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Bulaj G, Coleman M, Johansen B, Kraft S, Lam W, Phillips K, Rohaj A. Redesigning Pharmacy to Improve Public Health Outcomes: Expanding Retail Spaces for Digital Therapeutics to Replace Consumer Products That Increase Mortality and Morbidity Risks. PHARMACY 2024; 12:107. [PMID: 39051391 PMCID: PMC11270305 DOI: 10.3390/pharmacy12040107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024] Open
Abstract
United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Melissa Coleman
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Blake Johansen
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Sarah Kraft
- Independent Researcher, Salt Lake City, UT 84112, USA
| | - Wayne Lam
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Katie Phillips
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
| | - Aarushi Rohaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA
- The Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84112, USA
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Hall MG, Ruggles PR, McNeel K, Prestemon CE, Lee CJY, Lowery CM, Campos AD, Taillie LS. Understanding Whether Price Tag Messaging Can Amplify the Benefits of Taxes: An Online Experiment. Am J Prev Med 2024; 66:609-618. [PMID: 38189693 PMCID: PMC10957315 DOI: 10.1016/j.amepre.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Excise taxes on unhealthy products like sugary drinks and tobacco can reduce purchases of these products. However, little research has investigated whether messages at the point of purchase, such as enhanced price tags, can increase the effects of taxes by heightening psychological reactions. This study aimed to examine whether including messages about taxes on price tags could amplify the benefits of excise taxes on unhealthy products. METHODS In 2022, an online study recruited 1,013 U.S. parents to view seven price tag messages (e.g., "includes a 19% sugary drink tax") and a control (i.e., standard price tag with the tax included in the price) displayed in random order alongside sugary drinks. Participants were randomly assigned to view a caution-symbol icon or no icon on price tags. Analyses were conducted in 2023. RESULTS All seven messages discouraged parents from buying sugary drinks for their children compared to control (average differential effects [ADEs] ranged from 0.28 to 0.48, all p<0.001). All messages led to greater attention to the price tag (ADEs ranged from 0.24 to 0.41, all p<0.001) and greater consideration of the cost of sugary drinks (ADEs ranged from 0.31 to 0.50, all p<0.001). Icons elicited higher cost consideration than text-only price tags (ADE=0.15, p<0.010), but not discouragement (p=0.061) or attention (p=0.079). CONCLUSIONS Messaging on price tags could make excise taxes more effective. Policymakers should consider requiring messaging on price tags when implementing taxes.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Phoebe R Ruggles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine McNeel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Carmen E Prestemon
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cristina J Y Lee
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aline D'Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Radoš Krnel S, Pravst I, Hribar M, Blažica B, Kušar A. How effective are health messages/warnings in improving knowledge and awareness of alcohol-related harm? The Slovenian case on using a mobile app. BMC Public Health 2023; 23:2467. [PMID: 38082375 PMCID: PMC10712114 DOI: 10.1186/s12889-023-17353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app. METHODS Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol. RESULTS Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products. CONCLUSIONS The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol.
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Affiliation(s)
- Sandra Radoš Krnel
- Analysis and Development Centre, National Institute of Public Health, Trubarjeva Cesta 2, Ljubljana, Slovenia.
| | - Igor Pravst
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska Ulica 98, Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, Ljubljana, Slovenia
- VIST - Faculty of Applied Sciences, Gerbičeva Ulica 53, Ljubljana, Slovenia
| | - Maša Hribar
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska Ulica 98, Ljubljana, Slovenia
| | - Bojan Blažica
- Computer Systems Department, Jožef Stefan Institute, Jamova Cesta 39, Ljubljana, Slovenia
| | - Anita Kušar
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska Ulica 98, Ljubljana, Slovenia
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Grummon AH, Gibson LA, Musicus AA, Stephens-Shields AJ, Hua SV, Roberto CA. Effects of 4 Interpretive Front-of-Package Labeling Systems on Hypothetical Beverage and Snack Selections: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2333515. [PMID: 37703015 PMCID: PMC10500374 DOI: 10.1001/jamanetworkopen.2023.33515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Importance Policymakers and researchers have proposed a variety of interpretative front-of-package food labeling systems, but it remains unclear which is most effective at encouraging people to choose healthier foods and beverages, including among people with less education. Objective To test the effects of 4 interpretative front-of-package food labeling systems on the healthfulness of beverage and snack selections, overall and by education level. Design, Setting, and Participants This randomized clinical trial of a national sample of US adults 18 years and older was conducted online from November 16 to December 3, 2022. Intervention Participants were randomized to view products with 1 of 5 food labeling systems, including control (calorie labels only) or 1 of 4 interpretative labeling systems: green ("choose often") labels added to healthy foods; single traffic light labels added to healthy, moderately healthy, and unhealthy foods; physical activity calorie equivalent labels added to all products; and nutrient warning labels added to products high in calories, sugar, saturated fat, or sodium. All conditions had calorie labels on all products. Main Outcomes and Measures Participants selected 1 of 16 beverages and 1 of 16 snacks that they wanted to hypothetically purchase. The primary outcomes were calories selected from beverages and from snacks. Secondary outcomes included label reactions and perceptions. Results A total of 7945 participants completed the experiment and were included in analyses (4078 [51%] female, 3779 [48%] male, and 88 [1%] nonbinary or another gender; mean [SD] age, 47.5 [17.9 years]). Compared with the control arm, exposure to the green (average differential effect [ADE], -34.2; 95% CI, -42.2 to -26.1), traffic light (ADE, -31.5; 95% CI, -39.5 to -23.4), physical activity (ADE, -39.0; 95% CI, -47.0 to -31.1), or nutrient warning labels (ADE, -28.2; 95% CI, -36.2 to -20.2) led participants to select fewer calories from beverages (all P < .001). Similarly, compared with the control label, exposure to the green (ADE, -12.7; 95% CI, -17.3 to -8.2), traffic light (ADE, -13.7; 95% CI, -18.2 to -9.1), physical activity (ADE, -18.5; 95% CI, -23.1 to -13.9), or nutrient warning labels (ADE, -14.2; 95% CI, -18.8 to -9.6) led participants to select fewer calories from snacks (all P < .001). These effects did not differ by education level. The green labels were rated as less stigmatizing than the other interpretative systems but otherwise generally received the least favorable label reactions and perceptions (eg, elicited less attention, were perceived as less trustworthy), while the nutrient warnings and physical activity labels received the most favorable ratings. Conclusions and Relevance In this randomized clinical trial of front-of-package food labeling systems, all 4 interpretative labeling systems reduced calories selected from beverages and from snacks compared with calorie labels, with no differences by education level. Trial Registration ClinicalTrials.gov Identifier: NCT05432271.
