Planning and Performance Measurement Reporting System. Policy, Systems, and Environmental Change Module. User Guide

Transcription

1 Planning and Performance Measurement Reporting System Policy, Systems, and Environmental Change Module User Guide 1

2 Table of Contents Introduction Overview: Minnesota s Statewide Health Improvement Program.3 Overview: CDC s Community Strategies and Measurements to Prevent Obesity.4 Overview: Local Public Health Planning and Performance Measurement Reporting System...5 Formation of the New Module Training...10 Contact Information.. 10 Table comparing CDC and PPMRS strategies...11 References.. 13 Appendix A: Module Questions...14 Appendix B: Glossary

3 Introduction Overview of Minnesota s Statewide Health Improvement Program The Statewide Health Improvement Program (SHIP) was developed and established at the Minnesota Department of Health (MDH) in response to the 2007 Minnesota Legislature's request to develop a plan for statewide health promotion to address the rising cost of health and health care in the state. SHIP, which is an expanded version of the Steps to a HealthierMN model, will help Minnesotans live longer, better, healthier lives by reducing the burden of chronic disease. SHIP was written into the legislative bill calling for overall health care reform in Minnesota. In this health reform legislation that was signed into law in 2008, Governor Pawlenty and the Minnesota State Legislature allocated millions of dollars for the program over fiscal years 2010 and After a competitive process, SHIP implementation began July 2009 when grants were awarded to community health boards and tribal governments across Minnesota. Grantees are required to create community action plans, assemble community leadership teams, and establish partnerships. To improve the health of Minnesotans, grantees will utilize policy, systems and environmental changes in four settings: schools, worksites, health care and community. SHIP efforts focus on interventions that address either obesity (through physical inactivity and unhealthy eating) or tobacco as key risk factors. By focusing on these risk factors, SHIP will address the top three preventable causes of illness and death in the United States. The Menu of Interventions, a list of potential interventions that grantees selected as part of the application process, was developed by MDH and multiple stakeholders after a rigorous review process. Each intervention in the Menu meets a basic set of criteria. They: Address at least one SHIP risk factor (tobacco, physical activity, or nutrition); Occur in at least one SHIP setting (school, community, worksite or health care); Are population-based versus individual-based; Emphasize prevention versus individual treatment; Address policy, systems, or environmental change; Are evidence-based or practice-based; and Have associated evaluation methods. The program will be evaluated at both the state and local level to ensure progress is made toward a set of measurable outcomes. 3

4 Overview of the CDC s Community Strategies and Measurements to Prevent Obesity Many states and communities are working to reverse the obesity epidemic in the United States by creating policy, systems and environmental changes that support healthy eating and active living. To do so effectively, local governments need information about the current conditions in their community. They also need tools to track progress over time and to compare themselves to similar communities. To address these needs, the Centers for Disease Control and Prevention (CDC) began to work on identifying and recommending obesity prevention strategies and corresponding measurements that local governments and communities can use to plan, implement and monitor initiatives to prevent obesity. The process included an intensive review of the scientific literature to identify a broad range of strategies, consultation and discussion with nutrition and active living experts to identify the most feasible, valid and effective strategies from the review, and pilot testing by 20 local government representatives that led to additional revisions. This process resulted in the 2009 release of 24 Recommended Community Strategies and Measurements to Prevent Obesity in the United States (referred to from here on as CDC s Measures). At the same time these strategies and measures were being developed at the CDC, SHIP s menu of interventions and measures were being developed at the Minnesota Department of Health. Since these two programs have overlapping goals and objectives, the MDH evaluation staff recognized potential in using CDC s Measures to help document progress on the objectives of both SHIP and the Minnesota Obesity Plan. Therefore, they contacted and received permission from CDC to pilot-test an adapted version of the measures through the state s Local Public Health Planning and Performance Measurement Reporting System. 4

