Center for Health Behavior Research University of Pennsylvania April 3, 2012

Transcription

1 Center for Health Behavior Research University of Pennsylvania April 3, 2012

2

3

4

5

6

7

8

9

10

11 Unhealthy advertising in Philadelphia Counting ads in a 4-month period in Austin, Los Angeles, and Philadelphia Hillier, Health & Place, 2009

12 Key determinants of smoking Climate Normative behavior (up to 4 in 10 adults in some neighborhoods) Aggressive marketing in poor communities Access High density of tobacco retailers, particularly near schools High rate of illegal sales to youth Relatively low cigarette prices in Philadelphia Cessation resources Most smokers try to quit on their own Inadequate coverage for and use of quit aids Limited availability and use of cessation counseling

13 Key determinants of obesity Poor Diet Limited access to healthy foods in poor communities Easy availability and aggressive marketing of unhealthy foods Higher relative price of healthy foods Lack of Physical Activity Opportunities Auto-based planning Disrepair and lack of safety in neighborhoods Dramatic increase in indoor, screen-based activities

14 Overweight and Obesity in Philadelphia Overweight and Obesity Among Philadelphia Adults (18+) and Children (6-17), % 60.0% 60.0% 62.3% 60.3% 64.6% 64.3% 66.3% 50.0% Adult overweight-obesity Percent 40.0% 39.6% 39.6% 46.4% 42.0% 46.9% 40.7% 30.0% 20.0% Child overweight-obesity (6-17 years) 10.0% 0.0% PHMC Household Health Survey,

15 Diabetes and hypertension in Philadelphia Diabetes among Philadelphia Adults Hypertension among Philadelphia Adults P e r c e n t P e r c e n t PHMC Household Health Survey,

16 Smoking prevalence for 10 largest U.S. cities 25% 20% 20% 18% 17% 17% 16% 15% 14% 12% Philadelphia Chicago Phoenix San Antonio NYC Houston Dallas San Diego LA San Jose Behavioral Risk Factor Surveillance Survey and local data sources, 2007

17 Health and economic costs in Philadelphia Tobacco use Poor Diet and Physical Inactivity 2,400 deaths per year ~2,000 deaths per year $700 million in productivity losses annually ~$750 million in health care costs annually Philadelphia Vital Statistics Reports, Philadelphia Department of Public Health Obesity health care costs estimated from Finkelstein et al, Health Affairs, 2009

18 How can we make it easier for Philadelphians to engage in healthy behaviors?

19 Health Impact Pyramid Examples Smallest Impact Largest Impact Counseling & Education Clinical Interventions Long-lasting Protective Interventions Changing the Context to make individuals default decisions healthy Socioeconomic Factors Eat healthy, be physically active Rx for high blood pressure, high cholesterol, diabetes Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, 0g trans fat, iodization, smokefree laws, tobacco tax Poverty, education, housing, inequality Frieden T, AJPH 2009

20 How can we make it easier for Philadelphians to engage in healthy behaviors? Media Educational institutions Community retail environment and restaurants Built environment Legislation and regulation Workplaces Insurers and health care providers

21 Schools School Wellness Councils School Wellness Council Interventions, (November 2011) Healthy classroom rewards 100 Healthy fundraisers 80 Socialized Recess Classroom movement breaks Healthy school stores Philadelphia Department of Public Health, School District of Philadelphia

22 Afterschool programs food and fitness policies Food and fitness standards developed for over 207 afterschool programs, serving 20,000 low-income children Structured physical activity opportunities in 94 recreation center afterschool programs Healthier, more complete meals in 50+ recreation center afterschool programs

23 Built environment smoke-free rec centers, playgrounds, pools 183 smoke-free recreation centers, playgrounds, and pools, affecting over 2 million annual visits 850 new smoke-free acres!

24 Built environment safer walking and biking 2 new north-south bike lanes and an education & enforcement campaign for an area with a day-time population of 250,000 Over 28,000 2 nd and 5 th graders provided pedestrian and bicycle safety lessons

25 Built environment planning and zoning Encouraging the incorporation of fresh food markets into commercial and mixed-use developments by offering density bonuses that don t count the square footage of those markets against the maximum buildable area (14-603(7)) Requiring the provision of secure bicycle parking in developments above a certain size, and allowing the removal of 1 automobile space in exchange for the provision of 5 bicycle parking spaces (14-804)

26 Retail preventing youth tobacco sales & use Penalties raised for merchants that sell tobacco to minors Over 2,000 tobacco merchants educated about youth sales prevention New tobacco retailer permitting requirement The public can report retailers by calling SMOKE or online

