Importance of Obesity as Compared to Other Issues Among Kansas Policymakers

1. Importance of Obesity as Compared to Other Issues Among Kansas Policymakers Katie M. Heinrich, PhD Katherine B. Vaughan, BS Mellina Stephen, BS Melinda Kellogg Photo by Dave Gnojek

2. Session Objectives • To share what the most important issues were for Kansas policymakers in 2011 • To explain how legislation introduced or received by the 2011 Kansas legislature related to these issues, highlighting the need for public health advocacy • To explain policymakers’ perceptions and disconnect between health policy and obesity determinants

3. Background • Public policy provides structure and guidance to influence behaviors. (Schmid et al., 2006) • Types of policy: • Regulations, budget priorities, and legislation • Policy has larger reach than individual-level efforts on the health of the public. (Schmid et al., 1995) Understanding policymakers’ priorities is critical for influencing public health

4. Background • Obesity, poor nutrition and physical inactivityare major public health problems. • Kansas Statistics for Adults • Over 64% are overweight or obese (CDC, BRFSS, 2009) • Only 18.6% eat enough fruits and vegetables (KS BRFSS, 2009) • Less than half (48.5%) meet physical activity guidelines (KS BRFSS, 2009)

5. Background • Recommended community-level strategies for obesity prevention: • Policy changes • Environmental changes (Kettel Khan et al., 2009) • Long-term behavior changes are more likely to occur through permanent environmental and policy approaches than individual behavioral change interventions(Brownson et al., 2008)

6. Purpose • To understand how issues and problems related to obesity were rated in comparison to other issues AND • To understand if actual legislation discussed matched the perceived importance of each issue

7. Methods • Sample • All elected and appointed state-level officials in Kansas were contacted (n = 181) • 40 senators • 124 representatives • 2 executive branch • 15 appointed state-level officials • Response rate: 49 (27%) • 43 elected • 5 appointed • 1 unknown

8. Methods • Measure: adapted version of “Survey of Community Leaders” (Maddock et al., 2009) • Open-ended question: Top 3 issues in Kansas • Rate 25 common issues/problems faced by states • 1 = not a problem to 5 = problem of extreme importance • Asked to share any additional issues/problems • Indicate what type of assistance is most needed to address the specified problems

9. Survey Issues/Problems That Were Rated • Lack of good jobs • Lack of pedestrian walkways, crosswalks, and sidewalks • Lack of public health training • Lack of recreational activities • Obesity • Pandemic influenza • Pedestrian safety • Poor nutrition • Poorly planned development and sprawl • Poverty • Quality of public education • Underage drinking • Access to healthcare • Access to healthy groceries • Air pollution • Cost of living • Crime • Drug abuse • Ethics in government • Global warming • Government response to natural disasters • High taxes • Homelessness • Increasing traffic • Lack of good affordable housing

10. Methods • Procedure • Mailed cover letter, survey, pre-paid return envelope; online response option • Requested response in 2 weeks • All quantitative data entered into SPSS for analysis • Qualitative survey responses entered into excel • Thematically coded into categories by 2 research assistants

11. Methods • All bills, resolutions, concurrent resolutions, executive reorganization orders introduced or received by 2011 Kansas Legislature were coded to match the 25 issues/problems from the survey

12. Results • Political party affiliation • 75% were Republicans (n = 37) • 18.4% were Democrats (n = 9) • 6.1% were members of other political parties (n = 3)

13. Most Important Issues (open-ended) • Top five issues written in by policymakers (of 163 total) • Budget/spending/taxes (n = 35) • Education (n = 28) • Jobs/business/economy (n = 24) • Government regulation/efficiency (n = 21) • Healthcare (n = 20)

14. Issue/Problem Ratings • Overall problems that were rated of greatest importance

15. Issue/Problem Ratings • Obesity, nutrition, and physical activity

16. Issue/Problem Ratings • Economic issues

17. Issue/Problem Ratings • Other health issues

18. Issue/Problem Ratings • Problem behaviors and Other issues

19. Ratings for Obesity and Nutrition

20. Ratings for Obesity and Physical Activity

21. Solutions for problems • 57.1% (n = 28) felt that more active participation from citizens was needed • 10.2% selected more expert advice or more funding (n = 5 each) • 16.3% other (3.g., political leaders with guts, significantly lower taxes)

22. Legislation Analysis • 788 total pieces of legislation • Number of bills by 25 survey categories • Education (n = 100) • Ethics in government (n = 73) • Access to healthcare (n = 68) • Crime (n = 51) • High taxes (n = 40)

23. Legislation Analysis • Only one bill addressed obesity • Create task force on obesity prevention and management • 1 addressed access to healthy groceries • 0 addressed poor nutrition • 12 addressed poorly planned development & sprawl • 7 addressed pedestrian issues • 2 addressed lack of recreational activities

24. Report • 2-page report was disseminated • Kansas policymakers • K-State Today Announcement and Press Release • KPHA Conference!

26. Discussion • Policymakers viewed obesity as a significant problem (second after jobs), but they did not rate issues related to nutrition and physical activity as important • Legislation was limited for obesity (n = 1) and nutrition (n = 1), but more prevalent for physical activity (n = 21)

27. Discussion • High visibility of some issues “healthcare, taxes” may have led to more bills being introduced in those areas. • Government seemed to want to regulate itself as evidenced by the 73 bills relating to government ethics.

28. Practical implications • Need for educating policymakers on underlying causes of obesity • Nutrition • Physical Activity • Clear desire for “more active participation from citizens” • Public Health Advocacy!

29. References • Brownson, R. C., Kelly, C. M., Eyler, A. A., Carnoske, C., Grost, L., Handy, S. L., et al (2008). Environmental and policy approaches for promoting physical activity in the United States: A research agenda. Journal of Physical Activity & Health, 5 (4), 488-503. • Centers for Disease Control and Prevention. (2009). Behavioral Risk Factor Surveillance System Survey Data. Retrieved from http://apps.nccd.cdc.gov/BRFSS/ • Centers for Disease Control and Prevention. (2011). U.S. Obesity Trends: Trends by State 1985-2009. Retrieved March 30, 2011, from Centers for Disease Control and Prevention website, http://www.cdc.gov/obesity/data/trends.html • Kansas Behavioral Risk Factor Surveillance System. (2009). Percentage of adults who are overweight or obese. Retrieved June 27, 2011 from http://www.kdheks.gov/brfss/Expansion/index.html • Kansas Behavioral Risk Factor Surveillance System. (2009). Percentage of adults reported consuming fruits and vegetables 5 or more times per day. Retrieved June 27, 2011 from http://www.kdheks.gov/brfss/Expansion/index.html • Kettel Khan L, Sobush K, Keener D, et al. Recommended community strategies and measurements to prevent obesity in the United States. MMWR. 2009;58:1-26. • Maddock, J.E., Reger-Nash, B., Heinrich, K., Leyden, K.M., & Bias, T.K. (2009). Priority of activity-friendly community issues among key decision makers in Hawaii. Journal of Physical Activity and Health.6, 386-390. • Schmid TL, Pratt M, Howze E. Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease. Am J Public Health. 1995;85:1207-1211. • Schmid TL, Pratt M, Witmer L. A framework for physical activity policy research. J Phys Act Health. 2006;3(S1):S20-S29.