Deserae:
I cook for 650 people, breakfast and lunch. I come in at 4:30 in the morning. We have a menu we go by and so everything’s pre-planned. We prep stuff for the following day, so it’s a little easier on us, not so hard. A lot of us that come in have been drug addicts or homeless and so food is that feel good thing for us. A lot of us cling to that, really. You find people who just haven’t eaten well for a long time and so they get here and they eat and eat and eat and they gain weight. Foods the next addiction, really, honestly. I think when you eat like crap you feel like crap, honestly. Cheeseburgers and stuff like that, it’s just… It’s too heavy and greasy and if you can choose a smoothie or something like that, I think it nourishes not just in here, but everywhere.

They started cutting our sodium and so they ordered these new chicken and beef bases, which actually come frozen and they’re just so much better. They taste better, it’s more of a liquid and so to me it just tastes a hundred times better and it just… Because it’s got actual chicken bits in it or beef bits in it, I always feel better when I eat better. The fresher the vegetables… Your body craves that freshness after so long of not eating very healthy. I like to come out and go shopping out in the garden a lot so they just know I usually take a bowl and I just am gone out shopping. When I saute vegetables, you want to start with the base, so you’d put all your veggies in. The more you start with fresh herbs and stuff like that and you cook them in with your vegetables before you add any liquid or anything like that, it brings the flavor out more, that helps then you don’t have to use as much sodium as well.

I really enjoy making soup and I do at least three times a week and so everybody enjoys it, they always know when I’ve made the meal. Being able to have salad once a day or eating those vegetables and stuff, it just makes you feel better. It’s not so heavy you can get through the day okay. And it just makes you feel really good to be able to give back and do something, and I feel like that that’s what the cooking here is for me also is it’s knowledge that I’ve learned and I’m able to give back to all the crew that I work with as well. A lot of them have never even worked in a kitchen before. I want to take that with me when I leave. I don’t want to come back. I want a life with my family. I think that’s something we can apply to our children, and I think that that’s probably the biggest thing for me is I don’t want to go back to what I did before.

Speaker 2:
And then I wonder if you might tell us, you’ve mentioned maybe opening a restaurant or a food cart or something.

Deserae:
Mm-hmm (affirmative).

Speaker 2:
Could you tell us what kind of food cart you would have? Do you have a name?

Deserae:
I do. I really like sliders, something small. I would like to do something called Soup and Slides. It’s kind of cheesy what I really enjoy it because there’s so many different varieties of things that you can do. I’m super excited about it. Soup-er excited about it. (silence)

Ann Chawkin:
We really look at being incarcerated as a chronic condition that affects the mind, body and spirit. It lasts for six months or longer and has a negative effect on health. That is the definition of a chronic condition. The biggest I would say cost drivers of our medical system inside corrections certainly is cardiovascular disease, the hypertensions, the Chronic Obstructive Pulmonary disease as well as diabetes.

Betty Hansen:
My goal is that we can prevent diseases by eating healthier. There’s a lot of food related diseases out there, obesity, hypertension.

Ann Chawkin:
We the medical research community knows that reducing sodium has a significant impact on reducing the risk of stroke.

Betty Hansen:
I think the biggest challenge is our budget. We’re allowed $2.55 per day, per inmate. It’s very challenging to provide a healthy meal at that cost. Usually healthier foods are more expensive. So we have very little freezer space. We end up having to do more canned products, which they’re higher in sodium.

Ann Chawkin:
People who are incarcerated should have the opportunity to do better tomorrow than they did today. We as a Department of Corrections, needs to look at how do we develop a context in which they can do better.

Betty Hansen:
Cooking from scratch I think is the key. When you purchase ingredients separately and develop a product. It’s going to be less expensive than purchasing it through a distributorship. We used to purchase some bagels that were about $0.11 and now we’re doing English muffins from scratch for $0.02 and with less sodium. Some of the other things we’ve done is we’ve purchased low sodium chicken and beef bases. Those get incorporated of course into our soups into our casseroles and these bases actually have one tenth of the sodium that the original bases had. So that really has reduced the sodium quite a bit. We just did it with the cheese for instance, there. We found out that the vendor we were purchasing our cheese from actually could get us lower sodium cheese. By asking the vendor and putting the spec out on our bidding process, they were able to find us lower sodium cheese at the price that we were looking for.

