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Jennifer L. Harris, PhD, MBA Kathryn E. Henderson, PhD Roberta R. Friedman, ScM
Case studies in strategic science to inform public policy
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Agenda
• Defining “strategic science” • Marketing sugary cereals to
children • State competitive foods law • Sugar-sweetened beverages tax
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Strategic Science
Definition: • Science designed to inform and
affect social and policy change
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1. Identify Change Agents
• Legislators: Local, state, federal • Regulators (e.g., FTC, FCC) • Industry: Food, media • Advocates • Public health community • Schools • Attorneys general • Press and other media • General public: Consumers, parents,
constituents
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2. Develop Strategic Questions
Research Key change agents
What piece of science would inform and/or help implement effective public policy?
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3. Conduct the Science
• Timely • Applied vs. programmatic • Academic standards • Understandable to non-scientists
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4. Communication
Research Key change agents
Disseminate research findings • Customized for key audiences Solicit new research ideas
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Keys to Success
• Multi-disciplinary approach • Outside the “Ivory Tower” • Consider counter-arguments and
barriers to change • Speak language of change agents • Foster two-way communication
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Case Study 1
Reducing marketing of sugary cereals to children
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Key Change Agents
Rudd Center research and
communications
Regulators, Legislators
Food Industry
Reduce unhealthy food marketing to children
Awareness Outrage Advocacy (extent and impact)
Parents, Media,
Advocates
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Why Cereals?
• Most marketing to children • Disproportionately target children
with worst products (JADA, 2008)
• Self-regulatory pledges by General Mills, Kellogg and Post
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Increase Awareness
Comprehensive evaluation: • Nutrition quality of
child-targeted vs. other products
• Quantity and quality of marketing to children
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Barrier to Change?
• “Food does not become nutrition until it is eaten.”
• “Children like the taste of ready-to-eat cereals and are therefore more likely to eat breakfast.”
Celeste Clarke, PhD, Kellogg Company Susan J. Crockett, PhD, RD, General Mills - JADA, 2008
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Children Will Eat Low-Sugar Cereals
Pediatrics, 2011
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Evaluate Marketing Impact
• Playing unhealthy advergames increases unhealthy snack consumption (Journal of Children and Media, 2011)
• Nutrition-related claims on children’s cereals lead parents to infer they are healthier (Public Health Nutrition, 2011)
• Advertising to children increases sales 13X (Public Health Nutrition, 2011)
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Communications Campaign
Results were “news” • Time, ABC News, USA Today, AP, LA
Times, Chicago Tribune, Fox, NBC, CBS • >400 press mentions in national and
local TV, radio, print, blogs
Website for parents • >68,000 visits
Policymaker outreach
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Industry Response
• General Mills PR campaign “benefits of cereal”
• General Mills and Post announced reduced sugar in children’s cereals
• PepsiCo discontinued Cap’n Crunch website
• General Mills, Kellogg and Post agreed to meet
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Three Years Later…
• Two most-visited advergame websites were discontinued
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Nutrition Quality
• Improved for 13 of 16 child brands
37 40 42
0
10
20
30
40
50
60
70
Child brands
Ove
rall
nutr
ition
qu
ality
(0-1
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2006 Nutrition 2009 Nutrition 2012 Nutrition
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Reduced TV Ads to Children
1.8 per day
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More Than Other Categories
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Bottom-Line
Cereal marketing to children still has a long way to go • Cereal remains the most-advertised
packaged food/beverage to children • Companies continue to advertise their
worst products to children • Marketing techniques and target
audiences expanding
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Child-Targeted Cereals: 2012
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Case Study 2
Advocating for and Evaluating a State Competitive Foods Law
Kathryn Henderson
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CT Healthy Food Certification
• Standards for competitive foods
• Monetary incentive tied to meal participation (10 cents per meal)
• Limits fat, saturated fat, trans fats, sugar, sodium, portion sizes, calories
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Back to the Beginning…
• 2004 law • Healthy foods required when
unhealthy foods are available
• 2004 legislative effort • Bill introduced: nutrition standards
for all foods sold in schools • Defeated
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Where’s the evidence…
• 2003 - 2005: USDA Team Nutrition Grant • CT State Department of Education
and Rudd Center partnership • 8th grade students in 6 schools (3
intervention, 3 comparison) • Intervention: remove all unhealthy
snacks and beverages
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Key Questions
• Will children buy the healthy foods?
