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

Using DMV records for

• besity 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

• n DMV records?
• Police
• Elections officials
• Attorneys
• Financial institutions
• Collection agencies
• Process servers
• Health researchers
• Injured people
• Tow companies
• Private security
• Employers
• Toll facility owners
• Private investigators
• Motor vehicle

manufacturers

• Insurers

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

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

Defining weight status

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

Adult obesity and diabetes, U.S.

NHANES, NHIS

Data source: Oregon DMV records issued 2005-2012. PRELIMINARY

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 1910-1919 1920-1929 1930-1939 1940-1949 1950-1959 1960-1969 % flagged as deceased Birth year Underweight Healthy weight Overweight Obese

Mortality rates from DMV records

Don’t people lie about their weight?

22 23 24 25 26 27 28

2003 2004 2005 2006 2007 2008 2009 2010 Mean BMI

Mean BMI, Oregon BRFSS and DMV

Women DMV Women BRFSS Men DMV Men BRFSS

Age-adjusted estimates from Oregon BRFSS and DMV records, adults ages 18-84

• Avg. diff = 2%
• Avg. diff = 5%

500 1,000 1,500 2,000 2,500

1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

Average daily calories per capita

Flour and cereal products Added fats and oils and dairy fats Caloric sweeteners Meat, eggs, and nuts Dairy Vegetables Fruit

Average daily per capita calories from the U.S. food availability, adjusted for spoilage and other waste (USDA)

Food consumption

What changed?*

• Agriculture policies favoring overproduction
• Shareholder value movement
• Reagan-era deregulation

http://www.foodpolitics.com/wp- content/uploads/Dissent_Nestle_12.pdf *According to Marion Nestle

Restaurant portion sizes quadrupled since the 1950s

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.

50 100 150 200 250 300 350 400 450

1936 1946 1951 1963 1975 1997 2006 Average calories per serving Edition

Average calories per serving in 18 classic recipes in The Joy of Cooking

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

Food environment in Oregon

Oregon Employment Department, 2010 Oregon Farmer’s Market Association

• 1,000

2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000

Restaurants Convenience stores Groceries Produce stands

Number

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

• r 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

23 24 25 26 27 28 29

1988-1992 1983-1987 1978-1982 1973-1977 1968-1972 1963-1967 1958-1962 1953-1957 1948-1952 1943-1947 1938-1942 1933-1937 1928-1932 Pre-1928

Mean BMI

Birth Year

BMI by Birth Cohort and Year, Males

2003 2004 2005 2006 2007 2008 2009 2010 Oregon DMV records issued 2003-2010

2008 American Time Use Survey

American Time Use

42 73 36 83 36 69 27 85 39 64 22 86

10 20 30 40 50 60 70 80 90 100

Grocery shopping and meal prep Primary eating and drinking Secondary eating Secondary drinking

Average minutes per day Healthy weight Overweight Obese

Energy drinks, 451 RTD Tea, 1,063 Sports drinks, 1,378 Fruit beverages, 3,574 Bottled water, 9,109 Carbonated soft drinks, 13,565

U.S. beverage sales, 2011 (millions of gallons)

Beverage World State of the Industry Reports - http://www.beverageworld.com/

Sugary drinks

About half of 2-year-

• lds in Oregon have

a soda or other sugary drink at least

• nce a week

Bernice Raveche Garnett, Kenneth D Rosenberg and Daniel S Morris. Consumption of soda and other sugar-sweetened beverages by 2-year-

• lds: findings from a population-based survey. Public Health Nutrition, available on CJO2012. doi:10.1017/S1368980012004399.

About half of 2-year-

• lds in Oregon have

a soda or other sugary drink at least

• nce a week

Bernice Raveche Garnett, Kenneth D Rosenberg and Daniel S Morris. Consumption of soda and other sugar-sweetened beverages by 2-year-

• lds: findings from a population-based survey. Public Health Nutrition, available on CJO2012. doi:10.1017/S1368980012004399.

