THE FIELD POLL

Release #2460

THE INDEPENDENT AND NON-PARTISAN SURVEY OF PUBLIC OPINION ESTABLISHED IN 1947 AS THE CALIFORNIA POLL BY MERVIN FIELD

Field Research Corporation

601 California Street, Suite 900 San Francisco, CA 94108-2814 (415) 392-5763 FAX: (415) 434-2541 EMAIL: fieldpoll@field.com www.field.com/fieldpollonline

Release Date: Wednesday, February 12, 2014

VOTER CONCERNS ABOUT RISK FACTORS FOR OBESITY AND DIABETES HAVE ECLIPSED OTHER HEALTH CONCERNS FACING CALIFORNIA KIDS OVER THE PAST 10 YEARS. By Mark DiCamillo and Mervin Field

IMPORTANT: Contract for this service is subject to revocation if publication or broadcast takes place before release date. (ISSN 0195-4520)

TCE Contact: Jeff Okey (213) 928-8622 (o) (323) 533-8361 (c)

When The Field Poll first began tracking public perceptions of the health risks facing the states children for The California Endowment (TCE) ten years ago, two concerns were cited more frequently than all others unhealthy eating or a lack of physical activity, mentioned by 53%, and illegal drug use (49%). However, according to the latest TCE-Field survey the proportion of Californians citing unhealthy eating or a lack of physical activity among kids top two health risks has grown over the past ten years to 59%, and now far outranks the next highest ranking concern, illegal drug use (43%) by a considerable margin. Next most frequently mentioned is the threat of violence to children cited by 31%. Other survey findings show overwhelming public support for making fresh drinking water freely available in schools, parks and public buildings, and enacting policies to increase the availability of fresh fruits and vegetables in low-income neighborhoods. Voters also think it's important for food and beverage companies to change a number of their marketing policies to help reduce obesity and diabetes. In addition, greater than six in ten think its highly important for Medi-Cal to cover exercise and other organized physical activity programs. By wide margins Californians also feel its highly important to involve local community health workers in the fight to help reduce diabetes and to cover these services under Medi-Cal. While majorities of voters across all income and racial subgroups feel this way, lower income voters and Latinos are the subgroups most likely to say this. These are the findings from part one of the latest TCE-Field Obesity and Diabetes Prevention Survey conducted among 1,002 registered voters throughout California by telephone in English and Spanish November 14-December 5, 2013.

Field Research Corporation is an Equal Opportunity Employer

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These findings are a clear indication that there is a longstanding groundswell of concern among California voters about the related epidemics of diabetes and obesity. Voters strongly support interventions that will reduce risks for these conditions, such as assess to free clean drinking water and community health workers to help people live healthier lives in healthier places, states Dr. George Flores of The California Endowment. Increase in voter concerns about obesity and diabetes risk factors as health risks to California kids over the past 10 years The Field Poll first began tracking public perceptions of the health risks facing the states children for TCE in 2003. At that time when Californians were asked to name the top two health risks facing California kids, unhealthy eating or a lack of physical activity were mentioned most frequently by 53%, followed by illegal drug use at 49%. (Note: Percentages add to more than 100% due to multiple mentions) When asked the same question in the latest TCE-Field Poll, the proportion of voters citing unhealthy eating or a lack of physical activity now far surpasses illegal drug use and all other concerns. At present, 59% mention these obesity and diabetes risk factors, while the next most frequently cited health concern, illegal drug use, is cited by 43%. The threat of violence to children is cited next most frequently by 31%. (See Graph 1 in accompanying graphics packet) When the results are examined across the states major regions, concerns about unhealthy eating or a lack of physical activity are greatest among voters in the nine-county San Francisco Bay Area and Los Angeles County. (Graph 2) Make fresh drinking water freely available in schools, parks and public buildings Nearly all Californians support the idea of making clean fresh drinking water freely available in schools in any area where students eat meals or are physically active (93%, including 82% who support this strongly). Similarly, 92% favor making fresh drinking water available in all local schools, parks and public buildings, with 78% strongly supportive. (Graph 3) Increase the availability of fresh fruits and vegetables in low-income neighborhoods There is strong support for providing incentives and enacting policies to increase the availability of fresh fruits and vegetable in low-income neighborhoods. Nine in ten voters statewide (90%) favor such policies as a means to attract more farmers markets and produce stands in low-income neighborhoods, of whom 70% are strongly supportive. In addition, 81% favor providing similar incentives to attract more supermarkets selling fresh fruits and vegetables in such neighborhoods, with 62% strongly in favor. (Graph 4) Cover exercise and organized physical activity programs under Medi-Cal Six in ten voters (61%) attach high importance to providing Medi-Cal recipients access to exercise and other organized physical activity programs (like those offered by the YMCA or YWCA) as part

