TITLE. Subtitle Goes Here. Howard County Unsweetened. Policy + Outreach + Media = Change. Marlene B. Schwartz, Ph.D. June 21, 2017

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1 TITLE Howard County Unsweetened Subtitle Goes Here Policy + Outreach + Media = Change Photo Credit: J. Stephen Conn Marlene B. Schwartz, Ph.D. June 21, 2017

2 Overview Howard County Campaign components Findings to date Future directions

3 Demographics of Howard County High income: Median income in 2015 $110,234 Currently 4 nd highest in the US Highly educated: 95% High school 58% Bachelor s Degree 28% Professional Degree 2016 Total Residents = ~ 317,233 18% 19% 7% 4% 54% White (non- Hispanic) Black/AA (non-hispanic) Asian (non- Hispanic) Hispanic Other (non- Hispanic)

4 Childhood weight status Healthy Weight or Underweight Overweight or Obese Maryland 73% 27% Howard County 75% 25% From: MD YRBSS (2011) & HCPSS Fitness Gram (2013)

5 Social Ecological Model

6 Defining Sugary Drinks Early ads mentioned soda and sugary drinks In response to evaluation data, more recent ads specify fruit drinks and sports drinks 100% juice messages about limiting portion size consistent with AAP policy Flavored milk assessed in student survey, but not included in sales data or messaging

7 Individual and family decisions

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10 Media Campaign Messages primarily targeted mothers 30-second spots on local cable TV Digital and social media ad buys Direct mail to county households 17 million impressions from

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14 Child Care Policy and practice evaluation Improve beverages, screen time, breastfeeding support

15 Schools The Howard County Public School System district wellness policy Revised with over 500 residents involved in the process since Policy reaches 55,000 PreK-12 students

16 Community Coalitions Better Choices Coalition 50 community organizations, faith groups & businesses Agreed to improve vending and food at meetings Educate members, clients and visitors about the dangers of sugary drink consumption

17 American Academy of Pediatrics Maryland Chapter Obesity learning collaborative 13 practices and 40 providers Focus on sugary drinks

18 State Coalition Sugar Free Kids Maryland Coalition 250+ members Over 150 earned media stores in print/online news and radio, including three front-page articles in The Baltimore Sun

19 Policy Changes The Maryland Healthy Eating and Physical Activity in Childcare Act Passed in 2014, reaching 10,000 children in childcare in Howard County The Healthy Food and Beverages on County Property Ordinance Makes healthy food and beverages more widely available in government owned vending machines County executive order, repealed, passed, vetoed, overridden

20 Evaluation plan Retail sales 6 th grade survey Coding child care and school policies Health professional surveys

21 Retail Sales Data IRI matched 15 supermarkets in Howard County to 17 supermarkets in a neighboring state Targeted soda, diet soda, sports drinks, fruit drinks, juice Baseline sales patterns were as close as possible

22 Comparing 2012 to 2015 Difference-in-difference analysis (compares change in HC with change in control stores) Dependent variable: volume sales per product per week Average product price, competitor s product price, product size, weekly local temperature, and manufacturer were controlled in the model

23 Moving average of adjusted mean weekly volume sales of regular soda Sales of sugar-sweetened soda fell by almost 20 percent by volume in Howard County and remained stable in comparison stores

24 Results Sales of fruit-flavored beverages with added sugars fell about 15 percent; significantly more in HC than CS Sales of 100 percent juice fell 15 percent; significantly more in HC than CS Sports drinks did not differ between groups Diet soda did not differ between groups but both groups decreased

25 6 th Grade Survey baseline 2012 (n ~3,700) Daily sugary drink consumption 58%* Fruit Drinks 31% Flavored Milk* 22% Sports Drinks 22% Flavored Water/Tea 19% Regular Soda 17% Energy Drinks 5% Water 97% Plain milk 60% Diet beverages 7% *49% excluding flavored milk

26 6 th grade survey daily consumption (N~3,700) 100% Percentage Daily Consumers 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% * * * * * * * *

27 Any daily sugary drink by race/ethnicity 80% 70% Percentage of students 60% 50% 40% 30% 20% * * * % 0% White Black Hispanic Asian

28 6 th graders: Sugary drinks at home * * Percent of students Fruit drinks Regular soda Sports drinks Energy drinks

29 Conclusions and future directions A local, community-based media campaign and policy change effort Evaluation plan set before campaign started Data used to guide messages Retail and self-report student data reflect decreases, but sugary drinks are still prevalent Racial/ethnic disparities exist; however, changes are occurring across all groups Current messages emphasize fruit drinks and sports drinks, include messages in Spanish, and focus on real people

30 Thank you! Funding provided by: The Horizon Foundation, Robert Wood Johnson Foundation, Rudd Foundation

31 5% juice blend Ingredients: Contains pure filtered water, high fructose corn syrup, grape and pineapple juices from concentrate, less than 1% of: pear and apple juices from concentrate, natural flavors, citric acid (provides tartness), sucralose, grape skin extract (for color). nade/fruit-punch/

32 Ingredients Water, High Fructose Corn Syrup, Reconstituted Vegetable Juice (Water And Concentrated Juice Of Carrots), Contains Less Than 2% Of: Reconstituted Fruit Juice Blend (Water And Concentrated Juices Of Apples, Pears, Pineapples, Cherries), Malic Acid, Natural Flavoring, Vitamin C (Ascorbic Acid), Red 40, Sucralose. splash/fruit-medley/

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