Community prevention and the public: Full findings from focus groups and survey

1. Community prevention and the public: Full findings from focus groups and survey FULL REPORT 202.776.9066 | www.lakeresearch.com | November 2010

2. Methodology • Lake Research Partners (LRP) conducted a series of seven focus groups from July 21 to August 30, 2010: white males in LA, white Latinas and Latinos in LA, younger white females in LA, older white females in Chicago, African Americans in Chicago, females in Kansas City, and white males in Kansas City. • All focus groups were conducted among influential voters, defined as those who read national news more than 5 times a week, and who answered yes to three of five questions: pay a great deal of attention to government and politics; have written a letter or called a politician or newspaper about an issue; regularly participate in volunteer, church, or community activities; work closely with children in their profession or activities; or are a business owner with at least one non-family employee. • LRP designed and administered this survey that was conducted online between September 24-October 1, 2010. • The survey reached a total of 950 adults nationwide, with an oversample of 100 Latinos (with interviews offered in both English and Spanish). The margin of error for this survey is +/- 3.2%. 2

3. KEY FINDINGS - CONTEXT • The American public strongly supports prevention and believes it should be a much higher priority for the country than it is. • The terms “health and wellness” and “health care prevention” are extremely popular, and clearly encourage community-based as well as individual prevention. The term “community prevention” rates slightly lower but still very positively. • Americans believe the U.S. is doing poorly on health and prevention, with most giving our health a letter grade of C or D. 3

4. KEY FINDINGS – SUPPORT FOR COMMUNITY PREVENTION • In our qualitative research among influential voters in Los Angeles, Chicago, and Kansas City, we found that there is broad support for community prevention and recognition that something needs to be done—however, what that action is and who will lead the way are uncertain. • The public overwhelmingly supports allocating resources towards community prevention initiatives, described as efforts to make it easier for people to maintain their health and make healthier choices (73% support with 43% strong support vs. 20% oppose). Support and intensity are lower when taxes are mentioned, but a solid majority is still in favor with this tougher language (61% support with 32% strong support vs. 34% oppose). • The strongest supporters of investing in prevention include African American women (77% strongly support), strong Democrats (66%), African Americans (65%), West women (62%), Latinos (60%), unmarried people with children (44%), post-graduates (59%), Democratic women (59%), and Northeast women (57%). • Support for investment in community prevention remains solid after more information and messages for and against. • Americans are tax sensitive, especially Latinos, black women, those in the Mountain region, post graduates, and women, especially unmarried and Republican women. 4

5. KEY FINDINGS – SUPPORT FOR COMMUNITY PREVENTION • Americans are more divided on the dimension of responsibility for health and prevention. Individual and personal responsibility competes with community prevention, except when it comes to children. The strongest approaches emphasize the individual value. • A plurality agree with a statement that we are all in this together and communities can help make healthy choices easier (46%), while about one third (34%) choose an opposing statement that staying healthy is up to individuals. The divide between community (44%) and personal responsibility (36%) is closer when taxes are mentioned. • However, the public moves significantly toward the community view of responsibility as a result of information and messages. At the end of the survey, 55% agree with community responsibility (47% if taxes are mentioned), and only 22% stick to individual responsibility (32% with taxes). Moving people on this dimension should be a key goal of public campaigns on this issue. • Those who move most towards a community view of responsibility include Northeast women (32%), Northeast whites (30%), non-college educated older women (28%), weak Republicans (27%), and West men (26%). 5

6. KEY FINDINGS – PROPOSALS • Americans rate various community prevention initiatives, ranging from banning smoking to improving access to fresh fruits and vegetables, extremely high. It is clear there is broad support for specific initiatives, especially those that target children. As we saw in the focus groups, the concept of community prevention is vague to people and it helps to provide examples. • When the proposed actions are drawn together into broader strategies, one strongly stands out as the most popular among both base and persuasion audiences. “Healthy Schools, Healthy Kids” does best, indicating that going through schools to reach kids is the most popular approach for addressing community prevention. The second most popular strategy is “Two for One,” which acknowledges the tough economy and suggests fiscal efficiency in implementing community prevention initiatives. Both are especially strong with Latinos. • Not only is there strong support for policy changes, but the public also says they are more likely to vote for elected officials if they support these efforts. 66% said they are more likely and only 11% said less likely. Elected officials have little to lose, and much to gain, by advocating for these initiatives. 6

