Using DMV records for obesity tracking Daniel Morris, MS, PhD - PowerPoint PPT Presentation

Using DMV records for obesity tracking Daniel Morris, MS, PhD Oregon Environmental Public Health Tracking April 1, 2013 See oregonpublichealth.org/events for more public health week events

Who gets to access personal info on DMV records? • Police • Tow companies • Elections officials • Private security • Attorneys • Employers • Financial institutions • Toll facility owners • Collection agencies • Private investigators • Process servers • Motor vehicle manufacturers • Health researchers • Insurers • Injured people Oregon Revised Statutes 802.179

ORS 802.179 (1): The Department of Transportation, upon request or as required by law, shall disclose personal information from a motor vehicle record to a government agency for use in carrying out its governmental functions.

Core public health functions

Defining weight status Height Weight Range BMI Weight Status 124 lbs or less Below 18.5 Underweight 125 lbs to 168 lbs 18.5 to 24.9 Healthy 5' 9" 169 lbs to 202 lbs 25.0 to 29.9 Overweight 203 lbs or more 30 or higher Obese

N Engl J Med. 2010 December 2; 363(23): 2211 – 2219. doi:10.1056/NEJMoa1000367.

Adult obesity and diabetes, U.S. NHANES, NHIS

Mortality rates from DMV records 50% Underweight 45% 40% Healthy weight 35% % flagged as deceased Overweight 30% Obese 25% 20% 15% 10% 5% 0% 1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 Birth year Data source: Oregon DMV records issued 2005-2012. PRELIMINARY

Don’t people lie about their weight?

Mean BMI, Oregon BRFSS and DMV Women DMV Women BRFSS Men DMV Men BRFSS 28 Avg. diff = 2% 27 Avg. diff = 5% 26 Mean BMI 25 24 23 22 0 2003 2004 2005 2006 2007 2008 2009 2010 Age-adjusted estimates from Oregon BRFSS and DMV records, adults ages 18-84

Food consumption Average daily calories per capita 2,500 Flour and cereal products Added fats and oils and 2,000 dairy fats Caloric sweeteners 1,500 Meat, eggs, and nuts 1,000 Dairy Vegetables 500 Fruit 0 1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Average daily per capita calories from the U.S. food availability, adjusted for spoilage and other waste (USDA)

What changed?* • Agriculture policies favoring overproduction • Shareholder value movement • Reagan-era deregulation *According to Marion Nestle http://www.foodpolitics.com/wp- content/uploads/Dissent_Nestle_12.pdf

Restaurant portion sizes quadrupled since the 1950s

Average calories per serving in 18 classic recipes in The Joy of Cooking Average calories per serving 450 400 350 300 250 200 150 100 50 0 1936 1946 1951 1963 1975 1997 2006 Edition Wansink, Brian and Collin R. Payne (2009), "The Joy of Cooking Too Much: 70 Years of Calorie Increases in Classic Recipes,"Annals of Internal Medicine, 150, 291-291.

Congressional Research Service (2012) Consumers and Food Price Inflation, data from USDA Economic Research Service

Food environment in Oregon 9,000 8,000 7,000 Number 6,000 5,000 4,000 3,000 2,000 1,000 - Restaurants Convenience Groceries Produce stores stands Oregon Employment Department, 2010 Oregon Farmer’s Market Association

Food deserts or food swamps? USDA Food Access Research Atlas Low income census tracts where a significant number of households have low vehicle access or a significant number or share of residents are more than 20 miles from the nearest supermarket

Image from portlandoctopus.com

I haven’t updated my weight since high school

Oregon DMV records issued 2003-2010 Mean BMI 23 24 25 26 27 28 29 0 1988-1992 1983-1987 2003 1978-1982 BMI by Birth Cohort and Year, Males 2004 1973-1977 1968-1972 2005 1963-1967 2006 1958-1962 Birth Year 2007 1953-1957 1948-1952 2008 1943-1947 2009 1938-1942 1933-1937 2010 1928-1932 Pre-1928

American Time Use 100 Healthy weight Overweight Obese 86 90 85 83 Average minutes per day 80 73 69 70 64 60 50 42 39 36 40 36 27 30 22 20 10 0 Grocery shopping and Primary eating and Secondary eating Secondary drinking meal prep drinking 2008 American Time Use Survey

Energy drinks, 451 RTD Tea, Sports 1,063 drinks, 1,378 U.S. Fruit beverage beverages, 3,574 Carbonated sales, 2011 soft drinks, (millions of 13,565 Bottled gallons) water, 9,109 Beverage World State of the Industry Reports - http://www.beverageworld.com/

Sugary drinks

About half of 2-year- About half of 2-year- olds in Oregon have olds in Oregon have a soda or other a soda or other sugary drink at least sugary drink at least once a week once a week Bernice Raveche Garnett, Kenneth D Rosenberg and Daniel S Morris. Consumption of soda and other sugar-sweetened beverages by 2-year- Bernice Raveche Garnett, Kenneth D Rosenberg and Daniel S Morris. Consumption of soda and other sugar-sweetened beverages by 2-year- olds: findings from a population-based survey. Public Health Nutrition, available on CJO2012. doi:10.1017/S1368980012004399. olds: findings from a population-based survey. Public Health Nutrition, available on CJO2012. doi:10.1017/S1368980012004399.

