Priority Strategies: Improving Health and Reducing Chronic Disease

welcome we are so happy that you've all joined us this afternoon for the dnpo seminar series today's seminar we'll discuss priori strategies for improving health and reducing chronic disease my name is Eileen boso and I am the lead for the policy and Partnerships team in the division of nutrition physical activity and obesity or dnpo as you'll hear it refer to today and I'm going to be your moderator for today's session in case you missed it CD released its annual obesity Maps this week this new release covers adult obesity prevalence in 2021 19 States and two territories have at least 35% of residents with adult obesity more than doubling the number of states with high obesity prevalence since 2018 combined data from 2019 to 2021 shows the number of states and territories with high obesity varies widely across race and ethnicity I think this new data really highlights the importance of the work that you're going to hear about today if you want to learn more about our obuity Maps or see what your state looks like please see the link in the chat a few housekeeping items before we get started this Zoom call is being recorded if you're uncomfortable being on a recorded call we ask that you disconnect at this time a recording of the seminar will be posted on the dnpo seminar series webpage you can find that link in the chat as well to have the best experience we encourage you to use the zoom app or website to view the slides and to participate in today's meeting all participants will be muted however following our presentation we will have a question and answer session the Q&A Box is open now so feel free to drop in a question at any time if you're using the Zoom app or website you can type in a question by clicking on the Q&A icon we'll get through as many questions as we can in the hour for those of you who aren't familiar with the division you can see our vision and Mission on this slide you'll hear more about the strategies and efforts of the division to achieve this mission in today's presentation before we jump into today's presentations I want to introduce our four amazing speakers first we have Perry oul he is the chief of our program development and evaluation branch and dnpo Perry provides leadership and subject matter expertise to State and community- based programs National partners and health organizations focused on program efforts to promote good nutrition physical activity and obesity prevention next we have Steph Leonard she is a built environment coordinator at the Colorado Department of Public Health Steph works with local Regional and state Partners on policy and built environment change to promote access to Safe spaces for physical activity and prevent chronic disease in Colorado CA La Bru has been the program director for live healthy Miami Gardens since since 2014 she excels in bridging Partnerships that bring together Grassroots Leaders with professionals and policy makers to improve the city of Miami Gardens community in July Tamara received cdc's 2022 reach Lark award for advancing Health Equity finally we have a new pajara in the Le who is the lead for the program evaluation team and dmpo she employs a utilization focused evaluation approach to to provide guidance and technical assistance to 71 State and Community recipients to improve their physical activity and nutrition environments here's a quick look at our agenda you'll hear more about our five action steps to reduce chronic disease followed by examples of physical activity efforts in Colorado nutrition efforts in the city of Miami Gardens and then we'll wrap up with some of the successes we have seen in our span hop and reach recipients after that we'll have some time for Q&A and with that I'm going to turn it over to Terry to discuss the five action steps to reduce chronic disease through physical activity and nutrition Terry thanks so much alen welcome everyone it's pleasure to be with you more than half of all Americans live with chronic disease at least one chronic disease such as heart disease cancer type 2 diabetes and obesity chronic diseases are leading causes of death and disability as well as dve drivers of healthare costs and drivers of low worker productivity on the bottom of this slide you'll see dn's strategic priorities that we use and employ to combat chronic disease and how we help all Americans get a healthy start and stay healthy throughout their lives adequately addressing risk factors for chronic disease needs to consider the long-standing systemic social economic and environmental inequities which have resulted in inadequate healthy and safe food access as well as physical activity access often the most underserved groups are racial and ethnic groups that have historically suffered these risk factors disproportionately and alongside our partners we work intently to achieve Health Equity by lifting up Community assets lived experiences and removing those environmental and systemic barriers to health through our state physical activity and nutrition program known as span our High obesity program known as hop our racial and ethic approaches to community health or reach program we provide financial and Technical Support to States and communities to implement a variety of these evidence-based strategies and policies to promote sound nutrition and safe and convenient access to physical activity it's important that I underscore to you that context and Community voice really matters and that our funded States and communities have the flexibility to tailor interventions that meet their local context and needs and assets bottom line up front we know what works to build healthier communities we use information from evidence-based interventions expert recommendations practice based on lived experiences to determine what state and local public health actions are feasible and impactful this slide depicts the five specific population focused Public Health actions that work to reduce chronic disease through improved physical activity nutrition and I'll take a minute to just describe each one action one make physical activity safe and accessible for all being Physically Active is one of the most important actions that people of all ages and abilities can take to improve their health now and in the future people generally report that they lack this time and safe places for physical activity so to support this