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Community prevention and the public: Full findings from focus groups and survey FULL REPORT 202.776.9066 | www.lakeresearch.com | November 2010.

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Presentation on theme: "Community prevention and the public: Full findings from focus groups and survey FULL REPORT 202.776.9066 | www.lakeresearch.com | November 2010."— Presentation transcript:

1 Community prevention and the public: Full findings from focus groups and survey FULL REPORT | | November 2010

2 2 Methodology Lake Research Partners (LRP) conducted a series of seven focus groups from July 21 to August 30, 2010: white males in LA, white Latinas and Latinos in LA, younger white females in LA, older white females in Chicago, African Americans in Chicago, females in Kansas City, and white males in Kansas City. All focus groups were conducted among influential voters, defined as those who read national news more than 5 times a week, and who answered yes to three of five questions: pay a great deal of attention to government and politics; have written a letter or called a politician or newspaper about an issue; regularly participate in volunteer, church, or community activities; work closely with children in their profession or activities; or are a business owner with at least one non-family employee. LRP designed and administered this survey that was conducted online between September 24-October 1, The survey reached a total of 950 adults nationwide, with an oversample of 100 Latinos (with interviews offered in both English and Spanish). The margin of error for this survey is +/- 3.2%.

3 3 The American public strongly supports prevention and believes it should be a much higher priority for the country than it is. The terms “health and wellness” and “health care prevention” are extremely popular, and clearly encourage community-based as well as individual prevention. The term “community prevention” rates slightly lower but still very positively. Americans believe the U.S. is doing poorly on health and prevention, with most giving our health a letter grade of C or D. KEY FINDINGS - CONTEXT

4 4 In our qualitative research among influential voters in Los Angeles, Chicago, and Kansas City, we found that there is broad support for community prevention and recognition that something needs to be done—however, what that action is and who will lead the way are uncertain. The public overwhelmingly supports allocating resources towards community prevention initiatives, described as efforts to make it easier for people to maintain their health and make healthier choices (73% support with 43% strong support vs. 20% oppose). Support and intensity are lower when taxes are mentioned, but a solid majority is still in favor with this tougher language (61% support with 32% strong support vs. 34% oppose). The strongest supporters of investing in prevention include African American women (77% strongly support), strong Democrats (66%), African Americans (65%), West women (62%), Latinos (60%), unmarried people with children (44%), post-graduates (59%), Democratic women (59%), and Northeast women (57%). Support for investment in community prevention remains solid after more information and messages for and against. Americans are tax sensitive, especially Latinos, black women, those in the Mountain region, post graduates, and women, especially unmarried and Republican women. KEY FINDINGS – SUPPORT FOR COMMUNITY PREVENTION

5 5 Americans are more divided on the dimension of responsibility for health and prevention. Individual and personal responsibility competes with community prevention, except when it comes to children. The strongest approaches emphasize the individual value. A plurality agree with a statement that we are all in this together and communities can help make healthy choices easier (46%), while about one third (34%) choose an opposing statement that staying healthy is up to individuals. The divide between community (44%) and personal responsibility (36%) is closer when taxes are mentioned. However, the public moves significantly toward the community view of responsibility as a result of information and messages. At the end of the survey, 55% agree with community responsibility (47% if taxes are mentioned), and only 22% stick to individual responsibility (32% with taxes). Moving people on this dimension should be a key goal of public campaigns on this issue. Those who move most towards a community view of responsibility include Northeast women (32%), Northeast whites (30%), non-college educated older women (28%), weak Republicans (27%), and West men (26%). KEY FINDINGS – SUPPORT FOR COMMUNITY PREVENTION

6 6 Americans rate various community prevention initiatives, ranging from banning smoking to improving access to fresh fruits and vegetables, extremely high. It is clear there is broad support for specific initiatives, especially those that target children. As we saw in the focus groups, the concept of community prevention is vague to people and it helps to provide examples. When the proposed actions are drawn together into broader strategies, one strongly stands out as the most popular among both base and persuasion audiences. “Healthy Schools, Healthy Kids” does best, indicating that going through schools to reach kids is the most popular approach for addressing community prevention. The second most popular strategy is “Two for One,” which acknowledges the tough economy and suggests fiscal efficiency in implementing community prevention initiatives. Both are especially strong with Latinos. Not only is there strong support for policy changes, but the public also says they are more likely to vote for elected officials if they support these efforts. 66% said they are more likely and only 11% said less likely. Elected officials have little to lose, and much to gain, by advocating for these initiatives. KEY FINDINGS – PROPOSALS

7 7 From our qualitative and quantitative research, we have learned that the “children” narrative is the most powerful way to reach both influential voters and the public. A message labeled “Kids-gain” tested overwhelmingly well in both intensity and overall support among the broader public, and should be our primary narrative. “Michelle,” a narrative based on the First Lady’s message that invokes urgency and utilizes facts about Americans’ poor health status, also tested very well, even without specific mention of her name. From our focus group research we know that people respond to a few well-chosen statistics. Also significant is that this message connects prevention to the health care system (and the recent reform legislation). Other messages that tested well included one that gave the example of Oklahoma City’s successful community prevention efforts (tested especially well among base supporters) and one that focused on individual responsibility and extended this theme into an argument for broader action including involvement from government and businesses. The individual responsibility message did well among tougher audiences like Republicans and men, and will be helpful in reaching beyond the base. KEY FINDINGS – MESSAGES

