North Carolina has seen a marked decline in adult tobacco use from 26.1 percent in 2000 to 20.3 percent in 2010, and for the first time improved the grade to a B in tobacco.

Marks for physical activity are showing some recent improvement. However, grades for nutrition in the state have stalled, according to the 2010 Prevention Report Card, issued by NC Prevention Partners.

FirstHealth of the Carolinas and First-CarolinaCare Insurance Co. partnered with NC Preven-tion Partners to develop this report card. In addition, they were also sponsors of the Sandhills Report Card that came out a few weeks ago.

The report card grades the progress made in the state on preventing tobacco use, poor nutrition and physical inactivity from 2000 to 2010.

“What is extraordinary is that in 10 short years, North Carolina has moved from the bottom of the nation in tobacco prevention to the top third,” said Dr. Meg Molloy, president and CEO of NC Prevention Partners. “In 2000, we earned a D in tobacco use prevention, which was not surprising given the state’s roots in tobacco growing and manufacturing.

“What is surprising to many is that we have moved so far so fast in reducing adult and youth smoking and made a number of good policy changes that brings North Carolina to a B when benchmarking our progress against national goals for 2010.”

Molloy credits the large number of tobacco-free public spaces, including 100 percent tobacco-free schools and hospitals and smoke-free bars and restaurants, with helping to move North Carolina to the front of the class in tobacco use prevention.

She also cites the strong smoking cessation benefits offered by the state’s health insurers, progress made in increasing the cigarette tax during the past decade and the establishment of a quitline and the state-sponsored TRU anti-smoking campaign as positive elements of the better grade.

FirstHealth was the first health system in the state to go tobacco free. Its community health services department offers a comprehensive smoking cessation program (FirstQuit) to the community and patients in the hospital.

Health educators also facilitate area high school TRU (tobacco. reality. unfiltered) groups. These are groups of teenagers who have joined the tobacco-free movement.

Poor Nutrition

While progress was good in the area of tobacco prevention, the news was not so good in the areas of nutrition and physical activity — the big drivers in the state’s exploding obesity problem, according to a news release.

For progress in nutrition, North Carolina earned a D. For physical activity, the state received a D-plus.

“The state has less to brag about regarding nutrition and physical activity,” Molloy said. “North Carolina’s obesity and chronic disease rates will continue to spiral until we are able to build strong systems that offer accessible, affordable healthy food and convenient ways to be active.”

According to the report card, 65.4 percent of adults in the state are overweight or obese. This is up from 57.9 percent in 2000, and currently only 20 percent of adults eat at least five servings of fruits and vegetables daily.

The number of high school student who are obese has gone from 12.9 percent in 2000 to 13.4 percent in 2010.

“What we are seeing in North Carolina, and nationally, are malnourished obese people — those who eat too many high fat foods and not enough healthy foods,” Malloy said. “This is a deadly ‘cocktail’ for our chronic disease rates and the lives and health of our state’s residents.”

Molloy said North Carolina could do so much better in improving the nutrition grade if North Carolinians ate more of the foods that are grown in their own backyard.

“North Carolina could be a ‘breadbasket of healthy food,’” she said. “We need to concentrate efforts on getting fresh, locally grown fruits and vegetables to our schools, restaurants, workplaces, hospitals and other institutions.”

One bright spot in the report card is that hospitals across the state are establishing healthy food environments in their own facilities with the Red Apple initiative. The initiative ensures that healthy food is accessible, affordable, tastes good and is easy to find using nutrition labeling and other marketing strategies.

“Hospital leaders recognize that you can’t make a healthy food choice if there isn’t one,” Molloy said. “It will take many more organizations across the state offering and promoting healthy foods to see progress in the nutrition grade.”

FirstHealth Moore Regional Hospital and Montgomery Memorial Hospital are both Red Apple hospitals. Several years ago, Moore Regional implemented a new pricing structure in its cafeteria to increase the price of unhealthy food and beverage choices and decrease the price of healthy food choices. FirstHealth saw a marked increase in the purchases of healthier items after the change was made.

Physical Activity

Although the state received only a D-plus in physical activity, Molloy said she is encouraged by the fact that there is early progress being made in this area.

“The amount of active time is increasing among all age groups, which reflects the growing number of families, organizations and communities that are focusing on ways to support physical activity,” she said.

The number of adults getting the recommended amount of physical activity jumped from 42.4 percent in 2000 to 46.4 percent in 2010, and the number of middle school students getting enough physical activity went from 47.5 percent to 60 percent, exceeding the state goal.

Molloy said these positive trends will yield much better grades in physical activity in the years to come. She also credits the collaboration of a committed group of partners focused on health schools with fashioning a healthier future for the state’s children.

“A growing number of leaders and organizations are focusing on what works in this area and are dedicating resources, and collaborating and coordinating with each other to best focus efforts,” she said. “An example of this is NC School Health Connection, where NC Healthy Schools (NC Department of Public Instruction and NC Division of Public Health), NC Prevention Partners and 20 organizations addressing obesity in schools are working together to map their work.

“This will allow us all to work smarter rather than harder. This collaborative is empowering school leaders to improve nutrition and physical activity opportunities for staff and students.”

10-Year Look Back

This newly issued report card is the first time that NC Prevention Partners has done a 10-year look back on the health of the state. The first report card was issued in 1998.

The 2010 NC Prevention Report Card is a compilation of data published in 1999-2010 from sources including national and statewide surveillance systems, as well as other private and sector specific datasets for health plans and hospitals.

Prevention grades are based on progress made against Healthy People 2010 goals for the nation. Indicators include health behaviors, legislative and voluntary policies, and environmental supports for wellness for a wide variety of sectors.