Reaction Paper

Walk for the Health of It Junior! - City of Fort Worth Publie Health Department, Fort Worth - Karen Bell, MPH, CHES Walk for the Health of It Junior! was inspired by the adult ver- sion Walk for the Health of It! to eombat the problem of obe- sity and eardiovaseular disease by eneouraging physieal aetiv- ity. frhe Junior! version targets 6th graders between the ages of 11-12 years. The majority of the participants are Hispanie. This program lasts 21 weeks with students completing walk- ing logs of time walked during and outside of school. Parents are asked to participate with the ehildren. A health educator visits the sehool and teaehes the students about the importance of exercise and the health benefits that result from regular physieal activity. Anthropometrie measurements are taken for all partieipating students before the program begins.

Walk Aeross Texas - Texas Cooperative Extension/TAMU Sehqol of Rural Publie Health, College Station - Carol A. Riee, PhD, RN Walk Aeross Texas (WAT) is a fun, free fitness program aimed at helping all people to establish the habit of physieal aetiv- ity. Individuals participating in WAT can perform any aetivity that Increases their heart rate. Using the Mileage Equivalents list Ideated on the WAT website, individuals can convert time spent on other activities, such as gardening, into miles walked for the WAT eompetition. WAT participants log and track their mileage in an on-line database.

African Ameriean Breastfeeding Promotion Campaign - Texas Department of State Health Services WIC, Austin - Tracy Erickson This 9-month promotion campaign targeted African Ameri- can men and women between the ages of 13-47. The goals were increased awareness of the benefits of breastfeeding and increased breastfeeding rates among African American WIC participants. The brand and logo, "Breastmilk: 100% Natural Ingredients", was developed for the campaign and incorpo- rated into all components. A brochure explaining the benefits of breastfeeding to pregnant women was developed as well as broehures for the woman's partner and parents encourag- ing them to support breastfeeding. The brochures were given to al] African American WIC participants at initial pregnant eertifications. Breastfeeding promotion bags were given to healthcare providers to distribute. Posters were hung in WIC clinifcs, hospitals, and healthcare provider offices. Exhibits, flyeiis, and advertisements on TV, radio, billboards, and in the newspaper spread the message in the African American com- munity.

Eaeh recognized program was included in the 2006 Best Prac- tices Listing and received statewide recognition at the Annual Texas Public Health Association (TPHA) Conference and ongoing promotion on www.EatSniartBeActiveTX.org and www.dshs.state.tx.us/phn/phn.shtm. Additionally, representa- tives of selected interventions had the opportunity to discuss their intervention and lessons leamed at the TPHA Confer- enee held in Piano, Texas.

The Economic Impact (or Lack Thereof) of Smoke-Free Ordinances Philip Huang, MD, MPH

Secondhand smoke is reeognized as a significant health hazard by all of the major health authorities. Fornier U.S. Surgeon General Richard Carmona recently stated upon the release of the latest Surgeon General's report on seeondhand smoke that "The scientific evidenee is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults."*'' The report further noted that second- hand smoke contains more than 50 cancer-causing chemicals, and is itself a known human eareinogen. Nonsmokers who are exposed to secondhand smoke inhale many of the same toxins as smokers. Even brief exposure to secondhand smoke has immediate adverse effeets on the cardiovascular system and increases risk for heart disease and lung cancer, the report says.'^'

In order to protect the public from the dangers of secondhand smoke, many countries, states and local communities are adopting comprehensive smoke-free ordinances. As of No- vember 2006, 12 countries (Ireland, Italy, Seotland, England, Norway, Sweden, New Zealand, Uganda, Malta, Uruguay, Hong Kong, and Bhutan) and 16 states (California, Delaware, New York, Connecticut, Maine, Massachusetts, Rhode Is- land, Vermont, Washington, Hawaii, Ohio, Arizona, Montana, New Jersey, Colorado and Utah) have passed comprehensive smoke-free legislation that prohibits smoking in public places, including all workplaces, restaurants and bars. In Texas, cur- rently 9 cities (Austin, Beaumont, Benbrook, Copperas Cove, El Paso, Houston, Laredo, Vernon and Victoria) have passed ordinances that are considered 100% smoke-free and include all workplaces, restaurants and bars.'^' Houston just passed their ordinance in October 2006, but it does not go fully into effect until September 2007.

As those of us in the public health community are aware, ex- posure to secondhand smoke is first and foremost a publie health issue, and efforts to protect the public from involun- tary exposure to secondhand smoke are similar to other public health regulations to protect the public from a known public health hazard. Nevertheless, whenever these issues are dis- cussed, the potential adverse economic impact on private es- tablishments (especially restaurants, bars and clubs) is raised as a possible reason not to pass these ordinances.

