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‘Behavior is where it’s at.’ Tackling lifestyle choices for a healthier Oklahoma

Many Oklahomans want to be healthier, but making changes for themselves and their families may seem daunting. In reality, small changes can make a big difference toward feeling better and reducing the risk of diseases that account for a majority of deaths in Oklahoma.  

Tobacco use, poor nutrition and lack of physical activity contribute to heart disease and stroke, cancer, diabetes and lung disease. Together, these four diseases cause more than 60 percent of deaths in Oklahoma, according to the Oklahoma State Department of Health. But quitting tobacco and making simple choices like walking more and choosing refreshing water over sugary drinks can reduce those risks for Oklahoma families.

“Behavior is where it’s at,” said Dr. Bruce Christiansen, senior scientist and licensed psychologist at the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health.

“Our environment has changed – we don’t have to chase after our food sources; everything comes to us conveniently packaged,” Christiansen said. “But ultimately, we are the solution.” 

At wider state and local levels, health professionals and policy makers are working to create environments where Oklahomans have the knowledge and opportunities to make healthy choices. Policies that encourage healthy behaviors help, and the consistent education by health professionals is key.

Creating environments that promote health where people live, work, learn and play is effective because it affects day-to-day behavior, researchers say. Daily choices and behaviors account for 40 percent of health – more than any other single factor – including genetics, social circumstances and access to health care, according to research highlighted in Steven Schroeder’s well-publicized “Shattuck Lecture,” which appeared in the New England Journal of Medicine.

Christiansen and other health experts work with the Tobacco Settlement Endowment Trust (TSET) to make sure Oklahomans receive this message and have the tools to take action.

The Tobacco Settlement Endowment Trust is a state agency that is uniquely structured to fund programs and research aimed at reducing deaths caused by cancer and cardiovascular disease. TSET also funds the Oklahoma Tobacco Helpline and the Tobacco Stops With Me and Shape Your Future campaigns.

A look at Oklahoma’s health outcomes

Dr. Curtis Knoles is medical director of Oklahoma Emergency Medical Services for Children at The Children’s Hospital at OU Medical Center and a member of the TSET Board of Directors. As a pediatrician and emergency room physician, he sees many children with health problems related to obesity or unhealthy lifestyles – from broken bones in children who are overweight, to constipation from lack of exercise and dehydration, to kids that come in with asthma attacks or illnesses related to secondhand smoking.

The health problems are real, Knoles said, but efforts to reduce obesity in Oklahoma eventually will mirror the long-term benefits of the anti-smoking movement.

“There are a lot of changes that are happening to support healthier lifestyles but it takes years, and sometimes a generation to make a cultural change,” Knoles said.

Oklahoma ranks 46th in overall health, according to the 2016 United Health Foundation, up from 49th in 2009. Oklahoma is among the 10 worst states for rates of adult smoking, unhealthy diet and obesity in adults.

Knoles, a pediatrician, said it is vital that adults model healthy behavior for their children – not only when it comes to smoking, but also health habits around nutrition and exercise.

“I firmly believe in teaching people how to be healthy,” he said. “It is not enough to provide healthy options, you also have to show them how to prepare the food. It is about a lifestyle change around how we eat. It’s about living healthy.”

Addressing unhealthy behavior

It takes a team approach to achieve the best results. The Oklahoma Dental Association is a supporter of the Shape Your Future Rethink Your Drink campaign and other TSET initiatives. They have a common goal: help Oklahomans replace sugary drinks with water.

Sugary drinks contain empty calories that can lead to obesity and impact oral health.

Having dentists, physicians and even teachers sharing the same message is important to success, said Dr. Edmund Braly, president of the Oklahoma Dental Association.

“Our health and medical community is outnumbered by Madison Avenue,” Braly said. “Children see hundreds of hours of advertisements and product placements. Our children constantly receive the message that this drink is ‘oh, so good’.”

As a maxillofacial surgeon, who helps patients with facial injuries, Braly said he has seen the success of cohesive messaging and policy changes working first hand.

“I think of how much change we saw when seatbelts became law,” he said. 

Tools for Oklahomans

TSET public health education campaigns, like Shape Your Future, focus on educating Oklahomans on the small steps they can take towards living a healthier lifestyle – steps that adults, parents and kids can work into their daily lives.

The messaging supports the goals of a healthier lifestyle, like eating better by filling half your plate with fruits and veggies at every meal; moving more by getting 60 minutes of physical activity a day for kids and 30 for adults; rethinking your drink by reaching for water instead of sugar-sweetened beverages and living tobacco free. 

Melissa Johnson, director of Health Care Policy at the Oklahoma State Medical Association, said Oklahoma physicians appreciate the support and resources that these campaigns provide for patients.

“It’s creating awareness and helps people make better choices,” Johnson said. “And I think we’re starting to see people make better choices.”

Rethink Your Drink posters on doctor’s office walls are conversation starters that outline small, achievable goals.

“It’s a place to start for people who are overwhelmed,” Johnson said. “You can cut out the soda. Once you start feeling the impact of that you go ‘I can do this.’”

Resources such as the Oklahoma Tobacco Helpline have proven to be reliable, effective tools to refer patients to, Johnson added.

The Oklahoma Tobacco Helpline, at www.okhelpline.com, provides messaging about the free services to help Oklahomans walk through the process of quitting tobacco.  Oklahomans 14 years old and older can receive free quit coaching by phone or online, text messaging as well as free patches, gum or lozenges. 

TSET’s Tobacco Stops With Me and the Oklahoma Tobacco Helpline are two success stories that underscore the impact of educational messaging.

“Youth cigarette smoking has been cut in half and more than 350,000 Oklahomans have accessed the Helpline to date,” said Dr. Laura Beebe, a professor of Biostatistics and Epidemiology at the OU Health and Science Center, who led evaluation efforts of the campaigns.

The Tobacco Stops With Me campaign provides information at StopsWithMe.com on the dangers of secondhand smoke, the importance supporting of smoke-free and tobacco-free environments, reducing youth tobacco use, and sharing proven ways to help someone quit tobacco use through the Oklahoma Tobacco Helpline. 

Evidence-based resources

TSET’s approach is based on research, evidence and proven practices.

“Daily users of tobacco who are exposed to ’Tobacco Stops With Me’ messages were more than twice as likely to make a quit attempt,” said Beebe.

Tobacco Stops With Me also increased awareness of resources and changed attitudes regarding the serious dangers of smoking among smokers and non-smokers. TSET has conducted cross-sectional and/or longitudinal surveys of target populations in Oklahoma. The results of these evaluations document the effectiveness of each campaign, Beebe said.

Measuring results and adjusting as needed is important. The same approach is used for the newer campaigns focused on healthy behaviors.

 “The bottom line is that TSET’s mission is to improve health for all Oklahomans. We use the best research available, call upon experts, talk with Oklahomans and evaluate our messages,” said TSET Executive Director John Woods. “Each healthier choice made supports a culture shift to the healthy choice being the easy choice, and that is the key to healthier lives in our state and for our children for generations to come.”

For more information, visit tset.ok.gov, ShapeYourFutureOK.com, StopsWithMe.com and OKhelpline.com.