Suchergebnisse

AbstractWe investigate the distinct associations between Supplemental Nutrition Assistance Program (SNAP) participation and different experiences of food‐related hardship. Using a generalization of the Rasch model with USDA Economic Research Service 2022 data for 10 adult‐referenced food security survey items, we find evidence of uniform differential item function. The gap in odds of response between the first item (food‐related worry) and the third item (difficulty acquiring balanced meals) was larger for SNAP households than for non‐SNAP households. Similar differences were observed for other survey items. We consider whether SNAP policy or program changes could increase beneficial impacts differentially for particular food‐related hardships.

AbstractWhether direct farmer‐to‐consumer outlets compete with supermarkets on produce prices remains an empirical question; marketing costs are not consistently higher in one retail channel or the other. This study compared prices of 29 fruits and vegetables across North Carolina farmers' markets, roadside stands, and supermarkets. Larger farmers' markets had higher prices: three fruits and one vegetable were cheaper at a direct outlet, while four vegetables were cheaper at supermarkets. Weighting item prices by consumption share attenuated differences in mean price across outlets. Direct‐retail outlets are price competitive and should be considered among other tools to boost fresh fruit and vegetable intake.

BACKGROUND: Excess caloric intake is linked to weight gain, obesity, and related diseases including type 2 diabetes and cardiovascular disease (CVD). Obesity incidence is rising, with nearly 3 in 4 US adults being overweight or obese. In 2018, the US federal government finalized the implementation of mandatory labeling of calorie content on all menu items across major chain restaurants nationally as a strategy to support informed consumer choice, reduce caloric intake, and potentially encourage restaurant reformulations. Yet, the potential health and economic impacts of this policy remain unclear. METHODS: We used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes cases, gains in quality-adjusted life-years (QALYs), costs, and cost-effectiveness of the menu calorie labeling intervention, based on consumer responses alone, and further accounting for potential industry reformulation. The model incorporated nationally representative demographic and dietary data from NHANES 2009–2016; policy effects on consumer diets and BMI-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance and reformulation) and health-related costs (formal and informal healthcare costs, productivity costs) from established sources or reasonable assumptions. We modeled change in calories to change in weight using an established dynamic weight-change model, assuming 50% of expected calorie reductions would translate to long-term reductions. Findings were evaluated over 5 years and a lifetime from healthcare and societal perspectives, with uncertainty incorporated in both one-way and probabilistic sensitivity analyses. RESULTS: Between 2018–2023, implementation of the restaurant menu calorie labeling law was estimated, based on consumer response alone, to prevent 14,698 new CVD cases (including 1,575 CVD deaths) and 21,522 new type 2 diabetes cases, gaining 8,749 QALYs. Over a lifetime, corresponding values ...

BACKGROUND-: Sugar-sweetened beverage (SSB) taxes are a rapidly growing policy tool and can be based on absolute volume, sugar content tiers, or absolute sugar content. Yet, their comparative health and economic impacts have not been quantified, in particular tiered or sugar content taxes that provide industry incentives for sugar reduction. METHODS-: We estimated incremental changes in diabetes and cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs, and cost-effectiveness of three SSB tax designs in the United States, based on (1) volume ($0.01/oz.), (2) tiers (20 g/8 oz.: $0.02/oz.), and (3) absolute sugar content ($0.01/tsp added sugar), each compared to a base case of modest ongoing voluntary industry reformulation. A validated microsimulation model, CVD-PREDICT, incorporated national demographic and dietary data from NHANES; policy effects and SSB-related diseases from meta-analyses; and industry reformulation and health-related costs from established sources. RESULTS-: Over a lifetime, the volume, tiered, and absolute sugar content taxes would generate $80.4 billion, $142 billion, and $41.7 billion in tax revenue, respectively. From a healthcare perspective, the volume tax would prevent 850,000 CVD (95% CIs: 836,000–864,000) and 269,000 diabetes (265,000–274,000) cases, gain 2.44 million QALYs (2.40–2.48), and save $53.2 billion net costs (52.3–54.1). Health gains and savings were approximately doubled for the tiered and absolute sugar content taxes. Results were robust across for societal and government perspectives, at 10 years follow-up, and with lower (50%) tax pass-through. Health gains were largest in young adults, Blacks and Hispanics, and lower income Americans. CONCLUSIONS-: All SSB tax designs would generate substantial health gains and savings; tiered and absolute sugar content taxes should be considered and evaluated for maximal potential gains.

BACKGROUND: Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. Although SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. METHODS: We used the Diet and Cancer Outcome Model, a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults aged 20 years and older by income. RESULTS: A national SSB tax was estimated to prevent 22 075 (95% uncertainty interval [UI] = 16 040-28 577) new cancer cases and 13 524 (95% UI = 9841-17 681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50-$1.95) billion for government implementation and $1.70 (95% UI = $1.48-$1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67-$2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1486, 95% UI = -$3516-$9265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13 220, 95% UI = $3453-$28 120 per QALY). Approximately 4800 more cancer cases and 3100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤ 1.85) than higher-income individuals (FPIR > 1.85). CONCLUSIONS: A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the United States, with the largest health gains and economic benefits among low-income Americans.