New Hampshire Tobacco & Obesity Policy Project

Dates: 2010-2012

State: New Hampshire

Client(s): NH DHHS Division of Public Health Services

Services: Health Care & Public Health Planning, Health Communication, Training & Technical Assistance, Health Systems Transformation

Technical Expertise: Adolescent Health, Substance Use, Maternal and Child Health, Chronic Disease Management, Environmental Health, Population Health, Healthy Communities


Nationally, people are living with and suffering from preventable chronic diseases, many of which are impacting people at an increasingly younger age. Increasing numbers of children, even very young children, are overweight or obese. According to the NH Obesity Data book published in 2010, more than a third of NH Head Start children and third graders are overweight or obese. The 2009 Youth Risk Behavioral Survey data show more than a fourth of NH teens are either overweight or obese. Being overweight increases the risk of developing high blood pressure and cholesterol, orthopedic disorders, sleep problems, diabetes, low self-esteem, and becoming an overweight adult. Further, smoking remains the leading cause of preventable death and disability in this country. Despite significant progress, CDC reports that one in five adults and one in five high school students smoke. NH children are often involuntarily exposed to second hand smoke and particulate matter from their families and caretakers that put them at higher risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma.

JSI's Community Health Institute was contracted by the NH Obesity Prevention Program (OPP) and Tobacco Prevention and Control Program (TPCP) to support sustainable policy change in NH child care settings and schools. JSI engaged stakeholders to assess the feasibility of increasing healthy food/drink availability and physical activity, restricting screen times, and strengthening regulatory rules to mirror RSA 126:K7 state law (24/7 tobacco-free public schools) in child care settings, and limiting unhealthy food/drink availability in public schools. JSI worked with partners to develop a comprehensive training series providing child care staff the opportunity to learn policy development and implementation skills. The trainings sought to empower child care staff to increase the health of the environment in the programs where they work. JSI also worked with the Department of Education to implement an assessment of current wellness policy implementation activities in public schools and to develop a toolkit to assist schools in implementing newly passed administrative rules regulating foods served in schools. Lastly, JSI worked with Breathe-NH to assess the feasibility of educating municipality partners on strengthened clean indoor air regulations, and subcontracted with a nationally-known researcher to conduct an assessment of the effect NH's 2011 tobacco tax rollback on certain economic and health indicators.

This project provided a critical opportunity for NH stakeholders to engage in a collaborative educational process that has the potential to strengthen child care regulatory rules, implement high-impact public policy access strategies, and build stronger public health partnerships.

76% of child care training participants reported involvement in some sort of policy change activity in their child care program in the 60 days following the attendance of a training.