Beyond Supermarkets: Food Outlet Location Selection in Four U.S. Cities Over Time

INTRODUCTION

Understanding what influences where food outlets locate is important for mitigating disparities in access to healthy food outlets. However, few studies have examined how neighborhood characteristics influence the neighborhood food environment over time, and whether these relationships differ by neighborhood-level income.

METHODS

Neighborhood-level data from four U.S. cities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA) from 1986, 1993, 1996, 2001, 2006, and 2011 were used with two-step econometric models to estimate longitudinal associations between neighborhood-level characteristics (z-scores) and the log-transformed count/km2 (density) of food outlets within real estate-derived neighborhoods. Associations were examined with lagged neighborhood-level sociodemographics and lagged density of food outlets, with interaction terms for neighborhood-level income. Data were analyzed in 2016.

RESULTS

Neighborhood-level income at earlier years was negatively associated with the current density of convenience stores (β= -0.27, 95% CI= -0.16, -0.38, p<0.001). The percentage of neighborhood white population was negatively associated with fast food restaurant density in low-income neighborhoods (10th percentile of income: β= -0.17, 95% CI= -0.34, -0.002, p=0.05), and the density of smaller grocery stores across all income levels (β= -0.27, 95% CI= -0.45, -0.09, p=0.003). There was a lack of policy-relevant associations between the pre-existing food environment and the current density of food outlet types, including supermarkets.

CONCLUSIONS

Socioeconomically disadvantaged and minority populations may attract "unhealthy" food outlets over time. To support equal access to healthy food outlets, the availability of "less healthy" food outlets types may be relatively more important than the potential lack of supermarkets or full-service restaurants.

In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax

Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. Changes in purchases of taxed and untaxed beverages in the study period were estimated using two models, which compared 2014 and 2015 purchases with predicted (counterfactual) purchases based on trends in 2012-13. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. Households at the lowest socioeconomic level had the largest decreases in purchases of taxed beverages in both years. Purchases of untaxed beverage increased 2.1 percent in the study period. Findings from Mexico may encourage other countries to use fiscal policies to reduce consumption of unhealthy beverages along with other interventions to reduce the burden of chronic disease.

Gains Made By Walmart's Healthier Food Initiative Mirror Preexisting Trends

Healthier food initiatives conducted by national food retailers may offer opportunities to improve the nutritional profile of food purchases. Using a longitudinal data set of packaged food purchases made by US households, we examined the effect of a healthier food initiative officially launched by Walmart in 2011. From 2000 to 2013, household-level purchases of packaged foods at Walmart showed major declines in energy, sodium, and total sugar density, as well as in quantities of sugary beverages, grain-based desserts, snacks, and candy. These trends in packaged food purchases were more pronounced than similar concurrent trends seen at other major food retailers. However, the declines seen at Walmart after the initiative's official implementation did not exceed what would have been expected had pre-implementation trends continued, and therefore they cannot be attributed to the initiative. These results suggest that food retailer-based initiatives that purportedly create a healthier food environment may not suffice to improve the nutritional profile of food purchases. More systemic shifts in consumers' characteristics and preferences may be needed.

Trends in racial/ethnic and income disparities in foods and beverages consumed and purchased from stores among US households with children, 2000-2013

BACKGROUND

It is unclear whether racial/ethnic and income differences in foods and beverages obtained from stores contribute to disparities in caloric intake over time.

OBJECTIVE

We sought to determine whether there are disparities in calories obtained from store-bought consumer packaged goods (CPGs), whether brands (name brands compared with private labels) matter, and if disparities have changed over time.