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Affiliation(s)
- Anna H. Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Laura A. Gibson
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Aviva A. Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Now with Center for Science in the Public Interest, Washington, DC
| | - Alisa J. Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sophia V. Hua
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Christina A. Roberto
- Department of Medical Ethics and Healthy Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Grummon AH, Lazard AJ, Taillie LS, Hall MG. Should messages discourage sugary drinks, encourage water, or both? A randomized experiment with U.S. parents. Prev Med 2023; 167:107417. [PMID: 36592673 PMCID: PMC9898202 DOI: 10.1016/j.ypmed.2022.107417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Campaigns to improve beverage consumption typically focus on discouraging unhealthy beverages (e.g., soda), encouraging healthy beverages (e.g., water), or both. It remains unclear which of these strategies is most effective. We recruited a national convenience sample of U.S. parents of children ages 2-12 (n = 1078, 48% Latino[a]) to complete an online survey in 2019. We randomly assigned participants to view: 1) a control message, 2) a soda discouragement message, 3) a water encouragement message, or 4) both soda discouragement and water encouragement messages shown side-by-side in random arrangement. Intervention messages mimicked New York City's "Pouring on the Pounds" campaign. Participants rated messages on perceived effectiveness for discouraging soda consumption and encouraging water consumption (1-5 response scales) and reported feelings and intentions about drinking soda and water (1-7 scales). Compared to those with no exposure, participants who viewed the soda discouragement message reported higher perceived discouragement from drinking soda (Average Differential Effect [ADE] = 1.18), more negative feelings toward drinking soda (ADE = 0.83) and stronger intentions to avoid drinking soda (ADE = 0.45) (ps < 0.001). The soda discouragement message also exerted beneficial effects on perceived effectiveness, feelings, and intentions related to water consumption (ADEs = 0.33-0.68; ps < 0.001). Exposure to the water encouragement message had beneficial effects on outcomes related to water consumption (ADEs = 0.28-0.81, ps < 0.001), but limited impact on outcomes related to soda consumption. Across outcomes, results indicated diminishing returns from exposure to both message types. Messaging campaigns discouraging unhealthy beverages may be more promising for improving beverage consumption than messages only promoting healthier beverages.
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Affiliation(s)
- Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States of America; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States of America.
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Marissa G Hall
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Nurchis MC, Di Pumpo M, Perilli A, Greco G, Damiani G. Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1675. [PMID: 36767077 PMCID: PMC9913966 DOI: 10.3390/ijerph20031675] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
Background: The World Health Organization identified alcohol and tobacco consumption as the risk factors with a greater attributable burden and number of deaths related to non-communicable diseases. A promising technique aimed to modify behavioral risk factors by redesigning the elements influencing the choice of people is nudging. Methodology: A scoping review of the literature was performed to map the literature evidence investigating the use of nudging for tobacco and alcohol consumption prevention and/or control in adults. Results: A total of 20 studies were included. The identified nudging categories were increasing salience of information or incentives (IS), default choices (DF), and providing feedback (PF). Almost three-quarters of the studies implementing IS and half of those implementing PF reported a success. Three-quarters of the studies using IS in conjunction with other interventions reported a success whereas more than half of the those with IS alone reported a success. The PF strategy performed better in multi-component interventions targeting alcohol consumption. Only one DF mono-component study addressing alcohol consumption reported a success. Conclusions: To achieve a higher impact, nudging should be integrated into comprehensive prevention policy frameworks, with dedicated education sessions for health professionals. In conclusion, nudge strategies for tobacco and alcohol consumption prevention in adults show promising results. Further research is needed to investigate the use of nudge strategies in socio-economically diverse groups and in young populations.
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Affiliation(s)
- Mario Cesare Nurchis
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Alessio Perilli
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Greco
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianfranco Damiani
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
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