Numerous studies nationwide have examined the economic effeets of smoke-free ordinances. A study that appeared in the journal Tobacco Control in 2003 reviewed 97 studies that made statements about economic impact of smoke-free ordi-

Continued on page 32

TPHA Joumal Volume 58, Issue 3 31

nances. The authors concluded that "all of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment."

In Texas, we have published reports and produeed white papers examining the economic impact of smoke-free ordinances on restaurant sales in West Lake Hills, Arlington, Austin, Piano, Wichita Falls and El Paso."*''^ All of these reports examined sales tax data obtained from the Texas Comptroller of Public Accounts and none of the reports showed any adverse eco- nomic impact resulting from the smoke-free ordinances. The February 27, 2004 Morbidity and Mortality Weekly Report (MMWR) article was our first to also look at impact on bar and mixed beverage sales in El Paso (the first eommunity in Texas to pass a smoke-free ordinance that included all bars). Again, no adverse economic impact was noted on restaurant, bar or mixed beverage sales as a result of their 100% smoke- free ordinanee.

With the remainder of this artiele I will provide an update on some of the latest data that we have from Austin, as it is one of the most recent large Texas cities to implement a compre- hensive 100% smoke-free that includes bars and elubs. Since bars and clubs are the "final frontier" with regard to smoke- free ordinances in Texas, there has been partieular interest in any preliminary data on Austin bar sales, so I will foeus spe- cifically on the bar and mixed beverage sales data.

On September 1, 2005, Austin's 100% smoke-free ordinance went into effect as a result of a voter-approved referendum. Austin had previously had an ordinance that required smoke- free restaurants and the new ordinance extended the protee- tion to include all bars and clubs. What follows are data from sales tax revenues reported to the Texas Comptroller of Public Accounts for mixed beverage sales. Because the ordinanee has only been in effect for a little over a year, and because of delays in reporting, we cannot yet perform the statistical analyses that we typieally use, however, some trends ean al- ready be seen.

Figure 1 shows monthly mixed beverage sales from January 2000 through July 2006. Mixed beverage sales are broken down by sales in bars, restaurants and total sales. As seen in the figure, total mixed beverage sales have eontinued the increasing trend that has been present since 2003/2004. The breakdown between mixed beverage sales in restaurants ver- sus bars shows that mixed beverage sales in bars have essen- tially remained the same since implementation of the smoke- free ordinance while mixed beverage sales in restaurants has continued the inereasing trend.

Based on this preliminary data, it appears that sinee imple- mentation of the September 2005 smoke-free ordinanee in Austin, total mixed beverage sales eontinued an increasing trend that was seen before the ordinanee, primarily driven by increases in mixed beverage sales in restaurants, while mixed beverage sales in bars remained about the same.

Finally, I want to eomment on the plausibility of all of the studies that show no adverse economic impact resulting from smoke-free ordinanees. In Texas, our Behavioral Risk Fae- tor Surveillance System (BRFSS) data show that as of 2005, eurrent adult cigarette use is now down to just under 20% - so there are four times the number of adult non-smokers as smok- ers. The 2004 BRFSS also included a question about how a smoke-free ordinanee would affect people's deeisions to go out to restaurants, bars, bingo halls and bowling alleys. Forty four pereent of the Texas adult respondents said they would go out more often, 39% said it would make no differenee, and only 13% said they would go out less often. These survey results provide even more support for why it makes perfect sense that economic cost studies do not show decreased sales resulting from smoke-free ordinances.

In conclusion, as public health officials, the science is clear that we have a responsibility to proteet the publie from the health effects of exposure to secondhand smoke. Arguments that sueh actions will have adverse economic impact on com- munities are not supported by the data.

Figure

30000000 • 25000000 • 20000000 - 15000000 - 10000000 - 5000000 -

n -< 20 00 :

1 -Austin iViixed Beverage Saie (in Doiiars) ordin

A A— . AA . ., A A y

20 01

i

20 02

i

20 03

1 — Total — Bars

—

s ance

20 04 \

20 05 j

20 06 j

Restaurants

1. Carmona, Richard. "News Release: New Surgeon General's report Foeuses on the Effeets of Seeondhand Smoke." June 27, 2006. U.S. Department of Health and Human Services. Accessed Deeember 1, 2006 http://www.hhs.gov/news/press/ 2006pres/20060627.html. 2. U.S. Department of Health and Human Serviees. The Health Consequences of Involuntary Exposure to Tobaceo Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. 3. Gingiss, P, Roberts-Gray, C, Boerm, M, Greer, K, Sline, R. "Texas Smoke-Free Ordinanee Database." Houston Health Network for Evaluation and Training Systems. Accessed De- eember 1, 2006 http://txshsord.eoe.uh.edu/default.aspx. 4. Huang P, Tobias S, Kohout S, et al. "Assessment of the impaet of a 100% Smoke-Free Ordinance on Restaurant Sales -West Lake Hills, Texas, 1992-1994." MMWR, 1995;44:370- 372. 5. Hayslett J, Huang P. "Impact of Clean Indoor Air Ordi-

