Review of Education-Focused Health Impact Assessments Conducted in the United States.

BACKGROUND: Health impact assessment (HIA) provides a structured process for examining the potential health impacts of proposed policies, plans, programs, and projects. This study systematically reviewed HIAs conducted in the United States on prekindergarten, primary, and secondary education-focused decisions. METHODS: Relevant HIA reports were identified from web sources in late 2015. Key data elements were abstracted from each report. Four case studies were selected to highlight diversity of topics, methods, and impacts of the assessment process. RESULTS: Twenty HIAs completed in 2003-2015 from 8 states on issues related to prekindergarten through secondary education were identified. The types of decisions examined included school structure and funding, transportation to and from school, physical modifications to school facilities, in-school physical activity and nutrition, and school discipline and climate. Assessments employed a range of methods to characterize the nature, magnitude, and severity of potential health impacts. Assessments fostered stakeholder engagement and provided health-promoting recommendations, some of which were subsequently incorporated into school policies. CONCLUSIONS: Health impact assessment is a promising tool that education, health, and other stakeholders can use to maximize the health and well-being of students, families, and communities.

Use of research evidence in state policymaking for childhood obesity prevention in Minnesota.

OBJECTIVES: We describe how scientific evidence about obesity has been used in Minnesota legislative materials to understand how research evidence might more effectively be translated into policymaking. METHODS: We selected 13 obesity-related bills introduced from 2007 to 2011 in Minnesota. Using state archives, we collected all legislative committee meeting materials and floor testimony related to each bill. We used a coding instrument to systematically analyze the content of a sample of 109 materials for their use of research evidence and non-research-based information. RESULTS: Research evidence was mentioned in 41% of all legislative materials. Evidence was often used to describe the prevalence or consequences of obesity or policy impacts but not to describe health disparities. In 45% of materials that cited evidence, no source of evidence was indicated. By contrast, 92% of materials presented non-research-based information, such as expert beliefs, constituent opinion, political principles, and anecdotes. CONCLUSIONS: Despite an abundance of available research evidence on obesity, less than half of legislative materials cited any such evidence in discussions around obesity-related bills under consideration in Minnesota.

Uses of research evidence in the state legislative process to promote active environments in Minnesota.

PURPOSE: To describe how research evidence and non-research-based information are used in testimony and other legislative documents used in arguments for and against physical activity-related bills in Minnesota. DESIGN: Content analysis. SETTING: Documents and oral testimony archived by the Minnesota State Legislature from 2007 to 2011. SUBJECTS: Not applicable. MEASURES: A coding instrument was developed to measure descriptive features of materials (e.g., length, document type) and the presence or absence of certain types of research evidence and non-research-based information. ANALYSIS: Frequencies of variables and measures of associations using Pearson χ (2) tests. RESULTS: Over a third (36%) of the sample contained research evidence, and 88% of the sample contained non-research-based information. Compared to materials related to physical activity, materials related to built environment were significantly less likely to reference research evidence. CONCLUSION: Despite an abundance of evidence, research evidence was present in only about one-third of the sample. There may be opportunities during legislative discussions on the built environment for obesity-related data to help make the case for sound policies.

The land of 10,000 tobacco products: how Minnesota led the way in regulating tobacco products.

As state and local governments increase restrictions on cigarette smoking, tobacco manufacturers have shifted to marketing alternative tobacco products. Tobacco control laws need to be updated to reflect this shifting marketplace. With the 2010 enactment of the Tobacco Modernization and Compliance Act, Minnesota addressed regulatory gaps and created a model law for other states. We have detailed the updated definitions of tobacco and tobacco products and identified ways that future laws could be strengthened.

Influencing Taft-Hartley Funds to provide tobacco cessation benefits.

