SKIP the Salt, Help the Heart

1. SKIP the Salt, Help the Heart Overview and lessons learned from a sodium reduction pilot project & marketing communications campaign in Kansas City July 25,2013

3. Why reduce sodium? “High blood pressure is public health enemy No. 2 behind tobacco. There is nothing that will save more lives than getting blood pressure under control.” --Dr. Thomas Frieden, CDC director

4. Why Focus on Sodium? • 90% eat more sodium than recommended • Average intake nearly double recommended amount • 90% Americans will develop hypertension • Health care savings • Estimates as high as $26 billion annually • Health disparities • Prevalence of HBP in African Americans in the US is among the highest in the world Source: American Heart Association

6. Institute of Medicine Reports Documented increase in sodium in food supply and concurrent rise in high blood pressure across the country. • Recent report from IOM in news around sodium guidelines • Positive relationship between high Na intake and elevated risk of CVD • Most still eat more salt than recommended 2010 IOM Report 2013 IOM Report

7. SKIP Campaign Goals Strategic Focus Areas (from the Strategic Doing Process) • Create and promote SKIP brand among targeted audiences, including partners • Increase low sodium food options through corner store strategy • Encourage Missouri manufacturers to lower sodium content • Implement SKIP brand through the KC pilot project

8. Number of deaths due to essential hypertension by zip code, KCMO, 2000-2009

9. Number of deaths due to stroke by zip code, KCMO, 2000-2009

10. County Level Survey Data, MO DHSS

11. Formative Research in a Compressed Time Frame

12. Background Analysis • Included primary & secondary data collection • Literature review • Telephone survey • Focus groups • Intercept interviews • Key Informant Interviews • Corner store assessments • Community input & review • Other evaluated campaigns • NY • Mass. • Kansas

13. Phone Survey • Determine relevant knowledge, attitudes and behaviors around sodium as well as barriers • Determine appropriate communication channels for reaching target audience • January – April 2013 • 602 people • Females • Land lines

14. Demographics American Community Survey moving averages 2007-2011

15. Q: Which of the following do you think is the main source of salt in the American diet?

17. Q: In general, how much salt do you think you eat each day?

18. Q: If you feel comfortable sharing, please tell me what health conditions you are currently dealing with

20. Top 10 Salty Items CDC, MMWR, 2/2012 • Bread and rolls • Cold cuts and cured meats • Pizza • Poultry • Soups • Sandwiches • Cheese • Pasta Dishes • Meat Dishes • Snacks

21. From the Literature: Chicken • Top Salty Foods are NOT the same for all populations CDC, MMRW, 2/7/12

22. Field Research • Round 1 intercept interviews (n=37) • Round 2 additional interviews (n>30) • Focus group (n=11) • Community store owner interviews (n=5) Community-based • Neighborhood events and Bluford Library • Used feedback to choose and refine concepts • Looked for push back on tone, visuals

23. Hidden Salt Concept

24. Look Good, Feel Good, Stay Strong

25. Media Plan • Environmental • Billboards, transit • Radio • Magic 107 - 33% listen daily • Hot 103 – 28% listen daily • Print • KC Call – 49% read weekly • Public relations • Facebook • 53% have profile – of those, 43% use FB • Web presence via MOCAN

26. Getting the Word Out

27. From the Research:Store Owners’ Concerns • Main concerns: • Inventory and tracking sales • Suppliers • Security • Advertising • Uneven history selling healthy foods • Policies with food manufacturers • Incentives, tobacco and liquor sales

28. Partnering stores

29. Locally-owned grocery stores

30. 64128 Leakage The Policy Map, Estimated Grocery Retail Leakage Rate 2011

31. Community Action Getting Communal

32. Community Leadership Breakfast

33. Cleaver’s Market Event

34. Indiana Market Event

35. Grown in Ivanhoe – Indiana Market Partnership

36. Cleaver’s before and after

37. Cleaver’s continued

38. Indiana Market Before and After

39. Indiana Market “Health Shelf”

40. Reach

42. Promising Early Results • Feedback on media • Submitted for Mosaic Award • Calls from media about ads and campaign • Engagement growing on social media channels • Low-sodium message in stores • Veggie straws • Low sodium rub • KC Chiefs

43. Looking ahead • Potential for SKIP to expand work • Corner store pilot, post assessment • Texting AND answering machines • Launch rural convenience store pilot • Continue SKIP’s focus on food manufacturers (e.g., Panera, Ralcorp.) • Data from phone survey to be weighted.

44. Concluding Remarks • Funding for continuing KC SKIP needs to be secured. • Funding Team has initiated contact with Greater Kansas City Health Care Foundation. • Evaluation activities to be concluded. • Need for ongoing organization & engagement of SKIP leadership team.

45. Your input • How do we sustain this important work?

46. Questions? CONTACT US: Amy Dunaway Natalie Hampton dunawaya@missouri.eduhamptonn@missouri.edu Kris Kummerfeld Department of Health and Senior Services kris.kummerfeld@health.mo.gov