Survey Shows Lawmakers' Thoughts on Public Health

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Public Health Feature — February 2014 

Tex Med. 2014;110(2):33-36.

By Crystal Zuzek

Thanks to results of the 2013 Texas Health Perception Survey, you now have an idea of what Texas legislators think as they consider public health policies and initiatives each session. The results provide insight on lawmakers' knowledge, attitudes, and beliefs related to obesity prevention and related health measures. Survey findings also provide a glimpse into resources legislators use to access health policy information. Results show Texas legislators participating in the survey rank the Texas Medical Association as their No. 1 resource for obesity, nutrition, and physical activity information and policy. Online health sites, online news sites, and newspapers also ranked highly among survey respondents.

The Robert Wood Johnson Foundation (RWJF) funded the 2013 Texas Health Perception Survey project, which surveyed legislators during the 2013 legislative session. The Michael & Susan Dell Center for Healthy Living at The University of Texas School of Public Health and the Texas A&M University Health Science Center School of Rural Public Health collaborated on the research, which is part of the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) Project.  

About the Survey

TMA served on the project advisory committee, which included representatives from The University of Texas Health Science Center at Houston, Texas A&M Health Science Center, Texas Health Institute, Partnership for a Healthy Texas, the Texas Hospital Association, and the American Heart Association.

The advisory committee provided input on survey questions, promoted the survey among legislators, and assisted with interpreting survey results. The project had a 46-percent overall response rate. 

Deanna Hoelscher, PhD, director of the Michael & Susan Dell Center for Healthy Living, oversaw the project and says all Texas legislators received a hard copy or online survey to complete. Additionally, the project included a qualitative component that entailed 16 in-person interviews with members of the House Committee on Public Health, the House Committee on Appropriations, House and Senate transportation committees, and the Senate Committee on Health and Human Services. 

Because the project took place during the 2013 legislative session, which consisted of three special sessions, some legislators were unable to take part. Legislative aides therefore completed the survey from the perspective of the legislators who were unable to participate themselves. 

The health perception survey polled participating legislators on how they'd like to receive public health and obesity-related information. Email (79 percent), websites (76 percent), and written information (63 percent) ranked highest. Personal communication (49 percent), social media (47 percent), and other sources (24 percent) rounded out the responses.   

Qualitative data collected via in-person interviews can help public health advocates determine how to gain legislative support for childhood obesity-related legislation. Respondents identified the most important steps to increasing passage of such bills, including:   

  • Finding a cause that can easily be supported,
  • Visiting with legislators before the legislative session begins, 
  • Finding a champion, 
  • Working to build relationships with legislators, and 
  • Getting interest groups involved. 

By gauging legislators' attitudes about obesity, nutrition, and physical activity; support for obesity-related policies; and support for potential legislative initiatives, researchers identified the following policy recommendations with strong support among legislator respondents: 

  • Increase access to healthier food, specifically fruits and vegetables.
  • Improve nutrition and physical activity in early childhood programs.
  • Improve the health of schoolchildren by increasing physical activity, health education, and other related health measures such as school health advisory committees (SHACs).
  • Enhance community environments to promote physical activity.
  • Support coordinated school health programs that increase physical activity and nutrition education.
  • Support health education in high school.
  • Educate parents about childhood obesity and healthier eating habits for children.
  • Provide more physical activity in schools.
  • Provide healthier school lunches. 

Policy recommendations with little support among legislator respondents include:  

  • Prohibit the sale of soda, chips, and candy in school vending machines.
  • Prohibit the sale of soda, chips, and candy in school cafeterias.
  • Limit television ads for unhealthy foods and drinks targeted at young children. 

More complete results from the survey will be released in early spring 2014.

When asked about the role specific entities should play in fighting the obesity problem, transportation groups ranked lowest, with legislators indicating such groups should play a "minor role." Farmers, employers, and restaurants also ranked low. Parents, families, individuals, and health professionals ranked highest, with legislators indicating such groups should play "some role."

The survey findings will aid research in the T-COPPE project, which in part examines the impact of the Safe Routes to School program. Safe Routes to School provides states with federal funding to encourage physical activity in community environments through use of pedestrian and bike paths.

"This survey shows us that the influence transportation has on obesity isn't well understood. We need to do a better job of making the scientific and business case for walking and bicycling to school, for example," Dr. Hoelscher said.

An Active Living Research brief titled "Active Transportation: Making the Link from Transportation to Physical Activity and Obesity" illustrates how infrastructure investments and transportation programs can help children and adults become more physically active. Active Living Research is an RWJF program with a goal of supporting and sharing research on environmental and policy strategies that promote daily physical activity for U.S. children and families. 

One of the brief's key findings is that Safe Routes to School programs and traffic control in neighborhoods and near schools can increase physical activity among children, adolescents, and adults. The brief states federal, state, and local policies and funding that support infrastructure investments can help promote physical activity among children and adults. 

Respondents to the health perception survey indicated schools (kindergarten through grade 12) should play "some role" in fighting obesity in Texas. Last year, the Institute of Medicine (IOM) released a report, sponsored by RWJF, titled Educating the Student Body: Taking Physical Activity and Physical Education to School, which concluded schools can and should play a major role in encouraging and providing opportunities for children and teens to be more active.

Actions recommended by the IOM report include the following:   

  • School districts should provide high-quality physical education, equal to 150 minutes per week for elementary school students and 225 minutes per week for middle school and high school students.
  • Students should engage in additional vigorous or moderately intense physical activity throughout the school day through recess, dedicated classroom activities, and other opportunities.
  • Additional opportunities for physical activity before and after school hours should be accessible to all students.  


TMA Puts Survey Data to Use

The Texas Public Health Coalition (TPHC) ranked in the middle of the pack as a frequently used health policy and information resource among legislators, according to the 2013 Texas Health Perception Survey. TPHC Chair Eduardo Sanchez, MD, says that increasing the visibility and establishing the coalition as a trusted resource are priorities. 

To that end, the public health coalition plans to continue to host University of Health programs this year to educate legislators and staff members of the legislature and state agencies about key public health matters that have an impact on the state. In 2012, four programs, held at the Texas Medical Association building, addressed how public health affects the state's economy and the impact immunizations, obesity, and smoking have on physical and fiscal health. Program presenters polled attendees about each program's subject matter

"In addition, the coalition should consider visiting with key elected officials and their staff to present the group as a credible source of good public health information. The coalition should consider other ways to communicate messages regarding the value of public health for Texas," Dr. Sanchez says, suggesting methods like email blasts, text messages, and blog articles.

He says he's hopeful that by understanding legislators' attitudes regarding obesity prevention, nutrition, and physical activity policies and initiatives, TMA and TPHC can make a difference in the battle against the obesity epidemic 

"At the end of the day, we want to achieve our collective objective of effectively improving the health of all Texans," said Dr. Sanchez, American Heart Association deputy chief medical officer. 

Sen. Charles Schwertner, MD (R-Georgetown), witnesses the impact of obesity in his practice every day. 

"Obesity has a cost to our health care system and ultimately the taxpayers," said Senator Schwertner, a member of the Senate Committee on Health and Human Services. "Obesity is an epidemic with no easy solutions. Data that show legislators' thoughts on obesity, nutrition and physical activity, however, can be shared with members and legislative committees to provide a starting point for identifying potential solutions."

Crystal Zuzek can be reached by telephone at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629; or by email.  

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May 13, 2016