An economic analysis of community-level fast food prices and individual-level fast food intake: a longitudinal study

Neighborhood and Behavioral Effects on Weight Change Across Immigrant Generations: Evidence from the National Longitudinal Study of Adolescent to Adult Health (Add Health)

BACKGROUND

Childhood obesity is a global problem that disproportionately affects minority populations in the USA. Relative to all US-born individuals, some foreign-born populations also experience higher obesity risk. Prior research focuses on the role of healthy behaviors in increasing obesity risk, but the neighborhoods in which individuals reside shape those behaviors. The aim of this study is to examine how changes in health behaviors and neighborhood characteristics affect weight change across immigrant generational groups.

METHODS

The study uses a prospective longitudinal cohort of 3,506 adolescents first interviewed in 1994 (The National Longitudinal Study of Adolescent to Adult Health). To examine the relationship between immigrant generational status and weight change over time while considering healthy behaviors and the neighborhood environment, this research relies on linear multilevel methods.

RESULTS

Neighborhood disadvantage, not health behaviors, has a significant effect on weight change - for both first-generation Asians (β = 1.52; p < 0.001) and Latinxs across all immigrant generations. In neighborhoods where residents do not engage in much exercise, the role that one's level of physical activity plays in weight change is lower than in places where residents engage in much exercise, irrespective of immigrant generation.

CONCLUSION

These findings provide some evidence that neighborhood features and physical activity in the neighborhood may curb obesity risk among adolescents and young adults. The results can inform urban planning efforts and community-based interventions to increase physical activity across ethnic minority populations.

Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: an umbrella review of a global perspective

BACKGROUND

As part of the Global Strategy on Oral health, the World Health Organization (WHO) is exploring cost-effective interventions for oral health, including taxation on sugar-sweetened beverages (SSBs). To inform this process, this umbrella review aimed to identify the best available estimates pertaining to the impact of SSB taxation on the reduction of sugars intake, and the sugars-caries dose-response, such that estimates of the impact of SSB taxation on averting dental caries in both high (HIC) and low and middle (LMIC) countries be available.

METHODS

The questions addressed were: (1) what are the effects of SSB taxation on consumption of SSBs and (2) sugars? (3) What is the effect on caries of decreasing sugars? and (4) what is the likely impact of a 20% volumetric SSB tax on the number of active caries prevented over 10 years? Data sources included PubMed, Embase, Web of Science, Scopus, CINAHL, Dentistry and Oral Sciences Source, Cochrane Library, Joanna Briggs Institute (JBI) Systematic Review Register, and PROSPERO. The review was conducted with reference to JBI guidelines. The quality of included systematic reviews was assessed using AMSTAR to identify best evidence.

RESULTS

From 419 systematic reviews identified for questions 1 & 2, and 103 for question 3, 48 (Questions 1 & 2) and 21 (Question 3) underwent full text screening, yielding 14 and five included reviews respectively. Best available data indicated a 10% tax would reduce SSB intake by 10.0% (95% CI: -5.0, 14.7%) in HIC and by 9% (range -6.0 to 12.0%) in LMIC, and that a 20% tax would reduce free sugars intake on average by 4.0 g/d in LMIC and 4.4 g/d in HIC. Based on best available dose response data, this could reduce the number of teeth with caries per adults (HIC and LMIC) by 0.03 and caries occurrence in children by 2.7% (LMIC) and 2.9% (HIC), over a 10-year period.

CONCLUSION

Best available data suggest a 20% volumetric SSB tax would have a modest impact on prevalence and severity of dental caries in both HIC and LMIC.

Biopreservative efficacy of grape (Vitis vinifera) and clementine mandarin orange (Citrus reticulata) by-product extracts in raw ground beef patties

Beef patties were treated with 450 μg/g of extracts from grape (Vitis vinifera) seeds (GSE), pomace (GPE) or orange (Citrus reticulata) pomace (OPE) and compared to negative (no extract; CTR) and positive (sodium metabisulphite; SMB) controls for their effect on colour, lipid and protein oxidation and bacterial growth under simulated retail display conditions (4 °C) for 9 d, and sensory quality. Antioxidant activity and redness of beef patties increased in the order of CTR < OPE = GPE < GSE < SMB. The order of thiobarbituric acid reactive substances and carbonyl values were CTR > GPE = OPE > GSE > SBM, while that of bacterial counts were CTR > GSE = GPE > OPE > SMB. Retail display period had significant effect on all the shelf-life parameters. Overall, intensity of aroma, beef-like aroma and flavour in beef patties were highest in OPE. Results suggested that GSE and OPE could be commercially valorised as natural antioxidants and antibacterials in beef patties, respectively.

