August 18, 2022

In the latest U.S. News rankings, North Carolina came in No. 13 out of 50 states overall — but No. 30 for health care. The lower ranking for health is due, in part, to factors like the percentage of the population without health insurance, the number of preventable hospital admissions and the obesity rate.

But there’s good news for North Carolina: The state is home to a wealth of public health institutions and experts working to improve health and well-being for all.

Amid the complex web of policies, programs and interventions that influence health outcomes, researchers want to know: Which strategies will really make North Carolinians healthier?

Two teams of researchers from the UNC-Chapel Hill Gillings School of Global Public Health attempt to answer this question as part of the Policies and Programs section of the July issue of the North Carolina Medical Journal.

The issue focuses on the health behavior indicators and levers for change in Healthy North Carolina 2030.

“The Healthy North Carolina 2030 project brings together experts and leaders from multiple fields to inform the development of a common set of public health indicators and targets for the state over the next decade,” reads a statement from the North Carolina Institute of Medicine. “These indicators will serve as the population health improvement plan for the North Carolina Division of Public Health. With a focus on health equity and the overall drivers of health outcomes (health behaviors, clinical care, social and economic factors, and the physical environment), these indicators and targets will help drive state and local-level activities, provide a springboard for collaboration and innovation, and develop a new vision for public health in our state.”

The first Gillings School research team contributed their insights on tobacco use with the study “Evidence-Based Point-of-Sale Policies to Reduce Youth Tobacco Use in North Carolina.”

One of the Healthy North Carolina 2030 goals is to reduce rates of youth tobacco use. Accordingly, this publication outlines the evidence in favor of point- of-sale policies, including Tobacco 21 laws, restrictions on advertising and promotion, flavored tobacco product bans, tobacco retailer licensing and repealing preemption.

Sarah Halvorson-Fried

Sarah Halvorson-Fried

Lead author Sarah Halvorson-Fried is a doctoral student in the Department of Health Behavior at the Gillings School. Her co-authors are doctoral student Alexandria Reimold; Assistant Professor Sarah Mills, PhD, and Jo Anne Earp Distinguished Professor and Department Chair Kurt Ribisl, PhD, all in the health behavior department.

“Several tobacco control policies at the point-of-sale have been proven effective in other states and localities,” said Halvorson-Fried. “By replicating them, North Carolina could decrease youth tobacco use and reduce health inequities.”

The second research team published “Excise Taxes as a Policy Lever for Reaching Healthy North Carolina 2030 Targets,” which highlights the potential of tax-based price increases on specific products to reduce tobacco use, binge/heavy drinking and daily sugar-sweetened beverage consumption — three goals of the Healthy North Carolina 2030 initiative.

Dr. Shelley Golden

Dr. Shelley Golden

Lead author Shelley Golden, PhD, is an associate professor of health behavior at the Gillings School. Her co-authors are Shu Wen Ng, PhD, Distinguished Scholar in Public Health Nutrition, and Pamela Trangenstein, PhD, adjunct assistant professor of health behavior.

“Raising the price of unhealthy products through excise taxes is a proven health promotion strategy,” Golden said. “North Carolina lags behind many other states in its use of excise taxes to reduce consumption of harmful substances. Our article outlines several recommendations that could be implemented to meet multiple Healthy North Carolina goals.”

Overall, healthy behaviors contribute to healthy people and communities, and a prosperous state — but these behaviors are more complicated than simple individual choices. These two publications, and the journal issue in which they appear, put current behavioral trends in context and suggest concrete steps that can advance healthier behaviors in North Carolina.

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