7. KEY FINDINGS – MESSAGES • From our qualitative and quantitative research, we have learned that the “children” narrative is the most powerful way to reach both influential voters and the public. A message labeled “Kids-gain” tested overwhelmingly well in both intensity and overall support among the broader public, and should be our primary narrative. • “Michelle,” a narrative based on the First Lady’s message that invokes urgency and utilizes facts about Americans’ poor health status, also tested very well, even without specific mention of her name. From our focus group research we know that people respond to a few well-chosen statistics. Also significant is that this message connects prevention to the health care system (and the recent reform legislation). • Other messages that tested well included one that gave the example of Oklahoma City’s successful community prevention efforts (tested especially well among base supporters) and one that focused on individual responsibility and extended this theme into an argument for broader action including involvement from government and businesses. The individual responsibility message did well among tougher audiences like Republicans and men, and will be helpful in reaching beyond the base. 7

8. KEY FINDINGS – RECOMMENDATIONS • Run a broad campaign with broad themes. There is virtually no group we cannot win over, though some groups are more enthusiastic than others. • Base supporters who are most enthusiastic include Democrats, women, African Americans, Latinos, and people with post-graduate degrees. • Somewhat more skeptical groups include Republicans (especially strong Republicans), older men, older non-college adults, independent women, and those who live in the West North Central and West South Central regions—though all support community prevention by a majority, and all groups are reachable on this issue. • Frame the overall goal as making good, healthy choices easier. We found in focus groups that we can bridge the values of individual responsibility and collective action by framing this as a matter of individual choice that the community can play a role in making easier. • Target base supporters and focus on turning these groups into activists using segmentation and tailored messaging to excite and motivate them to action. • Coordinate efforts by advocacy groups in the coalition and focus overall messaging on two themes: one based on “Kids-Gain” and the other on “Michelle.” Focus on kids and schools in both our messaging and policy, for which there is broad and strong support.It will be important for the coalition to pick a coherent narrative and stay on message. 8

9. Research Our qualitative and quantitative findings include broad and widespread support for prevention, recognition that this currently isn’t a priority, and strong support for specific prevention efforts and strategies. Important targets include Latinos and women, both of whom are very supportive of prevention initially. Because so many Americans are already on board with community prevention efforts, messages tend to solidify rather than gain support. However, people do move significantly in the direction of community responsibility after hearing messages.

10. FOCUS GROUP – KEY FINDINGS - CONTEXT • Americans broadly agree that the country is not healthy and that prevention is not a priority, and that it should be. • “We’re not healthy at all.” [African American, Chicago] • “We need to eat better and exercise.” [African American, Chicago] • “We’re fat.” [Latino, Los Angeles] • “It’s expensive to be healthy. We have it all here but we can’t always afford it.” [White man, Los Angeles] • “I think as a nation we are not doing well at all with preventive care.” [Younger white woman, Los Angeles] • Americans agree on where we are, but not on how to move forward with an agenda that people can get behind. 10

11. How Americans Grade Our Health Nearly 8 in 10 Americans rate our health as a “C” or a “D”, a key indicator that the overall poor health of Americans is well known. 11 Now, here are a few questions about health, wellness, and prevention. First of all, thinking about the people of the United States, if you had to give us a grade, how healthy would you say we are? Would you say that in general you would rate the health of Americans as an A, B, C, D, or F?

12. FOCUS GROUP – KEY FINDINGS – PREVENTION AND HEALTH • Prevention is a popular concept, as well as language focused on being healthy and staying healthy. • “If you’re overweight, that’s a big factor in your health.” [Older white woman, Chicago] • “It depends a lot on being aware of what you’re eating and what you should do.” [Latino, Los Angeles] • “Prevention starts at home, with how the parents live and eat. It’s also what’s being taught at school.” [White man, Kansas City] • “It doesn’t mean medicine to me, it means being alive, vital, eating well, exercising.” [White woman, Kansas City] 12

13. The public strongly supports prioritizing prevention, but rates the current priority level of such initiatives as much lower than what they would like. Preferred vs. Actual Priority of Prevention (% 6-10) How high of a priority would you like [health and wellness/health care prevention] to be in this country, on a scale from 0 to 10, with 10 meaning a very high priority and 0 meaning a very low priority, and you can pick any number in between? Mean 7.9 8.0 How high of a priority is [health and wellness/health care prevention] in this country, on a scale from 0 to 10? 4.8 4.8 13