Using Restaurant POI Data to Explore Regional Structure of Food Culture Based on Cuisine Preference

As a result of the influence of geographical environment and historical heritage, food preference has significant regional differentiation characteristics. However, the spatial structure of food culture represented by the cuisine culture at the regional level has not yet been explored from the perspective of geography. Cultural regionalization is an important way to analyze and understand the spatial structure of food culture. It is of great significance to deeply mine intra-regional homogeneity and scientifically cognize inter-regional cultural characteristics. This study aims to explore such patterns by focusing on the restaurants of the eight most famous cuisines in Mainland China. Initially, the density based geospatial hotspot detector method is proposed to analyze and mapping the spatial quantitative characteristics of the eight major cuisines. A heuristic method for geographical regionalization based on machine learning was used to analyze spatial distribution patterns in accordance with the proportion of these cuisines in each prefecture-level city. Results show that some types of single-category cuisines have a stronger spatial concentration effect in the present, whereas others have a strong diffusion trend. In the comprehensive analysis of multicategory cuisines, the eight major cuisines formed a new structure of geographical regionalization of Chinese cuisine culture. This study is helpful to understand regional structure characteristics of food preference, and the density-based hotspot detector proposed in this paper can also be used in the analysis of other type of point of interest (POI) data.

Associations of early adulthood life transitions with changes in fast food intake: a latent trajectory analysis

BACKGROUND

Early adulthood is a period of rapid personal development when individuals experience major life transitions (e.g. leaving the parental home, leaving education, beginning employment, cohabitation and parenthood). Changes in social and physical environments associated with these transitions may influence development of health-related behaviours. Consumption of fast food is one behaviour associated with poor diet and long-term health outcomes. In this study we assess how frequency of fast food consumption changes across early adulthood, and how major life transitions are associated with changes in fast food intake.

METHODS

Data were collected across four waves of the Project EAT study, from mean age 14.9 (SD = 1.6) to mean age 31.1 (SD = 1.6) years. Participants reporting data at two or more waves were included (n = 2902). Participants reported past week frequency of eating food from a fast food restaurant and responded to questions on living arrangements, education and employment participation, and having children. To assess changes in fast food we developed a latent growth model incorporating an underlying trajectory of fast food intake, five life transitions, and time-invariant covariates.

RESULTS

Mean fast food intake followed an underlying quadratic trajectory, increasing through adolescence to a maximum of 1.88 (SE 0.94) times/week and then decreasing again through early adulthood to 0.76 (SE 2.06) times/week at wave 4. Beginning full-time employment and becoming a parent both contributed to increases in fast food intake, each resulting in an average increase in weekly fast food intake of 0.16 (p < 0.01) times/week. Analysis of changes between pairs of waves revealed stronger associations for these two transitions between waves 1-2 (mean age 14.9-19.4 years) than seen in later waves. Leaving the parental home and beginning cohabitation were associated with decreases in fast food intake of - 0.17 (p = 0.004) and - 0.16 (p = 0.007) times/week respectively, while leaving full-time education was not associated with any change.

CONCLUSIONS

The transitions of beginning full-time employment and becoming a parent were associated with increases in fast food intake. Public health policy or interventions designed to reduce fast food intake in young adults may benefit from particular focus on populations experiencing these transitions, to ameliorate their impact.

Improvements in the nutritional quality of US young adults based on food sources and socioeconomic status between 1989-1991 and 2011-2014

BACKGROUND

Fast food and other away from home food sources are linked with poorer diet quality and adverse health outcomes. The diet quality of young adults, major consumers of fast food, is understudied in terms of long-term shifts based on food sources for key subpopulation disparities.

METHODS

The study included young adults ages 18-39 (n = 8012) from the Continuing Survey of Food Intakes by Individuals 1989-1991 (n = 4217) and the National Health and Nutrition Examination Survey 2011-2012 and 2013-2014 (n = 3795). We stratified individuals based on their combination of food sources, race/ethnicity, and socioeconomic status. Using 24-h dietary recall data, we measured diet quality with the Healthy Eating Index-2015 (HEI-2015). Differences in diet quality were determined using 95% confidence intervals.