Ann Chawkin:
If we can all get together and on board with people deserve a second chance. I think that the people leaving prison with these new sets of skills and tools to live healthier or at least make more healthful choices, can have a ripple effect in our communities and decrease the likelihood of recidivism.

Steven Fiala:
Hey. Hi everyone. Thanks for joining us today for the Data Within Reach webinar. Today’s webinar is titled, Sodium Reduction in Communities. The webinar is being hosted by the Health Promotion and Chronic Disease Prevention section of the Oregon Public Health Division at the Oregon Health Authority. My name is Steven Fiala and I’m the Evaluation Lead for the Health Promotion and Chronic Disease Prevention section. And I’m joined by my colleague, Jennifer Chandler, who is a policy specialist in our section.

Steven Fiala:
As we get started today, I’d like to remind everyone to please mute your microphone when you’re not speaking. And when we get to the question and discussion section at the end, if you choose to share, please say your name, where you’re from, before asking your question or providing your feedback and comments. And we’d also like to note that the webinar will be recorded and posted to the Health Within Reach blog following today’s events and we’ll have a slide on the Health Within Reach blog if you’re not familiar with that. And then we’d like to ask that you hold all your questions until the end of the webinar. We’ll have about 10 to 15 minutes at the end for questions and discussions, and you’re also welcome to send your questions using the chat function of the webinar at any time throughout the presentation. And we’ll check the chat box for questions as we kick off the questions and discussion portion.

Steven Fiala:
So for our 20 to 30 minutes together today, we planned to describe the public health burden of excess sodium consumption. We’d like to present some sodium related data sources and we’re going to pull together data from three different sources, kind of triangulate those data to describe our sodium efforts. And then also discuss the current sodium reduction work at this stage, and future efforts that we plan on engaging in.

Steven Fiala:
Okay. And then most of you maybe came upon this webinar by logging into the Health Within Reach blog. We wanted to highlight the blog here. As part of the Health Within Reach blog, we occasionally hold one of these Data Within Reach webinars. And these webinars are meant to provide additional data that compliment the topic addressed in the Health Within Reach blog posts. So you can see the most current blog post here on your screen, called, Cooking Up Change With Oregon Department of Corrections. That highlights our collaboration with the Oregon Department of Corrections for sodium reduction work. And we’re going to be diving deeper into some of that on the webinar, but you can also go to the Health Within Reach blog to read all about that.

Steven Fiala:
Okay. And then, just wanted to highlight that this webinar is part of a larger webinar series called, Data Within Reach. And the purpose of the webinar is to provide a venue for timely sharing of data that we collect on a variety of topics. And we also wanted to provide an opportunity for people interested in Health Promotion and Chronic Disease Prevention to ask questions and have a discussion about the data and the program and policy information that we’re sharing. So now I’m going to turn it over to Jen to describe the problem of excess sodium consumption, and some of the work to reduce population-wide sodium consumption.

Jennifer Chandler:
Hi, yes, thank you for joining us today. Most of us are familiar with sodium as the salt that we use to flavor our food during cooking or at a meal. I also wanted to point out that sodium can be found occurring naturally. It is also found as a preservative in processed food. Sodium itself is a nutrient that we need for our bodies to work properly. It is estimated that we need about 500 milligrams of sodium daily to support the function of nerves and muscles, and to keep the right balance of fluid in our bodies.

Jennifer Chandler:
The dietary guidelines for Americans recommends however, that we have no more than 2,300 milligrams of sodium a day, for healthy adults. Most American adults consume about 50% more than the recommended upper limit, somewhere in the neighborhood of 3,400 milligrams of sodium per day. This level of excess sodium in the diet can lead to high blood pressure, increasing the risk for heart disease and stroke. Heart disease is the leading cause of death in the U.S., and combined heart disease and stroke are the leading cause of death here in Oregon. And Steven’s going to talk a little bit more about sodium, desire among Oregonians to reduce sodium.

Steven Fiala:
So we can look at the data collected from Oregon adults to characterize the population level burden of high blood pressure, as well as intentions to reduce sodium intake. So the data that we’re going to look at come from the Oregon Behavioral Risk Factor Surveillance System, or BRFSS, as we affectionately call it, which is a telephone survey administered annually to adults in Oregon. And on this, we ask them about a variety of chronic diseases and health risk behaviors. So on the Oregon BRFSS, we ask adults if they’ve ever been diagnosed with high blood pressure. And from those responses, we know that about 30% of adults in the state report having high blood pressure, which equates to nearly 1 million adults in the state, as you can see here on this data tile.