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of their covered services. While majorities of voters across all income categories and racial and ethnic subgroups believe this is highly important, lower-income voters and Latinos and ethnic voters are more likely than others to say this. (Graph 5) Voters believe it is important for food and beverage companies to change their marketing practices to fight obesity and diabetes Voters in the survey were also asked how important they felt it was for food and beverage companies to take actions to help reduce diabetes by changing their marketing practices. Four specific proposals were tested and large majorities of Californians rate each as an important action to take. These include: (Graph 6) Increasing their advertising and marketing of healthy, affordable foods and drinks like fruits and vegetables, whole grains and water to kids and teens (85%). Making healthy foods and drinks like fruits and vegetables, whole grains and water more affordable than unhealthy products (85%). Stopping the marketing of unhealthy products like high-calorie, fatty or salty foods, sodas and other sugary drinks to kids and teens (75%). Stopping the marketing of unhealthy products like high-calorie, fatty or salty foods, sodas and other sugary drinks on billboards in low-income communities (67%)

Community health workers seen as highly important in the fight to prevent and manage diabetes Increasingly, California communities are encouraging doctors and health professionals to team with community health workers to serve as go-betweens to strengthen communications between doctors and patients and to help patients, especially those with chronic conditions, to manage their care. Voters in the current survey were asked how important they felt it was for these workers, sometimes referred to as patients navigators, patient advocates, outreach workers or community health representatives, to provide each of four specific obesity and diabetes prevention services to patients. In each case, at least seven in ten voters considered community health worker services highly important in helping residents prevent and manage diabetes. These services include: Encouraging patients to be more physically active by developing appropriate exercise or walking routines (83%). Helping patients include more healthy foods and beverages into their diet (77%). Assisting patients in monitoring their medical conditions by checking blood pressure or blood sugar levels (73%). Serving as an advocate to promote better access to healthy foods and safe outdoor places in the community (70%).

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Larger proportions of Latinos than other voters rated each of these services as being highly important. (Graph 7) Medi-Cal should cover access to community health workers Two in three voters statewide (66%) believe it is highly important for the states Medi-Cal program to include patient access to community health workers as part of their covered services. While majorities of voters across all income and racial subgroups believe its highly important to include community health workers among Medi-Cals covered services, lower income voters and Latinos are most likely to feel this way. (Graph 8)
About the Survey The results in this release come from a statewide survey completed by The Field Poll on behalf of The California Endowment among a total of 1,002 California registered voters. The survey was conducted by telephone November 14-December 5, 2013 in English and Spanish. In order to cover a broad range of issues, some of the questions were asked of a random subsample of either 465 or 537 registered voters statewide. All interviewing was conducted by live interviewers working from Field Research Corporations central location call center in San Diego. Up to six attempts were made to reach, screen and interview each randomly selected voter on different days and times of day during the interviewing period. About half of the interviews were completed on a voters cell phone and about half on a landline phone. After the completion of interviewing, the sample was weighted to demographic, geographic and party registration characteristics of the states overall registered voter population. Sampling error estimates applicable to any probability-based survey depend upon sample size and the percentage distribution being examined. The maximum sampling error for results from the overall sample is +/- 3.2 percentage points at the 95% confidence level, while findings from the random subsamples have a maximum sampling error of approximately +/- 4.5 percentage points. The maximum sampling error is based on percentages in the middle of the sampling distribution (percentages around 50%). Percentages at either end of the distribution (e.g., 10% or 90%) have a smaller margin of error. Questions Asked See topline findings attached for the wording of the questions reported in this release. About The Field Poll The Field Poll was established in 1947 as The California Poll by Mervin Field, who is still an active advisor. The Poll has operated continuously since then as an independent, non-partisan survey of California public opinion. The current Field-TCE Obesity and Diabetes Prevention Survey is the latest in a series of surveys on the issue conducted by The Field Poll on behalf of The California Endowment. About The California Endowment The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of all Californians. Headquartered in downtown Los Angeles, The Endowment has regional offices in Sacramento, Oakland, Fresno and San Diego, with program staff working throughout the state. The Endowment challenges the conventional wisdom that medical settings and individual choices are solely responsible for peoples health. The Endowment believes that health happens in neighborhoods, schools and with prevention. For more information, please visit The Endowments website at www.calendow.org.

