Youth-generated policy recommendations regarding the urban nutrition and tobacco environments: Results from a photo-documentation study in Philadelphia

INTRODUCTION: In 2010, 25.2% of Philadelphians smoked—the highest rate in any of the ten largest American cities—and 66.3% were overweight or obese. To address these health threats, the Philadelphia Department of Public Health and the Centers for Disease Control and Prevention launched Get Healthy Philly, an initiative focused on improving the city's tobacco and food environments. Here we report findings from one element of that initiative: a photo-documentation project engaging Philadelphia youth to understand their perspectives on unhealthy nutrition- and tobacco-related behaviors and relevant policy interventions. METHODS: With community based photography, study participants examined Philadelphia's food and tobacco environments. Using participant-generated photographs we conducted 20 photo-elicitation interviews with youth ages 15-18. Interviews were transcribed verbatim and analyzed using Nvivo9 software. RESULTS: Regarding nutrition, participants spontaneously articulated the need for policy change and intervention. However, participants suggested few tobacco-related interventions. Participants photographed and discussed nutrition-related health concerns over eight times more frequently than tobacco-related health concerns. DISCUSSION: Philadelphia youth were eager to discuss issues surrounding nutrition and the need for policy intervention. In comparison, they infrequently discussed tobacco and often did so only after interviewer prompting. This relative lack of emphasis on tobacco may reflect social desirability bias (smoking is illicit, stigmatized behavior among youth participants) or it may reflect that the youth are in the "pre-contemplation" stage described by the Transtheoretical model. Philadelphia youth may be primed and ready for change regarding nutrition but may not have yet considered tobacco prevention as an important personal or community health goal.