Apr 3, 2012 ... Poor Diet. Limited access to healthy foods in poor communities .... 183 smoke-
free recreation centers, playgrounds, and pools, affecting over ...
Center for Health Behavior Research University of Pennsylvania April 3, 2012
Unhealthy advertising in Philadelphia Counting ads in a 4-month period in Austin, Los Angeles, and Philadelphia
Hillier, Health & Place, 2009
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
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
Overweight and Obesity in Philadelphia Overweight and Obesity Among Philadelphia Adults (18+) and Children (6-17), 2000 - 2010
70.0% 60.0%
62.3%
64.6%
64.3%
66.3%
60.3%
60.0%
50.0%
Adult overweight-obesity 46.9%
46.4% Percent
40.0% 39.6%
42.0%
39.6%
40.7%
30.0% Child overweight-obesity (6-17 years) 20.0%
10.0%
0.0% 2000
2002
2004
PHMC Household Health Survey, 2000-2010
2006
2008
2010
Diabetes and hypertension in Philadelphia Diabetes among Philadelphia Adults 14.0
13.0
Hypertension among Philadelphia Adults 13.3
38.0
12.0 12.0
36.0
10.9
P e r c e n t
35.8
2008
2010
34.0
10.2 10.0
35.7
34.0
32.7
9.4 P e r c e n t
8.0 6.0 4.0
32.0
31.3 29.6
30.0 28.0 26.0 24.0
2.0
22.0
0.0
20.0 2000
2002
2004
2006
2008
2010
PHMC Household Health Survey, 2000-2010
2000
2002
2004
2006
Smoking prevalence for 10 largest U.S. cities 25% 20% 20% 18% 17%
17%
16%
15%
14%
12%
Behavioral Risk Factor Surveillance Survey and local data sources, 2007
Philadelphia Chicago Phoenix San Antonio NYC Houston Dallas San Diego LA San Jose
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
How can we make it easier for Philadelphians to engage in healthy behaviors?
Health Impact Pyramid Examples Smallest Impact
Counseling & Education
Clinical Interventions
Long-lasting Protective Interventions Changing the Context Largest Impact
to make individuals’ default decisions healthy
Socioeconomic Factors Frieden T, AJPH 2009
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
How can we make it easier for Philadelphians to engage in healthy behaviors? Media Educational institutions
Built environment
Workplaces
Community retail environment and restaurants Legislation and regulation Insurers and health care providers
Schools – School Wellness Councils School Wellness Council Interventions, (November 2011) 140 Healthy classroom rewards 120 Healthy fundraisers 100
Socialized Recess 80
60
Classroom movement breaks
128 102
40
20
Healthy school stores
83 42 3
0
Philadelphia Department of Public Health, School District of Philadelphia
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
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!
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 2nd and 5th graders provided pedestrian and bicycle safety lessons
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)
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 1-888-99-SMOKE or online
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
Healthy corner stores
• • •
635 enrolled 423 with at least 4 new products 83 with mini-conversions
Workplaces – promoting and supporting quit attempts • City of Philadelphia • Expanded insurance coverage to include 6 of 7 FDA approved smoking cessation medications, affecting 7,000 employees and dependents
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
Workplaces – healthy vending Employers that have developed or implemented healthy beverage vending standards, June 2011
HUP
31,000
City of Philadelphia
25,000
Einstein
Total Employees Impacted: 69,114
7,200
PA Hospital
2,700
Horizon House
1,115
KPMG
857
Fox Rothschild
497
SRSY
445
Congreso
300 0
5,000
10,000
15,000
20,000
Number of Employees Impacted
25,000
30,000
35,000
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 Callers to 1-800-QUIT-NOW for Philadelphia County Counseling only
Counseling + NRT
4000 3500 3000
2500 2000
NRT Giveaway
1500
NRT Giveaway
1000 500 0 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 2010
2011
2012
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
“Time for a Change” (TV)
“Last Pack” (TV)
Buses and subway
Buses and subway
Media Recall of Get Healthy Philly Media Campaigns, 2010 - 2012
80% 70% 60%
Percent
50%
Tobacco
40%
Sugary Drinks
30%
20% 10% 0% 1
2
3
4
5
6
7
Month
8
9
10
11
12
13
14
15
The Annenberg Public Policy Center and School of Communications, University of Pennsylvania
Media – Do you know what your kids are drinking?
Amount of sugar
High
Low
Jordan et al, Annenberg Public Policy Center
Media – Do you know what your kids are drinking?
Intention
High
Low
Jordan et al, Annenberg Public Policy Center
Media – Quit with help. Quit for good. No recall
< 4x wk recall
≥ 4x wk recall
100%
Percent
80%
60%
40%
20%
0% Talked about the ad
Sought info on quitting Hornik et al, Annenberg School of Communications
Media – Quit with help. Quit for good. No Recall
< 4x Wk Recall
>=4x Wk Recall
100%
T2 Quit
Percent intending to quit
90% 80% 70% 60% 50% 40% 30% 20% 10% 0% No T1 Quit
Yes T1 Quit Hornik et al, Annenberg School of Communications
Legislation and regulation • On 12/23/10, Mayor Nutter signed Bill No. 100634 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
Menu labeling and exemption from federal preemption Philadelphia adopted its menu labeling ordinance (080167-A) on November 19, 2008.
The menu labeling requirements became effective January 1, 2010. Menu boards
Menus
Calories must be displayed directly on the menu board next to each food or beverage item.
Calories, sodium, saturated fat, trans fat, and carbohydrates must be displayed directly on the menu next to each food or beverage item.
Additional nutrition information must be available upon request.
What’s the Problem with Sodium?
What’s the Problem with Sodium? Average sodium in items served at Philadelphia sit-down restaurants, 2011 912
Kid's meals
1114
Senior meals
1759
Other entrees
1930
Appetizers
2213
Burgers and sandwiches 0
500
1000 1500 Milligrams of sodium
2000
2500
Drexel University School of Public Health, Philadelphia Department of Public Health
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
Questions?
