People often feel powerless when it comes to making their schools, workplaces, and communities healthier. When faced with a daily barrage of tobacco advertising or overexposure to processed, high-fat foods, children and adults often make poor choices that they might otherwise avoid.
New research by Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program alumna (2005-2007) Carolyn Cannuscio, ScD, shows that community residents can contribute to efforts to improve their surroundings. Her study participants also revealed that they were acutely aware of, and concerned about, the impact an unhealthy environment might have on their well-being.
“We conducted a photo-elicitation survey to learn what Philadelphia residents saw as contributing to poor health in their community. We asked adolescents and adults to photograph the food and tobacco environments they encountered regularly,” Cannuscio explains. “They chose to shoot advertising, school lunches, and even the junk food that was closest to their desks, but they were far less likely to photograph tobacco or people smoking.”
Improving an Unhealthy Urban Landscape
In 2010 the Philadelphia Department of Public Health created Get Healthy Philly, a campaign to improve access to nutritious food and participation in physical activities, while reducing the use of tobacco in and around the city. At that time, 25 percent of Philadelphia’s adults smoked and 66 percent were overweight or obese.
The photo-elicitation survey was designed to be a subjective evaluation of residents’ perspectives on food- and tobacco-related health threats in their environment three years later. “Study participants identified multiple negative influences on their nutrition choices. That was a huge issue for us because we have invested so much in increasing access to better foods in many Philadelphia neighborhoods,” Cannuscio says.
The study results were published in the article “Community-Generated Recommendations Regarding Urban Nutrition and Tobacco Environments: A Photo-Elicitation Study in Philadelphia” published in the Journal of Prevention of Chronic Disease in June 2013.
“People thought that food marketing had a great impact on their eating habits, but they seemed to see tobacco use as a problem related to willpower,” Cannuscio reports. “They were less likely to comment on cigarette advertising as having an influence on their behavior. They saw smoking as more of an individual choice.”
When given an opportunity to propose interventions to make their environment healthier, study participants offered ways to improve poor nutrition options four times more often than ways to limit exposure to tobacco. Study group members said they were well aware of the importance of physical activity and healthy eating, but they made fewer comments about tobacco as a public health concern.
The schoolchildren who participated in the study were also quite vocal about demanding better food choices. “The teens were disgusted by the poor quality of food that was offered to them in school lunches, especially if they participated in free lunch or breakfast programs. They said the food did not fill them up or make them feel good during the school day. They wanted their schools to show more respect for their health needs,” Cannuscio says.
Placing a New Emphasis on Tobacco Use
“As public health professionals, we found the results related to tobacco quite a concern,” Cannuscio says. Many study participants talked about how easy it was to get tobacco in the city, whether it was a pack of cigarettes or cigarettes sold individually as low-cost “loosies”—a practice that makes cigarettes cheaper for teens and others on tight budgets. Tobacco advertising was also a problem. “It is often omnipresent and close to the ground where it is easily seen by children,” Cannuscio adds.
“The public health community is complicit in tobacco being a back burner issue right now. We publish a great deal of research on food, but far less on smoking. We need to make an effort to bring this issue out front again,” Cannuscio advises. “Our team has been motivated to talk about extending smoking bans into new environments, like university campuses.”
Overall, Cannuscio thinks the study findings are a signal to think about ways to change the cultural cues related to eating. “Food is an important social connector. I think we need to look at how to use food to build healthy bodies and bring people together to create healthy communities. It is also time to put tobacco back on the public health agenda.”