Review, discuss and provide two descriptive epidemiologic statistics and describe two disparities (differences) in tobacco use across the population

There is no limit to how much you can write,  but it is suggested that you succinctly answer all components of the prompt you selected,  and then go back and add details.  There are several components to address,  be sure to cover each point.

Chapters 6 and 7. Choose and select one of the short answer essay prompts to respond to. Use the text as your only reference to respond to the prompt of choice.

PROMPT A

· Review, discuss and provide two descriptive epidemiologic statistics and describe two disparities (differences) in tobacco use across the population

· The Tobacco Control Act (TCA) was a was a game-changer in the tobacco industry regulation.

· When did the TCA go into effect, and what was the goal of implementation?

· Describe and discuss two of the point-of-sale strategies the act focused on at the retail level.

· Include and discuss one additional federal marketing and packaging legislation and key provision 

· Name one reason for political opposition to tobacco control policy efforts

Include an APA citation and reference for the text material used. Answer the question as best as you can. Be clear and concise. You do  not need to go beyond what the question is asking of you.

OR

PROMPT B

· Review, discuss and provide two descriptive epidemiologic statistics and describe two disparities (differences) relative to obesity that are illustrated in the population

· List three factors that influence the obesogenic environment (hint: view figure 7.3)

· Review the case of sugar-sweetened beverages (SSBs).

· Discuss two main points of why taxation would be beneficial for the population

· Discuss two aspects of industry opposition to SSBs

· Discuss two aspects of public support for SSBs

Include an APA citation and reference for the text material used. Answer the question as best as you can. Be clear and concise. You do  not need to go beyond what the question is asking of you.

Advocacy Recap

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

https://youtu.be/aTbtKRdYbYo

Advocacy Recap

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Advocacy Recap

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Advocacy & Media

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

https://youtu.be/VgqoHxZYY84

Advocacy Policy

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

https://youtu.be/atbZYs215Uw

Chapter 6

Public Policy and Tobacco

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Identifying the Problem: Tobacco Use and Consequences

Cigarette 1900s E-cigarette Now

Utilized production, advertising, design, and social behavior to influence social norms and create a culture around tobacco use

Death and disease patterns have emerged as a result of the cultural influence – Deeply engrained, but this is slowly changing

Public health prevention strategies used by tobacco control advocates have been integral to the changing social norms spurring the decline of tobacco use

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Figure 1.1 Adult per capita cigarette consumption and major historical and policy events

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Identifying the Problem: Tobacco Use and Consequences

Epidemiology

Tobacco use has long been a leading cause of morbidity and mortality worldwide

Currently accounts for an estimated 9% of deaths across the globe

United States, smoking is the leading preventable cause of premature death and disease.

Linked with several types of cancer, coronary heart disease, chronic obstructive pulmonary disease, diabetes, asthma, and stroke

Nonsmokers who are exposed to secondhand smoke suffer from tobacco-related illnesses as well

Since the United States Surgeon General began reporting on smoking more than 50 years ago, almost 2.5 million nonsmokers have died from smoking- related diseases

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Identifying the Problem: Tobacco Use and Consequences

Epidemiology

1965, 42% of Americans smoked cigarettes

Tobacco prevention and cessation efforts established and various policies implemented and the population better understands risks

2013 smoking prevalence rates:

18% of adults

<13% of youth

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Identifying the Problem: Tobacco Use and Consequences

Epidemiology

Rate of decline recently slowed recently: above Healthy People 2020 goals

Emerging growth of non-cigarette tobacco product use introduces health risks

More than one in five adults and high school students report using tobacco (non-cigarette tobacco products either alone or in addition to cigarettes)

The most commonly used non-cigarette tobacco products are smokeless products (e.g., snuff), little or regular cigars, pipes, hookah (water pipes), and electronic cigarettes

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Identifying the Problem: Tobacco Use and Consequences

Disparities

Differences in tobacco use across:

Gender

Race and ethnicity

Educational status

Poverty status

Sexual orientation

Groups that use tobacco at disproportionately high rates, less likely to quit successfully & experience poorer health outcomes

Military workers (e.g., active service members and civilian employ- ees)

Construction workers

Individuals with a history of mental health problems

Homeless

Incarcerated individuals

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Identifying the Problem: Tobacco Use and Consequences

Disparities

Differences across geographic location

United States smoking rates were lower than those in many countries like Norway, Egypt, China, and Chile

Higher rates than Mexico, Australia, Kenya, and India

Within the United States

Fewer than one in ten Utah residents smoke

More than one in four people in Kentucky, Arkansas, and West Virginia smoke

What else do you think contributes to health-related tobacco disparities?

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Why continued disparities?

Excessive exposure to tobacco product promotion

Tobacco industry targeting

Lack of comprehensive policies

Public Policy Strategies in Tobacco Control

A variety of tobacco control policies implemented at the international, federal, state, and local levels

Creating Smoke-Free Environments

Smoke-free laws protect employees and the public developing chronic disease due to secondhand smoke (cancer, heart disease, and respiratory diseases)

Encourage people to quit

Prevent smoking initiation

Change social norms around tobacco use and exposure

Smoke-free policies can be designed to impact public areas, private areas, or both.

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Public Policy Strategies in Tobacco Control

Creating Smoke-Free Environments

Policy has expanded to include:

Public access: Restaurant patios, parks, playgrounds, and beaches

Private settings such as multiunit housing and cars

Smoke-free laws can be adopted voluntarily or via policy

Policy preferred because it mandates rules and closes the gaps in secondhand smoke protection

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Public Policy Strategies in Tobacco Control

Raising the Price of Tobacco Products through Tax Increases

Increasing price = less affordable = reducing use

= Change social norms

Prevent youth initiation

Decrease tobacco-related healthcare costs

Reduce tobacco related health disparities

Additional benefit = make revenue for governments

Children’s Health Insurance Program in 2009

Largest increase in federal taxes

Resulted in federal tax of $1.01 per cigarette pack

In 2014, the total per pack tax ranged from $4.35 in New York to only $0.17 in Missouri

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Public Policy Strategies in Tobacco Control

Restrictions on Marketing, Packaging, and Youth Access

Tobacco advertising has been banned on television, radio, billboards, and public transportation

Industry focuses on point-of-sale

Exposure at this level = higher odds of initiation and regular daily smoking among youth, unplanned & relapse

Tobacco Control Act gave legal authority to states & communities to pursue intervention at the retail level

Read p.o.s. strategies p. 124 # 1-4

New York City, New York, Providence, Rhode Island, and Santa Clara County, California

ban on sales of cigars, hookah, cigarillos, pipe and chewing tobacco, and e-cigarettes flavored with tastes that might appeal to youth (e.g., apple, grape, or mint) in establishments where youth could be present

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Tobacco Control Support & Opposition

Policy Rationale

Financial burden on government and public

Protection of high-risk populations

Ensure clear and accurate information regarding tobacco products

Consequences of secondhand smoke and other chemicals for nonusers

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Testimonies used in new e-cigarette regulations

Tobacco Control Support & Opposition

Political Support

Local and state tobacco control programs do not have the flexibility or authority to influence tobacco control policies

Coalitions are most important for comprehensive tobacco control policy

Due to success in organizing and encouraging policy action through legislation and voter initiatives

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Tobacco Control Support & Opposition

Political Support

National-level voluntary organizations are also integral to advancement of policy

American Heart Association

American Cancer Society

American Lung Association

Advocacy organizations

Americans for Nonsmokers’ Rights

Campaign for Tobacco Free Kids

Counter Tobacco)

Legal partners

Tobacco Control Legal Consortium

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Tobacco Control Support & Opposition

Political Opposition

Tobacco industry

Utilizes financial resources

Lobbyists

Recruits policymakers via campaign funding in exchange for votes against TCC policies