5 Overview of the Planning and Performance Measurement Reporting System The Local Public Health (LPH) Planning and Performance Measurement Reporting System (PPMRS) is a web-based reporting system that collects consistent, comparable and relevant information about the activities, staffing, funding and performance of Minnesota s local health departments. The reporting system was established in 2006, and data are collected annually from all local health departments in Minnesota. The information helps to demonstrate the purpose and value of local health departments and aids in decision-making about public health activities and funding. It also provides information to a variety of stakeholders, including the Minnesota Department of Health, local elected officials, the Legislature, and local health departments. The PPMRS was chosen as the mechanism for pilot-testing the Minnesota adaptation of CDC s Measures because it was an existing data collection system used by every local public health agency. Using the PPMRS was beneficial for many reasons, including: Local public health were already familiar with the system. The policy, systems and environmental change questions around obesity and tobacco could be part of the larger pool of topics that were already being reported on by local public health (ex. alcohol problems, environmental health problems) and thereby normalize obesity prevention and policy, systems and environmental change as part of what public health does. It allowed for baseline reporting of local public health activities before community grants on obesity and tobacco prevention (SHIP) were distributed. It is part of a required annual reporting system for local public health, which assures 100% response rate every year that the measures are included in the state s system. All local public health are able to report on these strategies, even if they do not get funding for obesity and tobacco prevention. This allowed for the collection of state baseline data, irrespective of who applied for and participated in SHIP. 5

6 The Formation of the Policy, Systems and Environmental Change Module In order to accommodate the differences between CDC s Measures and the objectives of the Statewide Health Improvement Program and Minnesota Obesity Plan, MDH adapted the measures to create a new module for the Local Public Health Planning and Performance Measurement Reporting System. The new module was named the Policy, Systems and Environmental Change Module Questions (PSE). The SHIP Evaluation and Data Collection Work Group worked to adapt CDC s Measures. The Work Group had 20 members representing 11 units across MDH, local public health and the Minnesota Department of Education. After the Work Group modified the measures, additional local public health staff reviewed the measures and provided feedback. The modifications included: added strategies; added clarification questions to the indicators, added preliminary question and modified wording. Details of the modifications are listed below. Strategies Added: 1. Tobacco strategies added: Tobacco is a targeted risk factor of SHIP, but it is not part of CDC s Measures. Thus, eight strategies were added (strategy #33-#40). These strategies were based primarily on the SHIP interventions (from the Menu of Interventions) that target tobacco as a risk factor. 2. Worksite strategies added: With the exception of breastfeeding in worksites, two settings which SHIP nutrition and obesity interventions address that are not addressed in CDC s Measures are worksites and health care. Three strategies were added to address worksite interventions (#29 worksite physical activity, #30 consumption of healthy foods in worksites, #32 worksite wellness policies); they were based on the SHIP interventions. Nutrition and obesity strategies in health care settings were not added; instead SHIP will collect information on these topics through progress reports and other methods. 3. Divided two of CDC s strategies: The data collection questions for CDC s #1 and #2 strategies ask about policies in local government facilities and schools. The SHIP interventions are categorized by risk factor and setting, so similarly, the PPMRS PSE Module is organized first by risk factor, then by setting within each risk factor. Therefore, because CDC s #1 and #2 strategies have corresponding SHIP interventions for communities and schools, these strategies were divided into two separate PPMRS strategies to create a separate measure for the two different settings. 4. Cocurricular physical activity strategy added: CDC s Measures address physical activity in schools as part of physical education and extracurricular activities. However, further work is being done throughout Minnesota that includes the comprehensive integration of physical activity throughout the school day (cocurricular physical activity), not just in physical education classes or as part of extracurricular activities. In order to capture this, and additional strategy and corresponding performance measure was added (#24). 6

7 5. CDC s Strategy 10 divided into two separate strategies: The performance measure for CDC s strategy #10 was divided into two separate PPMRS strategies (#17 and #18 in PPMRS PSE) to account for the difference between sugar-sweetened beverages and fruit juice and to emphasize the difference between their corresponding strategies. The first refers to restricting the consumption of sugar-sweetened beverages and the second refers to reducing the consumption of fruit juice. Questions Added to Each Indicator: 6. Policy development process question added: Since policy changes take place over an extended period of time and happen in various ways, a policy development process question was added to all indicators. 1 This will allow for better documentation of incremental changes in the policy process from year to year. This measure was adapted from the Community Health Assessment and Group Evaluation (CHANGE) tool that was developed by the Division of Adult and Community Health within the National Center for Chronic Disease Prevention and Health Promotion (K. Voetsch, personal communication, December 1, 2008). Example: 2f. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 7. SHIP funding question added: As part of the ongoing evaluation of SHIP, it is important that the work being completed with SHIP funds can be differentiated from work that is funded from other sources. Therefore, it was necessary to add the following question to all strategies/indicators 1 for which data is being collected: Has any work on this policy, rule or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? This question was grayed out* for the baseline reporting year (2008) but data collection will begin in 2010, for the reporting year