RESULTS

Overall, diet quality increased across all food sources between the 1989-1991 and 2011-2014 surveys. The restaurant category overtook the at home category as the healthiest food source, while the fast food category remained the unhealthiest on days it was consumed. Vegetable intake decreased, while added sugar intake increased across all sources. Non-Hispanic whites and non-Hispanic blacks experienced similar increases in HEI-2015 scores across all food sources except restaurants, while Mexican American diet quality remained unchanged. Although all income levels experienced an increase in diet quality, the disparity between low- and high-income groups increased considerably.

CONCLUSIONS

US young adults consume healthier foods from all food sources, however, fast food consumers have significantly lower quality in the remainder of their diets. Additionally, Mexican Americans and low-income individuals emerge as high-risk groups for poor diet quality.

Improving Healthy Eating and the Bottom Line: Impact of a Price Incentive Program in 2 Hospital Cafeterias

PURPOSE

To evaluate the impact of a health-promoting price intervention on food sales and profit.

DESIGN

Nonrandomized evaluation study.

SETTING

Two hospital cafeterias.

PARTICIPANTS

Hospital employees (2800) were the priority population.

INTERVENTION

During baseline phase, healthy versions of existing unhealthy items were introduced. The intervention phase included marketing and price incentives/disincentives for healthy and unhealthy items, with a 35% price differential.

MEASURES

Average and proportional change in sales and impact on financial outcomes were assessed.

ANALYSIS

Two-way factorial analyses of variance and two-proportion Z-score tests were run to assess change in sales. Independent samples t tests were used to test for changes in profit.

RESULTS

Significant impact was demonstrated on all burger sales in the desired direction during intervention (P < .001). Most notably, the average weekly turkey burger sales at Penrose Hospital (PH) increased 13-fold (10.85-145.59) and became the majority of the market share (51.8%, P < .001). For salads, significant interaction between phase and food type was found at St. Francis Medical Center (SFMC) (P = .002) but not at PH (P = .304). Healthy PH salads were popular at baseline and intervention, comprising the majority of the market share throughout the entire study (68.4%-70.2%, respectively, P = .238). Cafeteria gross sales and burger profit (P < .001) increased at both cafeterias.

CONCLUSION

Incentivizing consumers through price interventions changed hospital cafeteria food sales in the desired direction while improving the bottom line.

[Mortality due to hypertensive diseases: evidence from the southern border of Mexico in the period 1998-2014]

This article analyzes patterns of mortality due to hypertensive diseases in the southern border of Mexico, as well as the evolution of such mortality in the 1998-2014 period. The emphasis is directed at the causes "Essential (primary) hypertension" (I10X) and "Hypertensive heart disease with heart failure" (I110). Using data from the mortality records of the National Health Information System, two types of analyses were carried out: cross-sectional analysis and time trends. Over the 16 years included in the study, the age-adjusted mortality rates show a clear increase. The findings suggest that the higher presence of indigenous populations is a trait of importance in the determination of the mortality pattern, with the state of Yucatán a case of particular interest. In addition, it is the female population that which exhibits the greatest adverse impact.

Change in diet in the period from adolescence to early adulthood: a systematic scoping review of longitudinal studies

BACKGROUND

Late adolescence to early adulthood is a period of lifestyle change and personal development which may influence dietary behaviour. Understanding dietary trajectories across this age range may help in targeting interventions appropriately. This scoping review aimed to assess how longitudinal change in diet is conceptualised and measured between the ages of 13 to 30.

METHODS

We searched Medline, SCOPUS, Embase, PsycInfo (EBSCO), ASSIA, Sportdiscus, and Web of Science Core Collection (January 2016) using search terms combining diet outcomes, longitudinal methods and indicators of adolescent or young adult age. Titles and abstracts were screened and data extracted following published guidelines for scoping reviews. Data were analysed to summarize key data on each study and map availability of longitudinal data on macronutrients and food groups by age of study participants.

RESULTS

We identified 98 papers reporting on 40 studies. Longitudinal dietary data were available on intake of energy, key macronutrients and several food groups, but this data had significant gaps and limitations. Most studies provided only two or three waves of data within the age range of interest and few studies reported data collected beyond the early twenties. A range of dietary assessment methods were used, with greater use of less comprehensive dietary assessment methods among studies reporting food group intakes.