California Voter Views About Obesity and Diabetes Prevention

Summary Graphics to Story #1: Concerns and Policy Options Related To Obesity and Diabetes

Conducted by

The Field Poll

for

The California Endowment

About the Survey

Population surveyed: Data collection method and sample sizes: California registered voters. Telephone interviews with 1,002 registered voters conducted in English and Spanish. In order to cover a broad range of issues, some of the questions were asked of a random subsample of either 465 or 537 registered voters statewide. November 14 December 5, 2013. Conducted by The Field Poll on behalf of The California Endowment. Findings from the overall sample have a maximum sampling error of +/- 3.2 percentage points at the 95% confidence level, while results from each random subsample have a sampling error of +/- 4.5 percentage points.
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Interviewing period: Auspices: Sampling error estimates:

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Graph 1

More Californians consider unhealthy eating/lack of physical activity to be the greatest health risk facing kids than said this 10 years ago
Among top 2 health risks 59% 53% 43% 49% 31%

Unhealthy eating or lack of physical activity

Illegal drug use

2013 2003 2013 2003 2013 2003 2013 2003 2013 2003 2013 2003

40 35 26 27

Violence

14
N/A

Alcohol abuse

6 11 4 15 4 11 10% 11%

16% 26%

Smoking

24%

Unsafe sexual behaviors

28%
Top health risk

Next greatest health risk

Note: 2003 survey conducted among all California adults. 2013 survey conducted among registered voters. N/A: Not included in 2003 survey.

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Graph 2

Concerns about unhealthy eating/lack of physical activity among kids greatest in the San Francisco Bay Area and Los Angeles County
Unhealthy eating/lack of physical activity among top 2 health risks

Total registered voters (statewide) Region Los Angeles County

2013 2003 2013 2003 2013 2003 2013 2003 2013 2003 2013 2003

40 35 43 36 38 30 34 33 48 41 33 38
Top health risk

59%

53%
61% 57% 59% 48% 53% 50% 64% 57% 47% 51%
Next greatest health risk

Other Southern California

Central Valley

San Francisco Bay Area

Other Northern California*

* Small sample base.

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Graph 3

Nearly all voters support increasing the availability of fresh drinking water in schools and other public areas

Oppose strongly Oppose 2% 3% No opinion somewhat 2% Favor somewhat 11%

Oppose strongly 2% 4% No opinion Oppose somewhat 2% Favor somewhat 14%

82% Favor strongly

78% Favor strongly

Require free, clean water to be available in schools in any area that students eat meals or are physically active.

Make fresh drinking water freely available in all local schools, parks and public buildings.

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Graph 4

Strong support for providing incentives and enacting policies to increase the availability of fresh fruits and vegetables in low-income neighborhoods

4% Oppose 4% strongly 2% No opinion Oppose somewhat

6% Oppose somewhat

9% Oppose strongly

4% No opinion

20% Favor somewhat 70% Favor strongly

19% Favor somewhat

62% Favor strongly

Provide incentives and enact policies to attract more farmers markets and produce stands selling fresh fruits and vegetables in low-income neighborhoods.

Provide incentives and enact policies to attract more supermarkets selling fresh fruits and vegetables in low-income neighborhoods.