8 8. Number of sites question added: In order to get a more comprehensive measure of how much work was done and not just if work was done, a question was added to all strategies 1 asking how many sites are working on the strategy. Example question and corresponding explanation for the remainder of the questions in the strategy: 2a.Is your LHD working with any planning department (or has your LHD worked with your planning or other departments) within your local jurisdiction on a policy for designing and operating streets 2b.If yes to question 2a, how many sites are you working with on the above policy? Enter whole number_ The questions below are to be answered by anyone who answered yes to question 2a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources 9. A text box was added at the end of each indicator 1 to allow LPH to report on anything not captured by the previous questions. Example: 2g. Please include any additional information that will be important to understanding your progress on this policy Preliminary Question Added: 10. Preliminary question added: So as to minimize the burden to local public health, at the beginning of the PSE Module, a list of all the strategies covered in the PSE Module was presented. If the local public health reporting entity had done work on any of the strategies, they would proceed to answer questions relevant to each strategy. If they had not done work on any of the strategies, then the skip pattern took them out of the PSE Module and to the next section in the PPMRS. In 2009, the policy systems and environmental change questions were incorporated into the PPMRS for the 2008 reporting period. In an effort to collect baseline data, LPH departments were instructed to answer these questions based on their activities over the past five years. For the 2009 reporting period and beyond, local public health will be asked to report their activities in the past year. Please answer the following questions for each strategy based on your work over the past 5 years. <because this was baseline, next year they will only record what happen in the past year> You only need to complete the strategies questions if you have done work in this strategy over the past 5 years. All bold words are defined in the Glossary. If you have not done any work on the following strategies please check here: 8

9 Wording Modified: 11. Changed wording on the first data collection question: CDC s Measures ask local governments to report on all activities in the local jurisdiction. However, the PPMRS exists specifically as a reporting system for local public health agencies to report on their activities. So, to stay consistent with the existing PPMRS format, the PSE questions ask local public health to report on the activities they were involved in. If they were not involved in the change, it will not be recorded. Hence, the reporting system does not give an overview of every policy system or environmental change that has happened in the local jurisdiction. Example: 2a. Is your Local Health Department (LHD) working with any planning department (or has your LHD worked with your planning or other departments) within your local jurisdiction on a policy for designing and operating streets with safe access for all users? 12. Changed wording on CDC s Strategy 5: The suggested measure for CDC s strategy #5 refers to farmer-days. This term is not well known, so instead, the PSE Module asks about famers markets, community supported agriculture, farm stands and farm to school. Other Change: 13. Did not collect data on strategies and corresponding measures that required GIS information: Concerns were expressed about how all the LPH departments would be able to get the information needed for the GIS indicators and the burden it might place on their departments. For this reason, the GIS indicators were not asked at baseline and it was decided that MDH would explore GIS opportunities for local public health in a validation study beginning in the latter part of These measures were also grayed out* for the baseline reporting year. * In the attached PSE module, some of the questions are grayed out. In the actual data reporting system, these questions are preceded by the following instructions: Not to be answered at this time. These questions were inputted into the web-based reporting system with the intent that the data would not be collected at baseline but could easily be added for future data collection if needed. 1 These questions were not added for the PPMRS PSE strategy #19 which is about participating in community coalitions. 9