CONCLUSION

Despite limited availability of longitudinal data to aid understanding of dietary trajectories across this age range, this scoping review identified areas with scope for further evidence synthesis. We identified a paucity of longitudinal data continuing into the mid and late twenties, variability in (quality of) dietary assessment methods, and a large variety of macronutrients and food groups studied. Advances in dietary assessment methodologies as well as increased use of social media may facilitate new data collection to further understanding of changing diet across this life stage.

The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis

Background

While food pricing is a promising strategy to improve diet, the prospective impact of food pricing on diet has not been systematically quantified.

Objective

To quantify the prospective effect of changes in food prices on dietary consumption.

Design

We systematically searched online databases for interventional or prospective observational studies of price change and diet; we also searched for studies evaluating adiposity as a secondary outcome. Studies were excluded if price data were collected before 1990. Data were extracted independently and in duplicate. Findings were pooled using DerSimonian-Laird's random effects model. Pre-specified sources of heterogeneity were analyzed using meta-regression; and potential for publication bias, by funnel plots, Begg's and Egger's tests.

Results

From 3,163 identified abstracts, 23 interventional studies and 7 prospective cohorts with 37 intervention arms met inclusion criteria. In pooled analyses, a 10% decrease in price (i.e., subsidy) increased consumption of healthful foods by 12% (95%CI = 10–15%; N = 22 studies/intervention arms) whereas a 10% increase price (i.e. tax) decreased consumption of unhealthful foods by 6% (95%CI = 4–8%; N = 15). By food group, subsidies increased intake of fruits and vegetables by 14% (95%CI = 11–17%; N = 9); and other healthful foods, by 16% (95%CI = 10–23%; N = 10); without significant effects on more healthful beverages (-3%; 95%CI = -16-11%; N = 3). Each 10% price increase reduced sugar-sweetened beverage intake by 7% (95%CI = 3–10%; N = 5); fast foods, by 3% (95%CI = 1–5%; N = 3); and other unhealthful foods, by 9% (95%CI = 6–12%; N = 3). Changes in price of fruits and vegetables reduced body mass index (-0.04 kg/m² per 10% price decrease, 95%CI = -0.08–0 kg/m²; N = 4); price changes for sugar-sweetened beverages or fast foods did not significantly alter body mass index, based on 4 studies. Meta-regression identified direction of price change (tax vs. subsidy), number of intervention components, intervention duration, and study quality score as significant sources of heterogeneity (P-heterogeneity<0.05 each). Evidence for publication bias was not observed.

Conclusions

These prospective results, largely from interventional studies, support efficacy of subsidies to increase consumption of healthful foods; and taxation to reduce intake of unhealthful beverages and foods. Use of subsidies and combined multicomponent interventions appear most effective.

Fast food price, diet behavior, and cardiometabolic health: Differential associations by neighborhood SES and neighborhood fast food restaurant availability in the CARDIA study

Little research has addressed whether neighborhood context influences associations between fast food price, diet, and cardiometabolic health. We investigated these associations using 25 years of Coronary Artery Risk Development in Young Adults (CARDIA) study data (n=4,469, observations=21,134). We found a negative association between fast food price and consumption, with stronger inverse associations in more (vs. less) deprived neighborhoods [3rd tertile: β=-0.68 (95% CI: (-0.85, -0.51); 1st tertile: β=-0.22 (95% CI: -0.42, -0.02); p-interaction-0.002], and a similar association for BMI [3rd tertile: β=-1.34 (95% CI: -1.54, -1.14); 1st tertile: β=-0.45 (95% CI: -0.66, -0.25); p-interaction<0.001], but not insulin resistance [3rd tertile: β=-0.07 (95% CI: -0.24, 0.09); 1st tertile: β=0.09 (95% CI: -0.08, 0.26); p-interaction=0.40]. We observed no modification of fast food price by fast food availability. Future research on obesity disparities should consider potential differences in the association between fast food prices and health outcomes across neighborhood socioeconomic levels.