action item we provide funding to States and communities and provide technical assistance to improve safe access and convenient activity friendly routes to every destinations essentially making it easier for everyone to walk to school to bike to the store to roll to work or play in the Park action item number two make healthy food choices easier you know that people make hundreds of decisions every day about consumptions of foods and Beverages and if you had a chance to tune in to yesterday's White House conference on Hunger nutrition and health we learned that when healthy items are not readily available many people settle for unhealthy foods that are high in added sugars sodium and starches thus increasing their risk for chronic disease States and communities have a variety of levers to improve access to healthy foods such as bulk food purchasing nutrition standards in food pantries and school food environments and implementation of school foods of food service guidelines we provide technical assistance and funding to States and communities to assess their needs around healthy food for all action item three make breastfeeding easier to start in sustain human milk is the first food provided to most infants born in the US and delivers not only needed nutrients but numerous health benefits for the child and mother we know breastfeeding initiation and duration is influenced by many factors including unsupportive work policies lack of Parental leave cultural norms and lack of family support we support our partners in Span recipients to work with hospitals to safely implement the 10 steps to successful breastfeeding a set of evidence-based maternity practices to promote and support breastfeeding and after leaving maternity care settings ready access to continued and culturally tailored breastfeeding support is needed in the workplace and community and our dnpo recipients have successfully implemented a variety of Continued Care interventions including developing communication and referral systems between hospitals and community support groups to make it easier for moms to breastfeed action item four strengthen obesity prevention standards in early care and education settings Early Childhood is an important period of growth and development and health for our children about 21 million CH children age Z to five are not yet in kindergarten and in care outside the home at least once a week with center-based care being the most common and infl infants and toddlers who attend ECE centers spend an average of 31 hours a week in in Center Care so we know that ECE settings can really help many children establish healthy behaviors to support this action step we provide funding and technical assistance to State and local recipients to develop action plans that can use system and policy levers to improve the nutrition physical activity and breastfeeding environments in ECE facilities using cdc's spectrum of opportunities action item five spread and scale family healthy weight programs childhood obesity is putting millions of America's children at risk for poor health many factors that drive excess adiposity unfortunately disproportionately impact children from lowincome households and racial and ethnic minority groups we know that intensive family- centered lifestyle programs can promote Children's Health including a quality of life and a reduction in excess adiposity for children with overweight obesity and here at cdc's dnpo we work with Partners to address State and policy systems and supports to facilitate local level spread and scale of family healthy weight programs now you might be wondering what states and communities need to implement the five action steps we know that State Health departments and their Community Partners need focused and specific expertise to tailor these uh and Implement these five actions and it takes specialized staff in State Health departments and Community Health departments including physical activity Specialists Public Health nutritionists evaluators policy experts communication experts and a dedicated program manager as I mentioned earlier our our current resources enable us to support 16 States through spam and we know the need exists across all 50 states and we currently support 40 organizations through reach and we know the need exists in at least 250 more communities across the US so if you're wondering what's one thing you can do you can go to our website and join active people healthy Nation initiative where you can learn more of what you can do to help our goal to get 27 million more Americans more physically acve by 2027 and again if you tuned into yesterday's White House conference on Hunger nutrition Health you heard that it will take all of us to make it easier for people to be more physically active so please join us at active people healthy Nation to create a more active America together thank you so much and it's my pleasure to turn it over to Steph Leonard thanks Terry hello everyone my name is Steph Leonard uh and as Eileen mentioned I am a buil environment coordinator at the Colorado Department of Public Health and environment or cdph as we call it um thank you to dnpo for inviting me to participate today and many thanks to each of you for tuning in um so I'm going to present some of Colorado's strategies to promote physical activity and reduce chronic diseases through our span program and active people healthy Colorado efforts so on this Slide the physical activity in Colorado slide um as background uh survey data shows that show that more than 50% of children and 40% of adults in Colorado do not meet the CDC physical activity guidelines the proportions of for this metric are greater than the state average among communities of color and older children 45% of African-American adults and 54% of Hispanic adults and 52% of high school students reported that they do not meet the CDC guidelines of note uh report physical activity within all population groups in Colorado is decreasing over time since the origination of Colorado's span program in 2018 we've made significant progress towards increasing activity friendly routes to Everyday destinations this table highlights the sum of Colorado's reporting throughout years 1 through four the first row shows numbers of potential miles and destinations called out in new plans or policies and the second row shows numbers of actual miles and destinations that have been installed as a