10 The training for the Policy Systems and Environmental Change Module In late January of 2009, MDH conducted two WebEx trainings on the new module for local public health departments. Almost all Local Public Health departments had at least one representative who attended the training. The topics included the purpose of the PSE Module, the layout, an explanation of the five year time period for baseline data collection and an example of one of the PSE strategies and corresponding questions. During the training and throughout the month that the LPH departments were completing the Module, MDH staff was available to answer questions. There were only a few questions asked by LPH departments, and the questions that were asked were for clarification purposes, including why five years of data was needed, what the data are being used for and how the information should be collected for the past five years. For more information please contact: Joanne Moze CDC Research and Evaluation Fellow Statewide Health Improvement Program Minnesota Department of Health (651) Joanne.moze@state.mn.us Laura Hutton, M.A. Obesity Prevention Evaluation Coordinator Chronic Disease Risk Reduction Unit Minnesota Department of Health (651) Laura.Hutton@state.mn.us Sapna Swaroop, Ph.D. Monitoring & Evaluation Coordinator Steps to a Healthier Minnesota & Statewide Health Improvement Program Minnesota Department of Health (651) sapna.swaroop@state.mn.us 10

11 Table of CDC strategies with the corresponding PPRMS PSE Module strategies CDC Strategy Corresponding PPRMS Strategy Additional Info 1. Communities should increase availability of healthier food and beverage choices in public service venues 2. Communities should improve availability of affordable healthier food and beverage choices in public service venues 12. Increase availability of healthier food and beverage choices in the public service venues 26. Increase availability of healthier food and beverage choices in schools 14. Use pricing strategies to promote healthy choices in public service venues 27. Use pricing strategies to promote healthy choices in school Split into communities and schools Split into communities and schools, strategies are worded slightly different but the measures are the same 3. Communities should improve geographic availability of supermarkets in underserved areas 4. Communities should provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas. 5. Communities should improve availability of mechanisms for purchasing foods from farms 6. Communities should provide incentives for the production, distribution, and procurement of foods from local farms 7. Communities should restrict availability of less healthy foods and beverages in public service venues 8. Communities should institute smaller portion size options in public service venues 9. Communities should limit advertisements of less healthy foods and beverages 10. Communities should discourage consumption of sugar-sweetened beverages 11. Communities should increase support for breast feeding 12. Communities should require physical education in schools 13. Communities should increase the amount of physical activity in PE programs in schools 14. Communities should increase opportunities for extracurricular physical activity 9. Improve geographic availability of supermarkets 8. Provide incentives to food retailers that offer healthier choices in underserved areas. 10. Improve availability of mechanisms for purchasing foods from local farms 11. Provide incentives for procurement of food from local farms 25. Restrict availability of less healthy foods and beverages in schools 13. Institute smaller portion size options in public service venues 15. Limit advertisements of less healthy foods and beverages in public service venues 17. Restrict consumption of sugarsweetened beverages in child are venues 18. Reduce consumption of fruit juice in child care venues 31. Increase support for breastfeeding in worksites 22. Require physical education in school 21. Increase the amount of physical activity in physical education programs in schools 23. Increase opportunities for extracurricular physical activity in schools GIS GIS Split into sugar-sweetened beverages and fruit juice 11

12 CDC Strategy Corresponding PPRMS Strategy Additional Info 15. Communities should reduce screen time in public service venues 16. Communities should improve access to outdoor recreational facilities 17. Communities should enhance infrastructures supporting bicycling 18. Communities should enhance infrastructure supporting walking 19. Communities should support locating schools within easy walking distance of residential areas 20. Communities should improve access to public transportation 21. Communities should zone for mixed use development 22. Communities should enhance personal safety in areas where persons are or could be physically active 23. Communities should enhance traffic safety in areas where persons are or could be physically active 24. Communities should participate in community coalitions or partnerships to address obesity None None None None None 16. Reduce screen time in child care venues 5. Improve access to recreational facilities 6. Enhance infrastructure supporting bicycling 3. Enhance infrastructure supporting walking 20. Locate schools within easy walking distance from residential areas GIS GIS GIS 4. Improve access to public GIS transportation 7. Zone for mixed use development GIS 1. Enhance personal safety in areas where persons are or could be physically active 2. Enhance traffic safety in areas where persons are or could be physically active 19. Participate in community coalitions 24. Increase opportunities for cocurricular physical activity in schools 28. Improve availability of affordable healthier food and beverage choices in schools 29. Increase opportunities for physical activity in worksites 30. Increase consumption of healthy foods in worksites 32. Implement comprehensive wellness policies and programs for employees Grayed out - See note below GIS Cocurricular education Grayed out -See note below Worksite Worksite Worksite None Tobacco strategies Tobacco Note: PPRMS strategies #20 and #28 were based on an earlier version of CDC's Recommended Community strategies and Measurements to Prevent Obesity. According to the MMWR article, these strategies were changed after final revisions in January 2009, which was after the PPRMS PSE module was finalized (Kettel, 2009). Therefore, these changes were not captured in the final version of the PPRMS PSE module that was used in March of

