CVHP Institute: FRIDAY, Sept 27, 2002

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DIVING Into Policy and Evaluation Change
CVHP Institute FRIDAY, Sept 27, 2002
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DIVING Into Policy and Evaluation Change!
1) Jody Stones VIRGINIA 2) Margaret Casey NEW
YORK3) Julie Harvill ILLINOIS4) Eduardo
Simoes MISSOURI5) Scott McIntosh TOBACCO
CONTROL
GET YOUR SCORE CARDS READY! HOW WOULD YOU RATE
EACH DIVE? How Relevant Is Each Concept to YOUR
State Initiatives? 0 (Not Relevant) to 6 (Very
Relevant)
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INSTRUCTIONS Virginia, New York, Illinois, and
Missouri have lessons to share about Policy and
Environmental Interventions and Changes. Tobacco
Control also has lessons to share. Each of these
states, and tobacco control, is represented by
"A Diver". Each "Diver" will step up and perform
a one-slide "dive" into the each of the following
issues 1) Baseline assessment, 2) Building
partnerships, 3) Strategic planning, 4) Funding,
5) Environmental Interventions, 6) Policy
Interventions, 7) Impact evaluation. After
each "Dive", please use your score card to rate
how relevant that lesson is (or can be) to YOUR
STATE!
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DIVING Into Policy and Evaluation Change!
GET YOUR SCORE CARDS READY! HOW WOULD YOU RATE
EACH DIVE? How Relevant Is Each Concept to YOUR
State? 0 (Not Relevant) ? 6 (Very
Relevant)
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Virginias Resource Inventory
Diver JODY 1
Community Assessments, Surveys Key Informant
Interviews Faith Assessments, Surveys Key
Informant Interviews School Assessments
Surveys Worksite Assessments Surveys VCU
Worksite, Restaurants, School Personnel Key
Informant Questionnaires Secondary Prevention
Data QIO Medicaid Data, HEDIS DATA CD Rom,
Trigon claims data, Community Health Center
Patient Data, Hospital discharge data, Stroke
Hospital Survey (AHA) AHA Richmond Northern VA
Community Data Other state agencies data VDOT,
DOE, VDACS, WIC
CVHP ENVIRONMENTAL POLICY IMPLEMENTATION GUIDE
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Diver JULIE 1
ILLINOIS
Baseline assessment - Measuring the current state
of our state. Illinois used samples from
Wisconsin and Nebraska to create a survey for
state agencies to inventory State Agencies with
Programs Related to Cardiovascular Health
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Diver MARGARET 1
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CVD Mortality Rates (1990-1998)
Diver EDUARDO 1
Missouri Baseline
Rates are per 100,000 population, age adjusted
uses1940 U.S. population as standard. Source MICA
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Diver SCOTT 1
Smoking is the most important of the known
modifiable risk factors for coronary heart
disease in the United States. (Former Surgeon
General, and Current Faculty Member,Community and
Preventive Medicine -- UNIVERSITY OF ROCHESTER)
Cardiovascular Disease DeathsAttributable to
Cigarette Smoking
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CVHP Partnership Grid
Diver JODY 2
CVHP Team Roles CVHP Team Leads
CVHP Team Timelines
Learning to be a Snake Charmer
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Diver JULIE 2
ILLINOIS
Building Partnerships - Getting others to the
table, finding how to work together. The
Illinois Cardiovascular Health Task Force has a
Transportation and Built Infrastructure committee
within the Physical Activity and Nutrition
Subcommittee. Their focus is on pedestrian and
bike purposeful travel (travel to work, school,
and shopping).
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Socio-Ecological Approach
Diver MARGARET 2
SOCIETY
Policies
Legislation
COMMUNITY
Social Norms
Trails
Rec Centers
Sidewalks
ORGANIZATIONAL
Schools
Worksites
INTERPERSONAL
Family
Friends
Social Networks
INDIVIDUAL

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Partnership Building
Diver EDUARDO 2

• Coalition building
• Participation of coalition members in communitys
  political process

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Diver SCOTT 2
Tobacco Control Partnerships Multi-systemic
Individual (physicians), Office (Health
Providers), System (HMOs), Community
(Municipalities, Counties, States), Organizations
(AHA, ALA, ACS, RWJ, AAP, AAFP), National (CDC,
AHA, ALF), Global (WHO Framework Convention on
Tobacco Control). At all these levels, there has
been successful at getting others to the table
working together.
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Healthy Pathways Call to Action Plan
Diver JODY 3
Shifting Paradigms to include Environmental
Policy with traditional CVD Risk
Reduction Presenting the Data to the Coalition
Members Training Coalition Members on Strategic
Planning Process Collecting Strategies from
Committees Kicking off the Call to Action Plan
Population Based and Priority Population
Strategies
Environmental Policy Changes
Individual Counseling
Community Based Projects
Preventive Health Promotion Strategies
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Walking Strategies
Diver MARGARET 3
Process
Short termoutcomes
IntermediateOutcomes
Long Term Outcomes
WOCS
Slide Show
StatePolicies
Citizens Influential
PedestrianConference
Increase Walking
Walkable Communities (Opportunity)
Decision Makers
HHP Coalitions
CommunicationCampaign
TrainedProfessionals
NormalizeWalking (Attitudes)
Awareness Campaign
MFL!
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Strategic Planning
Diver EDUARDO 3