result of existing plans or policies One Way Colorado has promoted physical activity is through the development of Colorado downtown streets guide cdph partnered with the Department of local Affairs and the Department of Transportation to produce this guide to help support effective planning and promote coordination between technical professionals and local leaders U as well as community members to create better streets for people walking and biking one strategy called out in this multi-agency guide is the use of quick win projects to rapidly enhance local streetscapes and promote active Transportation pulling from the Colorado downtown streets guide Colorado has used span funding to support quick-win projects that promote activity friendly routes to Everyday destinations quick wins are lowcost locally driven projects designed to promote Safe physical activity often quickin projects help provide essential streetscape components that may get value engineered out of larger scale improvements while these projects may be small scale or temporary they can have large impacts on promoting physical activity while also providing momentum toward or helping to implement long-term policy changes that promote healthy built environments some examples of funding quick WI projects include adding bike boxes at a busy intersection in Lakewood shown on the left and the addition of bicycle racks and fixed stations outside of a food kitchen and near a pop a popular Transit stop in Durango shown on the right to highlight a few more quick wins the photo on the left shows high school students working on a trail Crossing Improvement near a school in Delta County and on the right uh you'll see two artists that design benches for the town of Hotchkis Main Street Hotchkis has a vision to be more walkable and socially connected for their growing senior population and benches were installed after learning that older adults would avoid Main Street because there wasn't a place for them to sit over the last four years Colorado has committed funding to 42 community-based quick win projects throughout the state as shown on the map here we opened our application for year four in April and received 63 applications requesting over 20 660,000 in funding which is highlighting the clear need for these types of funding opportunities uh while we initially budgeted only $330,000 we were able to leverage additional funds from the Colorado Comprehensive Cancer control program to fund 23 quickin projects in total to evaluate the applications Colorado uses Equity centered variables in the scoring rubric including comparing county level heel disparity index rankings which is a metric we've developed at cdph and assigning a higher score to projects that help improve activity friendly connections for priority populations like lower income communities Youth and vulnerable roadway users building on principles within Colorado downtown streets and the momentum gain from Quick win projects the uh the Colorado Department of Transportation recently launched revitalizing main streets to help communities Implement Transportation related projects that improve Pro safety and yield long-term benefits to community main streets for this funding Main Street is defined in a context specific manner to be inclusive of inclusive of Rural and Frontier communities that may not have traditional main streets uh this program was originally funded by the Colorado State Legislature through the covid-19 recovery plan and developed in partnership with cdph and the department of local affairs cdph provided guidance on the request for application language and project scoring criteria as well as sit on the monthly application review panel revitalizing main streets is a dynamic shift for Colorado as it is one of SE Do's first opportunities aside from safe routs to school to focus on active or funding active Transportation uh and to date around 140 projects totaling nearly $10.7 million have been funded fed to promote activity friendly roots to Everyday destinations and Revitalize Colorado's main streets thank you again for your attention I look forward to answering any questions during the Q&A session and now it's my pleasure to hand it off to Tamara to share about the city of Miami Gardens reach program thank you so much Steph um good afternoon everyone as mentioned my name is Tamar La Bruce and I am with the city of Miami Gardens and I serve as the program director for live healthy Miami Gardens I am really pleased to have some time with you this afternoon this afternoon I will present on three current projects that reflect areas of work that are consistent with the cdc's priority of reducing chronic disease through physical activity and nutrition and in particular this work reflects a work that is aligned with action items two and three which Terry have already covered just in terms of background live healthy Miami Gardens was started in 2014 through to a health Foundation of South Florida Healthy Community Partnership Grant which was a six-year $33.75 million Grant the city of Miami Gardens was selected as the grantee to implement this new initiative and serve as the backbone organization overall the goal is to strengthen Community capacity to collaboratively plan and collectively carry out strategies to improve health outcomes in the city and this initiative is part of the city's strategic and systemic effort to reduce poor health outcomes by engaging Community residents to improve identified selected public health indicators we are a collective impact initiative which is really an essential and intentional way of working together and sharing information for the purpose of solving complex problems Collective impact is carried out within a broad and diverse network of community members organizations and institutions our Collective impact initiative is currently made up of 68 organizations and about 100 indiv individuals and the conditions for Collective impacts are reflected here our theory of change helps to guide our work and keeps us keep us focused um the theory of change is a comprehensive descriptive and illustration of how and why a desired change is expected to happen in a com in a particular context and it really reflects the desired long-term goals and outcomes live healthy Miami Gardens focuses on five health impact areas Alcohol Tobacco and Other Drugs mental health Primary Health Care nutrition and physical activity today