Leveraging Tax Policy to Improve Child Health In Low- Resourced Schools in Tucson, Arizona

Abstract

BACKGROUND: This dissertation builds on Activate Tucson efforts to identify drivers of childhood obesity in Tucson, Arizona. After mapping the drivers, tax policy emerged as part of a policy, systems, and environmental (PSE) change strategy to improve health equity and health programming in schools. The Public School Tax Credit (PSTC) in A.R.S. § 43-1089.01 is a potential mechanism to improve child health and wellness and address drivers of childhood obesity. Early in the dissertation, Activate Tucson partnered with a tax and accounting firm to create awareness campaign assets intended to bring PSTC funding to a low-resourced, partner school.OBJECTIVES: The dissertation project had three aims. The primary aim was to design, implement and evaluate a pilot study. The study sought to determine feasibility of undertaking a larger study to assess the pilot initiative and to understand tax and accounting professionals’ knowledge regarding the PSTC, their engagement with clients about the PSTC, and to identify opportunities to improve education and awareness of resources available to this population and the public. The second aim was to use implementation science best practice, public health theory and education framework to create an implementation guide for Activate Tucson to use to expand efforts to leverage tax policy to support child health in more low-resourced schools. The final aim was to analyze A.R.S. § 43-1089.01 and provide recommendations to improve equitable distribution of PSTC dollars thereby increasing opportunities to improve child health. METHODS: Practical Robust Implementation Sustainability Model was used to ground the mixed method study. A survey and semi-structured interviews were used to analyze the reach, effectiveness, implementation, adoption and maintenance of the study and provide insights into how to improve the study design and expand the underlying intervention. Implementation science best practices were followed to develop the implementation guide and the policy analysis following the CDC Policy Process. RESULTS: The results of the pilot study indicated that with recommended adjustments, the study can and should be conducted at a larger scale. Additionally, there is interest and justification for focusing additional resources on improving and expanding efforts to leverage tax policy to support child health and wellness in low-resourced schools. Qualitative findings suggest that the opportunity exists to partner with tax and accounting professionals to support the intervention efforts and use of a novel multi-sector approach to address childhood obesity in Tucson, Arizona and share findings with other states. The implementation guide provides information on expanding and tailoring the pilot intervention. The policy analysis has recommendations to inform Activate Tucson’s advocacy efforts to improve the statute. CONCLUSION: Opportunities exist for Activate Tucson to use these findings and deliverables to improve ongoing efforts to address drivers of childhood obesity in Tucson, Arizona. These findings can also be used to address drivers of childhood obesity in other areas within the state. These deliverables can be used to support Activate Tucson’s efforts to improve the underlying PSTC policy.