Trail Markers: Tracking Course Direction through Surveillance

Trail Markers:Tracking Course Direction

through Surveillance

Trail Markers:Tracking Course Direction

through Surveillance

Deb GaluskaOn behalf on the DNPAO surveillance working group

Disclaimer: The conclusions of this presentation represent those of the

speaker and not necessarily those of CDC

Deb GaluskaOn behalf on the DNPAO surveillance working group

Disclaimer: The conclusions of this presentation represent those of the

speaker and not necessarily those of CDC

Definition of surveillanceDefinition of surveillance

“The ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice”

(Thacker 1988)

“The ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice”

(Thacker 1988)

The Program Map

Change environment

Change behavior

Change health condition

Change individual knowledge, skills,

and attitudes

Change policy

Key trail markers for the DNPAO programKey trail markers for the DNPAO program

Key marker What are measures of progress?

Change in health condition •Obesity•Other chronic health conditions

Change in behavior •Physical activity•Breastfeeding•Television viewing•Fruit and vegetable•Energy density•Sweetened beverage

Change in environment •School•Medical•Worksite•Community

Change in policy •Environment•Other

The Tools for States: Health Conditions and Behaviors

Tools for childrenTools for children

System Population Data collection State or local data

Pediatric Nutrition Surveillance System(PedNSS)

•Primarily < 5 years of age •Receive services for low income families

•Part of clinic visit •Ongoing

Select

National Immunization Survey (NIS)

• 19 – 35 months •Parental report•Telephone survey•Ongoing

All states

Pregnancy Nutrition Surveillance System (PNSS)

•Pregnant women in federally funded public health programs (WIC, MCH)


Select states

Youth Risk Behavior Survey (YRBS)

•Grades 9 through 12•Attend school

•Self report•Questionnaire in classroom•Biannual

Select

National Survey of Children’s Health (NSCH)

•0 to 17 years of age•Non-institutionalized US population

•Parental report•Telephone survey•2003 and 2007

All states

Tools for adultsTools for adults

System Population Data collection

State or local data

Behavioral Risk Factor Surveillance System(BRFSS)

•Non-institutionalized adults

•Telephone survey•Self-report•Ongoing

All states


•Pregnant women in federally funded public health programs (WIC, MCH)


Select states

Change environment

Change behavior



and attitudes

Change policy

Health conditions for childrenHealth conditions for children

System Obesity Other chronic diseases


X X


X


X X



Health Conditions for AdultsHealth Conditions for Adults

System Obesity Other chronic disease


X X


X X

Change environment

Change behavior



and attitudes

Change policy

Nutrition behaviors for childrenNutrition behaviors for children

System Breastfeeding Fruit and vegetable

Sweetened beverage

Energy density


x


x x



x


x

Nutrition behaviors for adultsNutrition behaviors for adults

System Fruit and vegetable

Sweetened beverage

Energy density


x


Physical activity and sedentary behaviors for children

Physical activity and sedentary behaviors for children

System Physical activity

Television viewing


x


x x


x x



Physical activity and sedentary behaviors for adults

Physical activity and sedentary behaviors for adults

System Physical activity

Television viewing


x


Change environment

Change behavior



and attitudes

Change policy

Inventory questionsInventory questions

• What federal systems collect state specific data on environment and policy?

• What models have states used to collect environmental and/or policy information for their state programs?

• What federal systems collect state specific data on environment and policy?

• What models have states used to collect environmental and/or policy information for their state programs?

Key components Key components

• Setting– School– Medical– Worksite– Community

• Indicator(s)

• Methodology

• Setting– School– Medical– Worksite– Community

• Indicator(s)

• Methodology

Methods of assessing environments or policy

Methods of assessing environments or policy

• Direct – Individuals in the environment– Decision makers in the environment– Direct measurement

• Indirect (data collected for other reasons)– Written documents– Web– Publicly accessible dataset

• Direct – Individuals in the environment– Decision makers in the environment– Direct measurement

• Indirect (data collected for other reasons)– Written documents– Web– Publicly accessible dataset

The Tools for States: Environment and Policy

Maternity Practices in Infant Nutrition and Care Survey

Maternity Practices in Infant Nutrition and Care Survey

Target behavior:Breastfeeding

Setting: Medical care (hospitals and birth centers that provide intrapartum care)

Method:Report of most knowledgeable staff

Examples of environment or policy measures (or domains):Labor and delivery careBreastfeeding assistanceContact between mother and infantFeeding of breastfeeding infantsFacility dischargeStaff trainingStructural and organizational aspects of care delivery

Other information:

Done in 2007 – repeat planned All states

Target behavior:Breastfeeding

Setting: Medical care (hospitals and birth centers that provide intrapartum care)

Method:Report of most knowledgeable staff

Examples of environment or policy measures (or domains):Labor and delivery careBreastfeeding assistanceContact between mother and infantFeeding of breastfeeding infantsFacility dischargeStaff trainingStructural and organizational aspects of care delivery

Other information:

Done in 2007 – repeat planned All states

School Health ProfilesSchool Health Profiles

Target behavior:Physical activity, sugar sweetened beverage, fruit and vegetable,

energy density (high fat and high sugar foods)

Setting: Secondary public schools (Grades 6 through 12)

Method:Report principal and teacher

Examples of environment or policy measures (or domains):CurriculumCompetitive foodsAdvertising of foodsTraining of staff

Other information: Done biannually State and local data for select states

Target behavior:Physical activity, sugar sweetened beverage, fruit and vegetable,

energy density (high fat and high sugar foods)

Setting: Secondary public schools (Grades 6 through 12)