I will present on these three um projects our breastfeeding project the healthy Corner Store project and our healthy out of school time so our breastfeeding project um offers Education and Training for providers uh we also focus on policy development and implementation we assess OB patients on knowledge history interest and support needs we refer to breastfeeding Support Services we provide out Outreach to local businesses to help support breastfeeding promotion and workplace lactation policies and we also provide Outreach to local universities to encourage them to incorporate evidence-based breastfeeding curriculum in their programs one of the things that I wanted to focus on is our breastfeeding Cafe which um went virtual because of covid and since then we've had 31 virtual sessions of those who participated 56% returned for at least one additional group session and there's been some major um Lessons Learned there one is to be flexible in regards to the virtual space due to covid another is the internal collaboration with Clinic staff to ensure patients enroll for services is key and we've have five different clinics that we're in partnership with to achieve this and another is the collaboration with Community Partners including wig and Metro Miami agency to help promote the program to their client population our healthy Corner Store project is designed to increase access to healthy food by assisting small neighborhood corner stores to stock and Market produ produce currently we're working with 11 stores we also have a healthy recipe contest which takes place on a monthly basis we have a healthy Corner Store designation policy which was passed by our city council we have a healthy retail committee which also is made up of residents to help monitor what happens with the stores and support their efforts we are currently working on a healthy checkout policy which hopefully will be going to Council really soon the project also includes a a huge component focus on marketing and um promoting the stores and making sure that residents know that the stores have these produce we also provide technical assistance to help Implement a work plan which is developed with each of the stores and reflect their individual needs and to help them achieve certification and we also maintain a healthy retail website to promote F fresh food access points and routes and and currently we're working on a community purchasing Group which we hope will help our stores be able to to get produced at a price point that makes it profitable for them our healthy corner store also has have we've partnered with the 11 stores it's currently 11 we just signed on one yesterday um which have taken the pledge to increase access to produce within the city um the impact really what we're trying to achieve is to increase access to produce and to produce and we've been able to do this for about 25,000 and residents and there are some major lessons learned that i' like to cover one is the important of strengthening relationships among the stores the other is to build customer demand through interactive events um which are held at locally at the stores our healthy out of school program it provides assessment of after school settings technical assistance where we also develop a Wellness Plan and work with individual organizations to implement their plans we uh provide a small $10,000 up to $10,000 Grant to support action plan implementation and also to help the sites develop and um strategies for adopting the national Hippa standards I just like to add that since we've been doing the host project which has been in the last five years we have 30 host providers that are meeting an average of 82 .5% of the Hippa standards and this has been a really um huge accomplishment for these organizations thank thank you so much I look forward to your questions and now i' like to pass it on to my colleague Anu thank you Tamara I'm Anu page ja and as Eileen mentioned I lead our divisions program evaluation efforts I get the extreme pleasure today of rounding out our presentation with a celebratory message I will share the collective progress of our span reach and hop recipients as of three years into their five-year Cooperative agreements our recipients have made tremendous progress in such a short period of time and have demonstrated such a commitment to making a difference in our country's efforts to improve places to make the Healthy Choice the Easy Choice we have been truly wowed by them so I'm proud to get to share a little bit about their work as Terry mentioned and as we heard further described in Steph's and Tamara's presentations span reach and hop recipients work on a variety of funded strategies which you can see here some of which are specific to certain Cooperative agreements like food systems for hop and reach and early care and education just for span we ask recipients to report progress to us in two categories the number of settings that provide increased access to opportunities to make healthy choices and the number of people potentially reach through those efforts we have more data than we have time to cover today but I will highlight just a few examples of each this is a depiction of the summary of progress made across the strategies in just three years time isn't this impressive let's talk a little bit more about each of these starting with the first two circles related to physical activity as we heard from Steph earlier span reach and hop recipients work on policies and plans to support improvements in activity-friendly routes to Everyday destinations and they made great progress in this area recipients collectively built or installed over 2,000 miles of activity friendly routes such as sidewalks bike lanes and connections to public transit these are actual routes built out that you can physically see in communities right now and because the high obesity program or hop recipients work in primarily rural areas they have built fewer miles than span and reach but they are no less important in fact much of this work is occurring in underserved communities with the highest need recipients collectively created or enhanced 469 everyday destinations by year three these are places for living working or playing some of the common destinations recipients worked on included parks playgrounds community centers and recreation centers now let's touch on the two nutrition strategies for Healthy nutrition standards