what factors affect the passage of state legislation to prevent childhood obesity? ellen jones, phd...
TRANSCRIPT
What factors affect the passage What factors affect the passage of state legislation to prevent of state legislation to prevent
childhood obesity?childhood obesity?
Ellen Jones, PhD
Elizabeth Dodson, MPH
CollaboratorsCollaborators Saint Louis Univ. School of Public Health
• Chris Fleming (Mathematica Policy Research, Inc.)• Tegan Boehmer (CDC)• Debra Haire-Joshu• Doug Luke• Ross Brownson• Ellen Jones• Amy Eyler• Leah Wentworth
Background Background
Childhood obesity epidemic
Environmental and policy interventions
Individual states have much of the authority over public health policy
4
Art and Science Art and Science
changing the physical and sociopolitical environments
opportunities, support, and cues may directly affect behaviors
• Influence of price of tobacco on consumption or may alter social norms
• Physically active people in public spaces Often more permanent than many public
health programs focused on individual-level behavioral change• Important complement to individual-level programs
Why Why policypolicy interventions? interventions?
Schmid, Pratt, and Witmer. Schmid, Pratt, and Witmer. J Physical Activity HealthJ Physical Activity Health 2006. 2006.
COPS:COPS:Childhood Obesity Policy StudyChildhood Obesity Policy Study Objective: Examine childhood
obesity prevention legislation in all 50 states, 2003-2005
Phases 1 and 2:1. Identify relevant legislation
describe patterns intro/adoption2. Explore predictors and contextual
factors affecting bill enactment
Results Summary: Objective 1Results Summary: Objective 1 Descriptive statistics to describe
patterns by time, place, and topic area
During 2003-2005• 123 of 717 (17%) bills were adopted• 71 of 134 (53%) resolutions were adopted
• Introduced legislation increased 70%• Adopted legislation increased 38%
Boehmer, et al. Preventing Chronic Disease 2007
10
700 bills 2003-2005!700 bills 2003-2005!
Fewer than 20% enacted More likely if bi-partisan sponsors More likely in 2 year sessions (Boehmer, 2007 and 2008)
Only 7% have a review of evidence base
(Hartsfield, 2007)
11
Mississippi 2009 provisionalMississippi 2009 provisional
HB=1,597 SB=3302 About 300 health About 60 made it out of committee About 10 passed into law
Bill Enactment (%) by Topic Bill Enactment (%) by Topic Area, 2003-2005Area, 2003-20050% 10% 20% 30% 40%
Nutrition/Vending
Physical Education/Activity
Health Education
Curriculum & Credit
Local Authority
Safe Routes to School
BMI Reporting
Model School Policies
Farmers Markets
Task Force/Study
Snack/Soda Tax
Walking/Biking Paths
Statewide Initiatives
Menu/Product Labeling
Bill Enactment (%) by State, Bill Enactment (%) by State, 2003-20052003-2005
Results Summary: Results Summary: Objective 2Objective 2
Bills were more likely to be introduced if:• Introduced in Senate vs. House• >1 sponsor from a single party
Bills were more likely to be enacted if:• Budget bills – enacted 75% of time• Involved community walking/biking paths
Bills were less likely to be enacted if:• Proposed a new law (vs. amendment)• Proposed to generate revenue through taxes or fines• Involved PE, health curriculum, nutrition/vending
regulations
Boehmer, et al. American J of Preventive Medicine 2008.
Phase 3: PurposePhase 3: Purpose
Objectives:• Identify factors of state legislative
environment important for successful childhood obesity prevention legislation
• Describe significant barriers to passing & adopting childhood obesity prevention legislation
Phase 3: MethodsPhase 3: Methods
Key informant interviews with state legislators and staffers
Interview questions Sample selection Telephone interviews conducted: Dec
05 – April 06 Qualitative data analysis
Results: SampleResults: Sample N=16: 11 legislators, 5 staffers
Political party: 80% Democratic
Backgrounds: law & ed (20% health)
Time in state legislature: range=4-21 years; mean=11.8 years
Legislative responsibilities
Interview Question #1Interview Question #1
In your view, what factors support or facilitate the introduction and adoption of childhood obesity prevention legislation?
Results: FacilitatorsResults: Facilitators
National Media Exposure
“[Which bills pass] depends on what makes it into the media.”
