FY03 - NDSU Extension Service
PROGRAM #208 - Nutrition, Food Safety & Health
Program Planning Team:
Julie Garden-Robinson and Jane Edwards (co-chairs), Andrea Becker, Kristi Berdal, Donna Bernhardt, Jamie DeVries, Sue Fagerholt, Suzanne Fundingsland, Shauna Grove, Linda Hauge, Marcia Hellandsaas, Barbara Holes-Dickson, Jane Horner,Tom Jirik, Susie Keenaghan, Deb Lee, Jenny Marhula, Pam-Leino-Mills, Macine Lukach, Marty Marchello, Karen Midgarden, Laura Morelli, Anita Rohde, Dolores Roy, Joann Runner, Eunice Sahr, Lori Scharmer, Gail Slinde, Jenny Steinhaus, Sherry Stover, Brad Strand, Colleen Svingen, Rita Usattis
Overall Situation:
Nutrition & Health
Risk for several chronic diseases such as heart disease, cancer, type 2 diabetes, and osteoporosis are related to diet and physical activity. It has been estimated that these health conditions cost society over $200 billion a year in medical expenses and lost productivity. There is strong evidence supporting the health benefits of consumption of a varied diet with less total and saturated fat; more fruits, vegetables, and whole grain products which contribute dietary fiber and a variety of vitamins and minerals; greater inclusion of lower-fat dairy products including fluid milk; and regular, moderate physical activity. However Americans including North Dakotans are not meeting national nutrition and health goals.
Physical activity and overweight /obesity are listed as two of the ten Leading Health Indicators identified by the Healthy People 2010 document (U.S. DHHS, 2000) which signifies the importance of these issues for the public's health.
Among the Healthy People 2010 objectives for prevention and control of chronic diseases are the following:
In a statewide survey of North Dakotans with an interest in nutrition, food safety and health, the following areas were identified as focus areas in nutrition and health:
1. Families eating together;
2. Teen nutrition issues;
3. Obesity/overweight;
4. Healthful eating, healthy people;
5. Physical activity.
Food Safety
According to the Centers for Disease Control and Prevention (1999) foodborne illness is responsible for approximately 5,000 deaths, 325,000 hospitalizations and 76 million cases of illness in the United States each year. Among the most vulnerable are the elderly, the very young, pregnant women and people with compromised immune systems.
The definition of potentially hazardous foods, which includes high-protein foods like meat and seafood, has expanded to include atypical foods such as alfalfa sprouts, melons, and other types of produce.
Food safety has become a priority at the national level and much research is underway to reduce food safety risks. New technology is increasingly being used to detect and identify bacteria more rapidly. Federal regulations addressing inspection methods have changed. In 2000, for example, all federally-inspected meat processing plants were required to have a Hazard Analysis Critical Control Point (HACCP) plan in place. National consumer food safety education campaigns, including "Fight BAC! Keep Food Safe from Bacteria" and the "Thermy" campaign promoting food thermometer use, are underway. To further assist consumers, warning labels are required on unpasteurized juices, and safe handling directions are listed on fresh meat packages.
PROGRAM COMPONENT
NUTRITION AND HEALTH-CHILDREN AND ADULTS
Persons Responsible: Julie Garden-Robinson and Jane Edwards, Food and Nutrition Emphasis Group
Situation:
Most health care dollars are spent on treatment rather than on prevention. Nationally, researchers estimate that unhealthy eating and physical inactivity are responsible for 35% of premature deaths in the U.S., or about 1200 deaths per day. Nearly 55 percent of the US adult population was defined as overweight or obese (BMI >25) in 1988-94 compared to 46 percent in 1976-80. The prevalence of obesity (BMI >30 kg/m2 ) has been increasing in the past decade from 12.0% in 1991 to 17.9% in 1998 to 19.8% in 2000. In North Dakota 40% of adults were overweight with another 20.4% being obese in 2000 (BRFSS, CDC). The rising level of obesity in North Dakota is evident from data indicating that in 1990 only 12.1% of the adult population reported being obese (BMI >30). About 36% of North Dakotans surveyed indicated they were trying to lose weight in 2000.
