Health Policy

Calorie Labeling and Consumer Estimation of Calories Purchased.

Calorie Labeling and Consumer Estimation of Calories Purchased.
Taksler GB, Elbel B. Calorie Labeling and Consumer Estimation of Calories Purchased. International Journal of Behavioral Nutrition and Physical Activity. 2014; 11: 91.

Taksler GB, Elbel B.
09/10/2015

BACKGROUND:

Studies rarely find fewer calories purchased following calorie labeling implementation. However, few studies consider whether estimates of the number of calories purchased improved following calorie labeling legislation.

FINDINGS:

Researchers surveyed customers and collected purchase receipts at fast food restaurants in the United States cities of Philadelphia (which implemented calorie labeling policies) and Baltimore (a matched comparison city) in December 2009 (pre-implementation) and June 2010 (post-implementation). A difference-in-difference design was used to examine the difference between estimated and actual calories purchased, and the odds of underestimating calories.Participants in both cities, both pre- and post-calorie labeling, tended to underestimate calories purchased, by an average 216-409 calories. Adjusted difference-in-differences in estimated-actual calories were significant for individuals who ordered small meals and those with some college education (accuracy in Philadelphia improved by 78 and 231 calories, respectively, relative to Baltimore, p = 0.03-0.04). However, categorical accuracy was similar; the adjusted odds ratio [AOR] for underestimation by >100 calories was 0.90 (p = 0.48) in difference-in-difference models. Accuracy was most improved for subjects with a BA or higher education (AOR = 0.25, p < 0.001) and for individuals ordering small meals (AOR = 0.54, p = 0.001). Accuracy worsened for females (AOR = 1.38, p < 0.001) and for individuals ordering large meals (AOR = 1.27, p = 0.028).

CONCLUSIONS:

We concluded that the odds of underestimating calories varied by subgroup, suggesting that at some level, consumers may incorporate labeling information.

Corner store purchases in a low-income urban community in NYC.

Corner store purchases in a low-income urban community in NYC.
Kiszko K, Cantor J, Abrams C, Ruddock C, Moltzen K, Devia C, McFarline B, Singh H, Elbel B. Corner store purchases in a low-income urban community in NYC. Journal of Community Health. In press.

Kiszko K, Cantor J, Abrams C, Ruddock C, Moltzen K, Devia C, McFarline B, Singh H, Elbel B.
09/10/2015

We assessed purchases made, motivations for shopping, and frequency of shopping at four New York City corner stores (bodegas). Surveys and purchase inventories (n = 779) were collected from consumers at four bodegas in Bronx, NY. We use Chi square tests to compare types of consumers, items purchased and characteristics of purchases based on how frequently the consumer shops at the specific store and the time of day the purchase was made. Most consumers shopped at the bodega because it was close to their home (52 %). The majority (68 %) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27 %), sugary snacks (22.34 %), coffee, (13.99 %), sandwiches, (13.09 %) and non-baked potato chips (12.2 %). Nearly 60 % of bodega customers reported their purchase to be healthy. Most of the participants shopped at the bodega frequently, valued its convenient location, and purchased unhealthy items. Work is needed to discover ways to encourage healthier choices at these stores.

Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance.

Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance.
13. Lee DC, Long JA, Wall SP, Braithwaite RS, Elbel B. Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance. American Journal of Public Health. In press.

Lee DC, Long JA, Wall SP, Braithwaite RS, Elbel B.
09/10/2015

Development and Evaluation of the US Healthy Food Diversity Index.

Development and Evaluation of the US Healthy Food Diversity Index.
Vadiveloo M, Dixon LB, Mijanovich T, Elbel B, Parekh N. Development and Evaluation of the US Healthy Food Diversity Index. British Journal of Nutrition. 2014; 112(9): 1562-1574.

Vadiveloo M, Dixon LB, Mijanovich T, Elbel B, Parekh N.
09/10/2015

Varied diets are diverse with respect to diet quality, and existing dietary variety indices do not capture this heterogeneity. We developed and evaluated the multidimensional US Healthy Food Diversity (HFD) index, which measures dietary variety, dietary quality and proportionality according to the 2010 Dietary Guidelines for Americans (DGA). In the present study, two 24 h dietary recalls from the 2003-6 National Health and Nutrition Examination Survey (NHANES) were used to estimate the intake of twenty-six food groups and health weights for each food group were informed by the 2010 DGA. The US HFD index can range between 0 (poor) and 1 - 1/n, where n is the number of foods; the score is maximised by consuming a variety of foods in proportions recommended by the 2010 DGA. Energy-adjusted Pearson's correlations were computed between the US HFD index and each food group and the probability of adequacy for fifteen nutrients. Linear regression was run to test whether the index differentiated between subpopulations with differences in dietary quality commonly reported in the literature. The observed mean index score was 0·36, indicating that participants did not consume a variety of healthful foods. The index positively correlated with nutrient-dense foods including whole grains, fruits, orange vegetables and low-fat dairy (r 0·12 to 0·64) and negatively correlated with added sugars and lean meats (r - 0·14 to - 0·23). The index also positively correlated with the mean probability of nutrient adequacy (r 0·41; P< 0·0001) and identified non-smokers, women and older adults as subpopulations with better dietary qualities. The US HFD index may be used to inform national dietary guidance and investigate whether healthful dietary variety promotes weight control.

