Charting the Advocacy Landscape: A Qualitative Content Analysis of Syllabi in Public Health Graduate Education.

CONTEXT: Addressing public health challenges necessitates policy approaches, but concerns persist about public health graduates' preparedness to advocate. OBJECTIVE: This qualitative study sought to assess advocacy content and skills taught to Master of Public Health students enrolled in US accredited schools and programs of public health (SPPHs) by analyzing 98 course syllabi submitted to the Council on Education for Public Health (CEPH) between 2019 and 2021. Syllabi were submitted by SPPHs during their (re)accreditation process to demonstrate compliance with CEPH's advocacy competency requirement. DESIGN: Qualitative content analysis study. Syllabi were analyzed using MAXQDA Qualitative Data Analysis Software using a 2-coder approach. SETTING: SPPHs accredited by CEPH. PARTICIPANTS: Ninety-eight syllabi submitted to CEPH by 22 schools of public health and 54 programs of public health. MAIN OUTCOME MEASURES: Exemplary language from advocacy courses and assignments and aggregate frequency of syllabi advocacy content and skills. RESULTS: Most advocacy courses (61%) were survey, health policy, or health care delivery courses, covering policy (66%), policy communication (46%), coalition-building (45%), lobbying (36%), community organizing (33%), and media advocacy (24%) skills. Only 7% prioritized advocacy skill instruction, and 10% addressed how to advocate in an equitable way. CONCLUSIONS: Defining public health advocacy and essential skills is crucial. Issuing competency guidelines, supporting advocacy faculty, offering standardized training, and expanding experiential learning are important first steps. More research is needed on how academic institutions are incorporating equity skill training into courses, whether separate from or combined with advocacy skills.

Retail Soda Purchases Decrease and Water Purchases Increase: 6-Year Results From a Community-Based Beverage Campaign.

Introduction: This study aimed to document the long-term impacts on beverage sales of a 6-year intervention campaign to reduce consumption of sugar-sweetened beverages. Methods: In 2013, a multicomponent intervention campaign designed to reduce the intake of sugary drinks was launched in Howard County, Maryland. A difference-in-differences regression approach was used to compare data on Howard County supermarket beverage sales (in ounces) from 2013 to 2018 with a set of control supermarkets. Outcome variables were average weekly sales by store of top brands of sugar-sweetened beverages (regular soda, sports drinks, fruit drinks) as well as diet soda and 100% juice. Trends in the sales of water products from 2016 to 2018 were estimated separately using a linear regression model. Results: In Howard County, the sales of regular soda, fruit drinks, and 100% juice decreased significantly more than predicted each year. These changes correspond to a 29.7% decrease in sales for regular soda, a 7.5% decrease for fruit drinks, and a 33.5% drop for 100% juice between 2012 and 2018 in Howard County stores. There was a significant trend such that the net reduction in regular soda sales in Howard County stores became larger over time. The amount of plain water sold in Howard County increased significantly from 2016 to 2018. Conclusions: Multicomponent efforts by local government, nonprofit organizations, and other community-based organizations are needed to decrease sugar-sweetened beverage consumption at the population level. Substantial and sustained improvements in retail beverage sales can be achieved through coordinated messaging, community organizing, and targeted advocacy for policy changes.

Race, Ethnicity, and Neighborhood Food Environment Are Associated with Adolescent Sugary Drink Consumption During a 5-Year Community Campaign.

BACKGROUND: A multi-level county-wide campaign to reduce sugary drink consumption was associated with significant decreases in retail sales of soda and fruit drinks. The aim of the current study was to examine changes in adolescent beverage consumption during the campaign by race/ethnicity and neighborhood food environment. METHODS: Beverage consumption among adolescents was evaluated at four time points in a repeated cross-sectional survey of a racially and ethnically diverse sample of sixth graders (N = 13,129) from public middle schools in the county. Each school's surrounding attendance zone (i.e., neighborhoods where students live) was characterized as providing high or low exposure to unhealthy food retail (e.g., convenience stores, fast-food restaurants). Logistic and multiple linear regression models were used to evaluate changes in beverage consumption over time by student race/ethnicity and high versus low unhealthy food exposure. RESULTS: Over the 5 years, there were significant declines in the overall share of students who reported daily sugary drink consumption (49.4 to 36.9%) and their reported daily calories from these products (220 to 158 calories). However, disparities were observed, with higher levels of consumption among Black and Hispanic youth and among youth living in neighborhoods with more unhealthy food retail. Notably, Black students living in healthier neighborhood food environments reported significant decreases in daily consumption and calories after 5 years, while Black students living in neighborhoods with more convenience stores and fast-food outlets did not. CONCLUSION: These findings suggest that both race/ethnicity and neighborhood food environments are important considerations when designing interventions to reduce sugary drink consumption among adolescents.

Association of a Community Campaign for Better Beverage Choices With Beverage Purchases From Supermarkets.

Importance: Data are needed to evaluate community interventions to reduce consumption of sugary drinks. Supermarket sales data can be used for this purpose. Objective: To compare beverage sales in Howard County, Maryland (HC), with sales in comparison stores in a contiguous state before and during a 3-year campaign to reduce consumption of sugary beverages. Design, Setting, and Partipicants: This observational experiment with a control group included 15 HC supermarkets and 17 comparison supermarkets. Weekly beverage sales data at baseline (January 1 to December 31, 2012) and from campaign years 1 to 3 (January 1, 2013, through December 31, 2015) were analyzed. A difference-in-differences (DID) regression compared the volume sales per product per week in the HC and comparison stores, controlling for mean product price, competitor's product price, product size, weekly local temperature, and manufacturer. Exposures: The campaign message was to reduce consumption of all sugary drinks. Television advertising, digital marketing, direct mail, outdoor advertising, social media, and earned media during the 3-year period created 17 million impressions. Community partners successfully advocated for public policies to encourage healthy beverage consumption in schools, child care, health care, and government settings. Main Outcomes and Measures: Sales were tracked of sugary drinks highlighted in the campaign, including regular soda, sports drinks, and fruit drinks. Sales of diet soda and 100% juice were also tracked. Sales data are expressed as mean fluid ounces sold per product, per store, per week. Results: Regular soda sales in the 15 HC supermarkets decreased (-19.7%) from 2012 through 2015, whereas sales remained stable (0.8%) in the 17 comparison supermarkets (DID adjusted mean, -369 fl oz; 95% CI, -469 to -269 fl oz; P < .01). Fruit drink sales decreased (-15.3%) in HC stores and remained stable (-0.6%) in comparison stores (DID adjusted mean, -342 fl oz; 95% CI, -466 to -220 fl oz; P < .001). Sales of 100% juice decreased more in HC (-15.0%) than comparison (-2.1%) stores (DID mean, -576 fl oz; 95% CI, -776 to -375 fl oz; P < .001). Sales of sports drinks (-86.3 fl oz; 95% CI, -343.6 to 170.9 fl oz) and diet soda (-17.8 in HC stores vs -11.3 in comparison stores; DID adjusted mean, -78.9 fl oz; 95% CI, -182.1 to 24.4 fl oz) decreased in both communities, but the decreases were not significantly different between groups. Conclusions and Relevance: A locally designed, multicomponent campaign to reduce consumption of sugary drinks was associated with an accelerated decrease in sales of regular soda, fruit drinks, and 100% juice. This policy-focused campaign provides a road map for other communities to reduce consumption of sugary drinks.