DESIGN

We used NHANES individual dietary intake data among households with children along with the Nielsen Homescan data on CPG purchases among households with children. With NHANES, we compared survey-weighted energy intakes for 2003-2006 and 2009-2012 from store and nonstore sources by race/ethnicity [non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanic Mexican-Americans) and income [≤185% federal poverty line (FPL), 186-400% FPL, and >400% FPL]. With the Nielsen data, we compared 2000-2013 trends in calories purchased from CPGs (obtained from stores) across brands by race/ethnicity (NHW, NHB, and Hispanic) and income. We conducted random-effect models to derive adjusted trends and differences in calories purchased (708,175 observations from 64,709 unique households) and tested whether trends were heterogeneous by race/ethnicity or income.

RESULTS

Store-bought foods and beverages represented the largest component of dietary intake, with greater decreases in energy intakes in nonstore sources for foods and in store sources for beverages. Beverages from stores consistently decreased in all subpopulations. However, in adjusted models, reductions in CPG calories purchased in 2009-2012 were slower for NHB and low-income households than for NHW and high-income households, respectively. The decline in calories from name-brand food purchases was slower among NHB, Hispanic, and lowest-income households. NHW and high-income households had the highest absolute calories purchased in 2000.

CONCLUSIONS

Across 2 large data sources, we found decreases in intake and purchases of beverages from stores across racial/ethnic and income groups. However, potentially beneficial reductions in calories purchased were more pronounced in some subgroups over others.

Highly Processed and Ready-to-Eat Packaged Food and Beverage Purchases Differ by Race/Ethnicity among US Households

BACKGROUND

Racial/ethnic disparities in dietary quality persist among Americans, but it is unclear whether highly processed foods or convenience foods contribute to these inequalities.

OBJECTIVE

We examined the independent associations of race/ethnicity with highly processed and ready-to-eat (RTE) food purchases among US households. We determined whether controlling for between-group differences in purchases of these products attenuated associations between race/ethnicity and the nutritional quality of purchases.

METHODS

The 2000-2012 Homescan Panel followed US households (n = 157,142) that scanned their consumer packaged goods (CPG) food and beverage purchases. By using repeated-measures regression models adjusted for sociodemographic characteristics, we examined time-varying associations of race/ethnicity with processed and convenience food purchases, expressed as a percentage of calories purchased. We estimated associations between race/ethnicity and saturated fat, sugar, or energy density of total purchases with and without adjustment for processed and convenience food purchases.

RESULTS

Compared with white households, black households had significantly lower purchases of highly processed foods (-4.1% kcal) and RTE convenience foods (-4.9% kcal) and had higher purchases of basic processed foods, particularly cooking oils and sugar (+5.4% kcal), foods requiring cooking/preparation (+4.5% kcal), and highly processed beverages (+7.1% kcal). Hispanics also had lower purchases of highly processed and RTE foods than whites. Blacks had CPG purchases with significantly higher median sugar (+2.2% kcal) and energy density (+72 kcal/1000 g), whereas Hispanics had purchases with lower saturated fat (-0.6% kcal) and energy density (-25 kcal/1000 g) than whites. Racial/ethnic differences remained significant after adjustment for processed and convenience food purchases.

CONCLUSIONS

In our study, compared with white households, both black and Hispanic households had lower purchases of highly processed and RTE foods, yet had total CPG purchases with differing nutritional quality. Our findings suggest that highly processed convenience foods are associated with, but cannot fully explain, racial/ethnic disparities in the nutritional quality of CPG purchases.

US Food Industry Progress During the National Salt Reduction Initiative: 2009-2014

OBJECTIVES

To assess the US packaged food industry's progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years.

METHODS

Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396).

RESULTS

In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001).

CONCLUSIONS

National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest.

PUBLIC HEALTH IMPLICATIONS

The US Food and Drug Administration's proposed voluntary targets will be an important step in achieving more substantial sodium reductions.

The Local Food Environment and Body Mass Index among the Urban Poor in Accra, Ghana

Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries shows that obesity among the poor is partly the result of an obesogenic-built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level 2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level 1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores, and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2 kg/m(2) increase in BMI for every additional convenience store and a 0.1 kg/m(2) reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors, and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.