recipients work in settings where food is served or sold to increase the number of healthier foods offered recipients are working in over 700 sites and the potential impact in just three years time is a whopping four million people some of the most common sites implementing Healthy nutrition standards are work sites hospitals government agencies food pantries and faith-based organizations now let's look at the progress made by hop and re reach recipients charged with working on the food system strategy recipients work with new or existing food outlets for this strategy they work with Partners to increase the number of places that sell or distribute healthy food in a community such as farmers markets food pantries or mobile markets or by enhancing Transportation options to food Outlets such as by increasing public transit routes or sidewalks to access grocery stores or markets recipients also work with existing food settings to accept food incentive vouchers such as snap the supplemental nutrition assistance program or Wick the women infants and children program they collectively reached over 1.7 million people through these efforts in over 600 places some of the most common places where recipients are doing this kind of work are farmers markets food pantries mobile markets and faith-based organizations taking a look at the bottom row of C CES from the earlier graphic recipients have made impressive strides with millions of people Nationwide to support breastfeeding and early care and education breastfeeding continuative care is achieved by consistent collaborative and seamless delivery of highquality Services for Families from the prenatal period until no longer breastfeeding recipients are working with a variety of new or existing places to enhance lactation support such as clinics hospitals community centers libraries work sites and even online lact support span and reach recipients have made tremendous progress on this strategy potentially reaching over 1.4 million people span recipients are also working to increase implementation of physical activity nutrition and breastfeeding standards and practices in early care and education programs through these efforts they have reached over 1.9 million children now let's talk about how covid-19 impacted this work since the pandemic started two and a half years ago we have heard about recipient creative pivots to continue important chronic disease work in their communities some of those pivots turned out to be fortuitous and recipients discovered new ways to support the communities they serve in the business and Innovation world you may have heard the term stickiness it refers to ideas or methods that have a la lasting impact we ask recipients to share examples of their creative pivots that have staying power and which they plan to continue beyond the pandemic allow me to share just just a couple similar to the example that Tamara shared earlier of Miami Gardens virtual breastfeeding cafes several recipients shifted from an in-person to Virtual format of their breastfeeding lactation support so they could sustain the offering during the pandemic despite facility closures and physical distancing distancing measures they found in fact that this virtual format helped overcome barriers some families were facing with in-person attendance such as those that might not have had child care or transportation to attend an in-person support group doing these classes virtually has been so popular that many recipients have said that they plan to continue offering it to families post pandemic recipients also conducted a number of in Innovations around food security and distribution that may have some stain power power to avoid in-person contact some recipients used a drive-through model to distribute produce at food pantries they noted that clients like this model plus it increased efficiency for the pantry so it allowed them to serve more clients and so they plan to continue beyond the pandemic and this just scratches the surface of recipients progress and Innovations to summarize we have been truly wowed by all that our recipients have accomplished in just three years time all made even more remarkable knowing the added challenges none of us could have predicted with the pandemic span reach and hop recipients have been transforming their communities in many ways and we feel proud to Bear witness to that work I'll now pass it back to Eileen great thank you Anu and thanks to all our speakers for those great presentations on your screen now you'll see several dnpo online resources including our data Trends and Maps State and Community Health Media Center our website and our social media the links for all of these will be provided in the chat also if you're interested in receiving the latest news from dnpo please use the QR code or the link in the chat to subscribe to our list Ser you will receive The dmpo Insider our research Roundup and announcements on future dmpo seminar series Once you register your email address you'll see all of the CDC list serves and you'll want to subscribe to the one that's nutrition physical activity and obesity if you have other questions about the division you can contact us at dnpo policy cdc.gov and with that I think we can open it up for Q&A Harry I think I'm going to kick it off with you earlier we mentioned the latest obesity Maps release where we see rates continue to climb could you talk a little more about what type of investment is needed to really move the needle and obesity thanks Eileen so while Dano's current work through our 71 Public Health practice recipients span reach and hop really adds tremendous value as you saw and have heard from from Steph and Tamara brand a new lots of great successes improving health so there's some great work being done there um however the current resources dedicated to funding States and communities and landrat universities to implement what we know works these five actions it's really quite limited um this is related to the level of available dmpo Investments not the demand of the field as I mentioned earlier uh dnpo resources equivalent to about 32 cents investment per American per year is unlikely to prevent obesity among at risk Americans nor reduce the racial and ethnic disparities in in the National burden of obesity so we really need more commitment um to adequately spread and scale what we know works and what we know is needed for chronic disease