Food Away from Home and Childhood Obesity

Childhood obesity is associated with a number of serious health risks that can persist into adulthood. While trends in food away from home and fast-food consumption have paralleled trends in childhood obesity, it is important to identify whether this is a causal relationship. This paper reviews recent literature in this area to summarize if there is a consensus in research findings. We group the literature into two areas - consumption of and access to food away from home (FAFH). While no consensus findings have been reached in either area, the evidence of an association between FAFH consumption and childhood obesity has gained strength. Further, there is evidence that FAFH meals add calories to children's diets. The literature on the role of FAFH access and childhood obesity has continued producing mixed results.

Sociodemographic differences in fast food price sensitivity

IMPORTANCE

Fiscal food policies (eg, taxation) are increasingly proposed to improve population-level health, but their impact on health disparities is unknown.

OBJECTIVE

To estimate subgroup-specific effects of fast food price changes on fast food consumption and cardiometabolic outcomes.

DESIGN, SETTING, AND PARTICIPANTS

Twenty-year follow-up (5 examinations) in a biracial US prospective cohort: Coronary Artery Risk Development in Young Adults (CARDIA) (1985/1986-2005/2006, baseline N = 5115). Participants were aged 18 to 30 years at baseline; design indicated equal recruitment by race (black vs white), educational attainment, age, and sex. Community-level price data from the Council for Community and Economic Research were temporally and geographically linked to study participants' home address at each examination.

MAIN OUTCOMES AND MEASURES

Participant-reported number of fast food eating occasions per week, body mass index (BMI), and homeostasis model assessment insulin resistance (HOMA-IR) from fasting glucose and insulin concentrations. Covariates included individual-level and community-level social and demographic factors.

RESULTS

In repeated measures regression analysis, multivariable-adjusted associations between fast food price and consumption were nonlinear (quadratic, P < .001), with significant inverse estimated effects on consumption at higher prices; estimates varied according to race (interaction P = .04), income (P = .07), and education (P = .03). At the 10th percentile of price ($1.25/serving), blacks and whites had mean fast food consumption frequency of 2.20 (95% CI, 2.07-2.33) and 1.55 (1.45-1.65) times/wk, respectively, whereas at the 90th percentile of price ($1.53/serving), respective mean consumption estimates were 1.86 (1.75-1.97) and 1.50 (1.41-1.59) times/wk. We observed differential price effects on HOMA-IR (inverse for lower educational status only [interaction P = .005] and at middle income only [interaction P = .02]) and BMI (inverse for blacks, less education, and middle income; positive for whites, more education, and high income [all interaction P < .001]).

CONCLUSIONS AND RELEVANCE

We found greater fast food price sensitivity on fast food consumption and insulin resistance among sociodemographic groups that have a disproportionate burden of chronic disease. Our findings have implications for fiscal policy, particularly with respect to possible effects of fast food taxes among populations with diet-related health disparities.

Impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package policy on fruit and vegetable prices

Obesity is generally inversely related to income among women in the United States. Less access to healthy foods is one way lower income can influence dietary behaviors and body weight. Federal food assistance programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), are an important source of healthy food for low-income populations. In 2009, as part of a nationwide policy revision, WIC added a fruit and vegetable (F/V) voucher to WIC food packages. This quasi-experimental study determined whether F/V prices at stores authorized to accept WIC (ie, WIC vendors) decreased after the policy revision in seven Illinois counties. It also examined cross-sectional F/V price variations by store type and neighborhood characteristics. Two pre-policy observations were conducted in 2008 and 2009; one post-policy observation was conducted in 2010. Small pre- to post-policy reductions in some F/V prices were found, particularly for canned fruit and frozen vegetables at small stores. Compared with chain supermarkets, mass merchandise stores had lower prices for fresh F/V and frozen F/V and small stores and non-chain supermarkets had higher canned and frozen F/V prices, but lower fresh F/V prices. Limited price differences were found across neighborhoods, although canned vegetables were more expensive in neighborhoods with higher concentrations of either Hispanics or blacks and fresh F/V prices were lower in neighborhoods with more Hispanics. Results suggest the WIC policy revision contributed to modest reductions in F/V prices. WIC participants' purchasing power can differ depending on the type and neighborhood of the WIC vendor used.

Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis

BACKGROUND

Excess intake of sugar sweetened beverages (SSBs) has been shown to result in weight gain. To address the growing epidemic of obesity, one option is to combine programmes that target individual behaviour change with a fiscal policy such as excise tax on SSBs. This study evaluates the literature on SSB taxes or price increases, and their potential impact on consumption levels, obesity, overweight and body mass index (BMI). The possibility of switching to alternative drinks is also considered.

