Published by the CDC
Preventing Chronic DIsease
Public Health Research, Practice & Policy
Volume 10 - August 8, 2013

Contributing Authors: Ludmila Anderson, MD, MPH; Scot Foster, BS; Regina Flynn, BS; Mindy Fitterman, MEd, RD


The New Hampshire Obesity Prevention Program and the 9 New Hampshire regional planning commissions assessed the state's obesity-related policies and assets by using community measures recommended by the Centers for Disease Control and Prevention. A self-administered questionnaire that focused on policies and assets that promote healthful eating, physical activity, and breast-feeding was sent to 234 municipalities; 59% responded (representing 73% of the state's population). Of the municipalities that responded, 52% had sidewalks, 22% had bicycle lanes, none had nutrition standards, and 4% had a policy supporting breastfeeding. Through collaboration, we gathered baseline information that can be used to set priorities and assess progress over time.


Policy and physical assets (eg, trails, playgrounds) are important elements in obesity reduction (1,2). To guide public health practice related to obesity reduction, the Centers for Disease Control and Prevention released Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide, also called the Measures Project (MP) (3). The MP recommends strategies and measures that support and promote healthful eating and physical activity in towns and cities. The objective of our study was to assess the extent to which MP-recommended policies and assets already exist in New Hampshire municipalities.


The New Hampshire Obesity Prevention Program (NHOPP), in collaboration with New Hampshire's 9 regional planning commissions (RPCs), designed a cross-sectional survey using MP questions on policies and assets related to healthful food and beverage choices, physical activity, and breastfeeding. The selected questions were those that the NHOPP considered best suited for a baseline assessment and for a future evaluation of progress. Because the intended respondents were municipal representatives, questions related to schools or school environments were excluded. Any city or town with its own corporate status and local government was considered a municipality.

The survey instrument adhered to the original language of the MP as closely as possible; however, some questions were modified, and a question related to clearing snow from sidewalks was added. Modifications were related to the self-administration, target audience, and specific aspects of our largely rural state. Some questions were simplified, and other questions had example responses. Questions about information that could be gathered from the RPCs were not included in the survey.

To ensure relevance to city and town respondents, representatives of the RPCs previewed and provided input on the survey instrument. RPCs also assisted with distribution and data collection by sending the survey directly to town and city contacts in their respective regions. The survey was disseminated electronically by using the online tool SurveyMonkey (SurveyMonkey, Palo Alto, California). Data were collected from March through December 2011; nonrespondents received 2 electronic reminders and a telephone call. Municipal representatives received a printed copy of the survey (Appendix) and had the option to fax or mail their responses to the NHOPP. Each RPC provided data on the total population and acres of land in each municipality in its region. Data were analyzed using SAS software version 9.2 (SAS Institute Inc, Cary, North Carolina). Proportions of municipalities reporting assets and policies were calculated with "I do not know" responses included in the denominators.


Of 234 municipalities, 137 (59%) responded to the survey, representing 53% of the state's surface area and 73% of the state's population. Respondents were mainly town administrators and administrative assistants. Of the 137 respondents, 112 (82%) finished the survey; 104 (76%) answered every question. Of municipalities that responded to the relevant questions (Table 1), 52% reported having sidewalks, 39% areas for mixed-use development, 21% designated shared-use paths and bike lanes, 37% medium-to-large grocery stores, and 34% policies to encourage local agriculture. No municipality reported having nutrition standards or policies related to selling or advertising unhealthful foods or to encouraging healthful eating.

Altogether, 97 municipalities reported having 5,724 miles of paved streets; 20 of those municipalities reported having 211 miles (4% of the reported miles of paved roads) of shared-use paths and bike lanes. A total of 47 municipalities reported having 1,347 miles of sidewalks (24% of reported miles of paved streets), and 23 reported having 66,338 acres of land zoned for mixed-use development (2.5% of total zoned acres in all reporting municipalities). In addition, 33 municipalities reported having 83 community gardens (1.5 per 10,000 residents of those 33 municipalities), 57 municipalities reported having 100 farmers' markets (1.6 per 10,000 residents of those 57 municipalities), and 40 reported having 108 medium-to-large grocery stores (1.7 per 10,000 residents of those 40 municipalities). Twenty-one municipalities reported having partnerships that address physical activity or healthful eating. Some of those partners are local government centers, local businesses, and parks and recreation programs. To questions about outdoor recreational facilities, most responding municipalities reported having walking and hiking trails (86%), snowshoe and cross-country ski trails (70%), open-play fields (87%), and community playgrounds and parks (84%) (Table 2).


Although only 59% of municipalities responded, most (73%) of the New Hampshire population resides within those municipalities. Survey findings allow communities to set priorities, plan improvements, and reassess their policies and assets in 5 years.

Numerous initiatives are under way: one example is the launch of the New Hampshire Livable Walkable Communities Toolkit (4), a comprehensive needs assessment to set goals and priorities for regional planning and the imminent implementation of identified strategies, and projects done by community partners. Most municipalities have walking, hiking, and other built-environment assets that support and encourage daily physical activity. Although no municipality reported nutrition standards or policies related to healthful eating, 4% of responding municipalities have a policy supporting employees who breastfeed.

Limitations of our assessment stem from the survey being self-administered, which influenced survey length and content. Although no question was consistently unanswered, open-ended questions were most often skipped. The response rate and appreciation of the survey purpose could have been improved by advance promotion of the survey among municipal representatives. However, the involvement of regional planners improved survey accuracy and shortened the questionnaire.

Survey distribution by the RPCs added credibility to the assessment. In addition to acquiring baseline data, the NHOPP built a partnership with the RPCs, which is invaluable for planning and implementing our shared goal to create environments that support healthful eating and active living.


The NHOPP thanks the respondents from the 137 towns and cities who took time from their busy schedules to complete the survey. This work was supported by the Centers for Disease Control and Prevention grant no. 5U58DP001471-05 for the establishment of an Obesity Prevention Program within the New Hampshire Division of Public Health Services.

Author Information

Corresponding Author: Ludmila Anderson, MD, MPH, Department of Health and Human Services, 29 Hazen Drive, Concord, NH, 03301-6504. Telephone: 603-271-4473. E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..

Author Affiliations: Scot Foster, Regina Flynn, Mindy Fitterman, New Hampshire Department of Health and Human Services, Concord, New Hampshire.

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