Continued on page 33

32 Volume 58, Issue 3 TPHA Joumal

nances on Restaurant Revenues in Four Texas Cities: Ar- lington, Austin, Piano and Wichita Falls, 1987-1999." Texas Department of State Health Services, March 2000, Accessed December 1, 2006 http://www,dshs.state.tx.us/tobacco/pdf/ cleanairord.pdf 6. Huang P, McCusker M. "Impact of a Smoking Ban on Res- taurant and Bar Revenues - El Paso, Texas 2002." MMWR, 2004;53:150-152.

From the

Chronic Disease Training Opportunities:

A nqmber of training opportunities and resources in different training modes and accessibility exist. The following is an ab- breviated list of those opportunities that you can access.

New York and New Jersey Public Health Training Center Training Title: Move It: A Case Study in Policy Change and Health Promotion Program Planning Available at: www.nynj-phtc.org/leaming/default.cfm

Subject Area(s): Health Promotion and Prevention Overweight and Obesity Physical Activity and Fitness Program Development/Planning Audience: Environmental health professionals Health educators State or local public health workers

Pacific Public Health Training Center Online Training: Obesity and Overweight Available at: http://pphtc.org/training/courselist.htm

South Central Public Health Training Center Community health and disease & Diversity and cultural com- petency in public health settings Available at: http://www.southcentralpartnership.org/training/ train jng. asp? I D=4

School of Public Health University at Albany Chronic Disease Grand Rounds (Podcast/video/handouts)

• The Diabetes Epidemic: Preventing the Preventable • Clinical Breast Examination • Colorectal Cancer • Healthy Schools Approach: Type 2 diabetes in children

Available at: http://www.albany.edu/sph/coned/webstream. htmffchronic

Florida DOH Chronic Disease Resources Online Provider Education Modules

Available at: http://www.onlinece.net/subpages/doh_over- view.asp

Continuing Education Courses • CRASH: Cultural Competency Skills for Diabetes Care • The Insulin Resistance Syndrome—^No Longer Just For Adults! • Obesity, Metabolic Syndrome, and Diabetes Prevention in Adults • Pre-Hypertension: Diagnosis and Recommendations • Hypertension ~ Where Are We Now? • Addressing the Psychosoeial Aspects of Diabetes

Available at: http://www.onlinece.net/courses.asp?discipline= DOH&action=list

World Health Organization (WHO) Fact File: Test your knowledge with ten startling facts about chronic disease. Videos: Learn about misunderstandings surrounding chronic disease. Available at: http://www.who.int/chp/en/

Important Resource!

Fr«nitlie World Healtli Organizitioii IWHO) Glob.il report on c Ironic disease -

fie venting cAromc diseases: a vAa/ investment The report makes the case for urgent aotion to halt and turn baok the groWng threat of chronic diseases, and dispels the iong-heid misunderstandings about heart disease, stroke, cancer and other chronic diseases, it presents a stateof-the-art guide to effective and feasible interventions, provides practical suggestions for how countries can implement these interventions. To acceso re)>ort go to: httpi/Mww.who Jnt/chptehronio.disease.report/en/indexhtml

TPHA Joumal Volume 58, Issue 3

Visit the TPHTC website www.txphtrainingcenter.org to see about available and upcoming trainings and news. For ques- tions or suggestions, you may contact Liz Trevino, TPHTC Coordinator at 817.735.0311 or [email protected]

On the Hunt for a Reliable Definition of Chronic Disease and Other Health Information Carolyn Medina, M.A., MLIS Librarian Texas Department of State Health Services Austin, Texas

Where do people go to get more infonnation about a chronic health issue? According to the Pew Intemet & American Life Project October 2006 report,*" 80% of Intemet users go on- line looking for health information but 75% do not consis- tently check the source and date of the infomiation they find online. Where could these people go and know they are get- ting current expert information? 1 decided to go on a hunt and see what I could find on the Intemet.

First of all, I wanted to know what exactly is a chronic dis- ease? A definition was not found in a medical encyclopedia, nor in a medical dictionary. Going to Google,* '̂ typing in

Continued on page 34 33