METHODS

The following databases were used: Pubmed/Medline, The Cochrane Database of Systematic Reviews, Google Scholar, Econlit, National Bureau of Economics Research (NBER), Research Papers in Economics (RePEc). Articles published between January 2000 and January 2013, which reported changes in diet or BMI, overweight and/or obesity due to a tax on, or price change of, SSBs were included.

RESULTS

Nine articles met the criteria for the meta-analysis. Six were from the USA and one each from Mexico, Brazil and France. All showed negative own-price elasticity, which means that higher prices are associated with a lower demand for SSBs. Pooled own price-elasticity was -1.299 (95% CI: -1.089 - -1.509). Four articles reported cross-price elasticities, three from the USA and one from Mexico; higher prices for SSBs were associated with an increased demand for alternative beverages such as fruit juice (0.388, 95% CI: 0.009 - 0.767) and milk (0.129, 95% CI: -0.085 - 0.342), and a reduced demand for diet drinks (-0.423, 95% CI: -0.628 - -1.219). Six articles from the USA showed that a higher price could also lead to a decrease in BMI, and decrease the prevalence of overweight and obesity.

CONCLUSIONS

Taxing SSBs may reduce obesity. Future research should estimate price elasticities in low- and middle-income countries and identify potential health gains and the wider impact on jobs, monetary savings to the health sector, implementation costs and government revenue. Context-specific cost-effectiveness studies would allow policy makers to weigh these factors.

A systematic review of the effectiveness of taxes on nonalcoholic beverages and high-in-fat foods as a means to prevent obesity trends

BACKGROUND

As part of the efforts to curb obesity, a new focus seems to be put on taxing foods that are perceived as being associated with obesity (eg, sugar-sweetened beverages and foods high in fat, sugar, and salt content) as a policy instrument to promote healthier diets.

OBJECTIVE

To assess the possible effects of such taxation policies by identifying and analyzing all studies which investigate the impact of price increases on consumption, caloric intake, or weight outcomes.

METHODS

Electronic data bases were searched with appropriate terms and their combinations. Thereafter, abstracts were reviewed and studies were selected based on predefined criteria. The characteristics of the selected studies and the results were extracted in a special form and consequently were reviewed and synthesized.

RESULTS

Price increase may lead to a reduction in consumption of the targeted products, but the subsequent effect on caloric intake may be much smaller. Only a limited number of the identified studies reported weight outcomes, most of which are either insignificant or very small in magnitude to make any improvement in public health.

CONCLUSION

The effectiveness of a taxation policy to curb obesity is doubtful and available evidence in most studies is not very straightforward due to the multiple complexities in consumer behavior and the underling substitution effects. There is need to investigate in-depth the potential underlying mechanisms and the relationship between price-increase policies, obesity, and public health outcomes.

Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment?

This review summarises the evidence for inequalities in community and consumer nutrition environments from ten previous review articles, and also assesses the evidence for the effect of the community and consumer nutrition environments on dietary intake. There is evidence for inequalities in food access in the US but trends are less apparent in other developed countries. There is a trend for greater access and availability to healthy and less healthy foods relating to better and poorer dietary outcomes respectively. Trends for price show that higher prices of healthy foods are associated with better dietary outcomes. More nuanced measures of the food environment, including multidimensional and individualised approaches, would enhance the state of the evidence and help inform future interventions.

Taxing junk food to counter obesity

We examined the advantages and disadvantages of implementing a junk food tax as an intervention to counter increasing obesity in North America. Small excise taxes are likely to yield substantial revenue but are unlikely to affect obesity rates. High excise taxes are likely to have a direct impact on weight in at-risk populations but are less likely to be politically palatable or sustainable. Ultimately, the effectiveness of earmarked health programs and subsidies is likely to be a key determinant of tax success in the fight against obesity.