14. When we use the label “community prevention,” a similar gap exists between the desired high priority and the current low priority. Preferred vs. Actual Priority of Community Prevention (% 6-10) Mean How high of a priority would you like community prevention to be in this country, on a scale from 0 to 10, with 10 meaning a very high priority and 0 meaning a very low priority, and you can pick any number in between? 7.5 How high of a priority is community prevention in this country, on a scale from 0 to 10? 4.3 14

15. FOCUS GROUP – KEY FINDINGS - SUPPORT • Overall, the focus groups brought good news: the public is on board with prevention efforts, and further along in terms of support than even the experts give them credit for. • “People pay too much stock in medicine, instead of taking care of themselves.” [White woman, Kansas City] • “I don’t think there is enough prevention because I think a lot of people can’t afford it.” [White woman, Kansas City] • “It’s really important, what you eat and how much you exercise.” [Younger white woman, Los Angeles] • “It’s not a cultural thing of being Latino or Jewish or Armenian or whatever, it’s that people don’t have time now, we don’t have someone at home taking care of the kids. Our lifestyle is so busy, it affects all races and social levels.” [Latino, Los Angeles] • However, advocates must focus on turning support for prevention into action for prevention. 15

16. FOCUS GROUP – KEY FINDINGS - FRAMING • Certain communities are more concerned about access to care, particularly preventive care – especially Latino and African American groups. • “Prevention means getting regular check-ups, going to the doctor.” [Younger white woman, Los Angeles] • “Healthy people have the liberty of seeking health care, because they have insurance.” [Latino, Los Angeles] • “Health is maintaining health, not waiting to get sick but going to get regular checkups.” [Latino, Los Angeles] • All voters really like emphasizing and focusing on education and awareness. They believe that we can make the most difference by giving people more knowledge. The challenge is to expand this concept from a purely individual focus to broader policy changes. • “We can be more aware of issues, like salt and processed foods. We’re just now getting that understanding.” [White man, Los Angeles] • “Any kind of education, like on a children’s show.” [Older white woman, Chicago] • “We need more places where you can get information, not necessarily for treatment.” [African American, Chicago] 16

17. Initial support for allocating resources towards community prevention, described as efforts to make it easier for people to maintain their health and make healthier choices, is overwhelmingly popular, though opposition increases somewhat when taxes are mentioned. Those who are most tax sensitive and drop off in the greatest numbers in terms of strong support include Latinos, black women, Mountain region, post graduates, and women, especially unmarried and Republican women. Initial Support: Investing in Prevention No taxes* With taxes* +53 points +26 points *split sampled question Darker color indicates intensity 17 Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly?

18. The mention of taxes has a surprisingly large impact on Latinos. Intensity drops by 20 points and the commanding margin of support for community prevention narrows a bit. Initial Support: Investing in Prevention - Latinos No taxes* With taxes* +39 points +58 points *split sampled question Darker color indicates intensity 18 Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly?

19. Taxes also increases opposition to community prevention, even among women. Overall support drops more among men, though strong support drops by 14 points among women. Initial Support: Investing in Prevention by Gender No taxes* With taxes* Men Women Men Women *split sampled question Darker color indicates intensity 19 Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly?

20. FOCUS GROUP – KEY FINDINGS – INDIVIDUAL vs. COMMUNITY • Voters tend to focus on personal choices and personal responsibility. • “The individual is where it starts, you’re responsible for yourself and your children, but if communities and cities have ideas to promote health, it’s reinforcement.” [Younger white woman, Los Angeles] • “Personal motivation is necessary.” [White man, Kansas City] • “We can’t ‘make people healthy’ – they have to choose to be.” [White man, Kansas City] • “It has to start with the family; you learn by example.” [White woman, Kansas City] • They understand the community has a role to play, too. • “People feel a connection to the area they live in.” [Older white woman, Chicago] • “People with lower incomes, they don’t have access to better groceries.” [White woman, Kansas City] • “I think it really does take a whole community of people to really prevent certain things, certain health issues because even if people are getting it from home, you go out and there are billboards everywhere.” [Latina, Los Angeles] • The challenge is to bridge the values of personal responsibility and community action. Personal responsibility should be a part of the overall narrative, because it is a core value of Americans. • Yet Americans also recognize that these choices can be made easier or harder. They want businesses, government, and communities to work together in providing access and opportunities for better choices and better health. 20

