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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
11-20-00
Toxic Agents6%
Toxic Agents6%
Alcohol8%
Alcohol8%
Firearms,Sexual Behavior,Motor Vehicles,
10%
Firearms,Sexual Behavior,Motor Vehicles,
10%
Diet / Activity28%
Diet / Activity28%
Microbial Agents8%
Microbial Agents8%
Tobacco Related40%
Tobacco Related40%
Actual Causes of Premature DeathActual Causes of Premature Death
Adult Smoking Prevalence by Age Hawai`i 1999
Adult Smoking Prevalence by Age Hawai`i 1999
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
18-24 25-34 35-44 45-54 55-64 65+
MalesFemales
Behavior Risk Factor Survey 1999Behavior Risk Factor Survey 1999
0.00%0.00%
5.00%5.00%
10.00%10.00%
15.00%15.00%
20.00%20.00%
25.00%25.00%
30.00%30.00%
HawaiianHawaiian JapaneseJapanese CaucasianCaucasian FilipinoFilipino ChineseChinese
TotalMalesFemales
Adult Smoking Prevalence by Ethnicity Hawai`i 1999
Adult Smoking Prevalence by Ethnicity Hawai`i 1999
Behavior Risk Factor Survey 1999Behavior Risk Factor Survey 1999
The Honolulu Advertiser – Nov. 17, 1998The Honolulu Advertiser – Nov. 17, 1998
Tobacco Settlement SpecialFund Structure
Tobacco Settlement SpecialFund Structure
How Hawaii's Tobacco Settlement Money Works
Rainy Day FundState Administration‘s
Emergency & Budget Reserve 40%
Tobacco Preventionand Control Trust Fund
25%
Department of HealthThe Healthy Hawaii Initiative
25%
Department of Health35%
Tobacco Settlement Special Fundwithin State Treasury
Administered by Department of Health
Department of Human ServicesChildren'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 2010Understanding and Improving Health
The Healthy Hawai`i InitiativeThe Healthy Hawai`i Initiative
Improved environment
Improved individual health
Healthy behavior
Improved health of population
Reduction in:
Diabetes Heart Disease Cancer Stroke
2-5years
5-10years
10-20years
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
11-20-00
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
Levels of HHI Evaluation
Distal
Immediate
Profiles/HHIC/Tumor Registry
BRFSS – Behavioral:National Control
Media Survey (Zip code)Knowledge/Attitude/Behavior
Highlight Communities/Schools,Moderators & Process Data
HHI Assessment TimelineLongitudinal and Multiple Cross-sectional Design
Base 6 mo 12 mo 18 mo 24 mo 30 mo
X1 X2 X3 X4 X5 X6
Y Y Y Y Y Y
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 2002Baseline, Spring 2002• 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
• 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 2002Baseline, Spring 2002• 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
• 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
SchoolsCoordinated School Health Program
16 funded schools Run their own intervention Tracking process data
Objectives, Activities, Progress, Barriers Facilitators, Planning
Will become internet basedWill 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
SchoolsHealth Education/Physical Education Standards
Educate at the new published standards in HE/PEIncludes training workshops, policies,
curriculum etc…
Long term impact of curriculum changes to meet HE/PE standards are “huge”
Schools: Initial Process ResultsSchools: 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 2003.
• 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 2003.
Communities
26 funded communities ($24,000 each) Run their own intervention Aid in creating action plan
Health Concerns SurveyCommunity Needs assessment for 3 health areasDisseminate best practices
Communities cont…
Aid in tracking process dataComputer basedMay 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
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
$100-150K/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
11-20-00
Public Education
6 TV spots6 radio adsMovie trailersLaunched in Jan 2002
Website
www.healthyhawaii.org
Newspaper CoverageNewspaper Coverage• 5 newspapers covering all counties were
tracked during the summers of 2001 and 2002.
• 28.3% 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 2002.
• 28.3% 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 beingimplemented
Evaluation design will allow us totrack changes and assess how wellthe initiative remains on track.