Overweight status and physical inactivity are among the contributing factors for cardiovascular disease and other chronic illnesses. Cardiovascular disease is the leading cause of death for North Dakotans, causing 139 deaths/100,000 people in 1998 (ND 2001 State Health Profile, DHHS, CDC.). About 25% of North Dakotans indicated that they had been told by a health professional that their blood pressure was elevated (1997 BRFSS, CDC) and 36% indicated they had not had their cholesterol checked in the past five years (1999 BRFSS, CDC).
Cancer, the second leading cause of death in North Dakota, accounted for 23% of deaths in 1997. Incidence of diabetes is slightly greater than 5% of the total adult population of North Dakota rising to greater than 12% in the 65 to 74 year old population (1997-99 BRFSS, CDC). National data from the Indian Health Service for 2000 (NIDDK,NIH) indicates that about 15% of the American Indians and Alaska Natives have diabetes.
According to the Surgeon General's 1995 report, all Americans should aim for 30 minutes of moderate physical activity on five or more days each week. Although physical activity has been shown to provide protection from heart disease, diabetes, cancer, and other chronic diseases and conditions such as high blood pressure, Americans including those living in North Dakota are predominantly sedentary. About 25% of North Dakotans surveyed in 2000 stated they were inactive during leisure time (down from 33% in 1998).
Despite research on the health benefits of fruits and vegetables, particularly for reducing the risk of cancer, about 77% of North Dakota adults did not consume the recommended five or more servings of fruits and vegetables a day in 2000.
Childhood obesity, inadequate calcium intake and low fruit and vegetable intake during childhood and adolescence are emerging issues. The percentage of children who are above the 95th percentile for BMI has more than doubled in the past three decades from 4-5% in the early 1970s to 11% in 1988-94 (NHANES data). Approximately 25 % of all children are at or above the 85th percentile for BMI. Children who are overweight have an increased incidence of type 2 diabetes and risk factors associated with heart disease such as elevated blood pressure and blood cholesterol.
Data from North Dakota high school students (YRBSS 2001) indicated that 12.2% were at risk of becoming overweight, 9.2% were overweight, 31.9% thought they were overweight, 47.5% were trying to lose weight. For 2001 in North Dakota, 81.9% of high school students reported eating fewer than 5 servings of fruits and vegetables and 71.1% reported less than 3 glasses of milk per day. About one third (34.1%) of North Dakota high school students had not participated in a sufficient amount of physical activity. Sufficient physical activity was defined as vigorous physical activity (for > 20 minutes on 3 of the 7 days preceding the survey) and had not participated in moderate physical activity (> 30 minutes on >5 of the 7 days preceding the survey).
PROGRAM COMPONENT
NUTRITION AND HEALTH-CHILDREN AND ADULTS
FY 2003
Educational Programs
A Childhood Obesity Prevention Task force consisting of NDSU Extension personnel will be formed to determine the focus of the effort within North Dakota for this important health problem among the state's children. Collaboration with other state agencies such as the North Dakota Department of Health and the North Dakota Department of Public Instruction will help foster a working relationship on this important health issue. Public policy initiatives will be determined for improved nutrition/physical activity for children in the school and community environment.
5 Plus 5 Coalitions including NDSU Extension personnel, North Dakota Department of Health Nutritionists, hospital/wellness center staff, commodity group representatives, Parks and Recreation staff, school representatives, decision makers and/or community members will promote variety in the diet (particularly 5 A Day), decreased fat consumption and regular moderate physical activity in a variety of settings including grocery stores and worksites. The community plans will be established at the local level and will use/adapt materials (lesson plans, handouts, press releases, etc.) developed by NDSU Extension Specialist(s) and North Dakota Department of Health staff and other members of the North Dakota Healthy Heart Council.
Calcium and folic acid intake remain issues of concern, particularly among children and young women. Osteoporosis is considered a pediatric disease with geriatric consequences. A new curriculum on calcium will be piloted. Adequate intake of folic acid has been shown to prevent birth defects such as spina bifida if consumed before pregnancy and in the early stages of pregnancy. Folic acid intake also may play a role in helping prevent heart disease and possibly, Alzheimer's Disease. A folic acid task force has been created to address the issue on a statewide basis.