13 References Keener, D., Goodman, K., A., Zaro, S., & Kettel Khan, L. (2009). Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Atlanta, GA: U.S. Department of Health and Human Services, Center for Disease Control and Prevention. Kettel Khan, L., Sobush, K., Keener, D., Goodman, K., Lowry, A., Kakietek, J., & Zaro, S. (2009). Recommended community strategies and measurements to prevent obesity in the United States. Morbidity and Mortality Weekly Report, 58(RR-7), Minnesota Department of Health. (2009). Guide to implementing and evaluating interventions. Retrieved from 09.pdf. 13

14 Appendix A Planning and Performance Measurement Reporting System (PPMRS) Policy, Systems, & Environmental Change (PSE) Module for Local Public Health (LPH) Questions *Note: Questions highlighted in gray on the document will not be asked for 2008* 14

15 Performance Measures: PSE Module FRONT SCREEN Please answer the following questions for each strategy based on your work over the past 5 years. You only need to complete the strategies questions if you have done work in this strategy over the past 5 years. All bold words are defined in the Glossary found at (SHIP website?). If you have not done any work on the following strategies please check here: POLICY, SYSTEMS, AND ENVIRONMENTAL CHANGE STRATEGIES: OBESITY, PHYSICAL ACTIVITY, & NUTRITION COMMUNITY 1. Enhance personal safety in areas where people could be physically active 2. Enhance traffic safety in areas where people could be physically active 3. Enhance infrastructure supporting walking 4. Improve access to public transportation 5. Improve access to recreational facilities 6. Enhance infrastructure supporting bicycling 7. Zone for mixed use development 8. Provide incentives to food retailers that offer healthier choices in underserved areas 9. Improve geographic availability of supermarkets 10. Improve availability of mechanisms for purchasing foods from local farms 11. Provide incentives for procurement of food from local farms 12. Increase availability of healthier food and beverage choices in public service venues 13. Institute smaller portion size options in public service venues 14. Use pricing strategies to promote healthy choices in public service venues 15. Limit advertisements of less healthy foods and beverages in public service venues 16. Reduce screen time in child care venues 17. Restrict consumption of sugar-sweetened beverages in child care venues 18. Reduce consumption of fruit juice in child care venues 19. Participate in community coalitions SCHOOLS 20. Locate schools within easy walking distance from residential areas 21. Increase the amount of physical activity in physical education programs in schools 22. Require physical education in schools 23. Increase opportunities for extracurricular physical activity in schools 24. Increase opportunities for cocurricular physical activity in schools 25. Restrict availability of less healthy foods and beverages in schools 26. Increase availability of healthier food and beverage choices in schools 27. Use pricing strategies to promote healthy choices in schools 28. Improve availability of affordable healthier food and beverage choices in schools WORKSITES 29. Increase opportunities for physical activity in worksites 30. Increase consumption of healthy foods in worksites 31. Increase support for breastfeeding in worksites 32. Implement comprehensive wellness policies and programs for employees HEALTHCARE 15

16 SHIP will collect information on your LHD s policy, systems, and environmental change work in healthcare settings through progress reports and other methods. TOBACCO COMMUNITY 33. Implement policies for tobacco-free recreational grounds 34. Implement voluntary smoke-free housing policies for multi-unit housing SCHOOLS 35. Reject funding/sponsorship from tobacco companies and tobacco front groups 36. Implement policies for tobacco-free school grounds and school-sponsored events 37. Implement mechanisms to connect students with existing cessation services WORKSITES 38. Implement policies for tobacco-free worksite grounds 39. Implement mechanisms to connect employees with existing cessation services HEALTHCARE 40. Implement policies for tobacco-free grounds for health care facilities 16

