This document summarizes a study presented at the American Public Health Association Annual Meeting on using state legislation to decrease obesity by increasing access to healthy foods. The study analyzed laws in the National Cancer Institute's State Cancer Legislative Database related to reimbursable school meals. It found that some states mandate school participation in federal meal programs, while others require school breakfast programs in high-poverty schools. However, the database does not include all state-level regulations and policies related to food access and obesity prevention.

1. National Cancer Institute’s State Cancer Legislative Database (SCLD):
Decreasing obesity and promoting healthy communities by increasing
access to healthy foods through state food policy
Jamie Weinstein, M.P.H.1, Jennifer Noll Folliard, R.D., M.P.H.1, Monica Holloway1, Shereitte C. Stokes IV, Ph.D., M.P.H.1, Regina el Arculli, M.A.2
Presented at the American Public Health Association Annual Meeting Washington, DC November 1, 2011  
1
The MayaTech Corporation 2National Cancer Institute
Methods and Limitations States’ Efforts to Increase Access to
Community Demographic of Farmers' Markets: Community Demographic of Farmers' Markets: Community Demographic of Farmers' Markets:
Reimbursable Meals: Laws Covered in the SCLD Education, California Poverty, California Race, California
Approach: The SCLD Program utilizes: (1) a standard approach to identifying and abstracting relevant state
legislation and adopted resolutions; (2) data dictionary and hierarchical keyword system; (3) quality control Percent Less Than a
procedures; and (4) multiple data output formats. • Mandatory includes laws addressing the requirement that schools serve reimbursable meals. 4-Year College Degree
(Age 25-64) Percent Below Poverty Level Percent of Minority Population
by Census Tract by Census Tract by Census Tract
Limitations: The SCLD does not contain state-level regulations; executive orders; measures implemented by - States that mandate school participation in a federal reimbursable meal program, such as Arizona 0.0 - 18.3 0.0 - 13.0 0.0 - 19.4
counties, cities, or other localities; opinions of Attorneys General; or data addressing the implementation of (Ariz. Rev. Stat. § 15-242), OR 18.4 - 26.4 13.1 - 23.0 19.5 - 33.8
26.5 - 33.8 23.1 - 34.0 33.9 - 49.2
state laws. Although coverage of Medicaid and Medicare law is not comprehensive, some SCLD records include 33.9 - 42.0 34.1 - 49.0
- Virginia, in which school boards must establish school breakfast programs in public schools in which Sacramento 42.0 - 100.0 Sacramento 49.1 - 100.0 Sacramento
49.3 - 67.0
these data. 67.1 - 100.0
25% or more of enrolled school-age children were eligible to receive free or reduced-price
meals in the federally funded lunch program during the previous school year. (Va. Code Ann. § 22.1-207.3) Stockton Stockton Stockton
San Francisco San Francisco
Background
San Francisco
• Reimbursable Meals Expansion includes laws addressing the expansion of the NSLP, NSBP or Snack Programs by: Oakland Oakland Oakland
Fresno Fresno Fresno
1. increasing state funds or adding new components to the programs; or 2. increasing access to and
San Jose San Jose San Jose
• Excess body weight has been linked to chronic diseases including certain cancers. implementation of the program(s).
• The International Agency for Research on Cancer estimates that obesity and physical inactivity may account for - In Washington, to the extent funds are appropriated, the Superintendent may award grants to school
25 to 30% of several major cancers (Vainio and Bianchini, 2002). Studies estimate that 3.2% of all new cancers districts to: (1) increase participation in school breakfast and lunch programs, (2) improve program
Farmers' Markets Farmers' Markets Farmers' Markets
are linked to obesity (Polednak, 2003) and 14% of deaths from cancer in men and 20% of deaths in women quality, and (3) improve the equipment and facilities used in the programs. WIC/SNAP Accepted WIC/SNAP Accepted
Los Angeles Los Angeles WIC/SNAP Accepted Los Angeles
are due to overweight and obesity (Calle, et al., 2003). Also contingent upon appropriation, the Superintendent must increase state support for school Non WIC/SNAP Accepted Non WIC/SNAP Accepted Non WIC/SNAP Accepted
Santa Ana Santa Ana Santa Ana
breakfasts and lunches. (Wash. Rev. Code Ann. §§ 28A.235.140 and 28A.235.150 to 28A.235.160)
• The problem is exacerbated in underserved populations (Ward et al. 2004, Haynes and Smedley, 1999). Anaheim Anaheim Anaheim
Long Beach Long Beach Long Beach
- The obesity rate for African Americans exceeds 40% in 15 states compared to the rate for Whites, San Diego San Diego San Diego
which exceeds 30% in only four states. State Laws Mandating Reimbursable Meals and
- Individuals who have not completed high school have higher rates of obesity compared to only one-fifth Addressing Reimbursable Meals Expansion
of college graduates. Community Demographic of Farmers' Markets: Community Demographic of Farmers' Markets: Community Demographic of Farmers' Markets:
(Enacted as of June 30, 2011) Education, District of Columbia Poverty, District of Columbia Race, District of Columbia
- Lower income earners have higher obesity rates than those at the highest income levels. NH
WA VT
Centers for Disease Control and Prevention. U.S. Obesity Trends. Trends by State 1985-2010. Available at: www.cdc.gov/obesity/data/trends.html.