Age, period and cohort effects on adult physical activity levels from 1991 to 2011 in China

BACKGROUND

To date no work has differentiated the effects of age, period, and cohort on physical activity (PA) among Chinese adults, while also considering biological, behavioral, economic, and environmental factors over time.

METHODS

We used data from the China Health and Nutrition Survey (CHNS) between 1991 and 2011 (20 years). The outcomes of interest are metabolic equivalent of task (MET) hours per week from work and domestic activities. Age, individual characteristics, household size, asset ownership, urbanization were included as covariates. Analyses for adult (≥20y) males (n = 29,343) and females (n = 31,094) was conducted to explicitly assess differences in PA due to age vs period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages.

RESULTS

The mean age of the sample rose from 41.31 to 50.8 years and PA decreased from 427.75 ± 264.35 MET hours per week (MET-hr/wk) in 1991 to 245.99 ± 206.65 MET-hr/wk in 2011, with much steeper declines for women compared to men. For both genders, we found non-linear decreases in PA with age over time. Controlling for age effects, negative period effects on PA were observed in each survey year, and were substantial from 1993 to 2000 for males and from 1993 to 2011 for females. The interaction between survey year and age (P < 0.05) were observed from 2004 to 2011. Higher community urbanicity, vehicle ownership, TV and computer ownership, overweight and obese, higher education served as negative predictors. Bicycle ownership, bigger household size, non-professional jobs, being married and having more children (for women) were positive predictors of PA (P < 0.05). Furthermore, at any given age, individuals who were younger at baseline had higher mean PA compared with individuals older at baseline.

CONCLUSION

This study followed a large cohort of adults over a significant portion of their lives. Strong age and secular trends were observed, resulting in an increasing number of participants who have or are likely to lower their PA levels. These trends suggest that tackling the rapid PA decline among its population is of high priority for China's public health outlook as its population ages and continues to experience significant economic and environmental changes.

Where people shop is not associated with the nutrient quality of packaged foods for any racial-ethnic group in the United States

BACKGROUND

In the literature, it has been suggested that there are race-ethnic disparities in what Americans eat. In addition, some studies have shown that residents of African American and low-income neighborhoods have less access to grocery stores and supermarkets, which tend to stock healthier foods. However, it is unclear whether differences in food shopping patterns contribute to the poorer nutrient profile of food purchases made by racial-ethnic minorities.

OBJECTIVES

We examined whether the mix of food stores where people shop (i.e., food-shopping patterns) was associated with the nutrient profile of packaged food purchases (PFPs) and the types of foods and beverages purchased, and we determined whether these associations differ across racial-ethnic groups.

DESIGN

We used PFPs by US households (Nielsen National Consumer Panel) from 2007 to 2012 and implemented a cluster analysis to categorize households according to their food-shopping patterns. Longitudinal random-effects linear regression models were used to examine the association between food shopping patterns and the nutrient qualities and types of packaged foods and beverages purchased by race-ethnicity in US households.

RESULTS

Shopping primarily at grocery chains was not associated with a better nutrient profile of household PFPs or the food and beverages that households purchased than was shopping primarily at mass merchandisers (value-oriented stores that sell merchandise lines in multiple departments) or at a combination of large and small stores. These results were consistent across racial-ethnic groups. Regardless of where households shopped, non-Hispanic African American households purchased foods with higher energy, total sugar, and sodium densities than did non-Hispanic white and Hispanic households.

CONCLUSION

Policy initiatives that focus on increasing physical access to stores or helping stores sell healthier products to encourage healthier purchases may be ineffective because other factors may be more important determinants of food and beverage purchases than where people shop or what is available in the store.

The Nutrient Content of U.S. Household Food Purchases by Store Type

INTRODUCTION

Little is known about where households shop for packaged foods, what foods and beverages they purchase, and the nutrient content of these purchases. This study describes volume trends and nutrient content (nutrient profiles, food and beverage groups) of household packaged foods purchases (PFPs) by store type.