17 Strategy #1: Enhance personal safety in areas where people could be physically active Performance measure: Total number of operating streetlights relative to the total non-highway street miles within a local jurisdiction and proportion of residential and commercial buildings that are vacant versus occupied. 1a. What is the total number of operating streetlights within your local jurisdiction? Enter a whole number 1b. What is the total number of vacant residences within your local jurisdiction? Enter a whole number 1c. What is the total number of non-vacant or occupied residences within your local jurisdiction? Enter a whole number 1d. What is the total number of vacant commercial buildings within your local jurisdiction? Enter a whole number 1e. What is the total number of non-vacant or occupied commercial buildings within your local jurisdiction? Enter a whole number 17

18 Strategy #2: Enhance traffic safety in areas where people could be physically active Performance measure: Local government has a policy for designing and operating streets with safe access for all users, including pedestrians, bicyclists, motorists, and mass transit riders, or all ages and abilities as suggested by the National Complete Streets Coalition. 2a. Is your LHD working with any planning department (or has your LHD worked with your planning or other departments) within your local jurisdiction on a policy for designing and operating streets with safe access for all users? 2b. If yes to question 2a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 2a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 2c. Which of the following elements does your policy include? (check all that apply) Specifies that all users includes pedestrians, bicyclists, transit vehicles and users, and motorists, of all ages and abilities. Aims to create a comprehensive, integrated, connected network. Recognizes the need for flexibility; that all streets are different and user needs will be balanced. Is adoptable by all agencies to cover all roads. Applies to both new and retrofit projects, including design, planning, maintenance, and operations. Makes any exceptions specific and sets a clear procedure that requires high-level approval of exceptions. Directs the use of the latest and best design standards. Directs that complete street solutions fit in with the context of the community. Establishes performance standards with measurable outcomes. 2d. Please name and briefly describe the policy, rule, or regulation: (Text Box 250 words) 2e. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 2f. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 2g. Please include any additional information that will be important to understanding your progress on this policy. (Text box 250 words) 18

19 Strategy #3: Enhance infrastructure supporting walking Performance measure: Total miles of paved sidewalks relative to the total non-highway street miles within a local jurisdiction. 3a. What is the total mileage of paved streets managed and paid for by your local jurisdiction? (excluding highways) Enter a whole number 3b. What is the total mileage of paved sidewalks in your local jurisdiction? Enter a whole number 19

20 Strategy #4: Improve access to public transportation Performance measure: The percentage of residential and commercial parcels in a local jurisdiction that are located within a one-quarter mile network distance of a bus stop. 4a. How many residential parcels are there in your local jurisdiction? Enter a whole number 4b. Of the total number of residential parcels reported in question 4a, what number are located within a one-quarter mile network distance of a bus stop? Enter a whole number 4c. How many commercial parcels are there in your jurisdiction? Enter a whole number 4d. Of the total number of commercial parcels reported in question 4c, what number are located within a one-quarter mile network distance of a bus stop? Enter a whole number 20

21 Strategy #5: Improve access to recreational facilities Performance measure: The percentage of residences within a local jurisdiction located within a one-half mile network distance of an outdoor public recreational facility entrance. 5a. What is the total number of residences within your local jurisdiction? Please enter a whole number 5b. Of the residences reported in 5a, how many are located within a one-half mile network distance of an outdoor public recreational facility entrance? Please enter a whole number 21

22 Strategy #6: Enhance infrastructure supporting bicycling Performance measure: Total miles of designated bike paths and bike lanes relative to the total non-highway street miles within a local jurisdiction. 6a. What is the total mileage of paved streets managed and paid for by your local jurisdiction (excluding highways)? Enter a whole number 6b. What is the total mileage of designated biking paths and bike lanes within your local jurisdiction (Class I bike facilities and Class II bike facilities)? Enter a whole number 22