Method:Report principal and teacher

Examples of environment or policy measures (or domains):CurriculumCompetitive foodsAdvertising of foodsTraining of staff

Other information: Done biannually State and local data for select states

School Health Policies and Program StudySchool Health Policies and Program Study

Target behavior:Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods)

Setting: Schools (Education agency for the state -elementary, middle, high school)

Method:Report of most knowledgeable person

Examples of environment or policy measures (or domains):CurriculumCompetitive foodsFood service foodsAdvertisingTraining of staff

Other information: Done every six years Data on all states

Target behavior:Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods)

Setting: Schools (Education agency for the state -elementary, middle, high school)

Method:Report of most knowledgeable person

Examples of environment or policy measures (or domains):CurriculumCompetitive foodsFood service foodsAdvertisingTraining of staff

Other information: Done every six years Data on all states

National Survey of Children’s HealthNational Survey of Children’s Health

Target behavior:Physical activity, television

Setting: Community (physical activity) and home (television)

Method:Telephone survey – parental report

Examples of environment or policy measures (or domains):Perceptions of safety and places for physical activity in communityFamily practices related to television

Other information: Done 2003 and 2007 Data on all states

Target behavior:Physical activity, television

Setting: Community (physical activity) and home (television)

Method:Telephone survey – parental report

Examples of environment or policy measures (or domains):Perceptions of safety and places for physical activity in communityFamily practices related to television

Other information: Done 2003 and 2007 Data on all states

DNPAO Legislative DatabaseDNPAO Legislative Database

Target behavior:Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods), television, breastfeeding

Setting: All settings possible

Method:Multiple outside data sources (e.g. legislative websites, National Counsel of State Legislators)

Examples of environment or policy measures (or domains):Legislation for physical educationLegislation that supports farmer’s markersLegislation for school vending policy

Other information:Need to do additional analysesState data

Target behavior:Physical activity, sugar sweetened beverage, fruit and vegetable, energy density (high fat and high sugar foods), television, breastfeeding

Setting: All settings possible

Method:Multiple outside data sources (e.g. legislative websites, National Counsel of State Legislators)

Examples of environment or policy measures (or domains):Legislation for physical educationLegislation that supports farmer’s markersLegislation for school vending policy

Other information:Need to do additional analysesState data

Examples of local trail markers:What are states doing?

State examplesState examples

Individuals in the environment• Addition of parental attitude toward PE policy to CHAMP survey

(NC)• Addition of questions related to supports for physical activity in

work environment to Minnesota Physical Activity (MN)

Decision makers in the environment• Restaurant Heart Healthy Survey (NC)• Worksite Survey and Health Care Site Survey (MA)• New York State Worksite Wellness Survey (NY)

External data sources• Monitoring miles of trials (NE)

Individuals in the environment• Addition of parental attitude toward PE policy to CHAMP survey

(NC)• Addition of questions related to supports for physical activity in

work environment to Minnesota Physical Activity (MN)

Decision makers in the environment• Restaurant Heart Healthy Survey (NC)• Worksite Survey and Health Care Site Survey (MA)• New York State Worksite Wellness Survey (NY)

External data sources• Monitoring miles of trials (NE)

ConclusionsConclusions

• Limited information on environmental and policy in worksites, communities, and medical care– Need for indicators– Need for methodology

• Need to share state experiences

• Limited information on environmental and policy in worksites, communities, and medical care– Need for indicators– Need for methodology

• Need to share state experiences

Proposed next stepsProposed next steps

• Community setting– Explore feasibility of developing

module for assessing individual perceptions of environmental/policy supports

– Explore the feasibility of using the Common Measures for Obesity Prevention for community level surveillance

• Worksite– Identity relevant indicators

• Work with state partners– Needs– How to be engaged

• Community setting– Explore feasibility of developing

module for assessing individual perceptions of environmental/policy supports

– Explore the feasibility of using the Common Measures for Obesity Prevention for community level surveillance

• Worksite– Identity relevant indicators

• Work with state partners– Needs– How to be engaged

Common Community Measures for Obesity Prevention

Common Community Measures for Obesity Prevention

• Multi-partner project• Identify core set of data elements that can be

used by communities for self-assessment – Identify strategies– Identify single measure

• Next steps– Internal and external review– Pilot– Add to International City and County Management

data collection tool– Planned release – summer 2009

• Multi-partner project• Identify core set of data elements that can be

used by communities for self-assessment – Identify strategies– Identify single measure

• Next steps– Internal and external review– Pilot– Add to International City and County Management

data collection tool– Planned release – summer 2009

Surveillance working group members

Surveillance working group members

• Heidi Blanck• Patricia Brindley• Susan Carlson• Karen Dalenius• Janet Fulton• Deb Galuska• Laura Kettel Khan• Liping Pan• Barb Polhamus

• Heidi Blanck• Patricia Brindley• Susan Carlson• Karen Dalenius• Janet Fulton• Deb Galuska• Laura Kettel Khan• Liping Pan• Barb Polhamus

Questions for Large Group Discussion Questions for Large Group Discussion

• What are your biggest barriers to conducting surveillance for environment and policy?

• What could CDC do to help you address these barriers:– In the next year?– In the next five years?

• How do we best use your expertise:– In the development of the CDC plan?– To guide activities in other states?

• What are your biggest barriers to conducting surveillance for environment and policy?

• What could CDC do to help you address these barriers:– In the next year?– In the next five years?

• How do we best use your expertise:– In the development of the CDC plan?– To guide activities in other states?

Documents

Trail Markers: Tracking Course Direction through Surveillance