prevention I mentioned that for example we fund 16 States and we know 50 states Plus DC can uh can really benefit from that and you know we have 40 reach recipients currently and we know that there are three to 400 communities that could benefit from that work thanks alen great thank you Terry um an new I have a related question for you one of our um registrants asked what are some of the ways we can measure success for obesity uh really looking Beyond just just BMI that's a great question you know Terry described this earlier um that you know we do have a good bit of evidence that shows what works as well as practice-based wisdom so really the evidence and the practice show that that multi-pronged multifaceted approach to obesity prevention is what works best so that's policy change systems environmental changes to ultimately make the Healthy Choice the easier choice so that we can see an increase in healthier Behavior so looking at measuring PR ress in healthier Behavior such as physical activity and healthier eating also looking at um measuring progress through impactful policy changes those can all illuminate progress being made in obesity prevention um something else to think about as we're talking about measurement and looking at progress it's important to consider prioritizing underserved communities that have the highest needs and those that have been disproportionately impacted by obesity and maybe have received fewer resources in the past and opportunities in the past so um I feel like all of that kind of fits Under the Umbrella of measuring progress it's not just about looking at BMI change but rather the entire systems changes that we would like to be seeing in the communities with the highest needs thanks so much and new and Terry I know these are these are hard questions so appreciate all of the thought and effort that that you all have put into this um Steph I'm going to have the next question for you how has Colorado promoted the Colorado downtown Street guide and its guidelines for the for better streets for people walking and biking thanks Eileen uh so this guide has been out for several years it was actually published before covid um and so we when it was initially uh launched we traveled throughout the state um our team at cdph as well as with Partners um with the Department of local Affairs and the Department of Transportation to host workshops with community members uh and leaders who are interested in learning more about how to create healthier streets and safer streets um so it was this again multi- agency promotion um through in-person interaction um so we can answer questions in real time um and provide context specific Direction um and then we continue to um share this Resource as much as we can when we're providing technical assistance with communities um uh most recently or an a recent example was uh we were providing technical assistance in um one of the counties in in Colorado um with their Public Health Department um where the public health department is actually participating uh was asked to participate in a master planning process so providing this Resource as guidance uh to the public health leaders who are then able to more um thoroughly interact in that Master planning process um and have some context that might not be um as readily available to them since they are public health uh professionals so those are a couple ways that we've been able to promote it great thank you Steph um I appreciate you highlighting the partnership component I think if we as we've said these are really complicated issues that and they're just not things that we can do in a silo or on our own it really requires partnership across federal state and local levels and so hearing these examples of how those Partnerships come together I think is is really helpful so thank you camera the next question that came in is for you uh can you talk a little bit more about the healthy techout policy sure um the healthy checkout policy is our latest attempt to really make the Healthy Choice the Easy Choice I think all of us have had the experience when you're waiting to check out that these stores intentionally put things right at that right at the checkout line just to Temp you and to get you to make those last minute very compulsive kind of um purchases usually those items are the are not the healthiest items they're really you know the bad the bad food and they're very tempting and um and they're just not what we want people to be you know making decisions around when they're making their purchases so the healthy checkout policy will change what the stores are able to carry and display in that area in those areas within the store so that when you are standing there and you're kind of just trying to pass time waiting to check out what's going to be reflected there are the choices that are a lot healthier for you so if you are tempted to make that last minute kind of compulsive impulsive um purchase then you're actually now you know having um the healthier item so that could be you know water versus sodas and and maybe fruit snacks versus you know potato chips and things of that nature so we're working right now with our city council um obviously to get something like this off the ground requires quite a bit of um education and really a shift in culture and thinking so we've been doing some um some pre-work with our city council our city manager's office and our City attorney to get something in writing that um that that they can support that will eventually go to to city council and then we'll be working with our partners to help Implement that policy in Miami Gardens great thank you Tamra I uh I think we've all been leaving the grocery store in the checkout line hungry and seeing all of the candy options and knowing how tempting it can be so it's it's I think this is a great example of how these little behavioral design changes can really make a difference every day for people so thank you for that example thank you um I also see a question about the Obesity maps and whether we have data on kids as well so these maps are only for adult obesity prevalence in 2021 but we are going to put a link in the chat where you can find National Data on childhood obesity um a new next question is for you are there any examples of ban hop and reach activities that you've been able to leverage that could also contribute to addressing behavioral mental health issues faced by