Division of Nutrition and Physical Activity’s

State Legislative DatabaseTamara S. Grasso, MS, RD

DNPA, Office of the Director

Tina Lankford, MPHDNPA, Physical Activity

and Health Branch

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.

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

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

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

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

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

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

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

Obesity Trends1999 2004

Overweight US Adults 64.5% 66.3%

Obese US Adults 30.5% 32.2%

At Risk for Overweight US Children and Adolescents

28.2% 33.6%

Overweight US Children and Adolescents

13.9% 17.1%

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.

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

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

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

Table 1. Introduced and Enacted* State Obesity-Related Legislation,by Year and Category, 2001– 2004

YearTask Force

School Community Health Care

Total

2001 8 (5) 2 (1) 2 (0) 8 (4) 20 (10)

2002 5 (0) 5 (1) 0 (0) 2 (0) 12 (1)

2003 17 (8) 23 (4) 3 (1) 7 (1) 50 (14)

2004 11 (2) 23 (6) 5 (2) 25 (4) 64 (14)

Total 41 (15) 53 (12) 10 (3) 42 (9) 146 (39)

% enacted

37% 23% 30% 21% 27%

* Numbers of enacted bills are in parentheses.

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

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

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

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

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

Tina Lankford

Email: tlankford@cdc.gov

DNPA’s State Legislative Database

Tamara S. Grasso

Email: tgrasso@cdc.gov