8 8 Run a broad campaign with broad themes. There is virtually no group we cannot win over, though some groups are more enthusiastic than others. –Base supporters who are most enthusiastic include Democrats, women, African Americans, Latinos, and people with post-graduate degrees. –Somewhat more skeptical groups include Republicans (especially strong Republicans), older men, older non-college adults, independent women, and those who live in the West North Central and West South Central regions—though all support community prevention by a majority, and all groups are reachable on this issue. Frame the overall goal as making good, healthy choices easier. We found in focus groups that we can bridge the values of individual responsibility and collective action by framing this as a matter of individual choice that the community can play a role in making easier. Target base supporters and focus on turning these groups into activists using segmentation and tailored messaging to excite and motivate them to action. Coordinate efforts by advocacy groups in the coalition and focus overall messaging on two themes: one based on “Kids-Gain” and the other on “Michelle.” Focus on kids and schools in both our messaging and policy, for which there is broad and strong support. It will be important for the coalition to pick a coherent narrative and stay on message. KEY FINDINGS – RECOMMENDATIONS

9 Our qualitative and quantitative findings include broad and widespread support for prevention, recognition that this currently isn’t a priority, and strong support for specific prevention efforts and strategies. Important targets include Latinos and women, both of whom are very supportive of prevention initially. Because so many Americans are already on board with community prevention efforts, messages tend to solidify rather than gain support. However, people do move significantly in the direction of community responsibility after hearing messages.

10 10 Americans broadly agree that the country is not healthy and that prevention is not a priority, and that it should be. –“We’re not healthy at all.” [African American, Chicago] –“We need to eat better and exercise.” [African American, Chicago] –“We’re fat.” [Latino, Los Angeles] –“It’s expensive to be healthy. We have it all here but we can’t always afford it.” [White man, Los Angeles] –“I think as a nation we are not doing well at all with preventive care.” [Younger white woman, Los Angeles] Americans agree on where we are, but not on how to move forward with an agenda that people can get behind. FOCUS GROUP – KEY FINDINGS - CONTEXT

11 11 Now, here are a few questions about health, wellness, and prevention. First of all, thinking about the people of the United States, if you had to give us a grade, how healthy would you say we are? Would you say that in general you would rate the health of Americans as an A, B, C, D, or F? Nearly 8 in 10 Americans rate our health as a “C” or a “D”, a key indicator that the overall poor health of Americans is well known.

12 12 Prevention is a popular concept, as well as language focused on being healthy and staying healthy. –“If you’re overweight, that’s a big factor in your health.” [Older white woman, Chicago] –“It depends a lot on being aware of what you’re eating and what you should do.” [Latino, Los Angeles] –“Prevention starts at home, with how the parents live and eat. It’s also what’s being taught at school.” [White man, Kansas City] –“It doesn’t mean medicine to me, it means being alive, vital, eating well, exercising.” [White woman, Kansas City] FOCUS GROUP – KEY FINDINGS – PREVENTION AND HEALTH

13 13 How high of a priority would you like [health and wellness/health care prevention] to be in this country, on a scale from 0 to 10, with 10 meaning a very high priority and 0 meaning a very low priority, and you can pick any number in between? The public strongly supports prioritizing prevention, but rates the current priority level of such initiatives as much lower than what they would like. How high of a priority is [health and wellness/health care prevention] in this country, on a scale from 0 to 10? Preferred vs. Actual Priority of Prevention (% 6-10) Mean

14 14 How high of a priority would you like community prevention to be in this country, on a scale from 0 to 10, with 10 meaning a very high priority and 0 meaning a very low priority, and you can pick any number in between? When we use the label “community prevention,” a similar gap exists between the desired high priority and the current low priority. How high of a priority is community prevention in this country, on a scale from 0 to 10? Preferred vs. Actual Priority of Community Prevention (% 6-10) Mean

15 15 Overall, the focus groups brought good news: the public is on board with prevention efforts, and further along in terms of support than even the experts give them credit for. –“People pay too much stock in medicine, instead of taking care of themselves.” [White woman, Kansas City] –“I don’t think there is enough prevention because I think a lot of people can’t afford it.” [White woman, Kansas City] –“It’s really important, what you eat and how much you exercise.” [Younger white woman, Los Angeles] –“It’s not a cultural thing of being Latino or Jewish or Armenian or whatever, it’s that people don’t have time now, we don’t have someone at home taking care of the kids. Our lifestyle is so busy, it affects all races and social levels.” [Latino, Los Angeles] However, advocates must focus on turning support for prevention into action for prevention. FOCUS GROUP – KEY FINDINGS - SUPPORT

16 16 Certain communities are more concerned about access to care, particularly preventive care – especially Latino and African American groups. –“Prevention means getting regular check-ups, going to the doctor.” [Younger white woman, Los Angeles] –“Healthy people have the liberty of seeking health care, because they have insurance.” [Latino, Los Angeles] –“Health is maintaining health, not waiting to get sick but going to get regular checkups.” [Latino, Los Angeles] All voters really like emphasizing and focusing on education and awareness. They believe that we can make the most difference by giving people more knowledge. The challenge is to expand this concept from a purely individual focus to broader policy changes. –“We can be more aware of issues, like salt and processed foods. We’re just now getting that understanding.” [White man, Los Angeles] –“Any kind of education, like on a children’s show.” [Older white woman, Chicago] –“We need more places where you can get information, not necessarily for treatment.” [African American, Chicago] FOCUS GROUP – KEY FINDINGS - FRAMING

17 Those who are most tax sensitive and drop off in the greatest numbers in terms of strong support include Latinos, black women, Mountain region, post graduates, and women, especially unmarried and Republican women. 17 Darker color indicates intensity Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly? No taxes* Initial support for allocating resources towards community prevention, described as efforts to make it easier for people to maintain their health and make healthier choices, is overwhelmingly popular, though opposition increases somewhat when taxes are mentioned. Initial Support: Investing in Prevention With taxes* *split sampled question +53 points +26 points

18 18 Darker color indicates intensity Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly? No taxes* The mention of taxes has a surprisingly large impact on Latinos. Intensity drops by 20 points and the commanding margin of support for community prevention narrows a bit. Initial Support: Investing in Prevention - Latinos With taxes* *split sampled question +58 points +39 points

19 19 Darker color indicates intensity Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly? No taxes* Taxes also increases opposition to community prevention, even among women. Overall support drops more among men, though strong support drops by 14 points among women. Initial Support: Investing in Prevention by Gender With taxes* *split sampled question Men Women

20 20 Voters tend to focus on personal choices and personal responsibility. –“The individual is where it starts, you’re responsible for yourself and your children, but if communities and cities have ideas to promote health, it’s reinforcement.” [Younger white woman, Los Angeles] –“Personal motivation is necessary.” [White man, Kansas City] –“We can’t ‘make people healthy’ – they have to choose to be.” [White man, Kansas City] –“It has to start with the family; you learn by example.” [White woman, Kansas City] They understand the community has a role to play, too. –“People feel a connection to the area they live in.” [Older white woman, Chicago] –“People with lower incomes, they don’t have access to better groceries.” [White woman, Kansas City] –“I think it really does take a whole community of people to really prevent certain things, certain health issues because even if people are getting it from home, you go out and there are billboards everywhere.” [Latina, Los Angeles] The challenge is to bridge the values of personal responsibility and community action. Personal responsibility should be a part of the overall narrative, because it is a core value of Americans. –Yet Americans also recognize that these choices can be made easier or harder. They want businesses, government, and communities to work together in providing access and opportunities for better choices and better health. FOCUS GROUP – KEY FINDINGS – INDIVIDUAL vs. COMMUNITY

21 21 Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Community vs. Individual Responsibility +12 points Voters are split on individual vs. community role. Initially, a plurality of the public agrees that the community – not just individuals - has a role in prevention efforts. Mentioning taxes has only a minor effect on this dimension. *split sampled question +8 points Some people say that while staying healthy is up to each individual, there are things that communities can do to make healthy choices easier for individuals and families. We are all in this together, and we all have a lot to gain from making it easier to eat better, exercise more, and ultimately live longer, [even if it means increasing taxes]. Other people say that a person’s health is due to their individual choices, and that becoming healthier is each individual’s responsibility. Instead of spending money on community programs, it will be more effective to leave it to individuals to take control and make healthier lifestyle choices. Without taxes*With taxes*

22 Men 22 Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Community vs. Individual Responsibility By Gender When taxes are not mentioned, women strongly support community efforts. However, when cost becomes part of the debate, the gender gap diminishes. *split sampled question Without taxes*With taxes* MenWomen

23 Democrats 23 Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Community vs. Individual Responsibility By PID Independents are more likely to support community responsibility when taxes are not mentioned. Republicans are more individual-oriented. *split sampled question Without taxes*With taxes* IndependentsRepublicansDemocratsIndependentsRepublicans

24 24 Regarding specific preventive actions, while Americans are clear on the problems and goals, they are much less certain about specific solutions to move forward with. Popular prevention actions include healthier school lunches (especially among women and African Americans), insurance and employer incentives (general interest in this, including among men, Latinos, and older women), grocery stores in more neighborhoods (mainly in less affluent urban groups), and biking and walking trails (especially among white, more affluent respondents). –Re: insurance discounts: “It encourages people to take responsibility.” [Younger white woman, Los Angeles] –Re: school lunches: “You have to start early, it’s a lifestyle that will lead to a healthier generation.” [Younger white woman, Los Angeles] –Re: grocery stores: “You can’t tell me that vegetables with worms in it is the best we can do.” [African American, Chicago] –“The residents don’t have choices.” [African American, Chicago] –Re: biking trails: “Wouldn’t it be nice if you could ride your bike to work?” [White woman, Kansas City] –“I’m lucky that I have a safe place to jog, but not everyone has that.” [White man, Los Angeles] FOCUS GROUP – KEY FINDINGS - ACTIONS

25 25 Anything that put money in people’s pockets was popular among everyone. –“I’d do whatever it took to get some money back.” [White man, Los Angeles] –“Money talks.” [Younger woman, Los Angeles] Some actions were less popular or didn’t make as much sense to voters, including encouraging eating dinner at home or more grocery stores in neighborhoods (for those that already have them). –“Every store has fresh produce.” [Older white women, Chicago] –“Telling people to eat dinner with their families…good idea but not effective. It’s like telling someone to love their wife.” [White man, Los Angeles] –“I don’t think it would motivate sedentary people. People already active would use [these preventive actions].” [White man, Los Angeles] FOCUS GROUP – KEY FINDINGS - ACTIONS

26 26 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between. Specific community prevention actions are tremendously popular, especially banning smoking and making school lunches healthier. Food labeling and health insurance discounts also rate highly. Mean *split sampled question

27 27 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between. Second-tier actions, including employer incentives and access to fresh produce, have less intense support but are still broadly popular. Mean *split sampled question

28 28 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between. Latinos are more intensely supportive of prevention actions in general. They rank restricting advertising and employer incentives higher than the general population. Mean *split sampled question

29 29 Now, here is a list of examples of community prevention actions that could help people be healthier and make healthier choices. Please read each one and rate your support for that item on a scale of zero to ten, where ten means you strongly support this action, and zero means you strongly oppose this action, and you can choose any number in between. Women are also more intensely supportive of prevention measures, particularly banning smoking and making school lunches healthier. Mean *split sampled question

30 30 Voters find it easy to understand how investing in prevention will save money in the long run, and are for the most part willing to invest money in it—as long as it doesn’t increase taxes. –“In the long run, prevention saves so much.” [Younger white woman, Los Angeles] –“Initially it will cost, but in the long run it saves.” [Latino, Los Angeles] –“No taxes.” [Latina, Los Angeles] They’d rather the money be located in places where they perceive it’s being wasted right now, particularly the health care system. –“There is wasted money.” [Latino, Los Angeles] –“Taxpayers shouldn’t fund it, I’m not going to wait around for the government to make things better.” [Latino, Los Angeles] –“We don’t have the money upfront – there are competing budget priorities.” [White man, Kansas City] –“The whole health care system is broken.” [Older white woman, Chicago] FOCUS GROUP – KEY FINDINGS - INVESTMENT

31 31 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Funding for Community Prevention +16 points Some people say that spending money on community prevention is a good investment because it results in better health, and it saves money in the long run by reducing the cost of expensive treatment for chronic diseases. Other people say that these may be nice things to have in a community, but times are tough and we just can’t afford to be spending more money on these prevention activities when governments are running deficits already. In an engaged debate, a plurality of the public agrees that spending money on community prevention is a good investment, even when challenged on the cost of the investment in these tough times. The strong support beats the strong opposition though support is under 50%.

32 32 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Funding for Community Prevention by Race Latinos and African Americans intensely and strongly agree that spending money on community prevention is a good investment. WhitesAfrican AmericansLatinos

33 33 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Funding for Community Prevention by Gender Women are more supportive of funding community prevention than men, both in terms of overall support and intensity. MenWomen

34 34 Thinking about the community prevention actions like the ones you just rated, here are two different statements about spending money on these actions. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Funding for Community Prevention by PID A majority of Democrats and a plurality of independents clearly believe that community prevention efforts are a good investment, while Republicans are more likely to say we can’t afford it. DemocratsIndependentsRepublicans

35 35 Regarding the role of government, people recognize that health is a large enough social problem that government should play a role; however, many are concerned that government could play too large a role and create a nanny state. –“Government has budgets they can spend. They can put some PSAs out there on buses. They can put some stuff up in all of these grocery stores.” [African American, Chicago] –“I would take out the government role – they have other priorities, not to get into our own business and spoonfeed us.” [Older white woman, Chicago] –“Where does the government come in if we’re taking control of our own lives?” [Older white woman, Chicago] –“We don’t want to be told what to do as adults.” [White man, Kansas City] Voters are more comfortable with the idea of government creating public education programs about nutrition, exercise, and generally making it easier for people to be healthy. –“I like government promoting and telling people how much vegetables to eat, where farmers markets are, etc.” [Younger white woman, Los Angeles] –“Education and awareness is the limit.” [White man, Kansas City] –“As a cheerleader, okay, but no direct action—that should be reserved for the community.” [White man, Kansas City] –“They can get to a wide amount of people if they do it correctly.” [White woman, Kansas City] FOCUS GROUP – KEY FINDINGS - GOVERNMENT

36 36 Now, here are some strategies that have been suggested as ways to make our communities healthier. Please read and rate each one on how effective you think this will be in making your community healthier, where ten means you think this would be extremely effective, and zero means you think this would not be at all effective in making your community healthier, and you can choose any number in between. With all of the community prevention strategies we tested that were popular, the best testing strategies by far focuses on kids and schools, while the next best strategy addresses how we can get “2 for 1” with smart, efficient investments. *split sampled question Mean

37 [HEALTHY SCHOOLS, HEALTHY KIDS – 3 DAYS] - Too many schools have become unhealthy, offering snacks and soda from vending machines as well as unhealthy school lunches to kids. We should limit junk food in schools and make the school lunch menu more nutritious. We should also have physical education classes at least 3 days a week, not cut them, so kids can be active, which helps them be healthier and learn better. [HEALTHY SCHOOLS, HEALTHY KIDS – EVERYDAY] Too many schools have become unhealthy, offering snacks and soda from vending machines as well as unhealthy school lunches to kids. We should limit junk food in schools and make the school lunch menu more nutritious. We should also have physical education classes every day, not cut them, so kids can be active, which helps them be healthier and learn better. [TWO FOR ONE]- In these tough times, we have to do more with less, and find ways to promote prevention while we do other things. Where possible, every school should have a community garden. We should use our school facilities after work for exercise programs. When we repair parks and streets, let’s build playgrounds and bike paths where it makes sense. For minimal cost and effort we can get multiple benefits. [TWO FOR ONE – SCIENCE PROJECT] In these tough times, we have to do more with less, and find ways to promote prevention while we do other things. Where possible, every school should have a science project community garden. We should use our school facilities after work for exercise programs. When we repair parks and streets, let’s build playgrounds and bike paths where it makes sense. For minimal cost and effort we can get multiple benefits. Text of top tier strategic proposals

38 38 Now, here are some strategies that have been suggested as ways to make our communities healthier. Please read and rate each one on how effective you think this will be in making your community healthier, where ten means you think this would be extremely effective, and zero means you think this would not be at all effective in making your community healthier, and you can choose any number in between. Strategies that focus on food also do well, though not as well as targeting kids specifically and the two-for-one theme. *split sampled question Mean

39 [BETTER FOOD] - Community programs are encouraging corner stores to stock fresh fruits and vegetables in places where grocery stores are scarce. With a little assistance and education to get started, store owners often make more money, so the program sustains itself. They are also encouraging opening full-service grocery stores in economically struggling neighborhoods that don’t have them. When people have access to fresh, healthy food in their neighborhoods, they can make better choices. [CHANGE THE FOOD INCENTIVES] Studies show that when unhealthy foods cost more, people eat less of it. We should continue to tax soda, candy, and other junk food, and lower or eliminate taxes on healthy, fresh foods including fruits and vegetables. We should use tax revenue from junk food to fund practical nutrition education programs in our schools, including lessons on nutrition labels, preparing healthy snacks, and healthy portion sizes. Text of second tier strategic proposals

40 Healthy Schools, Healthy Kids – 3 Days* (53% rate 10) Healthy Schools, Healthy Kids – Everyday* (45% rate 10) Two for One w/ Science Project* (35% rate 10) Democrats are most intensely supportive of the strategic proposals, followed by independents and Republicans. All like Healthy Schools, Healthy Kids best. DemocratsIndependentsRepublicans Healthy Schools, Healthy Kids – Everyday* (46% rate 10) Healthy Schools, Healthy Kids – 3 Days* (36% rate 10) Two for One w/ Science Project* (23% rate 10) Healthy Schools, Healthy Kids – Everyday* (40% rate 10) Healthy Schools, Healthy Kids – 3 Days* (40% rate 10) Two for One* (24% rate 10) Strategic Proposals by Party ID

41 Healthy Schools, Healthy Kids – 3 Days* (55% rate 10) Healthy Schools, Healthy Kids – Everyday* (50% rate 10) Two for One w/ Science Project* (35% rate 10) Latinos are intensely supportive of the strategic proposals. Women and Latinos, both key targets, are very supportive of healthy schools and 2 for 1. WomenLatinos Healthy Schools, Healthy Kids – 3 Days* (62% rate 10) Healthy Schools, Healthy Kids – Everyday* (60% rate 10) Two for One w/ Science Project* (47% rate 10) Strategic Proposals – Women and Latinos

42 42 Even influential voters have a hard time identifying visible leaders on prevention, nationally or locally. –“I’d like to see more Latino leadership, our kids are killing each other. We need to unite and become a political force, we could come together to get what we need.” [Latino, Los Angeles] –“It’s important for elected officials to take action.” [Latino, Los Angeles] The First Lady’s effort have been noticed and are often mentioned in a positive light. –“I like the awareness, with Michelle Obama planting a garden- look, this is a tomato.” [Younger white woman, Los Angeles] –“There’s an attempt, it’s coming from the Obamas, she’s taking obesity and that’s a start.” [White woman, Kansas City] FOCUS GROUP – KEY FINDINGS - LEADERS

43 43 Voters want to see the media and pop culture take more active roles in leading the way on prevention, including medical doctors on TV, celebrities, and others. –“It’s good, like when Sally Field talks about osteoporosis.” [Older white woman, Chicago] They also see a role for community institutions such as churches and schools. –“Schools…there’s junk food sold in schools now.” [Latino, Los Angeles] –“I was thinking, in schools if they provided some kind of an opportunity for kids to cook. Maybe you could teach them through that rather than waiting until they get to high school.” [White woman, Kansas City] –“It has to start from the schools because sometimes parents aren’t educated to know.” [White woman, Kansas City] –“Our church is getting involved in things like health as well, and even financial health. They have classes on managing your money.” [White man, Kansas City] FOCUS GROUP – KEY FINDINGS - LEADERS

44 44 Darker color indicates intensity Now that you’ve read more about community prevention, would you be more or less likely to vote for a local elected official if he or she supported these efforts, or would it not make a difference to you? Is that much more or less likely, or somewhat more or less likely? Advocates for the community prevention agenda should point out to elected officials that supporting such efforts would be beneficial in winning votes. Vote for Elected Official 80% of Democrats, 64% of independents, and 58% of Republicans say they are more likely to vote for an elected official who supports community prevention efforts. Only 5% of Democrats, 14% of independents, and 17% of Republicans say they are less likely.

45 45 Darker color indicates intensity Now that you’ve read more about community prevention, would you be more or less likely to vote for a local elected official if he or she supported these efforts, or would it not make a difference to you? Is that much more or less likely, or somewhat more or less likely? Three-quarters of Latinos would be moved to vote for an elected official who supports community prevention. Vote for Elected Official - Latinos

46 46 Darker color indicates intensity Now, thinking about community prevention, would you support or oppose efforts to target people in certain neighborhoods [ethnic and racial minorities or people who have lower incomes] who may have a harder time accessing and choosing healthy lifestyles? Would you say you support or oppose that strongly or not so strongly? Target in Certain Neighborhoods* Targeting to address health disparities is slightly more broadly supported when referred to as “certain neighborhoods” rather than “ethnic and racial minorities.” Disparity Questions Target Ethnic and Racial Minorities Or Low Income* *split sampled question

47 47 Darker color indicates intensity Now, thinking about community prevention, would you support or oppose efforts to target people in certain neighborhoods [ethnic and racial minorities or people who have lower incomes] who may have a harder time accessing and choosing healthy lifestyles? Would you say you support or oppose that strongly or not so strongly? Target in Certain Neighborhoods* A majority supports targeting prevention efforts to demographic groups, though the level of support is lower than for prevention actions more broadly. African Americans respond strongly to the specific reference to race. Latinos see an overall initial increase but less reach. Disparity Questions by Race Target Ethnic and Racial Minorities Or Low Income* *split sampled question

48 48 Messaging focused on kids resonates strongly among all groups, and particularly among women, Latinos, and African Americans. –“They ARE the future.” [Latino, Los Angeles] –“I like the concept. It’s okay for adults to do what they want, but the children don’t know.” [Older white woman, Chicago] –“Kids are our future, parents have to take responsibility and have to show their children…they have to be good role models.” [Older white woman, Chicago] Influentials want to see facts included in messages, such as “Michelle.” They also like messages that contain an economic component. –“The statistic makes it more real.” [Younger white woman, Los Angeles] –“I would use more facts on obesity, diabetes.” [White man, Kansas City] –“It’s a pocketbook issue, it’s more rational than emotional.” [Older white woman, Chicago] FOCUS GROUP – KEY FINDINGS - MESSAGES

49 49 The children narrative was a powerful one, opening up the conversation and helping people hone in on solutions. Talking about kids helps raise the stakes because everyone wants children to be healthy and knows they are the future, and they believe children can not be expected to take individual responsibility. –“Children spend a lot of time in front of the computer; we need to get them more active.” [Older white woman, Chicago] –“Education with kids…obesity starts in childhood.” [Older white woman, Chicago] –“Kids spend their money on trash.” [Younger white woman, Los Angeles] –“I never see kids out playing, versus our own childhoods…they are less active now.” [White men, Kansas City] –“Kids are taking pills, kids are drinking soda.” [Younger white woman, Los Angeles] –“A lot of kids are very obese, their diet is inappropriate.” [White woman, Kansas City] FOCUS GROUP – KEY FINDINGS – CHILDREN NARRATIVE

50 50 Messaging that wasn’t as successful was often found to be too vague. Voters are wary of rhetoric and want concrete facts and solutions. –Re: Falling Behind: “I think this is completely absurd.” [White man, Los Angeles] –“They used the word innovate three times without saying exactly what that means.” [White man, Los Angeles] –Re: Populist Demand: “I just didn’t like it because it sounded like a freshly written speech.” [African American, Chicago] –Re: Villains: “I thought this was full of excuses.” [African American, Chicago] –“I like what it said, but with all of these blanket statements, I want to know what the solution is or what are we going to do, or how are we going to start?” [African American, Chicago] –Re: Imagine: “It is all a great idea, but what are they proposing? There is no action.” [Younger white woman, Los Angeles] FOCUS GROUP – KEY FINDINGS - MESSAGES

51 51 Now, here are a series of statements people have made in support of community prevention. Please read and rate whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support community prevention. The most effective messages for community prevention focus on helping children grow up healthy, and highlight the health problems we face as a country. *split sampled question Kids-gain is a popular message among all adults, followed closely by Michelle. Individual responsibility does well among tougher audiences, including Republicans and men, and Like other cities resonates well among our base and could be used for consolidation.