children youth and students that's another great question you know I think we all recognize that health is not siloed right we want to treat people as whole individuals and and parts of communities so um yeah there's amazing examples of this with our span reach and H recipients um they have done a great job of you know with our community clinical linkages that providers clinical providers are not just referring patients to uh needs related to hunger or chronic disease prevention and management but also basic needs mental health services housing job assistance um things that really do affect a family's overall well-being able to thrive and survive um even Beyond just the nutrition and physical activity space I think also our our recipients do a great job of connecting with local leaders and community members to learn what is what works on the ground what matters to the people in the community the most so that again the efforts aren't siloed and we treat people as whole individuals Beyond just uh physical health but mental and Behavioral Health as well St um another question for you how does Colorado structure the quick win funding and what are the project par parameters um so we have a we've structur the quick win projects to be on a reimbursement model um so we um for previous years it's been that communities could apply for up to $5,000 to purchase equipment that could be used used for um promoting physical activity and active Transportation um so we can't uh pay for things like installation construction staff time or incentives but the direct equipment purchase um and when uh in our application within the most recent year year four um we asked community members to talk about how um this project would address existing Community needs and barriers and and to show that um show the need and barrier through the use of data so citing local plans any kind of walking audit results or survey results um we wanted to make sure we were uh working in populations that you know trying to Target some priority population so asking folks to identify um who this project was intended to serve and and the estimated reach for that um and showing a Clear Connection uh with local governments so um we open this up to you know libraries or school districts or nonprofits but often um these projects get installed on public land so making sure there's a close relationship with local governments to make sure um that um the equipment can be installed in the proper and Speedy methods as well um and this year in our application we also asked folks to um to identify how this project will help Advance equity in the community so we provided a definition um that cdph uses for equity and explaining how achieving Equity requires eliminating barriers and transportation systems um we we highlighted Transportation Systems in this project specifically um but that was a key component of the scoring criteria um as well as trying to prioritize communities where um there might be a disparity in healthy eating and that living throughout Colorado um so those are some of the key components of the equipment projects thank you so much Steph that's actually uh perfect lead into this next question which I think um Terry I'll start with you but then I'll open it up to the group because I think this is something that everyone everyone can weigh in on how do we address social determinants of health and Health Equity within our five action steps and strategies particularly around rural and urban populations and individuals with low income and vulnerable populations so I think Steph just gave some great examples of of Health Equity and the work that that her group is doing Terry can you talk about this a little bit more broadly um and you maybe share some thoughts on how we look at this in terms of evaluation and then Tamara also please jump in with your thoughts yeah thanks Eileen I'll just I'll just start by saying through our current program work through span reach and hop are the recipients really work to focus on the disparities Rel to inadequate nutrition or physical inactivity and we know these disparities we've discussed St can stem from a variety of factors race ethnicity geography Mobility limitations intellectual disability Etc and and we also uh encourage our recipients to design culturally tailored interventions you heard a little bit about that uh as well and I'm sure that Tamara and Steph can talk more about that um across the across these priority actions that states and communities can take um and the other thing I'll say at a broader level is you know Community voice matters and so we encourage the use of a community- based participatory approach where the local Coalition can really be active into driving the the work that that you do that they do to address some of these Health disparities and drivers of social terms of health sure I'd like to jump in I think a couple of things that Terry mentioned um are so critically important and and is reflective of the experience that we're having in Miami Gardens um for example Mii Gardens is like 87.5% you know black africanamerican but our Hispanic population is CH is CH is growing so that's a shift in our demographic and we've had to really be um much more intentional to be inclusive of that um segment of our population so we're getting ready to roll out an entire campaign that is um promoting physical activity that is promoting all of the amazing parks and green spaces that we have all of the activities that our residents have access to and then doing that campaign we're now for the first time having conversations and having to um allocate you know some aspect of our budget to having everything translated in Spanish so that again we can be much more inclusive we've never had to really consider that in mind Gardens and um and it's not something that we've done in other areas of work with the city obviously health and wellness is not a typical Municipal function but we've had to really play a role as an initiative of the city to really push this message and encourage the city to be much more inclusive in other areas of work as well um so that's a really important piece the other piece that he mentioned that um we're also trying to focus on this is the idea of of being intentional about having folks who are representative of the community be involved in the work so we're using Community Liaisons and actually hiring people from the community to play the role