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

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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

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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

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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.