Strengthening the roots: Community participation in the development and implementation of local policies to promote healthy eating and tobacco cessation in Puerto Rico

Chronic diseases are among the most common and costly health problems, but also the most preventable. According to PR Vital Statistics, 64.2% of all the deaths are related to preventable chronic conditions. Risk factors related to the high prevalence of chronic conditions include overweight and obesity and tobacco use. BRFSS data reveals that prevalence of overweight and obesity in Puerto Rico was 65.2% in 2009; 10.6% for tobacco use in adults. A youth behavioral survey estimated the tobacco use prevalence of 12.6% (12-17 years). To help address these issues, the Centers for Diseases Control and Prevention (CDC) subsidized Communities Putting Prevention to Work (CPPW). CPPW was implemented in Puerto Rico from 2010-2013 at two levels, state and community. The state level promoted the implementation of healthy eating policies and developed an educational campaign.  At the community level, the strategies were implemented to limit access to unhealthy foods.  Regarding physical activity, the program transformed urban areas in community walking trails. In terms of tobacco regulations, the project included the provision of technical assistance to local governments to implement regulations to tobacco selling points and counter advertising strategies.  As a result, a total of 11 communities developed local policy to regulate tobacco use, as of 2014.  A group of community members formed the Community Advisory Team to serve as liaison between the local government and the communities.  This initiative is an example of coordination between state level and local municipalities’ efforts to prevent chronic diseases. Policy is key when promoting health.