At the local level

Recruit third parties or front groups

Convenience store associations

hospitality industry groups

groups that oppose government regulation

“astroturf ” groups—grassroots organizations that are funded, organized, and sometimes run by the tobacco industry

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

CASE STUDY

Pp 131 in your text

First U.S. tobacco-free pharmacy policy

Reduces tobacco-related disparities at the local level

Sets the stage for state and national tobacco-free pharmacy efforts

Break into groups of 5

Review the case study

Summarize your section on the flip chart (3-4 important take homes)

Come back together as a class to share and discuss

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Tobacco-Free Pharmacies

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

https://youtu.be/R8-Fso5gieo

Health Communications & Tobacco

CDC Smoking and Tobacco Use Video Methods to Spread Awareness

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Reference

Eyler, A.A., Chriqui, J.F., Moreland-Russell, S.M., & Brownson,

R.C. (Eds.). (2016) Prevention, policy, and public health (1st ed.) New York, NY: Oxford University Press.

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Chapter 7

Food, Nutrition & Obesity Policy

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

1

Identifying the Problem: Obesity & Its Consequences

Obesity = excessive body fat/bodyweight

BMI—a ratio of weight to height, calculated as kilograms divided by meters squared

Categorize an individual as obese = BMI ≥30

In children, obesity refers to a BMI greater than, or equal to, the 95th percentile

Obesity is a major risk factor for:

Type 2 diabetes, cardiovascular disease, and hypertension

Greater risk for additional comorbid health conditions, including stroke, arthritis, nonalcoholic fatty liver disease, kidney disease, and mental health problems related to social stigma

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences Disparities

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences Disparities: Children

Between 1980 and 2004, obesity prevalence tripled among children aged 2 to 19 years increasing from 6% to 19%

Overall prevalence has remained fairly stable since 2004

2011–2012 = 17% of children obese

Hispanic children have the highest obesity prevalence, followed by: non-Hispanic Black and non-Hispanic White children

Black children are more likely to be severely obese than are White children

Trends indicate the most pronounced increase of severe obesity in White female and Black male children

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

4

Identifying the Problem: Obesity & Its Consequences Disparities: Adults

More prevalent in non-Hispanic Blacks and Hispanics

Exists at the highest rate among all adults aged 40 to 59 years

Gender- and income-based obesity-related disparities exist among all racial and ethnic groups

Most pronounced among non-Hispanic Black women across all age categories

Higher income non- Hispanic Black and Mexican American men have slightly higher obesity prevalence rates than those with lower incomes

Adults in rural areas are significantly more likely to be obese than those in urban areas

WHY?

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The Costs of Obesity

$315.8 billion was spent on adult obesity-related direct healthcare costs in 2010

Majority of expenses resulting from the treatment of comorbid health conditions, particularly type 2 diabetes

Medicare and Medicaid spending would see decreases of 8.5% and 11.8% if obesity-related costs were removed from the analysis

Obesity-related absenteeism translates to an estimated cost of $8.65 billion per year in lost productivity

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences Obesogenic Environment

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

8

https://youtu.be/5Rm7E2e1Su8

Identifying the Problem: Obesity & Its Consequences Obesogenic Environment

“Obesogenic environment”

Unhealthy options are frequently more accessible and affordable than healthy options

Physical activity opportunities are limited

Marketing of unhealthy options outweighs marketing of healthier options

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The U.S. Food System

Over the past 60 years, the American food system has transitioned from one of home- cooked meals to one of prepackaged, processed, convenience foods, and food eaten away from home (FAFH)

Food technology advanced (e.g., home refrigeration systems, mechanized industrial processes, microwave technology) food became more processed, faster to prepare, and cheaper while reducing the reliance on scratch-cooked meals

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The U.S. Food System

Americans now consume more convenience foods (packaged) at home

The amount of household food expenditures on FAFH increased from 25.9% in 1970 to 43.1% in 2012

FAFH is generally of lower nutritional quality than foods consumed at home

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The U.S. Food System

Packaged food industry further propagates obesity and health disparities by selling convenience foods and beverages higher in sugar, salt, and/or fat than unprocessed foods