Dietary Variety is Inversely Associated with Body Adiposity among US Adults Using a Novel Food Diversity Index.

Dietary Variety is Inversely Associated with Body Adiposity among US Adults Using a Novel Food Diversity Index.
Vadiveloo M, Dixon LB, Mijanovich T, Elbel B, Parekh N. Dietary Variety is Inversely Associated with Body Adiposity among US Adults Using a Novel Food Diversity Index. Journal of Nutrition. 2015; 145(3): 555-563.

Vadiveloo M, Dixon LB, Mijanovich T, Elbel B, Parekh N.
09/10/2015

BACKGROUND:

Consuming a variety (vs. monotony) of energy-poor, nutrient-dense foods may help individuals adhere to dietary patterns favorably associated with weight control.

OBJECTIVE:

The objective of this study was to examine whether greater healthful food variety quantified using the US Healthy Food Diversity (HFD) index favorably influenced body adiposity.

METHODS:

Men and nonpregnant, nonlactating women aged ≥20 y with two 24-h recalls from the cross-sectional NHANES 2003-2006 (n = 7470) were included in this study. Dietary recalls were merged with the MyPyramid Equivalent database to generate the US HFD index, which ranges from 0 to ∼1, with higher scores indicative of diets with a higher number and proportion of healthful foods. Multiple indicators of adiposity including BMI, waist-to-height ratio, android-to-gynoid fat ratio, fat mass index (FMI), and percentage body fat were assessed across US HFD index quintiles. ORs and 95% CIs were computed with use of multivariable logistic regression (SAS v. 9.3).

RESULTS:

The US HFD index was inversely associated with most adiposity indicators in both sexes. After multivariable adjustment, the odds of obesity, android-to-gynoid ratio >1, and high FMI were 31-55% lower (P-trend < 0.01) among women in quintile 5 vs. quintile 1 of the US HFD index. Among men, the odds of obesity, waist-to-height ratio ≥0.5, and android-to-gynoid ratio >1 were 40-48% lower (P-trend ≤ 0.01) in quintile 5 vs. quintile 1 of the US HFD index.

CONCLUSIONS:

Higher US HFD index values were inversely associated with indicators of body adiposity in both sexes, indicating that greater healthful food variety may protect against excess adiposity. This study explicitly recognizes the potential benefits of dietary variety in obesity management and provides the foundation to support its ongoing evaluation.

Spending at Mobile Fruit and Vegetable Carts and Using SNAP Benefits to Pay, Bronx, New York, 2013 and 2014.

Spending at Mobile Fruit and Vegetable Carts and Using SNAP Benefits to Pay, Bronx, New York, 2013 and 2014.
12. Breck A, Kiszko K, Abrams C, Elbel B. Spending at Mobile Fruit and Vegetable Carts and Using SNAP Benefits to Pay, Bronx, New York, 2013 and 2014. Preventing Chronic Disease. 2015; 12: E87.

Breck A, Kiszko K, Abrams C, Elbel B.
09/10/2015

This study examines purchases at fruit and vegetable carts and evaluates the potential benefits of expanding the availability of electronic benefit transfer machines at Green Carts. Customers at 4 Green Carts in the Bronx, New York, were surveyed in 3 waves from June 2013 through July 2014. Customers who used Supplemental Nutrition Assistance Program benefits spent on average $3.86 more than customers who paid with cash. This finding suggests that there may be benefits to increasing the availability of electronic benefit transfer machines at Green Carts.

Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations

Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations
Levin, I., Sinclair, J. A., & Alvarez, R. M. (2015). Participation in the Wake of Adversity: Blame Attribution and Policy-Oriented Evaluations. Political Behavior, 1-26.

Levin, Ines and J. Andrew Sinclair and R. Michael Alvarez
09/05/2015

In this paper we investigate to what extent perceptions of economic conditions, policy-oriented evaluations, and blame attribution affected Californians’ involvement in political activities in 2010. We use a statistical methodology that allows us to study not only the behavior of the average citizen, but also the behavior of “types” of citizens with latent predispositions that incline them toward participation or abstention. The 2010 election is an excellent case study, because it was a period when citizens were still suffering the consequences of the 2008 financial crisis and many were concerned about the state’s budgetary crisis. We find that individuals who blamed one of the parties for the problems with the budget process, and who held a position on the 2010 Affordable Care Act, were often considerably more likely to participate. We also find, however, that the impact of economic evaluations, positions on the health care reform, and blame attributions was contingent on citizens’ latent participation propensities and depended on the class of political activity.

Obamacare, five years after the law (French)

Obamacare, five years after the law (French)
Les Tribunes de la santé; (47): 81-89.

Rodwin, VG.
07/24/2015

Obamacare is the most important reform in the American healthcare system since 1965. Its introduction provoked unprecedented controversy between republicans and democrats. Whilst much remains to be done, it has already helped extend health insurance coverage, change the way the healthcare system is funded, establish federal regulations for private insurance, and above all, promote innovation and experiments to modernize the healthcare delivery. Seen from France, it is interesting to follow the array of ongoing experiments in the United States intended to modernize the healthcare system: adaptations to the payment systems for hospitals and doctors and organizational innovations to improve healthcare delivery.

Pages

Subscribe to Health Policy