21. Voters are split on individual vs. community role. Initially, a plurality of the public agrees that the community – not just individuals - has a role in prevention efforts. Mentioning taxes has only a minor effect on this dimension. Community vs. Individual Responsibility Without taxes* With taxes* Some people say that while staying healthy is up to each individual, there are things that communities can do to make healthy choices easier for individuals and families. We are all in this together, and we all have a lot to gain from making it easier to eat better, exercise more, and ultimately live longer, [even if it means increasing taxes]. +12 points +8 points Other people say that a person’s health is due to their individual choices, and that becoming healthier is each individual’s responsibility. Instead of spending money on community programs, it will be more effective to leave it to individuals to take control and make healthier lifestyle choices. *split sampled question 21 Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

22. When taxes are not mentioned, women strongly support community efforts. However, when cost becomes part of the debate, the gender gap diminishes. Community vs. Individual Responsibility By Gender Without taxes* With taxes* Men Women Men Women 22 *split sampled question Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

23. Independents are more likely to support community responsibility when taxes are not mentioned. Republicans are more individual-oriented. Community vs. Individual Responsibility By PID Without taxes* With taxes* Democrats Independents Republicans Democrats Independents Republicans 23 *split sampled question Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

24. FOCUS GROUP – KEY FINDINGS - ACTIONS • Regarding specific preventive actions, while Americans are clear on the problems and goals, they are much less certain about specific solutions to move forward with. • Popular prevention actions include healthier school lunches (especially among women and African Americans), insurance and employer incentives (general interest in this, including among men, Latinos, and older women), grocery stores in more neighborhoods (mainly in less affluent urban groups), and biking and walking trails (especially among white, more affluent respondents). • Re: insurance discounts: “It encourages people to take responsibility.” [Younger white woman, Los Angeles] • Re: school lunches: “You have to start early, it’s a lifestyle that will lead to a healthier generation.” [Younger white woman, Los Angeles] • Re: grocery stores: “You can’t tell me that vegetables with worms in it is the best we can do.” [African American, Chicago] • “The residents don’t have choices.” [African American, Chicago] • Re: biking trails: “Wouldn’t it be nice if you could ride your bike to work?” [White woman, Kansas City] • “I’m lucky that I have a safe place to jog, but not everyone has that.” [White man, Los Angeles] 24

25. FOCUS GROUP – KEY FINDINGS - ACTIONS • Anything that put money in people’s pockets was popular among everyone. • “I’d do whatever it took to get some money back.” [White man, Los Angeles] • “Money talks.” [Younger woman, Los Angeles] • Some actions were less popular or didn’t make as much sense to voters, including encouraging eating dinner at home or more grocery stores in neighborhoods (for those that already have them). • “Every store has fresh produce.” [Older white women, Chicago] • “Telling people to eat dinner with their families…good idea but not effective. It’s like telling someone to love their wife.” [White man, Los Angeles] • “I don’t think it would motivate sedentary people. People already active would use [these preventive actions].” [White man, Los Angeles] 25

26. Prevention Actions Specific community prevention actions are tremendously popular, especially banning smoking and making school lunches healthier. Food labeling and health insurance discounts also rate highly. Mean 8.5 8.9 8.6 8.5 *split sampled question 26 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between.

27. Prevention Actions, continued Second-tier actions, including employer incentives and access to fresh produce, have less intense support but are still broadly popular. Mean 8.1 8.5 8.4 8.0 *split sampled question 27 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between.

28. Top Prevention Actions Among Latinos Latinos are more intensely supportive of prevention actions in general. They rank restricting advertising and employer incentives higher than the general population. Mean 9.5 9.2 9.2 9.2 *split sampled question 28 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between.

29. Top Prevention Actions Among Women Women are also more intensely supportive of prevention measures, particularly banning smoking and making school lunches healthier. Mean 9.0 9.4 8.8 8.5 *split sampled question 29 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between.