METHODS

Cross-sectional analysis of U.S. households' PFPs (Nielsen Homescan) from 2000 to 2012 (N=652,023 household-year observations) with survey weights used for national representativeness. Household PFP trends (% volume), household purchases of key food and beverage groups based on caloric contribution, and mean caloric and nutrient densities (sugars, saturated fat, and sodium) of household PFPs were analyzed by store type. Data were collected from 2000 to 2012. Analyses were conducted in 2014-2015.

RESULTS

The proportion of total volume of household PFPs significantly increased from 2000 to 2012 for mass merchandisers (13.1% to 23.9%), convenience stores (3.6% to 5.9%), and warehouse clubs (6.2% to 9.8%), and significantly decreased for grocery chains (58.5% to 46.3%) and non-chain grocers (10.3% to 5.2%). Top common sources of calories (%) from household PFPs by food/beverage group included: savory snacks, grain-based desserts, and regular soft drinks. The energy, total sugar, sodium, and saturated fat densities of household PFPs from mass merchandisers, warehouse clubs, and convenience stores were higher compared with grocery stores.

CONCLUSIONS

PFPs from stores with poorer nutrient density (more energy, total sugar, sodium, and saturated fat-dense), such as warehouse clubs, mass merchandisers, and convenience stores are growing, representing a potential U.S. public health concern.

Ten-year beverage intake trends among US preschool children: rapid declines between 2003 and 2010 but stagnancy in recent years

BACKGROUND

It has been previously reported that total energy intake among US preschool children (ages 2-5 years) decreased between 2003-2004 and 2009-2010. However, little is known about how intakes of beverages among US preschoolers (ages 2-5 years) changed from 2003-2004 to 2011-2012.

OBJECTIVES

This paper examines changes in intakes of key beverages during this period, as well as how eating location (at home or away from home) and source (store vs. others) may have contributed to these changes.

METHODS

Cross-sectional day one dietary data among children ages 2-5 years from the National Health and Nutrition Examination Survey 2003-2004, 2005-2006, 2007-2008, 2009-2010 and 2011-2012 were used. Survey-weighted mean intakes by survey year, eating location and source were computed for total sugar-sweetened beverages (SSBs), milks, 100% juice, low/no-calorie beverages, 10 key beverages, total beverages and total foods. Means were compared using two-tailed z-tests with Bonferroni corrections (α < 0.05).

RESULTS

Between 2003-2004 and 2011-2012, among 2-5 year olds, total caloric intake fell by 132 kcal d(-1) , with intakes of beverages falling by 55 kcal d(-1) . Decreases in intakes of total SSBs (-57 kcal d(-1) ), fruit-flavoured or juice drinks containing <100% juice (juice drinks) (-37 kcal d(-1) ), caloric soft drinks (-13 kcal d(-1) ) and >1% fat, low-sugar milk (-42 kcal d(-1) ) were among the major changes. By eating location, total beverage intake at home fell by 73 kcal d(-1) . By source, total beverage intake from stores fell by 106 kcal d(-1) . Changes in intakes occurred primarily between 2003-2004 and 2009-2010, as there were no significant differences in beverage intakes between 2009-2010 and 2011-2012. Intakes of total calories (+49 kcal d(-1) ) and calories from foods (+53 kcal d(-1) ) trended upward between 2009-2010 and 2011-2012, but changes were not significant.

CONCLUSIONS

These findings suggest improvements in the diets of preschoolers between 2003-2004 and 2009-2010, of which stores were a major contributor.

Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: observational study

STUDY QUESTION

What has been the effect on purchases of beverages from stores in Mexico one year after implementation of the excise tax on sugar sweetened beverages?

