About Us

On this page:

Overview
Funded States
Progress in Funded States
Partnerships
Evaluating Funded State Programs
Definition of a Nutrition, Physical Activity, and Obesity-Prevention Intervention
The Social-Ecological Model
Social Marketing

Overview

The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases (NPAO) is based on a cooperative agreement between the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity and Obesity (DNPAO) and 28 state health departments. The program was established in fiscal year 1999 to prevent and control obesity and other chronic diseases by supporting states in developing and implementing nutrition and physical activity interventions, particularly through population-based strategies (e.g., policy-level changes, environmental supports).

States funded by NPAO work to prevent and control obesity and other chronic diseases through these strategies: balancing caloric intake and expenditure, increasing physical activity, increasing consumption of fruits and vegetables, decreasing TV-viewing time, and increasing breastfeeding. NPAO also helps states work to reduce soft drink consumption and decrease portion size. The following are examples of state interventions that use multiple strategies.

The Colorado Physical Activity and Nutrition Program (COPAN) funds eight rural communities to develop multi-sector obesity prevention work plans based on community assessment and formative research. COPAN has also successfully partnered to support comprehensive community approaches in 11 sites in metro Denver through the Kaiser Permanente Thriving Communities Initiative. In Commerce City, for example, there is a nutrition, cooking, and literacy program for low-income preschool students and their parents; a community gardening program for youth; a mobile market program that delivers fresh and affordable produce throughout the community; an environmental-education camping program for inner-city youth; and an organized walking program for seniors.
The Massachusetts school-based Healthy Choices program is a partnership between the Department of Public Health and Blue Cross Blue Shield of Massachusetts, which provides a considerable amount of funding. Healthy Choices, which evolved from the state’s 5-2-1 Go! program, is being implemented in more than 116 middle schools, affecting thousands of children. It aims to: (1) integrate nutrition and physical activity into existing core subjects such as math, science, and social studies by using the Planet Health curriculum; (2) assess the nutrition and physical activity policies and systems in schools using CDC’s School Health Index; (3) create before-school and after-school nutrition and physical activity programs; and (4) launch school-wide campaigns to promote the 5-2-1 message: eat at least five fruits and vegetables per day, watch two hours or less of TV per day, and engage in at least one hour of physical activity per day.

Funded States

The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases funds 21 states at the capacity-building level: Arkansas, Arizona, Florida, Georgia, Illinois, Iowa, Kentucky, Maryland, Maine, Michigan, Missouri, Montana, New Mexico, Oklahoma, Rhode Island, South Carolina, South Dakota, Texas, Vermont, West Virginia, and Wisconsin. These states are working to establish state infrastructure; plan obesity prevention and control efforts; identify data sources to monitor the burden of obesity; collaborate and coordinate with partners; and begin implementing interventions.

Seven other states are funded at the more advanced, basic-implementation level: Colorado, Massachusetts, Pennsylvania, New York, North Carolina, Oregon, and Washington. These states are implementing a comprehensive nutrition and physical activity state plan to prevent and control obesity and other chronic diseases; providing training and technical assistance to communities; implementing and evaluating nutrition and physical activity interventions to prevent obesity; and evaluating the progress and impact of the state plan and state interventions.

(Five of the states funded at the capacity-building level ― Georgia, Kentucky, Missouri, Texas, and Wisconsin ― have met all the required performance measures to qualify for basic-implementation status, when funding is available.)

Progress in Funded States

States funded by the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases documented 33 environmental changes in various settings during the second half of calendar year 2005. Most of these changes were related to physical activity, such as developing or improving trails (e.g., providing lighting, putting up signs, resurfacing, expanding) to increase access and improve safety for pedestrians and bicyclists. Other changes included restructuring a school parking lot to improve pedestrian safety, adding fitness challenge equipment to a school playground, building a skateboard park, and improving workplace stairwells. Environmental changes aimed at nutrition included adding healthful snacks to vending machines in schools and workplaces, planting student and community gardens, and setting up a local farmer’s market.

In addition, 61 policies or acts affecting nutrition and physical activity were initiated, modified, or enforced in funded states during the second half of 2005 (some of these carried over from the previous reporting period). Legislative acts can be defined as formal legal actions taken by local or state governments to support the health-promoting behavior of individuals and/or organizations. Policies include laws and regulations as well as formal and informal rules and understandings.

Partnerships

States funded by the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases partner with stakeholders in government, academia, industry, and other areas to create statewide health plans ― one of the most important ways to help guide state efforts. State plans promote working with a variety of partners and using all available resources to prevent and control obesity and other chronic diseases. Washington state, for example, has several strong, statewide partnerships.

In 2002, Washington formed the Access to Healthy Foods Coalition. Members of this statewide group include representatives of business, industry, agriculture, public health, and other areas. The coalition focuses its efforts on three environments: worksites, point-of-purchase areas (e.g., restaurants and vending machines), and food-assistance programs (e.g., food banks). Coalition members draw on one another’s knowledge and resources in these areas to improve access to healthful foods ― both by building on existing efforts and creating new ones.
The first-ever Northwest Healthy Foods Expo, sponsored by the state Department of Health and the AHFC, brought together dozens of vendors of healthful foods with people who buy products for food services and vending machines at schools and worksites.
The Washington Coalition for Promoting Physical Activity is made up of public- and private-sector members that work to: promote increased awareness and knowledge of physical activity and the benefits of an active lifestyle; develop and promote model policies, laws, and regulations supporting physical activity; establish and maintain a physical environment supporting physical activity; and share research/data on effective interventions in community settings.