• Can schools stay afloat financially?
• Will children compensate by eating more unhealthy foods out of school?
• Will the restrictions increase body dissatisfaction or disordered eating behaviors?
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Results
• Children purchased healthy snacks
• Food services were financially solvent
• No compensation in home snacking
• No increased dieting behaviors or body dissatisfaction
Schwartz, Novak & Fiore, Health Education and Behavior, 2009
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Passing A Law
• 2005: Senate President Donald Williams introduces bill • Mandatory competitive food
standards • Beverage restrictions • Research data presented at press
conference • Bill passes House, Senate
• Governor vetoes bill
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Passing A Law: Take 2
• 2006: Sen. Williams reintroduces bill
• Voluntary, incentivized standards • Beverage restrictions (no diet) • Presentation of research data for
School Nutrition Association • Success!
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Post-Mortem
• Pros/Cons of voluntary and incentive program • More palatable to schools • Lower overall impact • Vulnerable to budget
• Pros/cons of coupling with beverage standards • Drew greater lobbying fire • Appeased food service directors
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Evaluating Healthy Food Certification
• Necessary due to budget vulnerabilities
• First formal evaluation after first year of program
• 50% participation rate • State standards vs school wellness
policies: the test of “local control”
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Unhealthy a la carte snacks: Elementary School
Long MW, Henderson KE, Schwartz MB, Journal of School Health, 2010
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Unhealthy a la carte snacks: Middle School
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Unhealthy a la carte snacks: High School
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HFC Evaluation Update
• 6 years out
• Increased district participation – Now at 74%
• Near 100% recertification
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Financial and Dietary Impact
• Increase in middle and high school lunch participation
• Participation resulted in $30,000 in new revenue for an average district in the 2011-2012 school year
Long, Luedicke, Dorsey, Fiore, & Henderson, American Journal of Public Health, 2013
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Next Steps
• Incentive necessitates continued justification
• USDA competitive food standards coming... • Redundant program or opportunity
to raise the bar?
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Case Study 3
Using strategic science to advocate for sugar-sweetened
beverage taxes
Roberta Friedman
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Why target SSBs?
• Consumption rising • Clear assoc. w. chronic disease • Source of added sugar • Heavily marketed, esp. to kids • Gratuitous caffeine addition
• How best to reduce consumption?
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Who are the change agents?
• State and local legislators • Public health advocates/coalitions • Local/state public health departments • The public
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What are the barriers? Who is the opposition?
• Barriers – Taxes unpopular (esp. in
recession) – Conservative (anti-tax)
legislatures/governors – Industry money
• Opposition – Industry and front groups
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The Idea
• Model: tobacco taxes to reduce consumption – Will it work for SSBs?
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Set the Stage: Commentary
AJPH, 2000
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Set the Stage: Commentary
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Strategic questions
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AJPH, 2010
Are SSBs price-elastic?
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NEJM, Oct 2009
What Size Tax? Type?
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June, 2011
How much are we drinking? Would tax reduce caloric intake?
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What to do with revenue?
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Revenue generation? How to interest legislators?
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Communications
Legislators, Advocates
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TA for Legislators/Advocates
• ChangeLab Solutions:
• Help w. responses to industry
messaging • Resources on website
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TA
• Fact sheets for state advocates – Consumption – Revenues etc.
• Testimony • Webinars for advocates
– Science – Taxes in lay terms – Effect of penny per-ounce
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Legislation 2011
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Legislation 2012
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Legislation 2013
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Evaluation?
• No legislation passed *yet* • All bills need evaluation component
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Thank You!
We would also like to thank our research colleagues, partners, and funders: • The Robert Wood Johnson Foundation • The Rudd Foundation • USDA • CT State Department of Education