Results: FacilitatorsResults: FacilitatorsIntroduction by senior legislators & those
with personal interest “You need … committed legislators.
Legislators who are going to say, ‘I’m going to put myself on the line and push ...’”
“We said that we need to do something about the obesity issue instead of just inform the public…We just did basic fundamental thinking of, what can we do to help? And then: what can we do that will pass?”
Other Facilitators Other Facilitators
Gaining support of key players
Working in supportive political climate
Attempting incremental changes
Interview Question #2Interview Question #2
In your view, what factors oppose or inhibit the introduction and adoption of childhood obesity prevention legislation?
Results: BarriersResults: Barriers
Lobbyists “We cannot underestimate the power of the
food lobby, the soda lobby, the restaurant association…”
“You can’t blindside the lobbyists…I had this one…bill, we had as many lobbyists in the room as legislators…Lobbyists are there. They get paid and they can watch things a lot more carefully than public interest groups, which are not as well-funded.”
Results: BarriersResults: Barriers
“Representatives who voted no [on school junk food bill] indicated that their schools had encouraged them to vote no. Some of them implied that soft drink companies had put pressure on them as well. But most of them, even the ones who said they got pressure from the soda companies, all of them mentioned pressures from their school districts they represented, saying that their school districts feared they would lose money.”
Misconceptions - outcomes for schoolsMisconceptions - outcomes for schools
Interview Question #3Interview Question #3
Legislation sometimes passes in increments over a period of time, eventually leading to a comprehensive set of bills vs. the initial adoption of comprehensive bills. Do you think that childhood obesity prevention legislation is more likely to progress through (1) a series of several incremental bills or (2) a few comprehensive bills?
Question 3 ResultsQuestion 3 Results Childhood obesity prevention legislation is
more likely to pass through:• Series of incremental bills (73%)• One comprehensive bill (18%)
“I think incrementalism is the name of the game here in the legislature, given our fiscal constraints.”
So what?So what? What we already know:
• Lobbyists• Incrementalism• Political climate
What we can do: • Learn to work within the system• Learn from other areas of success (tobacco)• Train community advocates to use media• Educate constituents
Other needs & priorities• More on the evidence base for child obesity policy
e.g., IOM recommendations• Need for practice based evidence• Explore the generalizability of various policy approaches
RecommendationsRecommendations Build & advocate incrementally
“If you can get things into the media, it’s very helpful to legislators.”
“…to pass legislation like this, you really want to make sure that the people who are going to be implementing it and the people who are affected by it are involved in your legislative planning.”
Why do States Differ in the Level of Childhood Obesity
Legislation?
Ellen Jones, PhD
Objectives – to examine influence of
Type of legislature Legislator factors Political context Bill content Public support
Montana Capitol Rotunda
Factors in State Obesity Policy
Legislator Factors
Legislative Factors
2 x 2 TableLow Obesity High Obesity
SOUTH DAKOTAMONTANA
ARIZONA KANSAS
WASHINGTONMAINE
LOUISIANANEW YORK
Division of Legislation Tertiles:Low Legislation=0-3 Adopted Bills—17 statesMedian=4-7—16 statesHigh=8-30—17 states
Division of Childhood Obesity Tertiles: Lower Childhood Obesity=lowest (9.6%) to 13.2%—14 statesMedian=13.3% to 16%—21 statesHigh=16.1% to highest (21.9%)—15 states
Hig
h
Leg
isla
tio
n
Lo
w
Leg
isla
tio
n
35
Obesity Index Obesity Index
2003 and 2007 NSCH
Consistent Tertiles
9.6 - 13.2%
13.3 – 16%
16.1 – 21.9%
36
Ranking of Policy EnactedRanking of Policy Enacted
2006,2007,2008,2009 enacted
Low legislation = 0-3 bills Median legislation = 4-7 bills High legislation = 8-30 bills
Descriptive Analysis – Legislators
15 White, 3 Black, 2 Hispanic Children or grandchildren 9 Males, 11 Females 10 R, 10 D Senate Democrats 8 Chair, VC; 12 members
From left, New York’s Senator Joseph L. Bruno, Senator Hugh T. Farley, Gov. David A. Paterson and Assemblyman Sheldon Silver.