52 52 Now, here are a series of statements people have made in support of community prevention. Please read and rate whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support community prevention. Other strong messages are community- or kid- oriented. *split sampled question

53 53 Now, here are a series of statements people have made in support of community prevention. Please read and rate whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support community prevention. Disparities and moving beyond personal responsibility are less powerful than other messages. *split sampled question

54 [KIDS-GAIN] - Kids are our future, and to have a healthy future, we must help our children grow up healthy. We need to focus on improving nutrition at schools including getting rid of the junk food, make sure healthy fresh food is available at home, and that there are clean and safe parks in every neighborhood where kids can play. It’s the least we can do for our kids to grow up healthy. [MICHELLE] - It’s important to get preventive care, like checkups, vaccinations, and mammograms—but we need to do more. We need to change the way we eat, move, and interact so that health and prevention become priorities every day and not just when we get sick. This will help us combat diabetes, heart disease, and obesity, especially for children. These chronic diseases contribute to seven in ten deaths in the U.S. right now, and 75 percent of our current national health care costs. We owe it to ourselves to change this. [INDIVIDUAL RESPONSIBILITY]- It’s time we step up to the plate and take control over our own lives. By making healthier choices like buying fruits and vegetables, cooking instead of going through the drive-through, and playing outdoors with our kids instead of watching television, we will have more energy and fewer health problems. It is up to us to act, but we need government and businesses to work with us, not get in the way. We need information about nutrition, healthier choices on the menu at school and work, and safe places to exercise, so we are able to make good choices. [LIKE OTHER CITIES]- Community prevention can make a real difference—like it has in Oklahoma City. People there were among the most obese in the nation, and it was impacting their local economy since employers don’t want an unhealthy workforce who miss too many days of work and cost too much. They invested in prevention by making the city more pedestrian friendly, getting local businesses involved, and encouraging residents to exercise more. Oklahoma City lost half a million pounds and attracted new employers. so now they are not only healthier, but their economy is stronger too. Text of positive messages

55 [HEALTHY GENERATION] - This is the first generation of Americans that isn’t expected to live longer than their parents, and that isn’t right. Kids need help and guidance to make good choices. We need to implement these initiatives to keep our kids healthy, for them to learn good healthy behaviors early on so they become habit. We need to make this generation a healthy generation by enabling our kids to live longer and better lives. [INVESTMENT IN OUR FUTURE] - Prioritizing health isn’t just common sense, it makes financial sense as well. By taking charge and improving the health of ourselves, our families, and our communities, we can reduce health care costs by reducing the incidence of chronic disease and our reliance on medications. We can increase worker productivity so that local employers keep jobs here. And we can serve as role models for our kids, so that future generations learn healthy behaviors early on. This is an important investment in our future. [DO IT TOGETHER]- It’s up to all of us to get more exercise, eat healthier foods, and make healthy choices – but let’s support each other to make those choices easier. Let’s get together and go for walks or throw a football, and share quick and easy healthy recipes. And let’s make sure our elected officials know that we need safe places in our community to get together and exercise, and that we need easy access to affordable healthy foods. Living a healthy lifestyle is easier when we do it together. [TOOLS FROM THE COMMUNITY]- Clean, safe places to walk, grocery stores with affordable and healthy foods, and laws against smoking in public places are tools that our communities can give us to help us lead healthier lives. It’s up to all of us to get annual check-ups, eat healthy foods, and exercise, and no one can make us do these things. But the communities we live in can give us some places and opportunities that will help us along the way. Text of positive messages