Steven Fiala:
In addition, on the same survey, we also ask adults, “Are you currently trying to reduce your sodium intake?” And from this survey question, we know that 43% of adults in Oregon report that they are currently trying to reduce their sodium intake. So I’m going to turn it back over to Jen, who’s going to talk about some of the sources of sodium and some of our work to reduce population level sodium consumption to support these Oregon adults, who are trying to reduce their sodium intake.

Jennifer Chandler:
You may be surprised to hear that most of the sodium in our diets does not come from the salt shaker. Whether you’re talking about adding salt to flavor while you’re cooking or when you sit down at the dinner table and add a little extra salt to your plate. Typically the sodium in our diet is coming from processed, ready to eat food. Very common foods like breads and rolls, pizza, cold cuts and other cured deli meats, canned soups or vegetables, savory snacks like chips, crackers and pretzels, and also from cheese.

Jennifer Chandler:
Currently in Oregon, we are funded through the Sodium Reduction in Communities program, which is a program administered by The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, to reduce sodium in a variety of settings. This funding is awarded to communities across the country to implement comprehensive strategies to reduce sodium intake, to align with the dietary guidelines for Americans. The Oregon Health Authority is working with the Department of Corrections and the Department of Education to reduce sodium in the meals served to adults in custody and to students in Oregon public schools. These types of meal service programs offer a unique opportunity to significantly reduce sodium across an entire system, and effectively reach a large population of consumers. We’re now going to take a closer look at how this program is implemented in the Department of Corrections. Steven’s going to start us off with some data to highlight the Department of Corrections.

Steven Fiala:
Yeah, so we wanted to take a moment and note that the collaboration with the Oregon Department of Corrections really presents an opportunity to reduce chronic disease disparities. We know that in Oregon, adults in prison are four times more likely to have cardiovascular disease than adults in the general population. So there’s a higher burden among this population. And we also know that 95% of Oregon inmates will eventually be released. So it’s in everyone’s best interest to ensure that they reenter society healthier. And so to talk more about the ongoing collaboration between OHA and the Department of Corrections, turn it back over to Jen.

Jennifer Chandler:
We know that implementing comprehensive nutrition standards that include sodium limitations are an important tool. Nutrition standards are set of guidelines that may include minimum requirements for food categories that support good health, such as fruits, vegetables and whole grains, as well as limitations on foods that are known to harm health, like fried foods, added sugar, trans fats, and what we’re talking about here today, excess sodium. Since 2016, the Department of Corrections has been improving inmate meals by implementing comprehensive sodium reduction intervention, including product procurement because the purchasing of reduced sodium products. Some examples include reduced sodium cheese, soy sauce and soup bases. The Department of Corrections has also practiced extensive recipe reformulation by modifying high sodium menu items that are made in-house, like bread, salad dressing and sausage. They can have a significant impact on the sodium in meals served. An additional opportunity for sodium reduction includes menu modifications. An example of this is reducing the use of high sodium ingredients, such as processed meat, over the course of an entire meal menu cycle.

Steven Fiala:
Now we have a couple of data highlights, provided by the Oregon Department of Corrections, that demonstrates the impact of some of these sodium reduction efforts to date. Through product procurement and recipe reformulations that Jen described, the Oregon Department of Corrections has lowered sodium in inmate meals by 17% since 2016. So this represents a reduction from an average of 5,266 milligrams per day in 2016, to 4,362 milligrams per day in 2018, so a pretty significant reduction so far. And of note, these changes have been implemented in all DOC facilities, so across the entire system. For our next number here, 15,000, which is to show that these lower sodium meals benefit all 15,000 adults in the statewide prison population. So quite a reach there for these interventions.

Jennifer Chandler:
Lowering sodium in the foods served, in these large food service programs, is to encourage manufacturers to reduce sodium in common high sodium culprits, and illustrate the demand for these lower sodium foods through purchasing contracts. It’s important to note that sodium is a vital component in several aspects of food production, including the flavor profile of the product and its shelf life. This is why a multi-factorial approach to identifying consumer demand and reformulating existing high sodium products could be an effective strategy, increasing the variety of lower sodium food products available for participants by large meal service providers, such as the Department of Corrections, schools, hospitals and senior meals programs.