30. FOCUS GROUP – KEY FINDINGS - INVESTMENT • Voters find it easy to understand how investing in prevention will save money in the long run, and are for the most part willing to invest money in it—as long as it doesn’t increase taxes. • “In the long run, prevention saves so much.” [Younger white woman, Los Angeles] • “Initially it will cost, but in the long run it saves.” [Latino, Los Angeles] • “No taxes.” [Latina, Los Angeles] • They’d rather the money be located in places where they perceive it’s being wasted right now, particularly the health care system. • “There is wasted money.” [Latino, Los Angeles] • “Taxpayers shouldn’t fund it, I’m not going to wait around for the government to make things better.” [Latino, Los Angeles] • “We don’t have the money upfront – there are competing budget priorities.” [White man, Kansas City] • “The whole health care system is broken.” [Older white woman, Chicago] 30

31. In an engaged debate, a plurality of the public agrees that spending money on community prevention is a good investment, even when challenged on the cost of the investment in these tough times. The strong support beats the strong opposition though support is under 50%. Funding for Community Prevention Some people say that spending money on community prevention is a good investment because it results in better health, and it saves money in the long run by reducing the cost of expensive treatment for chronic diseases. Other people say that these may be nice things to have in a community, but times are tough and we just can’t afford to be spending more money on these prevention activities when governments are running deficits already. +16 points 31 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

32. Latinos and African Americans intensely and strongly agree that spending money on community prevention is a good investment. Funding for Community Prevention by Race Whites African Americans Latinos 32 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

33. Women are more supportive of funding community prevention than men, both in terms of overall support and intensity. Funding for Community Prevention by Gender Men Women 33 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

34. A majority of Democrats and a plurality of independents clearly believe that community prevention efforts are a good investment, while Republicans are more likely to say we can’t afford it. Funding for Community Prevention by PID Democrats Independents Republicans 34 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right.

35. FOCUS GROUP – KEY FINDINGS - GOVERNMENT • Regarding the role of government, people recognize that health is a large enough social problem that government should play a role; however, many are concerned that government could play too large a role and create a nanny state. • “Government has budgets they can spend. They can put some PSAs out there on buses. They can put some stuff up in all of these grocery stores.” [African American, Chicago] • “I would take out the government role – they have other priorities, not to get into our own business and spoonfeed us.” [Older white woman, Chicago] • “Where does the government come in if we’re taking control of our own lives?” [Older white woman, Chicago] • “We don’t want to be told what to do as adults.” [White man, Kansas City] • Voters are more comfortable with the idea of government creating public education programs about nutrition, exercise, and generally making it easier for people to be healthy. • “I like government promoting and telling people how much vegetables to eat, where farmers markets are, etc.” [Younger white woman, Los Angeles] • “Education and awareness is the limit.” [White man, Kansas City] • “As a cheerleader, okay, but no direct action—that should be reserved for the community.” [White man, Kansas City] • “They can get to a wide amount of people if they do it correctly.” [White woman, Kansas City] 35

36. Strategic Proposals – Top Tier With all of the community prevention strategies we tested that were popular, the best testing strategies by far focuses on kids and schools, while the next best strategy addresses how we can get “2 for 1” with smart, efficient investments. Mean 8.4 8.5 7.6 7.6 *split sampled question 36 Now, here are some strategies that have been suggested as ways to make our communities healthier. Please read and rate each one on how effective you think this will be in making your community healthier, where ten means you think this would be extremely effective, and zero means you think this would not be at all effective in making your community healthier, and you can choose any number in between.

37. Text of top tier strategic proposals • [HEALTHY SCHOOLS, HEALTHY KIDS – 3 DAYS] - Too many schools have become unhealthy, offering snacks and soda from vending machines as well as unhealthy school lunches to kids. We should limit junk food in schools and make the school lunch menu more nutritious. We should also have physical education classes at least 3 days a week, not cut them, so kids can be active, which helps them be healthier and learn better. • [HEALTHY SCHOOLS, HEALTHY KIDS – EVERYDAY]Too many schools have become unhealthy, offering snacks and soda from vending machines as well as unhealthy school lunches to kids. We should limit junk food in schools and make the school lunch menu more nutritious. We should also have physical education classes every day, not cut them, so kids can be active, which helps them be healthier and learn better. • [TWO FOR ONE]- In these tough times, we have to do more with less, and find ways to promote prevention while we do other things. Where possible, every school should have a community garden. We should use our school facilities after work for exercise programs. When we repair parks and streets, let’s build playgrounds and bike paths where it makes sense. For minimal cost and effort we can get multiple benefits. • [TWO FOR ONE – SCIENCE PROJECT] In these tough times, we have to do more with less, and find ways to promote prevention while we do other things. Where possible, every school should have a science project community garden. We should use our school facilities after work for exercise programs. When we repair parks and streets, let’s build playgrounds and bike paths where it makes sense. For minimal cost and effort we can get multiple benefits.