METHODS

In this observational study the authors used data on the purchase of beverages in Mexico from January 2012 to December 2014 from an unbalanced panel of 6253 households providing 205 112 observations in 53 cities with more than 50 000 inhabitants. To test whether the post-tax trend in purchases was significantly different from the pretax trend, the authors used a difference in difference fixed effects model, which adjusts for both macroeconomic variables that can affect the purchase of beverages over time, and pre-existing trends. The variables used in the analysis included demographic information on household composition (age and sex of household members) and socioeconomic status (low, middle, and high). The authors compared the predicted volumes (mL/capita/day) of taxed and untaxed beverages purchased in 2014-the observed post-tax period-with the estimated volumes that would have been purchased if the tax had not been implemented (counterfactual) based on pretax trends.

STUDY ANSWER AND LIMITATIONS

Relative to the counterfactual in 2014, purchases of taxed beverages decreased by an average of 6% (-12 mL/capita/day), and decreased at an increasing rate up to a 12% decline by December 2014. All three socioeconomic groups reduced purchases of taxed beverages, but reductions were higher among the households of low socioeconomic status, averaging a 9% decline during 2014, and up to a 17% decrease by December 2014 compared with pretax trends. Purchases of untaxed beverages were 4% (36 mL/capita/day) higher than the counterfactual, mainly driven by an increase in purchases of bottled plain water.

WHAT THIS STUDY ADDS

The tax on sugar sweetened beverages was associated with reductions in purchases of taxed beverages and increases in purchases of untaxed beverages. Continued monitoring is needed to understand purchases longer term, potential substitutions, and health implications.

FUNDING, COMPETING INTERESTS, DATA SHARING

This work was supported by grants from Bloomberg Philanthropies and the Robert Wood Johnson Foundation and by the Instituto Nacional de Salud Pública and the Carolina Population Center. The authors have no competing interests. No additional data are available.

Global growth of "big box" stores and the potential impact on human health and nutrition

Despite a large body of literature on the food environment, little is known about the role of supercenters in human nutrition and health. The objectives of this review are to examine what is currently known about the association between supercenters, nutrition, and obesity, to identify how supercenters may affect disparities in food access and nutritional quality of food purchases, and to document the rapid rise of supercenters as a source of food purchases in the United States. A case study of Wal-Mart, the largest food retailer in the United States, is presented that demonstrates the major and increasing role of supercenters as a source of packaged food purchases in the United States, particularly among low-income households, as well as the role of supercenters in supplying key nutrients. Taken together, this review and case study highlight the dominant role of supercenters in the US diet and the need to better understand how supercenters can be leveraged to improve the nutritional quality of what consumers buy and eat.

Estimating added sugars in US consumer packaged goods: An application to beverages in 2007-08

This study developed a method to estimate added sugar content in consumer packaged goods (CPG) that can keep pace with the dynamic food system. A team including registered dietitians, a food scientist and programmers developed a batch-mode ingredient matching and linear programming (LP) approach to estimate the amount of each ingredient needed in a given product to produce a nutrient profile similar to that reported on its nutrition facts label (NFL). Added sugar content was estimated for 7021 products available in 2007-08 that contain sugar from ten beverage categories. Of these, flavored waters had the lowest added sugar amounts (4.3g/100g), while sweetened dairy and dairy alternative beverages had the smallest percentage of added sugars (65.6% of Total Sugars; 33.8% of Calories). Estimation validity was determined by comparing LP estimated values to NFL values, as well as in a small validation study. LP estimates appeared reasonable compared to NFL values for calories, carbohydrates and total sugars, and performed well in the validation test; however, further work is needed to obtain more definitive conclusions on the accuracy of added sugar estimates in CPGs. As nutrition labeling regulations evolve, this approach can be adapted to test for potential product-specific, category-level, and population-level implications.

