title: Community-generated recommendations regarding the urban nutrition and tobacco environments: a photo-elicitation study in Philadelphia.
abstract: BACKGROUND
  Overweight, obesity, and tobacco use are major preventable causes of disability, disease, and death. In 2010, 25% of Philadelphia adults smoked, and 66% were overweight or obese. To address these health threats, the Philadelphia Department of Public Health launched Get Healthy Philly, an initiative to improve the city's nutrition, physical activity, and tobacco environments. The objective of this assessment was to identify residents' perspectives on threats to health and opportunities for change in the local food and tobacco environments.
  
  
  METHODS
  Participants (N = 48) took photographs to document their concerns regarding Philadelphia's food and tobacco environments and participated in photo-elicitation interviews. We coded photographs and interview transcripts and identified key themes.
  
  
  RESULTS
  Participants proposed interventions for nutrition 4 times more often than for tobacco. Participants spontaneously articulated the need for multilevel change consistent with the ecological model of health behavior, including changes to policies (food assistance program provisions to encourage healthful purchases), local and school environments (more healthful corner store inventories and school meals), and individual knowledge and behavior (healthier food purchases). Participants often required interviewer prompting to discuss tobacco, and they suggested interventions including changes in advertising (a local environmental concern) and cigarette taxes (a policy concern).
  
  
  CONCLUSIONS
  Participants were well versed in the relevance to health of nutrition and physical activity and the need for multilevel interventions. Their responses suggested community readiness for change. In contrast, participants' more limited comments regarding tobacco suggested that prevention and control of tobacco use were perceived as less salient public health concerns.
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: FitzGerald
authors.forename: Rosemary
authors.initials: R
authors.lastname: Frasso
authors.forename: Lorraine T
authors.initials: LT
authors.lastname: Dean
authors.forename: Terry E
authors.initials: TE
authors.lastname: Johnson
authors.forename: Sara
authors.initials: S
authors.lastname: Solomon
authors.forename: Eva
authors.initials: E
authors.lastname: Bugos
authors.forename: Giridhar
authors.initials: G
authors.lastname: Mallya
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Cannuscio
mesh_terms: D000293:Adolescent; D000328:Adult; D003256:Community Participation; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D015596:Nutrition Assessment; D050177:Overweight; D015143:Philadelphia; D010781:Photography; D012111:Residence Characteristics; D012907:Smoking; D012931:Social Environment; D019460:Tobacco Industry; D014505:Urban Population