Background and Purpose
in accordance with Social Ecological Theory, health and physical activity initiatives have been offered at the intrapersonal, interpersonal, environmental, and policy levels. Evidence across multiple populations indicates that environmental and policy changes are likely to have broad, population-level reach impact on physical activity, yet few researchers have engaged stakeholders from multiple disciplines (e.g., economic development, government administration, planning) in assessing the feasibility and acceptability (“winnability”) of obesity policy change strategies. in a previous study, researchers conducted in-depth interviews with county managers, planners, school nurses, city council members, and other local stakeholders to assess the winnability of the Common Community Measures for Obesity Prevention (COCOMO) policy and environmental change strategies recommended by the CDC. Policies to improve physical activity opportunities were deemed the most winnable, whereas policies to limit advertisement of unhealthy food were deemed the least winnable. Findings from this previous study were limited to only two counties in Eastern North Carolina. Therefore, the purpose of this research is to broaden the scope of the previous study to assess the winnability of CDC’s COCOMO recommended strategies among six stakeholder groups in all 100 NC counties.
Objectives
1. To develop and administer a survey using CDC’s COCOMO recommended strategies among six stakeholder groups in all 100 NC Counties. 2. To determine the most winnable and least winnable of COCOMO recommended strategies among all stakeholders. 3. To determine if perceptions of the winnability of each strategy varies between stakeholder groups or stakeholders from various “economic well-being” tiers in the state.
Methods
After conducting an online search to locate the names and email addresses of the stakeholders from each county, an online survey was sent to representatives from stakeholder groups in 100 NC counties (n= 197 out of 567; 37%): County managers (n = 19 out of 97; 20%), county planners (n = 20 out of 89; 22%), economic developers (n = 10 out of 86; 12%), child nutrition directors (n = 16 out of 86; 19%), health directors (n = 62 out of 82; 76%), and parks and recreation directors (n = 36 out of 97; 37%). When possible, the survey was routed to recipients by a listserve managed by that group’s state association (e.g., North Carolina Parks and Recreation Association). Two reminder emails sent approximately one week apart followed the original email. Upon survey completion, respondents had the option to enter their names into a drawing for one of ten $50 Amazon gift cards. Independent variables were the stakeholder’s occupation and the county tier designation of economic well-being, as assigned by the 2011 NC Department of Commerce. The 40 most distressed counties are designated as Tier 1, the next 40 as Tier 2 and the 20 least distressed as Tier 3. Dependent variables were the derived scores of the twenty four COCOMO recommended strategies based on ratings of how realistic each strategy was for their community in terms of culture, infrastructure, community leader support, and funding. Answer choices included very realistic, somewhat realistic, somewhat unrealistic and very unrealistic. Responses to the four components were summed to determine lowest and highest scoring strategies. Lastly, summed winnability scores were analyzed using SPSS to allow for comparison between stakeholder groups and region.
Results
Among all stakeholders, the most winnable COCOMO strategies, beginning with the most winnable, were: 1) require PE in schools; 2) increase the amount of physical activity in PE; and 3) improve access to outdoor recreation facilities. The least winnable strategies, beginning with the lowest rated strategy, were: 1) limit advertisements of unhealthy food and beverages (F&B); 2) provide incentives to food retailers to locate and/or offer healthier F&B choices in underserved areas; 3) discourage sugar-sweetened beverage consumption. Among Tier 1 stakeholders, the most winnable strategies were the same as for respondents in general, Tier 3 stakeholders rated improving access to outdoor recreation facilities over increasing the amount of physical activity in PE. Tier 3 respondents also differed from respondents in general in that they rated discouraging sugar-sweetened beverage consumption as less winnable than providing incentives to food retailers. Tier 1 respondents, on the other hand, had quite different opinions of which strategies were the least winnable: 1) locate schools within walking distance of residents; 2) provide incentives to food retailers; and 3) improve supermarket availability in underserved areas. ANOVA results comparing winnability scores between tiers and stakeholder groups are not included due to space restrictions. Significant differences were revealed in several instances, particularly between stakeholders from Tier 1 and Tier 3 counties.
Conclusions
In support of previous qualitative research by the same authors, strategies involving increasing opportunities for physical activity were deemed most winnable, whereas strategies to improve access to healthy F&B and to reduce access or interest in unhealthy F&B were scored least winnable. Results can inform future obesity prevention policy strategy development and to identify lower-income counties that are “ripe for change”.
Support / Funding Source
This publication was supported in part by Communities Putting Prevention to Work (Grantee Number 1U58DP003053-01), from the Centers for Disease Control and Prevention (CDC).