ME
Federal Efforts to Address Obesity Prevention MA
by Decreasing Food Disparities MI
PA NJ
RI
OH
IL IN
CA CO
• School Reimbursable Meals – National School Lunch Program (NSLP), National School Breakfast WV VA MD
KS
MO
Program (NSBP), Summer Feeding Program (SFP), After-School Snack Program DC
NC
- Children from families with incomes at or below 130% of the poverty level are eligible for free meals. AZ
NM AR SC
Those with incomes between 130% and 185% of the poverty level are eligible for reduced price meals,
GA Percent Less Than a
for which students can be charged no more than 40 cents. 4-Year College Degree
TX LA (Age 25-64) Percent Below Poverty Level Percent of Minority Population
by Census Tract by Census Tract by Census Tract
• Senior Farmers' Market Nutrition Program (SFMNP) 0.0 - 22.6 0.0 - 10.1 0.0 - 20.5
22.7 - 44.3 10.2 - 22.2 20.6 - 42.9
- Provides low-income seniors with coupons that can be exchanged for fruits, vegetables, herbs and honey Farmers Markets Farmers' Markets
43.0 - 74.9
Farmers' Markets
44.4 - 63.9 22.3 - 34.7
at farmers' markets, roadside stands and community supported agriculture (CSA) programs, and promotes 64.0 - 79.3
WIC/SNAP Accepted 34.8 - 54.5
WIC/SNAP Accepted
75.0 - 91.0 WIC/SNAP Accepted
Non WIC/SNAP Accepted Non WIC/SNAP Accepted Non WIC/SNAP Accepted
the use and expansion of farmers' markets, roadside stands, and CSA programs throughout the country. 79.3 - 100 54.6 - 97.0 91.1 - 100.0
Laws Addressing Reimbursable Laws Mandating State Laws Mandating State Reimbursable Meals and
• WIC Farmers' Market Nutrition Program (FMNP) Meals Expansion (n=5) Reimbursable Meals (n=13) Addressing Reimbursable Expansion (n=10)
- Provides locally grown fruits and vegetables through farmers' markets to WIC participants, and expands the
awareness and use of farmers' markets. States’ Efforts to Increase Access to Healthy Foods: States with Food Environment Laws Addressing Health Disparities The Database
• Supplemental Nutrition Assistance Program (SNAP) Laws Covered in the SCLD (Enacted as of June 30, 2011)
- Helps low-income households put food on the table by providing electronic benefits that are redeemed for Since 1989, the NCI SCLD Program has monitored laws and resolutions covering numerous cancer-related topics.
Number of Laws As of June 30, 2011, the database contained more than 8,000 records divided between general legislation and
food at authorized stores.
• Farmers’ Markets: Laws addressing any public market where farmers or vendors sell their goods directly to the year-end status. General legislation records are abstracts of individual legislative measures (bills, resolutions, and
public consumer. 5
• Let’s Move! ballot measures); year-end status records incorporate a stream of codified legislation related to a particular topic.
- The White House initiative is focused on five pillars: • Demonstration Program: Laws addressing food environment programs of a specific duration that are planned The SCLD Program added obesity prevention as a topic area in July 2010, with a baseline of state laws enacted as
1. Creating a healthy start for children; 2. Empowering parents and caregivers; 3. Providing healthy as a test or a trial in order to assess feasibility, effectiveness, and/or efficacy (e.g., pilot program). of December 31, 2009.
food in schools; 4. Improving access to healthy & affordable foods; and 5. Increasing physical activity
• Access to Healthy Foods: Laws addressing primary cancer prevention/obesity prevention with a goal of 4
reducing health/food disparities by improving access to healthy foods (e.g., fruits and vegetables, nuts, dairy, SCLD Program Resources
Federal – State Partnerships Addressing lean meats, etc.) and/or programs to reduce food insecurity.
Food Disparities • Environmental Risk Prevention: Laws addressing primary cancer prevention programs that include provisions
3
3 3 3 Standard Resources Conference Presentations
to reduce environmental cancer risk factors (e.g., environmental toxins) with a goal of reducing health - SCLD Program Web site Analysis of SCLD data and development of oral and
disparities. poster presentations for scientific and professional
Role of the Federal Government Role of the States - SCLD Update quarterly newsletter and Legislative
Data Byte organization meetings
• Administration of Food Assistance Programs • Financial Incentives: Laws addressing programs that provide primary cancer prevention/obesity prevention
• Sets the agenda for the country’s priorities The Web site is located at www.scld-nci.net.
through implementation of financial incentives to influence people's purchasing behavior with the goal of 2
2 2 2 2 2 - Topical fact sheets and data table
- Through Funding & Program Initiatives • State Interventions reducing health/food disparities.
Acknowledgment: The authors thank Min Qi Wang, Ph.D. , The MayaTech Corporation, for his contributions to the
- State may provide additional funding for NSBP,
• Policy Floor - Nutritional Guidelines • Vouchers: Laws addressing primary prevention programs that include provisions to reduce health disparities demographic data analysis.
NSLP, SNAP, & SFMNP
- WIC, SFMNP, & SNAP and use a type of payment authorization provided by the state to be used only for covered services related to
- May require more stringent nutritional guidelines 1 1 1 1 1 1 1 1 1 1 1 1
primary cancer prevention.
- NSLP and NSBP
Contacts
1
than federal policy floor
• New guidelines for NSLP & NSBP in January 2012 will - May require NSBP, and/or NSLP in schools with Examples
closely mirror 2010 Dietary Guidelines for Americans severe need LA HB 840: Creates the Louisiana Sustainable Local Food Policy Council within the state Department of Regina el Arculli, M.A. Jamie Weinstein, M.P.H.
Agriculture and Forestry, for the purpose of building a local food economy benefiting the state by increasing National Cancer Institute Center for Health Policy and Legislative Analysis
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consumer access to fresh and nutritious foods, and providing greater food security for all citizens of the Office of Government and Congressional Relations The MayaTech Corporation
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e-mail: elarculli@nih.gov
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