US Household Food Shopping Patterns: Dynamic Shifts Since 2000 And Socioeconomic Predictors

Under the assumption that differential food access might underlie nutritional disparities, programs and policies have focused on the need to build supermarkets in underserved areas, in an effort to improve dietary quality. However, there is limited evidence about which types of stores are used by households of different income levels and differing races/ethnicities. We used cross-sectional cluster analysis to derive shopping patterns from US households' volume food purchases by store from 2000 to 2012. Multinomial logistic regression identified household socioeconomic characteristics that were associated with shopping patterns in 2012. We found three food shopping patterns or clusters: households that primarily shopped at grocery stores, households that primarily shopped at mass merchandisers, and a combination cluster in which households split their purchases among multiple store types. In 2012 we found no income or race/ethnicity differences for the cluster of households that primarily shopped at grocery stores. However, low-income non-Hispanic blacks (versus non-Hispanic whites) had a significantly lower probability of belonging to the mass merchandise cluster. These varied shopping patterns must be considered in future policy initiatives. Furthermore, it is important to continue studying the complex rationales for people's food shopping patterns.

Corticosteroid adulteration in proprietary Chinese medicines: a recurring problem

OBJECTIVES

To investigate adulteration of proprietary Chinese medicines with corticosteroids in Hong Kong.

DESIGN

Case series with cross-sectional analysis.

SETTING

A tertiary clinical toxicology laboratory in Hong Kong.

PATIENTS

All patients using proprietary Chinese medicines adulterated with corticosteroids and referred to the authors' centre from 1 January 2008 to 31 December 2012.

MAIN OUTCOME MEASURES

Patients' demographic data, clinical presentation, medical history, drug history, laboratory investigations, and analytical findings of the proprietary Chinese medicines were analysed.

RESULTS

The records of 61 patients who consumed corticosteroid-adulterated proprietary Chinese medicines were reviewed. The most common corticosteroid implicated was dexamethasone. Co-adulterants such as non-steroidal anti-inflammatory drugs and histamine H1-receptor antagonists were detected in the proprietary Chinese medicine specimens. Among the patients, seven (11.5%) required intensive care, two (3.3%) died within 30 days of presentation, and 38 (62.3%) had one or more complications that were potentially attributable to exogenous corticosteroids. Of 22 (36.1%) patients who had provocative adrenal function testing performed, 17 (77.3% of those tested) had adrenal insufficiency.

CONCLUSION

The present case series is the largest series of patients taking proprietary Chinese medicines adulterated with corticosteroids. Patients taking these illicit products are at risk of severe adverse effects, including potentially fatal complications. Adrenal insufficiency was very common in this series of patients. Assessment of adrenal function in these patients, however, has been inadequate and routine rather than discretionary testing of adrenal function is indicated in this group of patients. The continuing emergence of proprietary Chinese medicines adulterated with western medication indicates a persistent threat to public health.

Targeted Beverage Taxes Influence Food and Beverage Purchases among Households with Preschool Children

BACKGROUND

How beverage taxes might influence purchases of foods and beverages among households with preschool children is unclear. Thus, we examined the relation between beverage taxes and food and beverage purchases among US households with a child 2-5 y of age.

OBJECTIVES

We examined how a potential tax on sugar-sweetened beverages (SSBs), or SSBs and >1% fat and/or high-sugar milk, would influence household food and beverage purchases among US households with a preschool child. We aimed to identify the lowest tax rate associated with meaningful changes in purchases.

METHODS

We used household food and beverage purchase data from households with a single child who participated in the 2009-2012 Nielsen Homescan Panel. A 2-part, multilevel panel model was used to examine the relation between beverage prices and food and beverage purchases. Logistic regression was used in the first part of the model to estimate the probability of a food/beverage being purchased, whereas the second part of the model used log-linear regression to estimate predicted changes in purchases among reporting households. Estimates from both parts were combined, and bootstrapping was performed to obtain corrected SEs. In separate models, prices of SSBs, or SSBs and >1% and/or high-sugar milk, were perturbed by +10%, +15%, and +20%. Predicted changes in food and beverage purchases were compared across models.

