Tobacco Prevention Initiative cost approximately $3 per capita and resulted in a 36 percent reduction in tobacco use among students in grades 6–12 and a 27 percent reduction in tobacco use among adults.

Texas applied these lessons learned in developing Steps to a Healthier Austin, the city’s first large-scale, funded, comprehensive chronic disease prevention program. This program targeted 460,000 high-risk, racially diverse residents within areas of Austin identified as having the highest concentrations of obesity (Figure 6-1). The intervention encompassed 20 contiguous zip code areas comprising 412 square miles, covering primarily east Austin. The racial/ethnic make-up of this area included 41 percent Hispanics, 39 percent non-Hispanic whites, and 14 percent African Americans. Compared with the rest of Travis County, twice as many people in this area were living in poverty, the median income was 60 percent lower, and the unemployment rate was 33 percent higher.

The scope of the childhood obesity problem in the intervention area was measured and established:

  • 15 percent of high school students were identified as overweight.

  • 85 percent of high school students were not meeting recommended nutrition guidelines by eating five or more servings of fruits and vegetables each day.

  • 71 percent of high school students had not been physically active for a total of 60 minutes per day for 5 or more of the past 7 days.

  • 69 percent of high school students did not attend a daily physical education class.

Additional statistics on the proportion of overweight students in Austin/Travis County according to different demographic categories are shown in Figure 6-2.

“The objectives for Steps to a Healthier Austin were comprehensive from the start,” said Huang. The program aimed to reduce adult obesity, increase daily consumption of fruits and vegetables, increase child and adult engagement in physical activity, and increase child engagement in school physical education. The program brought together partners from all sectors—schools, communities, health centers, the media, and academia—and engaged them in working toward a common vision. School activities included enhanced physical education curricula, healthy vending machine policies, increased healthy meal choices, school gardens, and safe routes to school. Community activities included summer playground programs; employee wellness programs; improvements to the built environment; healthy cooking programs; and dissemination of information on community resources, such as faith-based organizations, recreation centers, and trails.

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