• Establish baseline values for aggregate level
  health outcomes
• Estimate five year percent change in aggregate
  health outcome measures
• Surveillance based outcomes
• heart disease, ischemic heart disease and stroke
  mortality

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Diver SCOTT 3
Strategic Planning Examples Physician Education
on Guidelines, Intervention (not just prevention)
with Teens, Raise Taxes (from grassroots to
lobbying).
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Other Funding Sources
Diver JODY 4
Key Partners Collaborating with other federal
grants Pharmaceutical companies educational
grants Pursuing other grants Business Creating
Resources from Community Spirit Volunteers
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Diver JULIE 4
ILLINOIS
Funding? How and where to get resources?
Congestion Mitigation and Air Quality
Improvement Program (CMAQ) Departments of
Transportation - Bicycle Pedestrian Council
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NY will not compete in the funding category
Diver MARGARET 4
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Funding
Diver EDUARDO 4

• NGOs and private sector involved in creating
  environmental infrastructure
• Increased availability of environmental
  infrastructure and policies conducive to LPTA and
  healthy eating

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Diver SCOTT 4
FUNDING FOR TOBACCO CONTROL

• Medicare (Patches)
• Legislation (Taxes)
• Master Settlement
• Government (CDC)
• Research (NHLBI)
• Fund Raising (AHA)
• OTHER EXAMPLES

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Environmental Interventions
Diver JODY 5
Community Gardens Outdoor facilities
Increase Seniors Farmers Markets Media Campaign
with VDACS Patient education for blood pressure,
diabetes cholesterol Bicycle Safety Courses
Walk Safely to School Vending Machines in Schools
and Worksites Richmond Metro Bike Ped Plan
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Diver MARGARET 5
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Environmental Issues
Diver EDUARDO 5

• Prevalence of perceived environmental factors
• Prevalence of individual behaviors

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Diver SCOTT 5
Environmental Interventions

• Anti-Smoking Commercials
• Indoor Air Acts
• Vending Machine Bans
• Retailer Sting Operations
• Internet Environ-ment (Interven-tions and
  Support)
• CHANGING SOCIETAL NORMS

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Policy Changes
Diver JODY 6
School Lunches and A La Carte Lines Safety
Management System Executive Committee Joined the
Mid-Atlantic Strategic Planning Group for
AHA Language for the VDOT Bicycle Plan and the
VDCR Outdoor Plan Health Departments doing E P
Interventions Fatherhood network used for
CVH Local Diabetes Projects include E P
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Steps to Promote Heart Health
Diver MARGARET 6
Policies
Environmental Changes
Special Promotions
Programs/Classes
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Policy Interventions Assessed
Diver EDUARDO 6

• Policies
• LPTA in workplace
• Flex time for LPTA
• Fiscal incentive for heart healthy eating
• Use of open spaces
• Use of mixed space

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Diver SCOTT 6
Tobacco Control Policy Intervention Examples
Warning Labels Bans on advertising Workplace
bans, Youth Access Restrictions Spend Settlement
Dollars on TOBACCO CONTROL Trade
Restrictions Crop Substitution Address Concerns
of Decision-Makers Policy Relevant Research Fight
Smuggling, Internet Sales, Indian
Reservations 10 Price Increase Reduces Demand
by 4 (Young and Poor MOST Responsive)
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Environmental and Policy Interventions and
Changes Log System
Diver JODY 7
ACCESS Data Base Training of Projects Lap
Top Electronically Filed with us Reports are Easy
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EVALUATION vs. MONITORING
Diver MARGARET 7

• Remember the Differences!

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Impact Evaluation
Diver EDUARDO 7
Odds Ratio of Being Overweight Worksite

• RECOMMENDATIONS In a participatory approach,
  organize and involve communities to
• 1) increase number of outdoor facilities
• 2)increase safety of public areas
• 3) increase pleasantry and
• 4) increase number of sidewalks and shoulder

Odds Ratio of Being OverweightAll
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Impact Evaluation
Diver SCOTT 7

• Whats Measured?
• Prevalence of smoking across ages, populations,
  target communities
• Quit Attempts
• Morbidity and Mortality
• Teen Access

What works?
Pharmaceuticals, Behavior Mod., Social Support,
Self Help, Health Care Provider Intervention,
Price Increases, Restricted Access, Policy
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Diving Into Environmental and Policy Change
END