Inputs
Staff, time, money, equipment, technology, existing supporting educational materials and partners.
Outputs-Materials/curricula
Childhood Obesity Prevention:
5 Plus 5/Nutrition and Physical Activity Programming:
Kids Calcium Project:
Folic Acid Campaign:
Outputs: Activities
Outputs: Participation
Outcomes-Methods
5 Plus 5 Program:
Kids Calcium Project
Folic Acid Campaign
Anticipated Outcomes--Short Term
5 Plus 5 Program
Kids Calcium Project
Folic Acid Campaign
Anticipated Outcomes-Medium-term
Anticipated Outcomes-Long term
FY 2004
Education Program Topics -Outputs
Childhood Obesity Prevention
5 Plus 5 Communities
Folic Acid Campaign
Kids Calcium Project
FY 2005
Education Program Topics -Outputs
Childhood Obesity Prevention
5 Plus 5 Communities
Healthy Aging
Folic Acid Campaign
Kids Calcium Project
FY 2006
Education Program Topics -Outputs
Childhood Obesity Prevention
5 Plus 5 Communities
Healthy Aging
Folic Acid Campaign
Kids Calcium Project
PROGRAM COMPONENT
FOOD SAFETY
Key
Theme(s):
Food Safety, HACCP, Foodborne Illness
Persons Responsible: Julie Garden-Robinson, Marty Marchello, Food and Nutrition Emphasis Group
Situation
Over half of the consumer's food dollar is currently spent on food eaten away from home. Nationally, foodservice establishments are linked with the most food-related outbreaks. North Dakota has had a number of publicized cases of foodborne illness including hepatitis, E. coli O157:H7 and others. In 1999, a life-threatening case of botulism in North Dakota was linked to food improperly canned at home.
Hazard Analysis Critical Control Point (HACCP) methodology has been successfully used in the food industry to assure and document safe food handling practices. HACCP programs are required for the seafood and meat industries, and other industries such as the produce industry are applying similar principles.
Along with the increase in commercial foodservice operations, greater numbers of children and the elderly are participating in daycare. Many North Dakotans also are becoming food entrepreneurs and starting small-scale food processing businesses. Community dinners through nonprofit organizations, such as fraternal organizations, congregations and 4-H clubs, also remain popular. The volunteer food handlers are often untrained in quantity food production and handling. All of these trends present unique food safety concerns.
In a statewide survey of North Dakotans with an interest in food safety, the following issues were identified as priority areas:
1. Food safety in homes;
2. Food safety in foodservice;
3. Food safety where volunteers handle food;
4. Food safety in the food industry;
5. Food safety for wild game.
FY 2003
Inputs
Staff, time, money, equipment, technology and existing supporting educational materials.
Outputs
Overall Topics/Planned Materials
Consumers - adults
Consumers - children
Professionals
*statewide evaluation
Outputs - participation
Evaluation Plan
Pre/post surveys will be used at food safety workshops to measure increased knowledge, awareness and intentions to change behavior.
Six-month follow-up surveys on changed practices will be mailed to participants in food safety workshops.
Pre/post tests will be used to measure increased knowledge, awareness and intentions to change behavior among participants in volunteer food handler training and food preservation training.
Anticipated Outcomes - Short term
At least 75% of participants will increase awareness and knowledge of food safety/HACCP principles and implementation among foodservice managers, meat processors, sanitarians, and food processing entrepreneurs.
Increased collaboration among Extension agents, sanitarians, commodity groups and food distributors in providing food safety training.
At least 75% of consumers, daycare/eldercare providers and volunteer food handlers surveyed will increase awareness and knowledge of safe food handling practices among among extension staff.
Anticipated Outcome - Medium term
At least 50% of those surveyed will report changes in food handling practices to reduce risk of foodborne illness outbreaks.
Anticipated Outcome - Long term
A decrease in the overall incidence of foodborne illness as measured by state health department data.