Steven Fiala:
And to make the case to manufacturer for lower sodium products, information on consumer acceptability of lower sodium products may be needed. So this last set of data that we’re going to look at serves as an example of what this type of information could look like, that we would provide to manufacturers. So we’re going to review data from consumer sensory and acceptability testing. And I’ll describe in a bit more detail what those mean later, that the Oregon Health Authority conducted, in partnership with the Oregon State University, Food Innovation Center in 2013. So during testing, consumer’s ate pieces of sandwich bread with a typical amount of sodium that we call a control, and then ate pieces of bread with a 10% reduction of sodium, 20% reduction of sodium, and finally a 30% reduction in sodium. And then consumers were asked to rate the different bread products that they tasted on various sensory characteristics, like taste and texture.

Steven Fiala:
And this first graph here, that we’re looking at, shows consumer responses to the question of which was saltier. So again, they try to control with a regular amount of sodium and then those bread products that had a stepwise reduction in sodium and they were asked, “Which is saltier?” And so from this particular question used in the sensory testing, we know that consumers could tell a difference in the salt level between the control and the bread products that had a 20% and 30% reduction in sodium, but they could not tell a significant difference between the control and the 10% reduction. So kind of to recap, could reduce the sodium in the bread product by 10%, without consumers detecting a difference in saltiness.

Steven Fiala:
Great. And then for this next graph, we’re showing average consumer ratings on the overall liking of the bread products that they tasted. So again, consumers tried the control and then the three different reduced sodium bread products and they are asked to rate their overall liking of the products on a scale from one to nine, one indicating that they didn’t like it at all and nine indicating that they liked it a lot. And so you can see these average scores across the 109 consumers who tasted the bread products. And we found that overall liking was very similar across all of the bread products, regardless of the sodium content. So there was no significant difference across these average liking scores. And when we take these two graphs together, we know that while consumers could detect a difference in saltiness in those 20% and 30% reductions, this didn’t affect their overall liking of the product. So again, another example of some of the data that we can provide to manufacturers to make a case for lowering sodium bread products, that there’s still this consumer acceptability, even when you lower yourself levels.

Jennifer Chandler:
Now we have a little bit of understanding of the consumer acceptability of reduced sodium bread products, looking forward, we’re really interested in pursuing a relationship with Franz Bakery, a regional baker here in the Pacific Northwest, that provides a lot of products to food service programs. We’re going to take a closer look at the impact of shelf life on sodium reduction, as well as cost. And once we’ve got a better idea of the full spectrum of implications for sodium reduction in bread products, we’re very interested in continuing this model to assess the impact of sodium reduction on other high volume contributors of sodium. Some examples could be canned tomatoes, other canned vegetables, processed meats or cheeses.

Jennifer Chandler:
Providing the full ramification of reduced sodium products can help inform large scale food service purchasing contracts. For more information about the work that’s being done at the Department of Corrections, I encourage you to visit placemattersoregon.com. There’s quite a bit of information about the sodium reduction efforts in the Department of Corrections, as well as other sodium related information. You can also visit The Centers for Disease Control and Prevention, specifically www.cdc.gov/dhdsp/programs/sodium_reduction, and this will take you directly to the National Sodium Reduction in Communities program website.

Jennifer Chandler:
I would encourage you to take a look at any Place Matters Oregon website for all of the content. Specifically, I would encourage you to take a look at the Inmates Improve Health on the Inside video. There’s a video where Desarae, an inmate and lead cook, chooses herbs and spices instead of salt to flavor meals and tells you about sodium reduction efforts in her own words. We also hear from the Department of Corrections leadership, about how the importance of reducing sodium in inmate meals and how they’re going about doing this and improving health on the $2.55 cents a day.

Steven Fiala:
Great. So that’s all the content that we had for you today. So we just want to say thanks again for joining. We hope that this wet your appetite for Sodium Reduction in Communities program and policy work that we’re doing right now, as well as some of the data that we shared. We have our contact information here if you have any follow up questions and we’d also encourage you again, to go to the Place Matters Oregon website, where you can look at the videos Jen mentioned, as well as some other data that we have there on sodium reduction. And then we’d also encourage you to sign up for, if you haven’t already, the Health Within Reach blog. And yeah, so thank you again for joining us, and please contact us with any questions. And we will stop now.