Price, promotion, and availability of nutrition information: a descriptive study of a popular fast food chain in New York City

Legislation in NYC requires chain restaurants to post calorie information on menu boards in an effort to help consumers make more informed decisions about food and beverage items they are purchasing. While this is a step in the right direction in light of the current obesity epidemic, there are other issues that warrant attention in a fast food setting, namely the pricing of healthy food options, promotional strategies, and access to comprehensive nutrition information. This study focused on a popular fast-food chain in NYC. The study’s aims were threefold: (1) to determine the cost differential between the healthiest meal item on the chain’s general menu and meal items available specifically on a reduced cost menu for one dollar (US$1.00); (2) to identify and describe the promotions advertised in the windows of these restaurants, as well as the nutrition content of promoted items; and (3) to ascertain availability of comprehensive nutrition information to consumers within the restaurants. We found the healthiest meal item to be significantly higher in price than less nutritious meal items available for $1.00 (t = 146.9, p < .001), with the mean cost differential equal to $4.33 (95% CI $4.27, $4.39). Window promotions generally advertised less healthful menu items, which may aid in priming customers to purchase these versus more healthful options. Comprehensive nutrition information beyond calorie counts was not readily accessible prior to purchasing. In addition to improving access to comprehensive nutrition information, advertising more of and lowering the prices of nutritious options may encourage consumers to purchase healthier foods in a fast food setting. Additional research in this area is needed in other geographic locations and restaurant chains.

Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results

BACKGROUND

Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation.

METHODS

To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment.

RESULTS

On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility.

CONCLUSIONS

The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.

More neighborhood retail associated with lower obesity among New York City public high school students

Policies target fast food outlets to curb adolescent obesity. We argue that researchers should examine the entire retail ecology of neighborhoods, not just fast food outlets. We examine the association between the neighborhood retail environment and obesity using Fitnessgram data collected from 94,348 New York City public high school students. In generalized hierarchical linear models, the number of fast food restaurants predicted lower odds of obesity for adolescents (OR:0.972 per establishment; CI:0.957-0.988). In a "placebo test" we found that banks--a measure of neighborhood retail ecology--also predicted lower obesity (OR:0.979 per bank; CI:0.962-0.994). Retail disinvestment might be associated with greater obesity; accordingly, public health research should study the influence of general retail disinvestment not just food-specific investment.

Assessing the potential effectiveness of food and beverage taxes and subsidies for improving public health: a systematic review of prices, demand and body weight outcomes

Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar-sweetened beverages (SSBs), fast food, and fruits and vegetables, as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be -1.21, -0.52, -0.49 and -0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents, suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults, suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.

Does the local food environment around schools affect diet? Longitudinal associations in adolescents attending secondary schools in East London

Background

The local retail food environment around schools may act as a potential risk factor for adolescent diet. However, international research utilising cross-sectional designs to investigate associations between retail food outlet proximity to schools and diet provides equivocal support for an effect. In this study we employ longitudinal perspectives in order to answer the following two questions. First, how has the local retail food environment around secondary schools changed over time and second, is this change associated with change in diet of students at these schools?

Methods

The locations of retail food outlets and schools in 2001 and 2005 were geo-coded in three London boroughs. Network analysis in a Geographic Information System (GIS) ascertained the number, minimum and median distances to food outlets within 400 m and 800 m of the school location. Outcome measures were ‘healthy’ and ‘unhealthy’ diet scores derived from adolescent self-reported data in the Research with East London Adolescents: Community Health Survey (RELACHS). Adjusted associations between distance from school to food retail outlets, counts of outlets near schools and diet scores were assessed using longitudinal (2001–2005 n=757) approaches.

Results

Between 2001 and 2005 the number of takeaways and grocers/convenience stores within 400 m of schools increased, with many more grocers reported within 800 m of schools in 2005 (p< 0.001). Longitudinal analyses showed a decrease of the mean healthy (−1.12, se 0.12) and unhealthy (−0.48, se 0.16) diet scores. There were significant positive relationships between the distances travelled to grocers and healthy diet scores though effects were very small (0.003, 95%CI 0.001 – 0.006). Significant negative relationships between proximity to takeaways and unhealthy diet scores also resulted in small parameter estimates.

Conclusions

The results provide some evidence that the local food environment around secondary schools may influence adolescent diet, though effects were small. Further research on adolescents’ food purchasing habits with larger samples in varied geographic regions is required to identify robust relationships between proximity and diet, as small numbers, because of confounding, may dilute effect food environment effects. Data on individual foods purchased in all shop formats may clarify the frequent, overly simple classification of grocers as ‘healthy’.