23 Strategy #7: Zone for mixed use development Performance measure: Percentage of zoned land area within a local jurisdiction that is zoned for mixed use that specifically combines residential use with one or more commercial, institutional, or other public land uses. 7a. What is the total area of zoned land within your local jurisdiction, in square miles? Enter a whole number 7b. Of the area reported in 7a, how many acres are zoned for mixed use? Enter a whole number 23

24 Strategy #8: Provide incentives to food retailers that offer healthier choices in underserved areas Performance measure: The local government offers at least once incentive to new and/or existing food retailers that offer healthier food and beverage choices in underserved areas. 8a. Does your local government offer at least one incentive to new and/or existing food retailers that offer healthier food and beverage choices in underserved areas? 8b. If yes to question 8a, how many sites are you working with on the above incentive? Enter whole number The questions below are to be answered by anyone who answered yes to question 8a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 8c. Check each incentive that is offered to local retailers. (check all that apply) Tax benefits Technical assistance Waivers for local ordinance requirements Other (please specify: ) 8d. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 8e. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 8f. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 8g. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 24

25 Strategy #9: Improve geographic availability of supermarkets Performance measure: Within underserved areas within a local jurisdiction, the number of supermarkets located within one-quarter mile network distance of a public transit stop, per 10,000 residents. 9a. What is the total number of supermarkets that are located within underserved areas in your jurisdiction? Please enter a whole number 9b. Of the supermarkets that are located within underserved areas in your jurisdiction, how many are located within one quarter mile network distance from a public transit stop? Enter a whole number 25

26 Strategy #10: Improve availability of mechanisms for purchasing foods from local farms Performance measure: A policy exists to implement mechanisms for purchasing foods from local farms. 10a. Is your LHD working on (or has your LHD passed) a policy or regulations to implement mechanisms for purchasing foods from local farms, including farmers markets, community-supported agriculture (CSAs), farm stands, and farm-to-school initiatives? 10b. How many licensed farmer s markets are in your local jurisdiction? Please enter a whole number 10c. How many licensed farm stands are in your local jurisdiction? Please enter a whole number 10d. What is the total annual number of farmer-days at licensed farmers markets and licensed farm stands within your jurisdiction? Please enter a whole number 10e. If yes to question 10a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 10a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 10f. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 10g. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 10h. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 10i. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 26

27 Strategy #11: Provide incentives for procurement of food from local farms Performance measure: Local government has a policy that encourages the production, distribution, or procurement of food from local farms in the local jurisdiction. 11a. Is your LHD working on (or has your LHD passed) a policy that provides incentives for the production, distribution, or procurement of food from local farms? 11b. If yes to question 11a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 11a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 11c. Check each incentive that is offered to local farmers. (check all that apply) Purchasing electronic bank transfer (EBT) machines for farmer s markets Farm-to-school programs Farmland preservation Marketing of local crops within the jurisdiction Allowing farm stands Support for grower cooperatives for smaller farms Other (please specify: ) 11d. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 11e. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 11f. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 11g. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 27

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29 Strategy #12: Increase availability of healthier food and beverage choices in public service venues Performance Measure: A policy exists to apply nutrition standards (such as the Dietary Guidelines for Americans or other locally developed standards) to all applicable points of food service (including meal menus, vending machines, and competitive foods) within local government facilities within a local jurisdiction 12a. Is your LHD working on (or has your LHD passed) a policy that applies nutrition standards to food services (e.g., cafeterias, catering, vending) within any local government facilities? 12b. If yes to question 12a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 12a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 12c. Does this policy regarding nutrition standards apply to any of the following types of facilities? (check all that apply) Administrative office facilities 24-hour dormitory-type facilities Health care facilities Recreation/community center facilities Detention facilities Other facilities (please specify: ) 12d. Which of the following activities is your LHD working on? (check all that apply) Policies that increase the availability and affordability of nutritious foods, such as staple foods ordinances and healthy corner store initiatives Policies that require menu labeling Licensing new farmer s markets Adopting zoning ordinances that limit the number and density of restaurants selling fast foods Healthy vending Other activities (please specify: ) 12e. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 12f. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 12g. Please mark which stage best represents your progress on this policy, systems, or environmental change. Problem/issue addressed in action plan Action taken towards adoption of policy, rule, or regulation Policy, rule, or regulation adopted (enter date of initial adoption: ) Policy implementation Policy maintenance/enforcement Policy evaluation/adjustment (enter date of adjustment: ) Policy termination (enter date of termination: ) 12h. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 29