Nutritional labeling

Photo: Associated Press

Restaurant Foods 30.7% Carbonated Beverages 25.6%

Juice & Non- carbonated Bevs. 10.7% Snack Foods 8.3% Breakfast Cereal 7.5% Prepared Foods & Meals 5.7% Candy & Frozen Desserts 5.5% Dairy Products 4.8% Baked Goods 0.7% Fruits & Vegetables 0.6%

$9.6 billion in food marketing in 2009

Federal Trade Commission, A Review of Food Marketing to Children and Adolescents (2012). Data from 44 major food and beverage manufacturers, distributors and marketers

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, the "All Ages" data reported here do not include any spending for products that did not have child‐ or teen‐directed marketing.

Marketing $ distribution

TV 41.2%

Other 14.0% In‐Store 8.2% Premiums 6.0% Internet 5.7% Print 5.1% Radio 4.1% Athletic sponsorship 4.1% In‐School 3.4% Events 2.5% Pack/Label 1.6% Web 1.2% Cross‐promotion licenses 0.9% Viral/WOM 0.8% Celebrity fees 0.5% Philanthropy 0.4% Product Placement 0.3% Movie/Video 0.2%

147 164 184

20 40 60 80 100 120 140 160 180 200 Healthy weight Overweight Obese

Minutes

Average daily TV time

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

21 17 21 26 41

Average, all modes Walked, bicycled or

• ther means

Drove alone Carpooled Public transportation

Average time to work, in minutes

Commute time by mode in Oregon

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

Oregon Obesity Percent age-adjusted State Average: 24.5% 10% - 19.9% 20% - 25.9% >= 26%

Lake Harney Malheur Lane Grant Klamath Douglas Baker Linn Crook Jackson Coos Curry Deschutes Jefferson Josephine Lincoln Benton Umatilla Wallowa Union Morrow S h e r m a n Gilliam Marion Clackamas Polk Tillamook Clatsop Yamhill C

• l

u m b i a W a s h i n g t

• n

Hood River Multnomah Wasco Wheeler

Data Source: Oregon BRFSS 2006-2009

metro RLIS.mxd

I5 I 2 5 I84 SUNSET HWY 217 I 4 5 I 2 5

• I

5 I 5 F W Y

• I

8 4 F W Y I5 I84 I5 I5 I84 I84 I405 I205 I 4 5

Barton Carver Boring Tigard Sylvan Redland Gresham Stafford Damascus Sherwood Tualatin Rockwood Portland Fairview West Linn Oak Grove Milwaukie Beaverton Maplewood Lake Grove West Slope Eagle Creek Russelville

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.

Legend

23.4 - 25.1 25.2 - 26.0 26.1 - 26.7 26.8 - 27.4 27.5 - 30.9

BMI and economic status

Tract-level analysis using DMV records issued 2003-2010, American Community Survey 2006-2010

http://www.blogarithms.com

Protecting personal information

• Only publish aggregate statistics
• Strict policies on data access

39 states & territories collect height and weight

I.D. Checking Guide 2012. Drivers License Guide Company, Redwood City, CA.

DMV data

• Valuable resource for public health
• 10,000X greater resolution than survey data
• Reliably inaccurate

Thanks

Public Health Division

• Eric Main
• Mary Dinsdale
• Tara Chetock
• Marina Counter
• Jill Brackenbrough
• Curtis Cude
• Jae Douglas
• Dan Rubado
• Stacey Schubert
• Duyen Ngo
• Sami Stuchell

Oregon DMV

• Susie Hanlon

Oregon Department of Administrative Services

• Erik Endrulat

Texas A & M University

Questions?

Daniel Morris, MS, PhD

Epidemiologist Oregon Tracking Program daniel.s.morris@state.or.us 971-673-1210

healthoregon.org/epht Data Portal: epht.oregon.gov facebook.com/OregonEPHT