Nutritional labeling Photo: Associated Press

$9.6 billion in food marketing in 2009 Juice & Non- carbonated Bevs. 10.7% Snack Breakfast Cereal Foods 7.5% 8.3% Prepared Foods & Meals 5.7% Carbonated Beverages Candy & Frozen Desserts 25.6% 5.5% Restaurant Dairy Products 4.8% Foods 30.7% Fruits & Baked Goods Vegetables 0.7% 0.6% Federal Trade Commission, A Review of Food Marketing to Children and Adolescents (2012). Data from 44 major food and beverage manufacturers, distributors and marketers

Marketing $ distribution Athletic sponsorship Web 4.1% Print 1.2% Pack/Label In‐School Radio Internet 5.1% 1.6% 3.4% 4.1% 5.7% Events Premiums 2.5% 6.0% Cross‐promotion licenses In‐Store 0.9% Viral/WOM 8.2% 0.8% Celebrity fees 0.5% Philanthropy 0.4% Product Placement 0.3% Other 14.0% Movie/Video 0.2% TV 41.2% Federal Trade Commission, A Review of Food Marketing to Children and Adolescents (2012). Data from 44 major food and beverage manufacturers, distributors and marketers. Companies were required to report spending for “All Ages” only when they had child‐ or teen‐directed marketing for the product. Thus, t he "All Ages" data reported here do not include any spending for products that did not have child‐ or teen‐directed marketing.

Average daily TV time 200 184 180 164 160 147 140 Minutes 120 100 80 60 40 20 0 Healthy weight Overweight Obese Data source: USDA Economic Research Service, using data from 2006-2008 American Time Use Survey and ERS Eating & Health Module data

Physical activity http://media.treehugger.com

Trends in energy expended at work Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, et al. (2011) http://www.plosone.org/article/info:doi/10.1371/journal.pone.0019657

Transportation to work 1960 - 2009

Photo from onemorecyclist.wordpress.com, credited to e france

Commute time by mode in Oregon 41 Average time to work, 26 in minutes 21 21 17 Average, all Walked, Drove alone Carpooled Public modes bicycled or transportation other means Data source: American Community Survey 2006-2010 Data source: American Community Survey 2006-2010

Commuting in America III (2006): Third National report on commuting patterns and trends

Urban sprawl

Image from http://www.tranquilityokc.com

Community design for health http://www.healthycommunitiesbydesign.org/

Investment • Cost to acquire data from DMV: $900 • Staff time to geocode 1.5 million addresses • Simple, standard analysis

Obesity in Oregon, 2006-2009 C o l u m b i a Clatsop W a s h Hood River i n g Multnomah t o Umatilla n Wallowa S h e Tillamook r m Morrow a Gilliam Union n Yamhill Clackamas Wasco Polk Marion Baker Lincoln Wheeler Jefferson Grant Linn Benton Crook Lane Deschutes Oregon Obesity Percent age-adjusted Coos Malheur Douglas Harney State Average: 24.5% Klamath Lake 10% - 19.9% 20% - 25.9% Curry Josephine Jackson >= 26% Data Source: Oregon BRFSS 2006-2009

I5 I5 I405 I84 I84 Fairview I84 I84 SUNSET 5 Y 0 W 4 I Portland F 4 5 5 8 0 0 Russelville Rockwood I 4 - 2 Y I I W Sylvan F 5 I West Slope Gresham Beaverton Maplewood HWY 217 I5 Legend metro RLIS.mxd Milwaukie 23.4 - 25.1 Tigard 25.2 - 26.0 Boring 26.1 - 26.7 Damascus Oak Grove 26.8 - 27.4 Lake Grove 27.5 - 30.9 Carver I205 Tualatin Barton I5 5 I - West Linn 5 0 2 Sherwood Stafford I Eagle Creek Redland Age ‐ adjusted mean BMI for adult residents ages 18 ‐ 84 in Census block groups in the Portland Metro area, Data are age ‐ adjusted to the 2000 U.S. Census standard population. Data source: Oregon driver licenses and ID cards issued 2003 ‐ 2010 provided by the Oregon Department of Transportation.