Using CX 3 Tools to Assess the Food Environment
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1 Using CX 3 Tools to Assess the Food Environment Presented by: County of Orange Health Care Agency Nutrition Services Nutrition Education and Obesity Prevention (NEOP)
2 Neighborhoods Matter Research: Clear connection between neighborhood factors and health outcomes
3 What s in Your Neighborhood? How many places are providing food? Is it easy for your residents to choose healthier foods at nearby grocery stores? Are families able to make healthy food choices at fast food restaurants?
4 Objectives Use CX 3 tools to assess the food environment Describe sample findings from target neighborhoods List ways to share the CX 3 information
5 CX 3 Nutrition Education & Obesity Prevention Branch California Department of Public Health Communities of Excellence in Nutrition, Physical Activity and Obesity Prevention
6 2008 & target neighborhoods Orange El Modena San Juan Capistrano Mission Santa Ana Spectrum/Lacy Santa Ana Lyons La Habra (2012 only)
7 Maps of Census Tracts Santa Ana - Spectrum Santa Ana - Lyon San Juan Capistrano - Mission
8 2008 & 2012 Results Lower scores = healthier, Goal is 5 (Unhealthy Healthy) Orange El Modena = Few parks, fair access to grocery stores but none meet healthy standards San Juan Capistrano Mission = Many small & large parks, no major grocery store serving Latinos, 24 fast food Santa Ana Spectrum/Lacy = Fair access to grocery stores meeting standards, 27 fast food outlets (all types) Santa Ana Lyons = No parks, no nearby major grocery store accepting CalFresh/WIC
9 CX 3 Tier 1- Data Mapping GIS Maps (GIS Geographical Info System) Analyze Census Tracts Income levels Large/small markets Fast food sites Schools Parks Other (State website, internet-based, open to all)
10 CX 3 Tier 2 Data Collection What did we look at? Neighborhood food stores: Price, quality of f/v; marketing cues Safe, walkable? Around schools & parks: Marketing cues on outdoor ads Fast food: Cues, nutrition info posted, healthy options? Convenience markets and small stores
11 CX 3 Tools 1. Access to healthy food markets Was it easy & safe to get to the market? (Walkability survey) What was available? (Grocery Store survey) Areas for improvement 2. Access to fast food and ads What was available at restaurants? (Fast food survey) What advertising was seen? (Outdoor ads survey) Areas for improvement
12 Walkability Survey Is it safe to cross the street? No crosswalk Entrance to the store
13 What did we see? Where the sidewalk ends
14 Grocery Store Survey Sample questions
15 Exterior What is outside the store? 13) Fresh produce displays or bins outside store Circle 1 Yes
16 Exterior What is in the windows? 21) If store sells alcohol, more than 1/3 total window area covered by ANY type of ads: Circle 1 Yes
17 Interior What is by the check out stand? 24) Number of cash registers: Record 2
18 Produce Are healthy messages posted? 27) Health promotion items around the fruit and vegetable display: Circle 1 Yes
19 Is there a good variety of quality of fruits & vegetables?
20 Limited quantity
21 Quality Example of color change, yellowing
22 Do stores accept WIC or CalFresh? Food Costs? 22) WIC signage displayed: If either old or new logo on WIC vendor sign, circle 1 Yes (could be on interior)
