such as issues related to physical activity and the built environment. Methods such as consumer empowerment and community development to create more livable communities are not yet fully employed in nutrition and physical activity promotion programs.

Many states are exploring or implementing innovative programs related to childhood obesity prevention, and evaluation of these initiatives is the critical next step. For example, in Pennsylvania, the state department of health established Pennsylvania Advocates for Nutrition and Activity (PANA), a coalition-based organization supported by state and federal funds that provides technical assistance and resources for obesity prevention efforts and that serves as a communication clearinghouse. In 2005, PANA began the Keystone Healthy Zone Schools campaign, which recognizes schools that are working toward a healthier school environment (PANA, 2006). In West Virginia, the program WV Walks is a joint effort of the Monongalia County Health Department and West Virginia University that promotes walking through the use of the media, the Internet, and community-based campaigns (WV Walks, 2006). In Arkansas, efforts are under way to examine the link between receiving FSP benefits and childhood obesity.

The committee encourages the implementation and evaluation of innovative approaches and pilot programs that create incentives for the purchase of fruits and vegetables and other foods and beverages that contribute to healthful diets by participants in the FSP and other federal food assistance programs.

State- and Local-Level Surveillance and Monitoring

Existing surveillance systems have provided sufficient information to justify the implementation of actions that can address the obesity epidemic at the federal and state levels, but these systems often do not provide sufficient data that allow careful monitoring of long-term trends or the assessment of progress at the state and local levels.

Federally funded surveys may be designed to collect data at the national, state, and local levels; they may also collect only national data but provide technical assistance to state and local areas that collect state or local data. For example, CDC had conducted SHPPS every 6 years (e.g., 1994, 2000, and 2006) to assess school health-related policies and programs at the state, district, and local levels. In contrast, states and selected municipal health departments have conducted the SHP survey every 2 years since 1994, with technical assistance provided by CDC. In 2004, 27 states and 11 municipalities successfully completed the SHP survey. YRBSS has been conducted every 2 years since 1991. CDC provides technical assistance to states and municipalities that conduct YRBS at the state or local



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