glasses/day of milk during the seven days preceding the survey. During 1999 to 2005, no significant change was identified.

47. Rising Rates of Childhood Overweight in Lewis County

48. Continuing Survey of Food Intake by Individuals (CSFII) USDA 1994-1996 in-person interviews 24-hour dietary recall: 2 nonconsecutive days of food intake data collected 3-10 days apart 2 weeks later, one adult from each household asked questions about knowledge and attitudes toward dietary guidance, health, and use of food labels.

49. CFSII - Sample Nationally representative stratified multistage area probability sample of U.S. noninstitutionalized civilian population, all ages. Oversampling of low-income households For 1994�96, sample size for 1-day dietary data was 16,103; for 2-day dietary data, it was 15,303.

50. CFSII - Data kinds and amounts of foods consumed sources of foods time, name of each eating occasion food expenditures, shopping practices pregnancy, lactation, nursing status, height and weight income, poverty status, household size, participation in Food Stamp and WIC programs

51. CFSII - Data Availability National; four U.S. Census Bureau regions; Standard Metropolitan Statistical Areas http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm

52. CFSII - Nutrition food intakes in grams of 71 USDA-defined food groups and subgroups nutrient intakes of 28 nutrients and food components nutrient intakes expressed as percentages of the 1989 Recommended Dietary Allowance Pyramid servings from 30 food groups

53. Trends in Beverage Consumption � Youth aged 11-18 years

59. National Health and Nutrition Examination Survey (NHANES) CDC, National Center for Health Statistics (NCHS) In-person interview in household and mobile examination center stratified multistage probability sample, nationally representative of the U.S. civilian noninstitutionalized population Approximately 5,000 people are examined at 15 locations each year All ages beginning in 1999

60. NHANES - Continuous Periodic (1960�94); annual beginning in 1999 after 1999 annual sample size too small to provide reliable estimates for many measures and for most subgroups. Most analyses require 3 years of data for reliable estimates.

63. NHANES - Content Chronic disease prevalence and conditions (including undiagnosed conditions immunization status infectious disease prevalence health insurance measures of environmental exposures hearing vision mental health

64. NHANES - Content anemia diabetes cardiovascular disease osteoporosis obesity oral health physical fitness

65. NHANES - New in 1999 cardiorespiratory fitness physical functioning lower extremity disease full body DXA for body fat as well as bone density tuberculosis

66. NHANES - Data National; four U.S. Census Bureau regions Demographics: Gender, age, education, race/ethnicity, place of birth, income, occupation, and industry http://www.cdc.gov/nchs/nhanes.htm

67. NHANES - Nutrition Food Security Dietary supplements Weight history Dietary Recall - one 24 hour

68. NHANES III Anthropometric Procedures Video Body weight Standing height Sitting height Upper leg length Recumbent length Upper arm length Knee height Arm circumference Waist circumference Buttocks circumference Thigh circumference Head circumference Skinfolds (including thighs, triceps, subscapular, and suprailiac) Wrist breadth Elbow breadth

70. WHAT WE EAT IN AMERICA: NHANES-CFSII Integration Staged integration of the two surveys 2001 a year of testing, 2002 full integration Goals: continuous data collection, linkage of diet and health data, 2 days of dietary data collection (second day by phone 3 to 10 days after initial exam) DHKS not part of integrated efforts at this time, but under consideration

71. What We Eat in America Food intake data can be linked to health status data from other NHANES components HHS is responsible for the sample design and data and USDA is responsible for the survey�s dietary data collection methodology, maintenance of the database used to code and process the data, and data review and processing

73. History of the Food Security Measurement Project

74. Sample of Other Population Surveillance Systems Breastfeeding: National Immunization Survey Growth in Low Income Children: Pediatric Nutrition Surveillance System