27 Retail Philly Food Bucks & Healthy corner stores 10 new farmers markets in low-income neighborhoods $2 of free fruits and vegetables for every $5 of SNAP benefits 435% increase in SNAP redemption at farmers markets Over 600 corner stores selling healthier products, impacting 750,0000 Philadelphians 83 mini conversions completed On average, each store introduced 20+ new products as a result of a conversion

28 635 enrolled 423 with at least 4 new products 83 with mini-conversions Healthy corner stores

29 City of Philadelphia Workplaces promoting and supporting quit attempts Expanded insurance coverage to include 6 of 7 FDA approved smoking cessation medications, affecting 7,000 employees and dependents

30 Workplaces healthy vending City of Philadelphia Over 260 vending machines undergoing changes healthier mix, smaller sizes, calorie labeling, and healthy marketing affecting 25,000 employees

31 Workplaces healthy vending Employers that have developed or implemented healthy beverage vending standards, June 2011 HUP 31,000 City of Philadelphia 25,000 Einstein PA Hospital 2,700 7,200 Total Employees Impacted: 69,114 Horizon House 1,115 KPMG 857 Fox Rothschild 497 SRSY 445 Congreso ,000 10,000 15,000 20,000 25,000 30,000 35,000 Number of Employees Impacted

32 Insurers and health care providers promoting and supporting quit attempts 4 of the 5 Medicaid Managed Care Organizations in Philadelphia agreed to provide coverage for 5 (or more) of the 7 FDA-approved smoking cessation medications, expanding access for approximately 80,000 lowincome Philadelphia smokers More than tripling of Quitline use and NRT for 10,000 Philadelphians 4000 Callers to QUIT-NOW for Philadelphia County Counseling only Counseling + NRT NRT Giveaway NRT Giveaway Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

33 Media campaigns Do you know what your kids are drinking? Raising awareness about the negative health effects of sugary drinks and encouraging people to cut back ~24 million impressions Quit with help. Quit for good. Motivating smokers to quit with assistance, like counseling or medications. ~50 million impressions

34 Time for a Change (TV)

35 Last Pack (TV)

36 Buses and subway

37 Buses and subway

38 Media Recall of Get Healthy Philly Media Campaigns, % 70% 60% Percent 50% 40% Tobacco Sugary Drinks 30% 20% 10% 0% Month The Annenberg Public Policy Center and School of Communications, University of Pennsylvania

39 Amount of sugar Media Do you know what your kids are drinking? High Low Jordan et al, Annenberg Public Policy Center

40 Intention Media Do you know what your kids are drinking? High Low Jordan et al, Annenberg Public Policy Center

41 Percent Media Quit with help. Quit for good. 100% No recall < 4x wk recall 4x wk recall 80% 60% 40% 20% 0% Talked about the ad Sought info on quitting Hornik et al, Annenberg School of Communications

42 Percent intending to quit T2 Quit Media Quit with help. Quit for good. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No Recall < 4x Wk Recall >=4x Wk Recall No T1 Quit Yes T1 Quit Hornik et al, Annenberg School of Communications

43 Legislation and regulation On 12/23/10, Mayor Nutter signed Bill No into law, increasing penalties from $100 to $250 for illegal sales of tobacco products to youth Passed 15 0 by City Council On May 23, 2011, Mayor Nutter signed an executive order making all recreation centers, playgrounds, and pools 100% smoke-free In June 2011, City Council passed an ordinance that will require all tobacco retailers to obtain a permit from the Department of Public Health

44 Menu labeling and exemption from federal preemption Philadelphia adopted its menu labeling ordinance ( A) on November 19, The menu labeling requirements became effective January 1, Menu boards Menus Calories must be displayed directly on the menu board next to each food or beverage item. Additional nutrition information must be available upon request. Calories, sodium, saturated fat, trans fat, and carbohydrates must be displayed directly on the menu next to each food or beverage item.

45 What s the Problem with Sodium?

46 What s the Problem with Sodium? Average sodium in items served at Philadelphia sit-down restaurants, 2011 Kid's meals 912 Senior meals 1114 Other entrees 1759 Appetizers 1930 Burgers and sandwiches Milligrams of sodium Drexel University School of Public Health, Philadelphia Department of Public Health

47 New initiatives Point of purchase warnings Smoke-free spaces Housing, parks Salt reduction Take-out Chinese restaurants Media campaign Healthy food procurement Schools, afterschools City agencies Healthy supermarkets Value-based insurance design

48 Questions?