30 Strategy #13: Institute smaller portion size options in public service venues Performance measure: Local government has a policy to limit the portion size of any entrée (including sandwiches and entrée salads) by either reducing the standard portion size of entrees or offering smaller portion sizes in addition to standard portion sizes. 13a. Is your LHD working on (or has your LHD passed) a policy to limit the portion size of any entrée (including sandwiches and entrée salads) by either (a) reducing the standard portion size of entrees, or (b) offering smaller portion sizes in addition to standard portion sizes sold within any local government facilities? 13b. If yes to question 13a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 13a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 13c. Does this policy regarding portion sizes apply to any of the following types of facilities? (check all that apply) Administrative office facilities 24-hour dormitory-type facilities Health care facilities Recreation/community center facilities Detention facilities Other facilities (please specify: ) 13d. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 13e. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 13f. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 13g. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 30

31 Strategy #14: Use pricing strategies to promote healthy choices in public service venues Performance measure: A policy exists to affect the cost of healthier foods and beverages (as defined by the Institute of Medicine) relative to the cost of less healthy foods and beverages sold in local government facilities within the local jurisdiction. 14a. Is your LHD working on (or has your LHD passed) a policy to affect the cost of healthier foods and beverages (as defined by the Institute of Medicine) relative to the cost of less healthy foods and beverages sold in any local government facilities? 14b. If yes to question 14a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 14a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 14c. Does this policy regarding the cost of healthier food apply to any of the following types of food? (check all that apply) Entrees/Main Courses (including sandwiches and entrée salads) Dairy Fruits Vegetables Beverages Snacks Other (please specify: ) 14d. Does this policy regarding the cost of healthier food apply to any of the following types of facilities? (check all that apply) Administrative office facilities 24-hour dormitory-type facilities Health care facilities Recreation/community center facilities Detention facilities Other facilities (please specify: ) 14e. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 14f. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 14g. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 14h. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 31

32 Strategy #15: Limit advertisements of less healthy foods and beverages in public service venues Performance measure: Local government has a policy that prohibits advertising and promotion of less healthy foods and beverages (as defined by the Institute of Medicine) within local government facilities within a local jurisdiction. 15a. Is your LHD working on (or has your LHD passed) a policy that prohibits advertising and promotion of less healthy foods and beverages within any local government facilities? 15b. If yes to question 15a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 15a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 15c. Does this policy regarding advertising and promotion of less healthy foods and beverages apply to any of the following types of facilities? (check all that apply) Administrative office facilities 24-hour dormitory-type facilities Health care facilities o Recreation/community center facilities o Detention facilities o Other facilities (please specify: ) 15d. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 15e. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 15f. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 15g. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 32

33 Strategy #16: Reduce screen time in child care venues Performance measure: All licensed child care facilities in the local jurisdiction are required to limit screen time for children two years of age or older to no more than 2 hours per day. 16a. Is your LHD working on (or has your LHD passed) a policy to require all licensed child care venues in your local jurisdiction to limit screen time for children two years of age or older to no more than 2 hours per day? 16b. If yes to question 16a, how many sites are you working with on the above policy? Enter whole number The questions below are to be answered by anyone who answered yes to question 16a. If you are working with more than one site, think about the site to which your LHD has devoted the greatest resources. 16c. Please name and briefly describe the policy, rule, or regulation: (text box 250 words) 16d. Has any work on this policy, rule, or regulation been funded in part by grants from the Statewide Health Improvement Program (SHIP)? 16e. Please mark which stage best represents your progress on this policy, systems, or environmental change. o Problem/issue addressed in action plan o Action taken towards adoption of policy, rule, or regulation o Policy, rule, or regulation adopted (enter date of initial adoption: ) o Policy implementation o Policy maintenance/enforcement o Policy evaluation/adjustment (enter date of adjustment: ) o Policy termination (enter date of termination: ) 16f. Please include any additional information that will be important to understanding your progress on this policy. (text box 250 words) 33