Jamie F. Chriqui, Ph.D., M.H.S. Frank J. Chaloupka, Ph.D.
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1 It s More than the Sum of the Parts: Taking a Holistic Approach to Chronic Disease Prevention Examples from Tobacco Control and Obesity Prevention Policymaking Jamie F. Chriqui, Ph.D., M.H.S. Frank J. Chaloupka, Ph.D. Bridging the Gap Program Health Policy Center Institute for Health Research and Policy University of Illinois at Chicago Presentation at the American Public Health Association Annual Meeting Philadelphia, PA November 10, 2009
2 Presenter Disclosures Jamie F. Chriqui (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No Disclosures to make
3 Presentation Overview Brief overview of tobacco-related disease and prevalence Highlight policy/environmental strategies designed to reduce tobacco use Brief overview of obesity prevalence Highlight policy strategies designed to reduce obesity prevalence
4 TOBACCO TRENDS AND POLICY/ENVIRONMENTAL STRATEGIES
5
6 Smoking and Tobacco Smoke Pollution Damage Every Part of the Body
7 Current Cigarette Smoking (%) Among Adults 2006/07
8 Tobacco Policy/Environmental Strategies State and National Federal regulation of advertising, marketing, flavoring Local and Community State tobacco excise taxes Local youth smoking cessation programs School and Organizational Individual and Household Local smokefree air policies Strength of tobacco control infrastructure State level smoke-free air policies Local tobacco taxes Outdoor antismoking advertising State-level limits on youth access to tobacco and PPU policies School tobacco use prevention curriculum Availability of tobacco products School-based youth smoking cessation programs Allocations to state tobacco control programs Tobacco use, risk perceptions, attitudes towards tobacco, purchase experiences, and perceived availability Local youth tobacco prevention programs School policies limiting tobacco use School programs to prevent youth tobacco use Outdoor tobacco product advertising State tobacco control program activities Local policies limiting youth purchase, use or possession of tobacco products Point-of-sale tobacco product marketing State tobacco control program expenditures Market-level anti-smoking advertising
9 After a Systematic Review of the Scientific Literature, the Task Force on Community Preventive Services Recommends the Following Interventions to Reduce Tobacco Use and Protect Nonsmokers Source: Fielding et al, 2005
10 States Providing Strong Protection from Tobacco Smoke Pollution in Private Worksites, Restaurants and/or Bars as of April 30, 2009
11 States that Preempt Local Jurisdictions from Passing Stronger Smoke-free Air Laws as of September 30, 2008
12 Major Smoke-free Air Legislation in the 50 States and the District of Columbia Source: The MayaTech Corporation. Notes: data are for effective laws through 9/30/2008.
13 Smokers Receipt of Advice to Quit from a Physician 2006/2007
14 Provision of Tobacco Dependence Treatment Services to Medicaid Recipients 2006
15 Medicaid Coverage of Cessation Aids in the 50 States and DC: Source: Reference 40. Note: Iowa is included beginning in 2003 when cessation coverage for pregnant women was first reported. Iowa s exact start date is unknown (40).
16 Establishment of Quitline Services in the 50 States and DC: Source: North American Quitline Consortium.
17 States Offering Free/Discounted Cessation Medication to Eligible Smokers as of September 30, 2008
18 Implications of Tobacco Control Policymaking for Obesity Prevention Policy and environmental strategies across all levels of government have been effective at lowering tobacco consumption Tobacco control has largely been bottom-up policy making Prime examples of policy diffusion Core policy strategies to date focus on increasing price and reducing ability to smoke in public places combined with treatment options New FDA regulation will add new frontier regarding advertising/marketing/labeling Primary challenge: Single industry tobacco
19 OBESITY TRENDS AND POLICY STRATEGIES
20 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5 4 person) No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%
21 United States Obesity, 2008
22 Physical Activity Trends in the U.S., 2007
23 Obesity-related Policies Address both sides of the Energy Balance Equation Food Physical Activity
24 Obesity Policy/Environmental Strategies State and National Local and Community State level policies addressing the built environment State level policies and legislation around Safe Routes to School State taxation of beverages, snack foods, and restaurant food Availability and accessibility of physical activity opportunities Comprehensiveness of school district wellness policies Information on healthy eating and physical activity opportunities from key informant interviews Presence and content of vending machines at school Frequency and length of physical education and recess School and Organizational Individual and Household Availability and accessibility of healthy food and beverages in stores and restaurants Height and weight, physical activity, and measures of healthy eating Household food expenditures Implementation of school district wellness policies Marketing of food/beverages at school Awareness and implementation of Alliance for a Healthier Generation Guidelines Availability of various foods/beverages in the school environment Characteristics of the built environment that impact on physical activity National food and beverage television advertising Local zoning codes, regulations, and ordinances that can impact on healthy eating and physical activity Marketing of healthy/unhealthy foods and beverages in communities State policies related to healthy eating and physical activity Market-level PSAs related to healthy eating, physical activity, and obesity Federal and state policies related to school district wellness policies
25 Source: Center for Science in the Public Interest
26 Trans Fat/Menu Labeling Initiatives Source: Fitfrying.com
27 Selected Physical Activity-related Topics Addressed in Public Policies Policies affecting the built environment Growth management Smart Growth Zoning laws/subdivision ordinances Code reform efforts Design standards Master planning Bike plans, trail plans, open space/parks, recreation plans, etc.