Evaluating Funded State Programs

State program activities are evaluated based on a set of performance measures set out in the original Request for Applications from the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases. Specifically, states must provide evidence of the following:

Policies, environmental supports, and legislation that were initiated, modified, or planned for the prevention or control of obesity and other chronic diseases through improved nutrition and increased physical activity;
At least one community that implemented a nutrition and physical activity plan for the prevention and control of obesity and other chronic diseases;
Outcomes/impacts of at least one intervention that uses nutrition and physical activity strategies to prevent or control obesity and other chronic diseases;
Strategic planning activities to develop a comprehensive state nutrition and physical activity plan to prevent and control obesity and other chronic diseases; and
A state plan that promotes coordination of activities across all relevant state and community programs, in which relevant partners are identified in substantive roles.

Definition of a Nutrition, Physical Activity, and Obesity-Prevention Intervention

Broadly speaking, an intervention is a deliberate process by which desired changes are produced in the health and behaviors of targeted populations; specific interventions are defined by program goals and expected outcomes. The operational definition of an intervention used by the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases is “an activity with the main purpose of changing existing obesity-, nutrition- or physical activity-related behaviors and/or practices.” At a minimum, the interventions that funded states implement must contain all of the following components:

Grounded in theory;
Intervention design decisions can be linked to knowledge and understanding of the target audience;
Defined purpose with clearly stated goals and objectives;
Expected outcomes (to include BMI/BMI for age when appropriate);
Defined intervention methodology (where, when, and how);
Strategy for implementation (to include collaboration with partners);
Target population(s) segment(s) that relate to populations identified in the state plan; and
Defined evaluation design and methodology.

The Social-Ecological Model

Each state funded by the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases uses the Social-Ecological Model to more fully understand the obesity problem in that state. This model serves as a reminder to look at all levels of influence (individual, interpersonal, organizational, community, and societal) that can be addressed to support long-term, healthful lifestyle choices. Activities based on the Social-Ecological Model can do the following:

Teach skills needed to make individual behavior changes related to nutrition, physical activity, and healthful weight – and provide opportunities to practice these skills. For example, drawing on the expertise of volunteer chefs and nutritionists, South Carolina’s Cooking with the Chef program plans to use live, participatory cooking demonstrations to provide support to parents who want to cook healthful meals and teach positive links between food and health to their children.
Create supportive environments, making healthful lifestyle options more accessible, affordable, and safe. Pennsylvania’s Keystone Healthy Zone Campaign recognizes and rewards schools for making a commitment to improve nutrition and physical activity. The program provides resources, training, and mini-grant funding for schools to make changes to the school environment, including more healthful food choices. Over one six-month period, the program was implemented in more than 1,130 schools.
Help influence changes in rules, regulations, or structures of institutions and organizations. In early 2005, the Kentucky General Assembly approved the state’s first obesity-related public policy, State Bill 172, which sets new standards for nutrition and physical activity in schools. The legislation will significantly limit the sales of soft drinks and retail fast food, mandate the creation of school wellness policies, and improve the nutrition education of food service staff.
Establish programs in communities to increase physical activity and/or reduce caloric intake through healthful eating habits. The Community Gardens Project in Moses Lake, Washington, aims to increase fresh fruit and vegetable consumption and increasing recreational physical activity in the community. The project promotes community support for dozens of gardens and advises the city council, school board, and Healthy Communities advisory board on recommended nutrition policy changes. A Youth Wellness Team was developed to assist in garden projects and project committee recruitment.
Help influence the creation of policies and standards to support healthful eating and physical activity in communities. In New Mexico, the legislature allocated significant state resources to prevent obesity, beginning with youth and schools. The state public education department will receive all funding and oversee most of the one-year initiatives: increasing the number of certified physical education teachers in elementary schools; creating before-school and after-school programs that include nutrition and physical activity; expanding the Coordinated Approach To Child Health (CATCH) Program from grades 3–5 to K–5; addressing obesity in student-based health centers; and creating a documentary on girls and obesity.

Social Marketing

In designing interventions, states funded by the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases use social marketing, a consumer-driven approach that helps them better understand their audiences in order to develop and tailor programs and strategies to better serve their needs. The social marketing process can be used to address health issues at all levels of the Social-Ecological Model.

Kentucky is one of several state programs using social marketing to develop nutrition and physical activity interventions. In Lexington, Kentucky, the Tweens community coalition has used elements of CDC’s national VERB media campaign to create the VERB Summer Scorecard, a summer-long physical activity program that offers children ages 9–13 access to a variety of discounts and free activities, the chance to win prizes, and the opportunity to attend an activity-packed grand finale celebration. The Lexington-Fayette County Health Department recruited coalition members, identified a target audience and chose target behaviors, conducted formative research, tailored the VERB program to the community, and, finally, evaluated the pilot.

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Page last reviewed: May 22, 2007
Page last updated: May 22, 2007
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion