1. Public Health Informatics – New Opportunities for Public Health Practitioners The Children’s Hospital of Philadelphia’s Seventh Annual Mid- Atlantic Healthcare Informatics Symposium April 25, 2014 Giridhar Mallya, MD, MSHP Director of Policy and Planning Philadelphia Department of Public Health

2. Tobacco and obesity surveillance, research, and evaluation Challenges Chronic disease are the leading causes of death and disability Robust surveillance systems don’t exist Individual and environmental variables are critical Solutions Creating registries of food and tobacco retailers Conducting geospatial analyses of retailers, built environment Collecting primary data on tobacco/food/beverage ads, bike racks, food purchases Analyzing secondary data on food purchases, public health and health care service use Augmenting health behavior surveys Modeling policy impacts

3. Registries and geospatial analysis – healthy food retailers

4. ~61,000 fewer Philadelphians living in low-income neighborhoods with limited access to healthy foods Registries and geospatial analysis – healthy food retailers

5. There was a strong relationship between WIC/SNAP status and indoor and outdoor advertising for tobacco and sugary beverages. Primary data – advertising at WIC/SNAP stores Philadelphia Department of Public Health, Penn Design, 2012.

6. Primary data – bike racks via smartphone app Philadelphia Department of Public Health; Mayor’s Office of Transportation and Utilities. ESRI data collector tool Inventory Center City bike racks and assess their condition and use Identify areas of further need Identify and dispose of abandoned bikes 4 interns collected 2,084 points in summer 2013

7. Primary data – food purchase in restaurants – menu labeling evaluation Customers in unlabeled restaurants (n=321) Customers in labeled restaurants (n=327) Adjusted difference* P-value Calories in food purchased 1,691 kcal1,556 kcal-151 kcal (-270.0, -32.6) 0.013 Sodium in food purchased 3,315 mg3,111 mg-224 mg (-457.0, 8.0) 0.059 Saturated fat in food purchased 36.5 g33.5 g-3.7 g (-7.4,-0.1) 0.047 Carbohydrates in food purchased 131 g115 g-14.7 g (-25.8,-3.6) 0.010 Auchincloss A et al. Customer responses to mandatory menu labeling at full-service restaurants. American Journal Preventive Medicine. 2013 Dec;45(6):710-9. *Adjusted for age, race/ethnicity, income, education, day of the week, frequency of dining out, and body size

8. Secondary data – vending sales City of Philadelphia Over 220 vending machines with healthier mix, smaller sizes, calorie labeling, and healthy marketing, affecting 25,000 employees Nearly 100 machines with healthier snacks Philadelphia Department of Public Health, Vending sales data.

9. Secondary data – height and weight collected in schools Robbins et al, Preventing Chronic Disease, 2012 Accompanying editorial from RWJF, “Philadelphia Freedom” 5% decrease 8% decrease 7% decrease

10. Secondary data – calls to PA Free Quitline Start of state NRT giveaway Start of City secondhand smoke media campaign PA Department of Health, PA Free Quitline. Analysis by Philadelphia Department of Public Health.

11. Secondary data – hospital discharges PA Health Care Cost Containment Council. Analysis by Philadelphia Department of Public Health, Office of Health Information and Improvement.

12. Augmenting health behavior surveys – SSB consumption in Philadelphia CDC, Youth Risk Behavior Surveillance Survey; PHMC, Southeastern PA Household Health Survey. 20% reduction5% reduction

13. Modeling – impact of $2/pack cigarette tax Adapted from Stehr M. The Effect of Tobacco Control Policies and a City Wide $2 per Pack Cigarette Tax on Smoking, Health Care Costs, and Productivity in Philadelphia. LeBow College of Business, Drexel University, March 2012. Over 5 years, a $2/pack local tax would result in an additional… 8,000 fewer adult smokers $15 million in annual health care savings $9 million in annual productivity gains Smoking prevalence, 2010 Smoking prevalence, 2015 Annual health care savings, 2015 Annual productivity gains, 2015 Existing tobacco control efforts 25.2%22.0%$33.2 million$19.1 million Existing efforts + $2/pack tax 25.2%21.3%$48.1 million$28.1 million

14. Thank you! www.phila.gov/health www.phila.gov/gethealthyphilly www.smokefreephilly.org www.foodfitphilly.org www.phila.gov/health www.phila.gov/gethealthyphilly www.smokefreephilly.org www.foodfitphilly.org