23 Rate the Store: Tally the results If >75 pts, quality store with healthy items If <75 pts, room for improvement
24 Santa Ana 1 site was: Grocery Store WIC Store Water Store Coffee & Donut Shop
25 Santa Ana Same site 2014
26 Grocery Trucks Produce vendors
27 Grocery Trucks
28 Ads & other items on trucks
29 Where s the fruit?
30 There s the fruit! (and veggies)
31 Variety of items
32 Preliminary Results Santa Ana-Spectrum Total # of stores Chain/large 3 2 Small 4 8 Other 3 5 Convenience 6 6 # with >75 pts 6 8 & 1 close Food Assistance WIC = 5 CalFresh = 8 WIC = 11 CalFresh = 13 Network Retail F & V partner 7 2 (5 in 2013)
33 Preliminary Results Santa Ana - Lyon Total # of stores Chain/large 1 1 Small 4 3 Other 1 2 Convenience 6 7 # with >75 pts 1 2 & 2 close Food Assistance WIC = 2 CalFresh = 4 WIC = 5 CalFresh = 9 Network Retail F & V partner 0 1 (2 in 2013)
34 Preliminary Results San Juan Cap - Mission Total # of stores Chain/large 3 3 Small 3 5 Other 4 3 Convenience 5 5 # with >75 pts 3 4 & 2 close Food Assistance WIC = 2 CalFresh = 4 WIC = 4 CalFresh = 11 Network Retail F & V partner 3 0 (6 in 2013)
35 CX 3 Tools 1. Access to healthy food markets Was it easy & safe to get to the market? (Walkability survey) What was available? (Grocery Store survey) Areas for improvement 2. Access to fast food and ads What was available at restaurants? (Fast food survey) What advertising was seen? (Outdoor ads survey) Areas for improvement
36 Fast Food & Outdoor Ad Surveys
37 Exterior What ads are seen? 12) Amount of advertising on doors & windows (shown): Unhealthy: 0 Small, 0 Med., 5 Large Healthy: 0 Small, 0 Med., 0 Large
38 Marketing What is targeted to kids? 22) Yes to signs/ads kid-oriented 24) Yes to Kids Meals 24a) Yes to toy give-aways, e.g., Bratz and GI Joe
39 Is nutrition info posted? 26) On the menu board: Minimum of total calories next to each menu item- Circle 1 Yes
40 Rate the Site: Tally the results If >37 pts, quality site with healthy items If <37 pts, room for improvement
41 Santa Ana From grocery store to taco shop
42 What ads are in the area? Type/Size: 4 Transit Ad Product/Ad: 4 Unhealthy food items
43 What ads are in the area? Type/Size: 2 small billboards Top - Product/Ad is: Other Obesity prevention message Bottom - Product/Ad is: Fast food restaurant
44 Preliminary Results Santa Ana - Spectrum # of Fast Food Burger/FF 4 chain, 14 not 6 chain, 7 not Pizza 3 chain, 0 not 2 chain, 1 not Sandwich/Deli 2 2 Other (not chain) 4 2 # with >37 pts 1 1 Exterior healthy ads score 10 pts Healthy food option score >5 pts
45 Preliminary Results Santa Ana - Lyon # of Fast Food Burger/FF 5 chain, 7 not 9 chain, 6 not Pizza 0 chain, 0 not 1 chain, 0 not Sandwich/Deli 1 1 Other (not chain) 0 3 # with >37 pts 0 2 & 2 close Exterior healthy ads score 10 pts Healthy food option score >5 pts
46 Preliminary Results San Juan Cap - Mission # of Fast Food Burger/FF 10 chain, 8 not 9 chain, 0 not Pizza 2 chain, 1 not 3 chain, 1 not Sandwich/Deli 2 1 Other (not chain) 1 4 # with >37 pts 0 1 Exterior healthy ads score 10 pts Healthy food option score >5 pts
47 Share CX 3 Findings Community members Grocery vendors Fast food vendors City and County staff
48 Any Questions on Grocery or Fast Food Surveys?
49 Review Objectives Use CX 3 tools to assess the food environment Describe sample findings from target neighborhoods List ways to share the CX 3 information
50 CX 3 Communities of Excellence in Nutrition, Physical Activity & Obesity Prevention CDPH County of Orange Health Care Agency Dawn Robinson (714) drobinson@ochca.com Elsa Amezcua (714) eamezcua@ochca.com For CalFresh information, call Funded by USDA SNAP-Ed, an equal opportunity provider and employer. Visit for healthy tips.
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