Association between activity space exposure to food establishments and individual risk of overweight

OBJECTIVE

Environmental exposure to food sources may underpin area level differences in individual risk for overweight. Place of residence is generally used to assess neighbourhood exposure. Yet, because people are mobile, multiple exposures should be accounted for to assess the relation between food environments and overweight. Unfortunately, mobility data is often missing from health surveys. We hereby test the feasibility of linking travel survey data with food listings to derive food store exposure predictors of overweight among health survey participants.

METHODS

Food environment exposure measures accounting for non-residential activity places (activity spaces) were computed and modelled in Montreal and Quebec City, Canada, using travel surveys and food store listings. Models were then used to predict activity space food exposures for 5,578 participants of the Canadian Community Health Survey. These food exposure estimates, accounting for daily mobility, were used to model self-reported overweight in a multilevel framework. Median Odd Ratios were used to assess the proportion of between-neighborhood variance explained by such food exposure predictors.

RESULTS

Estimates of food environment exposure accounting for both residential and non-residential destinations were significantly and more strongly associated with overweight than residential-only measures of exposure for men. For women, residential exposures were more strongly associated with overweight than non-residential exposures. In Montreal, adjusted models showed men in the highest quartile of exposure to food stores were at lesser risk of being overweight considering exposure to restaurants (OR = 0.36 [0.21-0.62]), fast food outlets (0.48 [0.30-0.79]), or corner stores (0.52 [0.35-0.78]). Conversely, men experiencing the highest proportion of restaurants being fast-food outlets were at higher risk of being overweight (2.07 [1.25-3.42]). Women experiencing higher residential exposures were at lower risk of overweight.

CONCLUSION

Using residential neighbourhood food exposure measures may underestimate true exposure and observed associations. Using mobility data offers potential for deriving activity space exposure estimates in epidemiological models.

Do obesity-promoting food environments cluster around socially disadvantaged schools in Glasgow, Scotland?

Increase in the consumption of food and drinks outside the home by adolescents and young people and associations with rising levels of obesity is a significant concern worldwide and it has been suggested that the food environment around schools may be a contributory factor. As few studies have explored this issue in a UK setting, we examined whether different types of food outlets are clustered around public secondary schools in Glasgow, and whether this pattern differed by social disadvantage. We found evidence of clustering of food outlets around schools but a more complex picture in relation to deprivation was observed. Across all schools there were numerous opportunities for pupils to purchase energy dense foods locally and the implications for policy are discussed.

Associations of television viewing with eating behaviors in the 2009 Health Behaviour in School-aged Children Study

OBJECTIVE

To examine associations of television viewing with eating behaviors in a representative sample of US adolescents.

DESIGN

Cross-sectional survey.

SETTING

Public and private schools in the United States during the 2009-2010 school year.

PARTICIPANTS

A total of 12,642 students in grades 5 to 10 (mean [SD] age, 13.4 [0.09] years; 86.5% participation).

MAIN EXPOSURES

Television viewing (hours per day) and snacking while watching television (days per week).

MAIN OUTCOME MEASURES

Eating (≥1 instance per day) fruit, vegetables, sweets, and sugary soft drinks; eating at a fast food restaurant (≥1 d/wk); and skipping breakfast (≥1 d/wk).

RESULTS

Television viewing was inversely related to intake of fruit (adjusted odds ratio, 0.92; 95% CI, 0.88-0.96) and vegetables (0.95; 0.91-1.00) and positively related to intake of candy (1.18; 1.14-1.23) and fast food (1.14; 1.09-1.19) and skipping breakfast (1.06; 1.02-1.10) after adjustment for socioeconomic factors, computer use, and physical activity. Television snacking was related to increased intake of fruit (adjusted odds ratio, 1.06; 95% CI, 1.02-1.10), candy (1.20; 1.16-1.24), soda (1.15; 1.11-1.18), and fast food (1.09; 1.06-1.13), independent of television viewing. The relationships of television viewing with fruit and vegetable intake and with skipping breakfast were essentially unchanged after adjustment for television snacking; the relationships with intake of candy, soda, and fast food were moderately attenuated. Age and race/ethnicity modified relationships of television viewing with soda and fast food intake and with skipping breakfast.

CONCLUSION

Television viewing was associated with a cluster of unhealthy eating behaviors in US adolescents after adjustment for socioeconomic and behavioral covariates.