38. Strategic Proposals – Second Tier Strategies that focus on food also do well, though not as well as targeting kids specifically and the two-for-one theme. Mean 7.3 6.2 *split sampled question 38 Now, here are some strategies that have been suggested as ways to make our communities healthier. Please read and rate each one on how effective you think this will be in making your community healthier, where ten means you think this would be extremely effective, and zero means you think this would not be at all effective in making your community healthier, and you can choose any number in between.

39. Text of second tier strategic proposals • [BETTER FOOD] - Community programs are encouraging corner stores to stock fresh fruits and vegetables in places where grocery stores are scarce. With a little assistance and education to get started, store owners often make more money, so the program sustains itself. They are also encouraging opening full-service grocery stores in economically struggling neighborhoods that don’t have them. When people have access to fresh, healthy food in their neighborhoods, they can make better choices. • [CHANGE THE FOOD INCENTIVES]Studies show that when unhealthy foods cost more, people eat less of it. We should continue to tax soda, candy, and other junk food, and lower or eliminate taxes on healthy, fresh foods including fruits and vegetables. We should use tax revenue from junk food to fund practical nutrition education programs in our schools, including lessons on nutrition labels, preparing healthy snacks, and healthy portion sizes.

40. Democrats are most intensely supportive of the strategic proposals, followed by independents and Republicans. All like Healthy Schools, Healthy Kids best. Strategic Proposals by Party ID Democrats Independents Republicans • Healthy Schools, • Healthy Kids – 3 Days* • (53% rate 10) • Healthy Schools, • Healthy Kids – • Everyday* • (45% rate 10) • Two for One w/ Science • Project* (35% rate 10) • Healthy Schools, • Healthy Kids – • Everyday* (46% rate 10) • Healthy Schools, • Healthy Kids – • 3 Days* • (36% rate 10) • Two for One w/ Science • Project* (23% rate 10) • Healthy Schools, • Healthy Kids – • Everyday* • (40% rate 10) • Healthy Schools, • Healthy Kids – • 3 Days* • (40% rate 10) • Two for One* • (24% rate 10)

41. Latinos are intensely supportive of the strategic proposals. Women and Latinos, both key targets, are very supportive of healthy schools and 2 for 1. Strategic Proposals – Women and Latinos Women Latinos • Healthy Schools, • Healthy Kids – 3 Days* • (55% rate 10) • Healthy Schools, • Healthy Kids – • Everyday* • (50% rate 10) • Two for One w/ Science • Project* (35% rate 10) • Healthy Schools, • Healthy Kids – • 3 Days* (62% rate 10) • Healthy Schools, • Healthy Kids – • Everyday* • (60% rate 10) • Two for One w/ Science • Project* (47% rate 10)

42. FOCUS GROUP – KEY FINDINGS - LEADERS • Even influential voters have a hard time identifying visible leaders on prevention, nationally or locally. • “I’d like to see more Latino leadership, our kids are killing each other. We need to unite and become a political force, we could come together to get what we need.” [Latino, Los Angeles] • “It’s important for elected officials to take action.” [Latino, Los Angeles] • The First Lady’s effort have been noticed and are often mentioned in a positive light. • “I like the awareness, with Michelle Obama planting a garden- look, this is a tomato.” [Younger white woman, Los Angeles] • “There’s an attempt, it’s coming from the Obamas, she’s taking obesity and that’s a start.” [White woman, Kansas City] 42

43. FOCUS GROUP – KEY FINDINGS - LEADERS • Voters want to see the media and pop culture take more active roles in leading the way on prevention, including medical doctors on TV, celebrities, and others. • “It’s good, like when Sally Field talks about osteoporosis.” [Older white woman, Chicago] • They also see a role for community institutions such as churches and schools. • “Schools…there’s junk food sold in schools now.” [Latino, Los Angeles] • “I was thinking, in schools if they provided some kind of an opportunity for kids to cook. Maybe you could teach them through that rather than waiting until they get to high school.” [White woman, Kansas City] • “It has to start from the schools because sometimes parents aren’t educated to know.” [White woman, Kansas City] • “Our church is getting involved in things like health as well, and even financial health. They have classes on managing your money.” [White man, Kansas City] 43

44. Advocates for the community prevention agenda should point out to elected officials that supporting such efforts would be beneficial in winning votes. Vote for Elected Official 80% of Democrats, 64% of independents, and 58% of Republicans say they are more likely to vote for an elected official who supports community prevention efforts. Only 5% of Democrats, 14% of independents, and 17% of Republicans say they are less likely. Darker color indicates intensity 44 Now that you’ve read more about community prevention, would you be more or less likely to vote for a local elected official if he or she supported these efforts, or would it not make a difference to you? Is that much more or less likely, or somewhat more or less likely?