Senators Being Led in Physical Exercises by Physultopathy Founder Bernarr Macfadden, 1924: Black and White Photograph from the Library of Congress features American Work Outs throughout history
Descriptive Analysis – Legislative Factors
3 R Gov, 5 D Gov Party in House 3 D and 3 R Party in Senate 4 D and 3 R Term limits gov - 5 yes Term limits leg – 5 yes 1 professional legislatures 3 hybrid legislatures 4 part time legislatures
Washington Capitol Building
40
Red StatesRed StatesTime 80%Time 80%
Comp $68,599Comp $68,599
Staff 8.9Staff 8.9
White White StatesStates
Time 70%Time 70%
Comp $35,326Comp $35,326
Staff 3.1Staff 3.1
Blue StatesBlue StatesTime 54%Time 54%
Comp $15,984Comp $15,984
Staff 1.2Staff 1.2
NJNJ
CA NY CA NY
IL OHIL OH
FL PAFL PA
NA WINA WI
MI MI
www.ncsl.orgwww.ncsl.org
AL KY ORAL KY OR
AZ LA SCAZ LA SC
AK MD TNAK MD TN
CO MN TXCO MN TX
CT MO VICT MO VI
DE NE WADE NE WA
HA NC ARHA NC AR
IA OKIA OK
GA WVGA WV
ID MTID MT
IN NHIN NH
KS NDKS ND
ME SDME SD
MS UTMS UT
NV WYONV WYO
NM RI VTNM RI VT
41
LegislaturesLegislatures
CategoryCategory Time Time CompensatiCompensationon
StaffStaff
RedRed 80%80% $68,599$68,599 8.98.9
WhiteWhite 70%70% $35,326$35,326 3.13.1
BlueBlue 54%54% $15,984$15,984 1.21.2NCSL, 2008NCSL, 2008
Introduction Results
Legislator role (in and out of session) influences intent
Impetus for action not articulated Discomfort in state policy role Discomfort with evidence and results Philosophical support vs. policy action
Introduction Quotes “there’s support for prevention, but not for
legislation”
“In 10 yrs debate, several (bills) introduced but none passed…”
“can you legislate obesity?”
“well aware there is a problem; but the question is how to address it”
Bill Content Results
Unclear cost or new cost is barrier Need for immediate results No consensus around role of legislature Different definitions Different expectations of evidence/science
Bill Content Quote “not a whole lot of it is science….I think a lot
of it is anecdotal…”
“the science is hard because policies are so new”
…any proposed policies with start up money will be hard pressed”
“cost is a make or break issue”
Political Context Results
Legislators expect but don’t act on public health message
No compelling social movement Opposition viewed as well
planned Loss outweighs gain It’s the economy…
Maine’s Speaker of the House, Hannah Pingree announcing policies to curb obesity
Political Context Quotes “several people introduced bills but no one is
consistently pushing and prodding”…
“no one comes to mind”
“are you kidding me? Cost is a very critical issue – a deciding factor”
“overwhelming budget deficit makes funding obesity policy difficult”
Different Motivators End User: Researcher Legislator Staff
Time in Job long shortest short
Accountability university voters decision makers
Constituents funders
publishers
voters, party, supporters
Chair, VC,
Members, party
External factors funding, teaching, writing
media, money, public support
habit, relationships, culture
Time on issue long shortest short
Data used peer reviewed Stories, real life, testimony, results
internal/ external support, data
Public Support Results
Lack consensus on state role
Unclear wishes of
constituents
Uncertain evidence will work
Not tied to current priorities
Media messages inconsistent
No tie to policy actions Engagement not seen as a
desire of constituents Nonprofit Day in Montana Capitol Rotunda
Public Support Quotes
“…interest in home level, NOT the government…”
“1) economy, 2) jobs, 3) housing market”
“Messages would be important as long as they are giving me specific ideas what to do”
“even if it saves money, it wouldn’t be now, we have to balance a budget now…”
High Leg vs Low legHigh Leg vs Low leg
So What? Importance of non-modifiable factors
Legislator discomfort with role and science
Political context inhibits passage
Philosophical support vs. policy action
Kansas Capitol Rotunda
Factors in State Obesity Policy
Legislative Factors
Legislator Factors
54
Art and Science Art and Science Next Study:
Advocates in • LA• WA• CO• NY• CA• ME