Importance of Obesity as Compared to Other Issues

Among Kansas Policymakers

Katie M. Heinrich, PhDKatherine B. Vaughan, BS

Mellina Stephen, BSMelinda Kellogg

Photo by Dave Gnojek

1. To share what the most important issues were for Kansas policymakers in 2011

2. To explain how legislation introduced or received by the 2011 Kansas legislature related to these issues, highlighting the need for public health advocacy

3. To explain policymakers’ perceptions and disconnect between health policy and obesity determinants

Session Objectives

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

Background

Obesity, poor nutrition and physical inactivity are 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)

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)

Background

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

Purpose

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

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

Methods

1. Access to healthcare2. Access to healthy groceries3. Air pollution4. Cost of living5. Crime6. Drug abuse7. Ethics in government8. Global warming9. Government response to

natural disasters10. High taxes11. Homelessness12. Increasing traffic13. Lack of good affordable

housing

14. Lack of good jobs15. Lack of pedestrian walkways,

crosswalks, and sidewalks16. Lack of public health training17. Lack of recreational activities18. Obesity19. Pandemic influenza20. Pedestrian safety21. Poor nutrition22. Poorly planned development

and sprawl23. Poverty24. Quality of public education25. Underage drinking

Survey Issues/Problems That Were Rated

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

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

Methods

Political party affiliation 75% were Republicans (n = 37) 18.4% were Democrats (n = 9) 6.1% were members of other political

parties (n = 3)

Results

Top five issues written in by policymakers (of 163 total)1. Budget/spending/taxes (n = 35)2. Education (n = 28)3. Jobs/business/economy (n = 24)4. Government regulation/efficiency (n =

21)5. Healthcare (n = 20)

Most Important Issues (open-ended)

Overall problems that were rated of greatest importance

Issue/Problem Ratings

IssueMean Rating (SD)1 = not a problem to

5 = problem of extreme importance

% Rating as Problem of Extreme

Importance

1. Lack of Good Jobs 3.90 (0.92) 26.5

2. Obesity 3.73 (1.07) 24.5

3. Drug Abuse 3.71 (0.96) 20.4

4. High Taxes 3.51 (1.23) 28.6

5. Quality of Public Education

3.38 (1.30) 24.5

Obesity, nutrition, and physical activity

Issue/Problem Ratings

IssueMean Rating (SD)1 = not a problem to

5 = problem of extreme importance

% Rating as Problem of

Extreme Importance

Obesity 3.73 (1.07) 24.5

Poor nutrition 3.00 (0.99) 2.2Poorly planned development and sprawl

2.85 (0.91) 2.1

*Access to healthy groceries

2.37 (1.09) 2.0

Increasing traffic 2.34 (0.89) 0.0

Lack of pedestrian walkways, crosswalks, and sidewalks

2.25 (1.04) 2.1

Pedestrian safety 2.23 (0.84) 0.0

Lack of recreational activities

2.21 (0.99) 0.0

Economic issues

Issue/Problem Ratings

IssueMean Rating (SD)1 = not a problem to

5 = problem of extreme importance

% Rating as Problem of

Extreme Importance

Lack of good jobs 3.90 (0.93) 26.5

High taxes 3.51 (1.23) 28.6

Poverty 3.36 (1.05) 12.8

Lack of affordable housing 3.02 (1.01) 4.1

Cost of living 2.88 (0.95) 2.0

*Homelessness 2.86 (0.96) 4.1

Other health issues

Issue/Problem Ratings

IssueMean Rating (SD)1 = not a problem to

5 = problem of extreme importance

% Rating as Problem of

Extreme Importance

*Access to healthcare 3.20 (1.29) 18.4

*Lack of public health training

2.80 (1.05) 2.1

Pandemic influenza 2.38 (0.95) 0.0

Government Response to Natural Disasters

2.20 (0.89) 0.0

*Air Pollution 1.98 (1.05) 0.0

*Global Warming 1.94 (1.24) 6.3

Problem behaviors and Other issues

Issue/Problem Ratings

IssueMean Rating (SD)1 = not a problem to

5 = problem of extreme importance

% Rating as Problem of

Extreme Importance

Drug abuse 3.71 (0.96) 20.4

Crime 3.30 (0.89) 10.2

Underage drinking 3.29 (0.97) 6.3

Quality of public education

3.38 (1.29) 25.0

*Ethics in government 3.00 (1.14) 8.2

Ratings for Obesity and Nutrition

Not a

pro

blem

May

or M

ay N

ot b

e a

Prob

lem

Prob

lem

of E

xtre

me

Impo

rtanc

e0

4

8

12

16

Access to healthy groceries

Poor nutri-tion

Obesity

Ratings for Obesity and Physical Activity

Not a

Pro

blem

May

or M

ay N

ot b

e a

Prob

lem

Prob

lem

of E

xtre

me

Impo

rtanc

e0

4

8

12

16

Lack of Recreational ActivitiesLack of Pedestrian WalkwaysObesity

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)

Solutions for problems

788 total pieces of legislation Number of bills by 25 survey

categories 1. Education (n = 100)

2. Ethics in government (n = 73)

3. Access to healthcare (n = 68)

4. Crime (n = 51)

5. High taxes (n = 40)

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

Legislation Analysis

2-page report was disseminated Kansas policymakers K-State Today Announcement and Press

Release KPHA Conference!

Report

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)

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.

Discussion

Need for educating policymakers on underlying causes of obesity Nutrition Physical Activity

Clear desire for “more active participation from citizens” Public Health Advocacy!

Practical implications

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.

References