RESULTS

Price increases of 10%, 15%, and 20% on SSBs were associated with fewer purchases of juice drinks, whereas price increases of 10%, 15%, and 20% simulated on both SSBs plus >1% fat and/or high-sugar milk (combined tax) were associated with fewer kilocalories purchased from >1% fat, low-sugar milk, and meat, poultry, fish, and mixed meat dishes.

CONCLUSIONS

Our study provides further evidence that a tax on beverages high in sugar and/or fat may be associated with favorable changes in beverage purchases among US households with a preschool child.

Is the degree of food processing and convenience linked with the nutritional quality of foods purchased by US households?

BACKGROUND

"Processed foods" are defined as any foods other than raw agricultural commodities and can be categorized by the extent of changes occurring in foods as a result of processing. Conclusions about the association between the degree of food processing and nutritional quality are discrepant.

OBJECTIVE

We aimed to determine 2000-2012 trends in the contribution of processed and convenience food categories to purchases by US households and to compare saturated fat, sugar, and sodium content of purchases across levels of processing and convenience.

DESIGN

We analyzed purchases of consumer packaged goods for 157,142 households from the 2000-2012 Homescan Panel. We explicitly defined categories for classifying products by degree of industrial processing and separately by convenience of preparation. We classified >1.2 million products through use of barcode-specific descriptions and ingredient lists. Median saturated fat, sugar, and sodium content and the likelihood that purchases exceeded maximum daily intake recommendations for these components were compared across levels of processing or convenience by using quantile and logistic regression.

RESULTS

More than three-fourths of energy in purchases by US households came from moderately (15.9%) and highly processed (61.0%) foods and beverages in 2012 (939 kcal/d per capita). Trends between 2000 and 2012 were stable. When classifying foods by convenience, ready-to-eat (68.1%) and ready-to-heat (15.2%) products supplied the majority of energy in purchases. The adjusted proportion of household-level food purchases exceeding 10% kcal from saturated fat, 15% kcal from sugar, and 2400 mg sodium/2000 kcal simultaneously was significantly higher for highly processed (60.4%) and ready-to-eat (27.1%) food purchases than for purchases of less-processed foods (5.6%) or foods requiring cooking/preparation (4.9%).

CONCLUSIONS

Highly processed food purchases are a dominant, unshifting part of US purchasing patterns, but highly processed foods may have higher saturated fat, sugar, and sodium content than less-processed foods. Wide variation in nutrient content suggests food choices within categories may be important.

A dynamic panel model of the associations of sweetened beverage purchases with dietary quality and food-purchasing patterns

Investigating the association between consumption of sweetened beverages and dietary quality is challenging because issues such as reverse causality and unmeasured confounding might result in biased and inconsistent estimates. Using a dynamic panel model with instrumental variables to address those issues, we examined the independent associations of beverages sweetened with caloric and low-calorie sweeteners with dietary quality and food-purchasing patterns. We analyzed purchase data from the Homescan survey, an ongoing, longitudinal, nationally representative US survey, from 2000 to 2010 (n = 34,294). Our model included lagged measures of dietary quality and beverage purchases (servings/day in the previous year) as exposures to predict the outcomes (macronutrient (kilocalories per capita per day; %), total energy, and food purchases) in the next year after adjustment for other sociodemographic covariates. Despite secular declines in purchases (kilocalories per capita per day) from all sources, each 1-serving/day increase in consumption of either beverage type resulted in higher purchases of total daily kilocalories and kilocalories from food, carbohydrates, total sugar, and total fat. Each 1-serving/day increase in consumption of either beverage was associated with more purchases of caloric-sweetened desserts or sweeteners, which accounted for a substantial proportion of the increase in total kilocalories. We concluded that consumers of both beverages sweetened with low-calorie sweeteners and beverages sweetened with caloric sweeteners had poorer dietary quality, exhibited higher energy from all purchases, sugar, and fat, and purchased more caloric-sweetened desserts/caloric sweeteners compared with nonconsumers.