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. 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

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

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

6. 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.

7. Nutrition Monitoring in the United States

8. 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. National Nutrition Monitoring System • Jointly administered by USDA and DHHS • 22 federal agencies involved • Over 70 surveys and surveillance activities • Ten year comprehensive plan for Nutrition Monitoring and Related Research sent to congress in 1993

13. 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

14. 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

15. 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

16. 5 Areas of NNMS • Nutrition and related health measurements • Food and nutrient composition • Knowledge, attitudes, and behavior • Food composition and nutrient databases • Food Supply Determinations

18. 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

19. Food and Nutrient Composition • Nationwide Food Consumption Survey • Continuing Survey of Food Intakes by Individuals

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

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

22. Food Supply Determinations • US Food and Nutrition Supply Series

23. Major Surveys with Nutrition Content

24. 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

25. 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

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

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

32. The Youth Risk Behavior Surveillance System (YRBSS):2005 National, State, and Local Data

33. 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

34. 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

35. 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

36. 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%

37. Policy and Program Applications • Describe risk behaviors • Create awareness • Set program goals • Develop programs and policies • Support health-related legislation • Seek funding

38. Describe Risk Behaviors • Overall and among subgroups of youth • How risk behaviors are interrelated

39. Create Awareness Among: • Legislators, boards of education, and school administrators • Parents • Community members • School staff • Students • Media

40. Set Program Goals • Strategic plans for school health programs • Healthy People 2010 objectives • CDC’s Performance Plan

41. 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

42. 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

43. Seek Funding • Support funding requests to federal, state, and private agencies and foundations

44. YRBSS Information • www.cdc.gov/yrbs • 2005 questionnaire and item rationale • Morbidity and Mortality Weekly Report Surveillance Summaries • Youth 2005 Online • Data and codebooks for the national surveys • Publications, journal articles, and fact sheets

45. 2005 YRBS ResultsNutrition

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

47. Percentage of High School Students Who Ate Fruits and Vegetables ≥ 5 Times/Day,* by Sex** and Race/Ethnicity,*** 2005 * 100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables during the 7 days preceding the survey ** M > F*** B, H > W National Youth Risk Behavior Survey, 2005

48. Percentage of High School Students Who Ate Fruits and Vegetables ≥ 5 Times/Day,* 1999 – 2005 * 100% fruit juice, fruit, green salad, potatoes (excluding French fries, fried potatoes, or potato chips), carrots, or other vegetables during the 7 days preceding the survey 1 Significant linear decrease, P < .05 National Youth Risk Behavior Surveys, 1999 – 2005

49. Percentage of High School Students Who Drank > 3 Glasses/Day of Milk,* by Sex**and Race/Ethnicity,*** 2005 * During the 7 days preceding the survey ** M > F*** W > H > B National Youth Risk Behavior Survey, 2005

50. Percentage of High School Students Who Drank > 3 Glasses/Day of Milk,* 1999 – 2005 * During the 7 days preceding the survey 1 No significant change over time National Youth Risk Behavior Surveys, 1999 – 2005