BACKGROUND: Taft-Hartley Health and Welfare Funds ("funds") administer health insurance plans that cover approximately nine million U.S. adults. Unionized workers covered by funds work primarily in blue- and pink-collar occupations and smoke at a rate almost twice that of workers in other occupations. Most funds do not provide comprehensive coverage for tobacco cessation treatment for fund participants (workers, family members, and retirees). PURPOSE: This study tested a pilot intervention to increase the provision and promotion of cessation benefits among Minnesota-based funds by educating the funds' advisors. METHODS: Tailored educational outreach was conducted to advisors (administrators, consultants, attorneys) of 10 Minnesota-based funds (2009-2011). Pre- and post-intervention advisor interviews measured perceptions/knowledge/attitudes about tobacco use, cessation, coverage, and promotion of benefits. Pre- and post-intervention data on benefit provision were collected from Summary Plan Descriptions (SPDs) and Summary Material Modifications (SMMs) of 10 Minnesota-based funds and 19 comparison funds in Massachusetts and Washington, and compared in 2011. SPDs/SMMs were scored on benefit adequacy, comparing services covered and the extent to which they met DHHS recommendations. RESULTS: Minnesota-based funds provided significantly higher coverage (except for copays and pre-conditions) pre-intervention. However, there were no significant differences between Minnesota and comparison funds in rate of improvement in benefits over time. At follow-up, advisors reported a significant increase in confidence in their knowledge to address smoking issues in funds. Advisors also reported sharing intervention information with fund trustees. CONCLUSIONS: Educational strategies to influence advisors who provide guidance to fund trustees may help to increase advisors' confidence to address cessation benefit improvement.

An evaluation of health benefit modification in Taft-Hartley health and welfare funds: implications for encouraging tobacco-cessation coverage.

BACKGROUND: An estimated one fifth of all U.S. adult smokers receive health benefits through insurance plans administered by Taft-Hartley Health and Welfare Funds. Most funds do not offer comprehensive tobacco-cessation services to fund participants despite evidence that doing so would be cost effective and save lives. PURPOSE: This paper examines the decision-making processes of Minnesota-based fund trustees and advisors to identify factors that influence decisions about modifications to benefits. METHODS: Formative data about the process by which funds make health benefit modifications were collected in 2007-2008 from 25 in-depth key informant interviews with fund trustees and a cross-section of fund advisors, including administrators, attorneys, and healthcare business consultants. Analyses were performed using a general inductive approach to identify conceptual themes, employing qualitative data analysis software. RESULTS: The most commonly cited factors influencing trustees' decisions about health plan benefit modifications-including modifications regarding tobacco-cessation benefits-were benefit costs, participants' demand for services, and safeguarding participants' health. Barriers included information gaps, concerns about participants' response, and difficulty projecting benefit utilization and success. Advisors wielded considerable influence in decision-making processes. CONCLUSIONS: Trustees relied on a small pool of business, legal, and administrative advisors to provide guidance and recommendations about possible health plan benefit modifications. Providing advisors with evidence-based information and resources about benefit design, cost/return-on-investment (ROI), effectiveness, and promotion may be an effective means to influence funds to provide comprehensive tobacco-cessation benefits.

The role of labor organizations in tobacco control: what do unionized workers think?

PURPOSE: Examine unionized workers' knowledge and attitudes about workplace tobacco use, their exposure to secondhand smoke, and the role of labor unions in addressing smoking and cessation coverage policies. DESIGN: Random-digit dial telephone survey. SUBJECTS: Unionized workers in Minnesota (N = 508). MEASURES: Knowledge and attitudes about workplace tobacco use and tobacco control policy making. ANALYSIS: Multiple logistic regression. RESULTS: The majority of respondents viewed secondhand smoke exposure as an important workplace health and safety issue, a health risk to nonsmokers, and a driver of increased health care costs, but smokers were less likely than nonsmokers to agree. Only 7% of respondents supported their unions taking the lead in tobacco control policy making. A large majority of those surveyed rated smoking cessation programs as an important benefit for which their labor unions could bargain; however, smokers and those whose workplaces allowed smoking were less likely than their counterparts to agree. CONCLUSIONS: Most unionized workers were aware of the health effects of exposure to secondhand smoke and supported union bargaining for restrictions on workplace smoking and cessation programs, although few workers supported their unions taking the lead in initiating worksite smoking policies. Results suggest that campaigns to promote smoke-free worksites should be tailored to unionized workers, and further collaborations with labor unions to promote policy change are needed.