Required to extend the shelf life of the products

It has been found that processed foods with increased shelf life lends to their ready availability in low food-access areas

Resulting in increasing obesity prevalence in:

Low-income Black and Hispanic urban neighborhoods

Low-income, predominately White rural areas

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The U.S. Food System

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The U.S. Food System

The Child Nutrition and Women, Infants, and Children Reauthorization Act of 2004

USDA authority to update the National School Lunch Program (NSLP) and School Breakfast Program (SBP) nutrition standards to align them with the most current Dietary Guidelines for Americans

Healthy, Hunger-Free Kids Act of 2010

Sale of foods and beverages in schools (besides the NSLP and SBP) were not regulated at the federal level until the passage of the act

Gave USDA the authority to impose nutrition standards for all foods and beverages sold outside of meal programs

Commonly referred to as “competitive foods and beverages” because their sale competes with meal programs

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Obesity & Its Consequences The U.S. Food System

2013: USDA issued the Smart Snacks in School

Provides science-based nutrition standards for all foods sold on school campuses during the school day

Implementation started at the beginning of the 2014–2015 school year

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Public Policy Strategies Related to Obesity Politics of Obesity

Liberal policymakers frame their approach as an issue of social responsibility the need to regulate the food industry

Conservatives and libertarians emphasize personal responsibility, favor fewer regulations, and resent what they perceive as government interference with the market

Advocacy groups and professional organizations are also influential actors

bring expertise, consumer outreach, and grassroots influence to the political landscape

they do not leverage direct financial influence

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Center for Science in the Public Interest: One of the most prominent science-based food/nutrition advocacy groups

The most influential player in the food/nutrition industry political landscape is the food and beverage industry 

28M to federal, state, and local candidates in 2014

More than ½ contributions went to Republican party

80% greater to Republican: 9.1M than Democratic: 5M

75-90% of the public agree obesity is a major health concern

Little public consensus about who bears responsibility for addressing and solving the obesity crisis: individuals, governments, communities, or a combination of entities

Public Policy Strategies Related to Obesity Politics of Obesity

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

22

Public Policy Strategies Related to Obesity – Debate Activity

Sugar-Sweetened Beverage Taxation (pp153-157)

Break into 2 types of groups: Support OR Opposition

Topic: Case of Sugar-Sweetened Beverage Taxation

Group 1: Industry Opposition to Sugar-Sweetened Beverage Taxes

Group 2: Public Support for Sugar-Sweetened Beverage Taxes

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Public Policy Strategies Related to Obesity – Debate Activity

Sugar-Sweetened Beverage Taxation (pp153-157)

Break into 2 types of groups: Support OR Opposition

Get into pairs. Then, review the summary of SSBs p.153

Then, select your position (p.155 or 156) FOR or AGAINST

Then, using your pc or phone to research your position

Then, select one point to argue regarding the SSB policy that is being debated. Your point has to align with your position. Use one fact in your argument.

Each student has one minute to argue their position.

Let’s debate!

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

24

Example Policy SSB

Sugar-Sweetened Beverage Taxation

City:Berkeley

Ordinance # 7,388

Link to ordinance text: https://www.cityofberkeley.info/ uploadedFiles / Health_Human_Services /Level_3_-_Public_Health/SSB%20Tax%20Ordinance%207,388-N.S..pdf

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Soda Tax

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

26

https://youtu.be/8xF3XmuBu-M

Advocacy Pro SSB Tax- Berkeley

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

27

https://youtu.be/UwZV9Gq_0Gs

Industry Opposition

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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https://youtu.be/VBK4qACB7Uw

Berkeley Soda Tax: One Year Result

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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https://youtu.be/1mhszXEZEJI

Reference

Eyler, A.A., Chriqui, J.F., Moreland-Russell, S.M., & Brownson, R.C. (Eds.). (2016) Prevention, policy, and public health (1st ed.) New York, NY: Oxford University Press.

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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