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Graph 5

Six in ten voters attach high importance to covering exercise and other organized physical activities (like the YMCA or YWCA) under the states Medi-Cal program
Highly important* 1% No opinion Total registered voters 14% Low importance *** 24% Moderately important** Household income Less than $20,000 $20,000-$39,999 74% 67% 62% 52% 61%

$40,000-$99,999
61% Highly important* $100,000 or more Race/ethnicity White non-Hispanic Latino Other ethnic voters

55% 75% 68%

* Highly important equals a rating of 8, 9 or 10 when asked how important this is on an importance scale of 1 to 10. ** Moderately important equals ratings of 4, 5, 6 or 7. *** Low importance equals ratings of 1, 2 or 3.

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Large majorities believe its important for food and beverage companies to change their marketing practices to help reduce diabetes
Important
Very important
Somewhat important

Food and beverage companies should

Increase their advertising and marketing of healthy, affordable foods and drinks, like fruits and vegetables, whole grains and water, to kids and teens

Not important

64

21

85%

14%

Make healthy foods and drinks, like fruits and vegetables, whole grains and water, more affordable than unhealthy products
Stop advertising and marketing unhealthy products, like high-calorie, fatty or salty foods, soda and other sugary drinks to kids and teens Stop advertising and marketing unhealthy products, like high-calorie, fatty or salty foods, soda and other sugary drinks, on billboards in low-income communities

61

24

85%

13%

46

29

75%

28%

40

27

67%

31%

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Graph 7

Community health workers seen as highly important in helping to prevent and manage diabetes, especially among ethnic voters
% Highly important* White Other nonethnic Hispanic Latino voters

Total registered voters Encourage patients to be more physically active by developing appropriate exercise or walking routines Help patients include more healthy foods and beverages into their diet Assist patients in monitoring their medical conditions by checking blood presssure or blood sugar levels Serve as an advocate to promote better access to healthy foods and safe outdoor places in the community

83%

81%

90%

83%

77%

72%

84%

84%

73%

67%

86%

78%

70%

66%

78%

74%

Highly important equals a rating of 8, 9 or 10 when asked how important this is on an importance scale of 1 to 10.

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Two in three voters attach high importance to covering access to community health workers under the states Medi-Cal program
Highly important* Total registered voters Household income 26% Moderately important** Less than $20,000 $20,000-$39,999 79% 79% 66% 55% 66%

6% Low importance***

2% No opinion

66% Highly important*

$40,000-$99,999
$100,000 or more Race/ethnicity White non-Hispanic Latino Other ethnic voters

59% 81% 71%

* Highly important equals a rating of 8, 9 or 10 when asked how important this is on an importance scale of 1 to 10. ** Moderately important equals ratings of 4, 5, 6 or 7. *** Low importance equals ratings of 1, 2 or 3.

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Release Date: Wednesday, February 12, 2014

TCE-FIELD OBESITY AND DIABETES PREVENTION SURVEY Story #1: Concerns and Policy Options Related to Obesity and Diabetes (Topline Findings)

I am going to read some health risks to kids in California. Please tell me which one in your opinion poses the greatest health risk to kids in California today. The categories are (READ BACK ALL CATEGORIES IN RANDOM ORDER, ASKING:) Which of these do you think poses the greatest health risk to kids in California today? (RECORD 1ST MENTION FIRST) (IF FIRST MENTION GIVEN, ASK:) Which category poses the next greatest health risk to kids?
GREATEST HEALTH RISK AMONG TOP 2 HEALTH RISKS

Unhealthy eating habits/lack of physical activity (net) .......................... 40% ...................59% Illegal drug use....................................................................................... 26.......................43 Violence ................................................................................................. 14.......................31 Alcohol abuse .......................................................................................... 6.......................16 Smoking ................................................................................................... 4.......................11 Unsafe sexual behaviors......................................................................... 4.......................10 Other (volunteered).................................................................................. 2......................... 3 No opinion................................................................................................ 4......................... 4

All questions asked of overall sample size of 1,002 California registered voters unless otherwise noted. 1