45. Three-quarters of Latinos would be moved to vote for an elected official who supports community prevention. Vote for Elected Official - Latinos Darker color indicates intensity 45 Now that you’ve read more about community prevention, would you be more or less likely to vote for a local elected official if he or she supported these efforts, or would it not make a difference to you? Is that much more or less likely, or somewhat more or less likely?

46. Targeting to address health disparities is slightly more broadly supported when referred to as “certain neighborhoods” rather than “ethnic and racial minorities.” Disparity Questions Target Ethnic and Racial Minorities Or Low Income* Target in Certain Neighborhoods* *split sampled question Darker color indicates intensity 46 Now, thinking about community prevention, would you support or oppose efforts to target people in certain neighborhoods [ethnic and racial minorities or people who have lower incomes] who may have a harder time accessing and choosing healthy lifestyles? Would you say you support or oppose that strongly or not so strongly?

47. A majority supports targeting prevention efforts to demographic groups, though the level of support is lower than for prevention actions more broadly. African Americans respond strongly to the specific reference to race. Latinos see an overall initial increase but less reach. Disparity Questions by Race Target Ethnic and Racial Minorities Or Low Income* Target in Certain Neighborhoods* *split sampled question Darker color indicates intensity 47 Now, thinking about community prevention, would you support or oppose efforts to target people in certain neighborhoods [ethnic and racial minorities or people who have lower incomes] who may have a harder time accessing and choosing healthy lifestyles? Would you say you support or oppose that strongly or not so strongly?

48. FOCUS GROUP – KEY FINDINGS - MESSAGES • Messaging focused on kids resonates strongly among all groups, and particularly among women, Latinos, and African Americans. • “They ARE the future.” [Latino, Los Angeles] • “I like the concept. It’s okay for adults to do what they want, but the children don’t know.” [Older white woman, Chicago] • “Kids are our future, parents have to take responsibility and have to show their children…they have to be good role models.” [Older white woman, Chicago] • Influentials want to see facts included in messages, such as “Michelle.” They also like messages that contain an economic component. • “The statistic makes it more real.” [Younger white woman, Los Angeles] • “I would use more facts on obesity, diabetes.” [White man, Kansas City] • “It’s a pocketbook issue, it’s more rational than emotional.” [Older white woman, Chicago] 48

49. FOCUS GROUP – KEY FINDINGS – CHILDREN NARRATIVE • The children narrative was a powerful one, opening up the conversation and helping people hone in on solutions. Talking about kids helps raise the stakes because everyone wants children to be healthy and knows they are the future, and they believe children can not be expected to take individual responsibility. • “Children spend a lot of time in front of the computer; we need to get them more active.” [Older white woman, Chicago] • “Education with kids…obesity starts in childhood.” [Older white woman, Chicago] • “Kids spend their money on trash.” [Younger white woman, Los Angeles] • “I never see kids out playing, versus our own childhoods…they are less active now.” [White men, Kansas City] • “Kids are taking pills, kids are drinking soda.” [Younger white woman, Los Angeles] • “A lot of kids are very obese, their diet is inappropriate.” [White woman, Kansas City] 49

50. FOCUS GROUP – KEY FINDINGS - MESSAGES • Messaging that wasn’t as successful was often found to be too vague. Voters are wary of rhetoric and want concrete facts and solutions. • Re: Falling Behind: “I think this is completely absurd.” [White man, Los Angeles] • “They used the word innovate three times without saying exactly what that means.” [White man, Los Angeles] • Re: Populist Demand: “I just didn’t like it because it sounded like a freshly written speech.” [African American, Chicago] • Re: Villains: “I thought this was full of excuses.” [African American, Chicago] • “I like what it said, but with all of these blanket statements, I want to know what the solution is or what are we going to do, or how are we going to start?” [African American, Chicago] • Re: Imagine: “It is all a great idea, but what are they proposing? There is no action.” [Younger white woman, Los Angeles] 50