Design and First Year Results of the Healthy Hawaii Initiative Jay Maddock, Ph.D. Claudio Nigg, Ph.D. Jessica Yamauchi, M.A. University of Hawaii Funded by the Hawaii Department of Health

Toxic Agents 6% Toxic Agents 6% Alcohol 8% Alcohol 8% Firearms, Sexual Behavior, Motor Vehicles, 10% Firearms, Sexual Behavior, Motor Vehicles, 10% Diet / Activity 28% Diet / Activity 28% Microbial Agents 8% Microbial Agents 8% Tobacco Related 40% Tobacco Related 40% Actual Causes of Premature Death

Adult Smoking Prevalence by Age Hawai`i % 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% Males Females Behavior Risk Factor Survey 1999

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% Hawaiian Japanese Caucasian Filipino Chinese Total Males Females Adult Smoking Prevalence by Ethnicity Hawai`i 1999 Behavior Risk Factor Survey 1999

The Honolulu Advertiser – Nov. 17, 1998

Tobacco Settlement Special Fund Structure Tobacco Settlement Special Fund Structure How Hawaii's Tobacco Settlement Money Works Rainy Day Fund State Administration‘s Emergency & Budget Reserve 40% Tobacco Prevention and Control Trust Fund 25% Department of Health The Healthy Hawaii Initiative 25% Department of Health 35% Tobacco Settlement Special Fund within State Treasury Administered by Department of Health Department of Human Services Children's Health Insurance Program (CHIP) Up to 10% of Total Moneys

The Healthy Hawai`i Initiative (HHI) -Increase quality and years of healthy life for all of Hawai`i’s people -Reduce existing health disparities among ethnic groups in Hawai`i The Healthy Hawai`i Initiative (HHI) -Increase quality and years of healthy life for all of Hawai`i’s people -Reduce existing health disparities among ethnic groups in Hawai`i

The Relationship Between Individual and Community Health “There is a growing recognition that individual health is closely linked with community health, which is in turn reflected in the environment in which individuals live and work.” Healthy People 2010 Understanding and Improving Health

The Healthy Hawai`i Initiative Improved environment Improved individual health Healthy behavior Improved health of population Reduction in: Diabetes Heart Disease Cancer Stroke 2-5 years 5-10 years years

HHI has four major components - Healthy Community Initiatives - School Based Initiatives -Public & Professional Education -Hawai`i Outcomes Institute HHI has four major components - Healthy Community Initiatives - School Based Initiatives -Public & Professional Education -Hawai`i Outcomes Institute Social Ecological Approach

Pictorially… Individual – Pub. Ed. Social Norms – Pub. Ed. Social Professional – Teaching & Prof. Ed. Policy/Structure/Environment - Schools Policy/Structure/Environment - Communities Policy/Structure/Environment – County/State – Targeted RFP

HHI Assessment Timeline Longitudinal and Multiple Cross-sectional Design Base6 mo12 mo18 mo24 mo30 mo X1X2X3X4X5X6 YYYYYY X – Random digit dial at baseline, longitudinal sample (to be followed over time). - total N=3700 Y – Random digit dial sample at each time point. - n for each county =1200- total N= 4700

Baseline, Spring ,706 completed cross-sectional sample 16.2% current smokers 29.2% former smokers Hawaiians and Filipino males most at-risk Over 74% of former smokers quit on their own 4,706 completed cross-sectional sample 16.2% current smokers 29.2% former smokers Hawaiians and Filipino males most at-risk Over 74% of former smokers quit on their own

Baseline, Spring % in precontemplation 48% in contemplation 9% in preparation 10% less in preparation than other studies have shown 66% support smoke-free restaurants and bars 91% believe second-hand smoke harms non- smokers 43% in precontemplation 48% in contemplation 9% in preparation 10% less in preparation than other studies have shown 66% support smoke-free restaurants and bars 91% believe second-hand smoke harms non- smokers

Schools Coordinated School Health Program  16 funded schools  Run their own intervention  Tracking process data  Objectives, Activities, Progress, Barriers Facilitators, Planning  Will become internet based  Will include immediate outcome indicators  Chose 6 highlight schools for more in depth assessment (e.g., objective behavior counts)  Based on geography and potential for biggest impact

Schools Health Education/Physical Education Standards  Educate at the new published standards in HE/PE  Includes training workshops, policies, curriculum etc…  Long term impact of curriculum changes to meet HE/PE standards are “huge”

Schools: Initial Process Results 32 systems, environmental and policy changes related to tobacco. 23.7% of total number of changes. Biggest barrier to success is turnover in coordinators. Conferences are highly attended and useful to standards implementation. School standards survey to be implemented in Fall systems, environmental and policy changes related to tobacco. 23.7% of total number of changes. Biggest barrier to success is turnover in coordinators. Conferences are highly attended and useful to standards implementation. School standards survey to be implemented in Fall 2003.

Communities  26 funded communities ($24,000 each)  Run their own intervention  Aid in creating action plan  Health Concerns Survey  Community Needs assessment for 3 health areas  Disseminate best practices

Communities cont…  Aid in tracking process data  Computer based  May include immediate outcome indicators  Choose 6 highlight communities for more in depth assessment (e.g., objective behavior counts)  Based on geography and potential for biggest impact

Communities: Initial Process Results 10/23 (43%) listed tobacco use as one of their top 3 health concerns. 11/25 (44%) listed specific activities and objectives to reduce tobacco use in their action plans. 10/23 (43%) listed tobacco use as one of their top 3 health concerns. 11/25 (44%) listed specific activities and objectives to reduce tobacco use in their action plans.

Communities - Targeted RFPs  $ K/year over 2 years  5 awards granted summer 2002  Targeting environment, system, policy across communities (county or state level)  Provide guidance in evaluating process and outcomes – consultant to all grants  None deal with tobacco

Public Awareness and Education - Increase reliable information about healthy behaviors -Create clear, understandable health messages -Provide consistent health messages

Public Education 6 TV spots 6 radio ads Movie trailers Launched in Jan 2002

Website

Newspaper Coverage 5 newspapers covering all counties were tracked during the summers of 2001 and % increase in newspaper coverage on tobacco Most differences in clean-air and regulation stories due to Restaurant Smoking Ordinances. 5 newspapers covering all counties were tracked during the summers of 2001 and % increase in newspaper coverage on tobacco Most differences in clean-air and regulation stories due to Restaurant Smoking Ordinances.

Summary Initial findings are positive for process data: the program is being implemented Evaluation design will allow us to track changes and assess how well the initiative remains on track.