56 [ECONOMIC-KIDS] - Community prevention is good for our economy. By focusing on healthy lifestyles and healthy choices, we will reduce 80% of chronic disease, including diabetes, heart disease, and obesity, especially for children. Not only will we save on health care costs, our productivity will go up, our community will attract good employers and good jobs, and we will live healthier, happier lives. [BEYOND PERSONAL RESPONSIBILITY] - We are responsible for making healthy choices, but it’s hard when there is no place to buy fresh fruits and vegetables in the community, no safe parks or paths where we can bike or walk, and school cafeterias make unhealthy food cheap and don’t offer enough appealing, affordable healthy choices. We need everyone in the community, from elected officials to schools to employers, to do their part to support our healthy lifestyles. [DISPARITIES]- It's just not right that some children don't have the same opportunity to have good health as the rest. Our health should be determined by the choices we make, not the zip code we were born in or whether our parents could afford nutritious food. When we plan for preventing disease we need to address these inequalities, so that all children have a chance to grow up to lead healthy, productive lives. We need to make healthy choices and behaviors affordable and accessible to all: it’s only fair. [COMBINATION]- Every community is different. We need a combination of strategies to help make our communities healthier. For example, in communities without safe places to walk, we should make sure that enough police are out patrolling, and that crosswalks are visible to cars. In communities without big grocery stores, we should help smaller stores stock fresh produce. Let’s find the right strategies for our community, and let’s make them happen by working with community groups and elected officials to get things started. [IT’S TIME]- It’s time for us to take action to benefit ourselves, as well as our children, our communities, and our country. This is a great country, but we’ll be stronger if we are healthier. By helping each other make healthier choices in what we eat, how often we exercise, and reducing smoking, we can build a brighter future for our country. Text of positive messages

57 57 Now, here are a series of statements people have made in support of community prevention. Please read and rate whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support community prevention. Investment and Do It Together ranked in the top four messages among Latinos. *split sampled question

58 58 Now, here are a series of statements people have made in support of community prevention. Please read and rate whether each is a very convincing, somewhat convincing, not very convincing or not at all convincing reason to support community prevention. The top three messages for women all involve children. *split sampled question

59 59 Darker color indicates intensity Sometimes in a survey like this, people change their minds. Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly? No taxes* After the positive messages, support for community prevention remains strong, though tax sensitivity remains, and in fact increases slightly. Re-Vote: Investing in Prevention With taxes* *split sampled question +55 points +22 points

60 60 Now here are a series of statements people have made against investing more in community prevention. Please read and rate whether each statement raises serious doubts, some doubts, minor doubts, or no real doubts in your own mind about investing more in community prevention. Opposition messages following positive messages lack intensity and reach in persuading the public against investing in community prevention efforts.

61 [GOVERNMENT OVERREACH] - This is yet another example of government overreaching, telling us how to live our lives. It is unbelievable that government feels like they can tell us what to eat and how to exercise, and now, how to raise our kids. Government officials have no business telling us what we can eat for dinner or how we should pack our kids’ school lunches. [INDIVIDUAL LIFESTYLES] - Lifestyles are all about individual choices and personal responsibility, and there’s no need for government and employers to get involved. What we eat for dinner and what we do with our time and money is our business. Community prevention programs are just an excuse for government and big business to invade our privacy and interfere with our personal lives. [ECONOMIC]- During these tough economic times, we shouldn’t spend money we don’t have on community prevention efforts. Building recreational centers and biking paths while people are out of work, facing foreclosure, and struggling to make ends meet is not right. Now is not the time to focus on extras and parks—we need to focus on jobs and keeping taxes low. Text of negative messages

62 62 Darker color indicates intensity Sometimes in a survey like this, people change their minds. Would you support or oppose investing more money and resources in community prevention efforts to make it easier for people to maintain their health and make healthier choices, [even if it means increasing your taxes by $100 dollars a year]? Would you say you support or oppose this strongly or not so strongly? No taxes* Overall support for investing in prevention remains solid at the end of the survey, with little movement in either direction in part because support was already large. Final Vote: Investing in Prevention With taxes* *split sampled question +53 points +21 points

63 63 Now, here are two statements about health and prevention. Please read each carefully and rate which statement comes closer to your point of view, even if it isn’t exactly right. Final Vote: Community vs. Individual Responsibility +33 points The real movement is seen on the responsibility dimension. Net support for community responsibility increases in the version that doesn’t mention taxes from +11 to +33, and for the version that does mention taxes, the lead increases from +8 to +16. *split sampled question +16 points Some people say that while staying healthy is up to each individual, there are things that communities can do to make healthy choices easier for individuals and families. We are all in this together, and we all have a lot to gain from making it easier to eat better, exercise more, and ultimately live longer, [even if it means increasing taxes]. Other people say that a person’s health is due to their individual choices, and that becoming healthier is each individual’s responsibility. Instead of spending money on community programs, it will be more effective to leave it to individuals to take control and make healthier lifestyle choices. Without taxes*With taxes* 55%

64 64 The American public realizes the need for a focus on health, wellness, and community prevention, as evidenced by the wide gap between how high a priority they would like prevention to be, and how low a priority it is. Also, they overwhelmingly assign low ratings to the health of Americans today. Americans broadly and intensely support community prevention, described as investing more money to make it easier for people to maintain their health and make healthier choices (73% support, 43% strongly), even when taxes are mentioned explicitly (61% support, 32% strongly). The public is enthusiastic about a wide range of community prevention actions, including making school lunches healthier, better food labels, employer incentives, and many others. Similarly, Americans support combined strategies focused on improving the health of the country. They especially love focusing on kids and schools and two-for-one programs. Two-thirds of the public would be more likely to support a local elected official if they supported community prevention efforts. Findings to highlight to demonstrate public support for the community prevention agenda:

65 Celinda Lake David Mermin Shilpa Grover


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