of you know Health uh Champions and really be at the very grassroot level engaging with with residents and um demonstrating you know doing demonstration projects and kind of displaying and showing our community what is possible as it relates to um physical activity and both of those focus focuses have really been working well and we feel good about you know this new kind of approach in terms of being much much more inclusive great thank you so much um as Terry mentioned I think you know Equity is really foundational for dnpo work and so it's great to hear how it's embedded in the work and how our recipients are implementing this I knew I'm going to turn it back to you can you talk a little bit about how evaluation plays a role in equity yeah Tamara really touched on what I was thinking of which is engaging community members in the entire process start to finish whether it's program design and implementation or evaluation and so we've seen a lot of success with our recipients engaging community members to collect data or conduct evaluation activities building that capacity the community level and engaging those community members it just is a win-win all across because they know the community well as well as it's building a strength and an asset in the community so just wanted to underscore that point that Tamara made and um that Terry made about community- based participatory approaches I think that's what we love to see with uh program evaluation as well great thank you so much Anu we have a couple minutes left so I'm going to try and get through a few more questions Tamara another question for you this one around the virtual breastfeeding Cafe and I see a couple different questions on this so one it looks like the virtual options was was really successful do you see this as a um replacing in person do you see a hybrid approach moving forward and then for these breastfeeding cafes um are there certain uh ethnicities that you're seeing more who who take advantage of it sure um we've been having that conversation I think probably every organization every business you know is having the conversation in terms of what it what does it look like um in regards to either maintaining some virtual presence or being all virtual or all in person I think in order to again to be as inclusive as possible we're going to be looking at a hybrid I will say however that um we were able to make the shift very quickly to Virtual and it's actually paid off um and great dividends we know that for some people um the the option to to participate virtually has really worked out and when you talk about you know social determinance of health and all of the barriers that some folks in our community face on a daily basis um in regards to you know whether it's Transportation or not having you know know adequate uh support in terms of daycare and um and those kinds of things we know that more people are participating as a result of being virtual but we also know that um we we love the interaction and the face tof face time with our clients a lot of people need you know much more support than maybe we're able to provide on a on a virtual basis so we're definitely looking to do some hybrid but we can't imagine moving forward and not having that option you know um for our our res to participate virtually because the the feedback that we've gotten have really been positive and not just across the the breastfeeding breastfeeding Cafe but across all of our other projects so we definitely will be doing a hybrid and I'm sorry second part of your question I yes yes thank you I was just gonna say so um one of our other participants is asking um how the ethnic distribution looks in these breastfeeding cafes um we have been trying to to be really a lot more intentional in making sure that our residents our black and brown residents are um being engaged in breastfeeding we know that there's a disparity where that is concerned and we um we've been trying to to get the message out there and in terms of the importance of this and trying to build the support that is culturally uh relevant and and conducive to engaging more folks that are Bown in bra and we've seen an increase where that is concerned obviously Miami Gardens is predominantly African-American um as I mentioned earlier and there are some major um challenges where that is concerned but we are seeing a shift we're seeing a cultural shift and we're seeing a lot more acceptance not just in terms of our residents but also the city and all the um businesses that we've been working with who are you know willing to talk with us and have conversations about how they can be much more supportive um in terms of the policies and the and the programs that they put in place to support this very important function we're also um doing a lot more focusing on the the person who is nursing and their support system whether that be a mom um that is helping or a partner a husband or whatever the case may be to be much more inclusive so that we're building an entire support system for that individual to make sure that they're successful so as a result of quite a bit of effort we are seeing a bit of a shift all right we're getting close at the end of time but there's one more question that I do want to address because I see it coming in a couple different ways um a lot of excitement around these programs Perry can you tell us in one minute or less how people can get involved with these programs so uh first of all uh check out our state and local programs link that has been shared and you can see on that site you can see the program information that's available through span reach and hop each one of those programs will if you're in that state that has that program will have a contact name feel free to reach out to that person to learn more about that particular program um and and absolutely um uh do check out our forecast information that we shared in the chat about future funding and we'll we'll be having an information call in early 2023 about those uh span reach and hop future funding opportunities so love to have you involved thank you so much Terry thank you all again to all our speakers for these great presentations this is going to be our last seminar series for 2022 but we'll pick these back up in the new year so please keep an eye out for invitations um for invites thank you again to everyone for joining and again thank you to our speakers have a great afternoon