I am going to read some actions that government and communities can take to try to reduce diabetes among children and residents in your community. For each, please tell me whether you favor or oppose this action. (READ ITEMS IN RANDOM ORDER, ASKING:) Do you favor strongly, favor somewhat, oppose somewhat or oppose strongly this action as a way to try to reduce diabetes?
FAVOR FAVOR OPPOSE OPPOSE DK/ STRONGLY SOMEWHAT SOMEWHAT STRONGLY REF

Provide incentives and enact policies to attract more farmers markets and produce stands selling fresh fruits and vegetables in low-income neighborhoods* ...............................................................70%..........20 .............. 4 ............4 ........ 2 Make fresh drinking water freely available in all local schools, parks and public buildings*...............................78%..........14 .............. 2 ............2 ........ 4 Provide incentives and enact policies to attract more supermarkets selling fresh fruits and vegetables in low-income neighborhoods** ...................62%..........19 .............. 6 ............9 ........ 4 Require free, clean water to be available in schools in any area that students eat meals or are physically active** .....................................................82%..........11 .............. 2 ............2 ........ 3 Next, I am going to read some things that food and beverage companies could do to try to help reduce diabetes. For each, please tell me how important you feel it is for the food and beverage companies to do this. (READ ITEMS IN RANDOM ORDER, ASKING:) How important is it for food and beverage companies to do this to try to reduce diabetes very important, somewhat important, not too important or not at all important?
VERY SOMEWHAT NOT TOO NOT AT ALL DK/ IMPORTANT IMPORTANT IMPORTANT IMPORTANT REF

Stop advertising and marketing unhealthy products, like high-calorie, fatty or salty foods and soda and other sugary drinks to kids and teens* ...........................46%..........29 ............ 11 ..........11 ........ 3 Stop advertising and marketing unhealthy products, like high-calorie, fatty or salty foods and soda and other sugary drinks, on billboards in low income communities**..................................................................40%..........27 ............ 12 ..........19 ........ 2 Increase their advertising and marketing of healthy, affordable foods and drinks, like fruits and vegetables, whole grains and water, to kids and teens*...............................................................................61%..........24 .............. 6 ............8 ........ 1 Make healthy foods and drinks, like fruits and vegetables, whole grains and water, more affordable than unhealthy products** .............................64%..........21 .............. 5 ............8 ........ 2

* Item asked of a random subsample of 465 California registered voters. ** Item asked of a random subsample of 537 California registered voters. 2

Many communities are encouraging doctors and health professionals to team with trained community health workers to serve as go-betweens to strengthen communications between patients and doctors, and help patients manage and coordinate their care. They are also sometimes referred to as outreach workers, community health representatives, patient navigators or patient advocates (IF SPANISH, ADD: o promotora de salud). I am going to read some things that community health workers can do to help prevent or manage diabetes. Please tell me how important you think each is on a scale of 1 to 10, where 10 means it is among the most important and 1 means it is among the least important. Of course you may choose any number between 1 and 10 for your answer. (READ ITEMS IN RANDOM ORDER, AND THEN ASK:) On a scale of 1 to 10, how important do you think it is for community health workers to do this?
8-10 4-7 1-3
DK

( ) a. ( ) b. ( ) c. ( ) d.

Assist patients in monitoring their medical conditions by checking blood pressure or blood sugar levels............................................................ 73% ... 21.......5 ..... 1 Help patients include more healthy foods and beverages into their diet........ 77% ... 17.......6 ...... * Encourage patients to be more physically active by developing appropriate exercise or walking routines ...................................................... 83% ... 13.......3 ..... 1 Serve as an advocate to promote better access to healthy foods and safe outdoor places in the community .......................................................... 70% ... 24.......5 ..... 1

8-10

4-7

1-3

DK

On a scale of 1 to 10, how important do you feel it is for Medi-Cal, the government program that provides health insurance to low-income adults and children, to provide recipients with access to community health workers, as part of their covered services? ................................................................ 66% ... 26.......6 ..... 2 On a scale of 1 to 10, how important do you feel it is for Medi-Cal to provide recipients with access to exercise and other organized physical activities, like taking exercise classes at the YMCA or YWCA, as part of their covered services?...................................................................................................................... 61% ... 24.....14 ..... 1