Division of Nutrition and Physical Activity’s State Legislative Database

1. Division of Nutrition and Physical Activity’s State Legislative Database Tamara S. Grasso, MS, RD DNPA, Office of the Director Tina Lankford, MPH DNPA, Physical Activity and Health Branch

2. Session Overview Objectives: • Introduce and explain the purpose of the state legislative database • Provide instructions for how to use the database. • Discuss recent findings of impending MMWR article publication on obesity legislation. • Share other relevant policy resources in areas of nutrition and physical activity.

3. Nutrition and Physical Activity Legislative Database • Launched November 2003, but contains State legislation from 2001, updated regularly • Contains bills addressing nutrition and physical activity in various settings and subtopics. • Available on-line: http://apps.nccd.cdc.gov/DNPALeg/index.asp OR link from www.cdc.gov/nccdphp/dnpa

4. Purpose • The database is designed to • help professionals at the state and local levels become more aware of legislation • facilitate legislative analyses related to nutrition and physical activity topics • stimulate discussion about the value of legislation in addressing nutrition and physical activity issues

5. Legislative Database:Quality Assurance • Formed database internal workgroup • Developed protocol for entering and revising bills • Reviewed and revised existing bills • Cross reference bills in the database against subscription system

6. What can you use it for? • Following trends in your state (and others) on the type of legislation introduced and it’s success/failure over time • Becoming aware of the content of legislation and areas where you as the practitioner may offer insight to the policy makers and other constituents • Gathering examples of other states’ successes and making contact to learn what roles were played in the legislative process

7. Why Legislation? • Legislation is a form of policy • Policy  Laws, regulations, formal and informal rules that are adopted on a collective basis to guide individual and collective behavior • Policy impacts the population, not just individuals

8. Chronic Disease Prevention • Personal behavior change is best achieved if reinforced, stimulated, rewarded, and supported • Individual • Interpersonal (family, friends, and networks) • Organizational policies and procedures • Community environment • Public policy and legislation

9. Legislation and Public Health • Law is a traditional public health tool to protect or preserve human safety/health • Acute issues • Worker Safety • Motor vehicle safety • Emerging diseases SARS and pandemic influenza • Chronic issues • Tobacco Cessation • Reduced tooth decay • Childhood immunizations

14. Obesity Trends Source: Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006; 295(13); 1549-55.

15. State Legislation • Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity published in 2001 • Recommended formation of task forces and development of plans by state governments to address issue • Recommended creation of policies to promote environments that promote healthier eating and greater physical activity • States have increased their legislative efforts toward this goal during the past few years • Purpose of report is to describe state-specific trends in 2001-2004 obesity-related legislation

16. Methods • Using DNPA’s legislative database, a search across all legislation was performed using keyword “obesity” • Cross-checked all bills using state legislative websites • Obesity bills were classified according to their focus for action: • Task Force • School • Health Care • Community

17. Key Findings • Number of introduced bills aimed at preventing or treating obesity increased from 2001 to 2004 (20 to 64) • Largest number of bills introduced was for School environments • Largest number of bills enacted was in the Task Force category Reported by: C Hannan, MPH, T Lankford, MPH, T Gust, MPH, RD, T Grasso, MS, RD, T Teuber, MPH, L Kettel Khan, PhD, M Serdula, MD, Div Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, O Abid, MD, EIS Officer, CDC

18. Table 1. Introduced and Enacted* State Obesity-Related Legislation, by Year and Category, 2001– 2004 * Numbers of enacted bills are in parentheses.

19. Limitations • Limited ability to ascertain bills with “obesity” due to some state legislative websites not allowing keyword searches • Overlap occurs among categories • Eg. Bills in task force category may mandate studies on obesity-prevention interventions, including in schools • Analysis identifies bills that specifically mention obesity—therefore bills that may impact nutrition and/or physical activity, and hence obesity, are not included

20. Legislation (Policy) Challenges • Difficult to pass/enact • Agree on goals; disagree on causes, methods • Difficult to implement • Competing priorities • Typically not no cost • Competing priorities • Enforcement issues • Impact analysis/evaluation

21. Conclusion • Traditional strategies  individual behavior change • Newer approaches  individuals + building supportive environments • Guide to Community Preventive Services • State legislation can continue to be important when used as part of a comprehensive, multi-level approach that includes policy, education, communication, social marketing, and environmental strategies

22. Additional Policy Resources • CDC Public Health Law Program (est. 2000) www2a.cdc.gov/phlp/ • CDC Public Health Training, Policy Research and Development www.cdc.gov/phtrain/policy_research.html • Council of State governments www.healthystates.csg.org • National Conference of State Legislatures www.ncsl.org/programs/health/phdatabase.htm • Center for Health Improvement- Health policy guide www.healthpolicyguide.org/default.asp

23. We are interested in finding out … • How the database has been helpful to you (practitioners) in the past • What suggestions you may have for improvement • Any other comments you may have

24. DNPA’s State Legislative Database Tina Lankford Email: tlankford@cdc.gov Tamara S. Grasso Email: tgrasso@cdc.gov