Overall Topics/Planned Materials - Outputs
FY 2004
Consumers - adults
Consumers - children
Professionals
FY 2005
Consumers - adults
Consumers - children
Professionals
FY 2006
Consumers - adults
Consumers - children
Professionals
FY 2007
Consumers - adults
Consumers - children
Professionals
PROGRAM COMPONENT
EXPANDED FOOD AND NUTRITION EDUCATION
PROGRAM (EFNEP)
Key
Theme(s):
Food Accessability and Affordability, Food Resource Management, Food Security, Human Nutrition, Food Safety
Persons Responsible: Margaret Tweten, Interim EFNEP/FNP Coordinator, Julie Garden-Robinson, Food and Nutrition Specialist, EFNEP Supervisors, and
EFNEP Nutrition Education Assistants
Situation
The composition of North Dakota families continues to change in important ways. The percentage of families with children headed by a single parent has increased to 20% in 1997. Of particular concerns are children in families headed by single teen parents and children whose parents are struggling to meet their basic
needs. In 1997, 15% of North Dakota children were living in poverty. Another 13% of children live in near-poor families.
Economic pressures within the state have increased the number of parents working outside the home. Demand at local food banks is on the increase due to the downturn in agriculture and the decrease in assistance programs available such as TANF.
The target audiences for the EFNEP include: 1) low-income individuals/households living in either rural or urban areas who are responsible for planning
and preparing the family's food, with emphasis on households with young children; 2) low-income youth who live in rural or urban areas and who meet the state's
definition of 4-H age, which, in North Dakota, is 8 to 18 years.
North Dakota's EFNEP program is offered in six locations: two urban centers (Cass and Grand Forks Counties) and four Native American reservations (Fort
Berthold, Rolette County, Sioux County, and Spirit Lake Nation.) Site selection is based on poverty figures and criteria affected by poverty.
Educational Program
EFNEP participants are taught in an informal educational group setting or in individual sessions by nutrition education assistants. Using Eating Right is Basic Curriculum, nutrition education assistants working with program families focus on dietary quality, menu planning, food safety, food budgeting, and food selection.
Indirect contact may occur with program families through the use of telephones, newsletters, calendars, and displays, which are used to supplement the face-to-face teaching.
Each year, one component of the core elements will be a major focus of educational training for the nutrition education assistants. Using the train-the-trainer concept, these workshops will occur at the annual EFNEP/FNP conference and/or at the regional EFNEP/FNP meetings held across the state.
Educational instruction will continue to focus on the core elements, with NEA's selecting nutritional topics based on the needs of the target audience within their
community. Community-based needs education will continue to provide the NEA with the direction of nutrition programming at the local level.
Evaluation - Methods
Data from the EFNEP Evaluation/Reporting System is used to measure food practice improvement and dietary improvement.
Evaluation Plan
Data from the ERS-4 (Evaluation and Reporting System) is used to measure food practice improvement and dietary improvements. Pre-and post-assessment and observed behavior changes of participants will be the primary measures of program effectiveness. Results from the ERS-4 to be measured are: improved in one or more food resource management practices, improved in one or more nutrition practices, improved in one or more of the food safety practices, and improved in dietary intakes of six key nutrients.
Anticipated Outcomes
Low-income families and youth will acquire the knowledge, skills, attitudes, and changed behavior to form nutritionally sound diets and significant improvements in daily living skills. Collaboration between EFNEP and agencies with similar target audiences will continue to increase.
Upon successful completion of the EFNEP curriculum, participants will be encouraged to explore participation in other extension educational programs andeven become active volunteers to assist with future EFNEP lesson series.
FY02 NDSU Extension Service PROGRAM #208
NUTRITION, FOOD SAFETY & HEALTH
PROGRAM COMPONENT
FAMILY NUTRITION PROGRAM (FNP)
Key
Theme(s): Food Accessability and Affordability, Food Resource Management, Food Security, Human Nutrition, Food Safety
Persons Responsible
Margaret Tweten, Interim EFNEP/FNP Coordinator, Barb Holes-Dickson, FNP Specialist, Julie Garden-Robinson, Food and Nutrition Specialist, FNP
Supervisors, Nutrition Education Assistants/Agents, FNP
Situation
Food Stamp regulations allow states to submit a nutrition education plan to reach food stamp recipients and eligibles with education in nutrition, food purchasing
and food safety. North Dakota has chosen to submit such a plan, as there are currently 37,382 persons in 16,074 North Dakota households receiving food stamp benefits each month. Monthly benefits for the state=s food stamp program exceed $2,200,000.