28 Selected Built Environment-related Policy Issues Traditional, Euclidean, zoning Focus on use and density e.g., Residential zone only for residential use Does not support mixed-use Design standards/guidelines Street connectivity/networks vs. cul-de-sacs and lack of connectivity to parks/trails
29 Zoning Code Reforms Source: Talen, 2006 (Adapted to add in vehicular/pedestrian orientation)
30 Local Government Form-Based Codes Source: Placemakers, 2009
31 Selected School-related Public Policies Nutrition-related policies Nutrition education, school meals, competitive foods Physical activity-related policies Physical education, physical activity, recess, safe routes to school Federal wellness policy requirement (P.L , Sec. 204) District wellness policies
32 20 States Require BMI or Other Weight-Related Assessments for Children and Adolescents F as in Fat Map Legend State Law Requiring Assessment No State Law Requiring Assessment Levi J, Vinter S, Richardson L, et al. F as in Fat: How Obesity Policies Are Failing In America Washington: Trust for America s Health, (accessed July 2009)
33 F as in Fat 27 States Have Nutritional Standards for Competitive Foods Map Legend Has Nutritional Standards for Competitive Foods Does Not Have Nutritional Standards for Competitive Foods Levi J, Vinter S, Richardson L, et al. F as in Fat: How Obesity Policies Are Failing In America Washington: Trust for America s Health, (accessed July 2009)
34 State SRTS Program Laws and Other SRTS-Related Laws (As of January 1, 2009) No SRTS program law or other SRTS-related law(s) (n=2) Other SRTS-related law(s) only (n=38) Both SRTS program law and other SRTSrelated law(s) (n=11) Source: The MayaTech Corporation for the Bridging the Gap Program, UIC
35 Local Wellness Policies Nationwide Evaluation Local Wellness Policies: Assessing School District Strategies for Improving Children s Health. School Years and Executive Summary, Monograph and backup data available at:
36 Data reflect policies in place by the first day of the or school year. Due to rounding, some bars may not sum to exactly 100. Exact numbers are available at Source: Bridging the Gap, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, 2009.
37 Most District Physical Activity (PA) Policies are Relatively Weak 100% % Students in Districts with Policy, SY No policy Weak policy Strong policy E=Elem, M=Middle, H=High 80% 60% 40% 20% 0% E M H E M H E M H E M H E FW: Goals for PA PA for every grade level PA opps. (breaks) during day Not using PA as punishment Daily recess
38 and Most Address Physical Education (PE) but the Provisions also are Weak 100% % Students in Districts with Policy, SY No policy Weak policy Strong policy E=Elem, M=Middle, H=High 80% 60% 40% 20% 0% E M H E M H E M H E M H E M H PE* Addressed Mins PE/week NASPE std PE teaches lifelong skills PE devotes 50% time to MVPA Req. PE Taught by Auth. PE Teacher
39 Obesity Policymaking: Status and Opportunities Policy and environmental strategies seen as principal interventions early on Policy change rapidly diffusing across all levels of government Congress much more active role than in tobacco control Primary challenges Multiple industries (food, beverage, restaurant, agriculture) Food/beverages needed to live (unlike tobacco) Do not face the illegalities like with tobacco and youth Need time to understand true impact of policy strategies on system, community and individual behavior/attitudinal changes
40 For more information:
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