The purpose of the Food Stamp Program is to ensure that needy families have the resources to purchase an adequate supply of nutritious foods. The literature
indicates Food Stamp recipients typically exhaust their benefits five to ten days before the end of the month (JNE 32:72-83, 2000). FNP is a critical element in
the ongoing effort to educate limited resource families allowing them to increase nutritional awareness and intake on a fixed or limited budget.
Because food stamp recipients are blended throughout the state, three target audience groups have been selected to receive FNP programming; they include:
families with young children, families without children and older adults.
In North Dakota over 48% of the food stamp issuance is to families with children under the age of 18, making this group a primary audience for the Family
Nutrition Program. According to Kids Count Facts!, over half of North Dakota=s 53 counties have child poverty rates exceeding the state average of 16.8
percent. A growing number of working poor families may be reflected in the 24 counties with poverty rates between 17.6 percent and 40.8 percent.
With the accelerated downturn of the economy, many individuals are seeking assistance to help them stretch their limited dollars. According to Hunger in
America 2001, 39% of households who receive emergency food assistance include at least one employed adult. Families visiting food distribution programs
indicate they often choose between food and other necessities:
The fastest growing population segment in the United States and in North Dakota is the elderly. In ND 18.5 percent of the population as reported by the Census
in 2000 were individuals 600 years and older. By 2015, 28.7 percent of North Dakota's total population will be age 60 or older. The number of elderly moving
onto poverty is increasing in North Dakota. Currently persons age 65 and older constitute 15 percent of the population living below poverty levels. Poor
nutritional status is a primary concern for the elderly as reported in the USDA Food Review. Diets which are inadequate can contribute to chronic and acute
diseases among the elderly. According to the Food Review many of the diets of the elderly do not provide the level of nutrients needed for maintaining a healthy
body.
Because of limited resources, the diets of individuals and families experiencing those circumstances may be inadequate. The objective of the Family Nutrition
Program is to help food stamp participants acquire knowledge, skills, attitudes and changed behavior necessary for maximizing resources to achieve nutritionally sound diets.
FNP is operational in all 53 of North Dakota's counties and reaches 100% of the state's food stamp population with education in nutrition, food purchasing and
food safety.
Educational Program
Each year one component of the core elements will be a major focus of educational training for the nutrition education agents/assistants, FNP. Using the
Train-the-trainer concept, these workshops will occur at the annual EFNEP/FNP conference and/or at the regional FNP meetings held across the state.
Food Safety: FY 2002-2003 - focus on issues related to cross contamination.
Food Purchasing: FY 2002-2003 - focus on reading and understanding nutrition labels
Dietary Quality: FY 2002-2003 - focus on increasing the consumption of fruits and vegetables
Food Security: FY 2002-2003 - focus on using food assistance programs
Inputs
Staff, time, money, equipment, technology and existing supporting educational materials. "Building a Healthy Diet" curriculum materials from Iowa State University Extension will serve as the core educational resource.
Outputs
Demonstrations and displays will be provided at all project area food stamp offices and at other sites the target audience frequents.
Monthly newsletters will be developed and sent to each food stamp household in FNP counties/sites.
Classes designed for the target audience will be presented in group sessions or individually.
An educational calendar will be developed and distributed to the target audience across the state.
Outputs - participation
Youth
Adults
Senior citizens
Evaluation Plan
Quarterly, semi-annual and annual reports will document program activities and participation.
Survey instruments have been designed and piloted and will be implemented statewide to measure outcomes in dietary quality, food safety, food purchasing, and food security.
Anticipated Outcomes - Short term
75% of participants will increase their awareness and knowledge of nutrition or food budgeting concepts taught in lessons.
Anticipated Outcomes - Medium term
60% of participants surveyed will increase their consumption of fruits and vegetables.
75% of participants surveyed will make food purchasing changes through reading nutrition labels.
75% of participants surveyed will improve food safety practices by avoiding cross contamination.
55% of participants surveyed will be assured access to enough food.