Parents' willingness to pay for the prevention of childhood overweight and obesity

An examination of willingness to participate and willingness to pay for a universal school food program in the Canadian context

OBJECTIVE

To examine parents'/caregivers' willingness to participate and willingness to pay (WTP) for a cost-shared school food program (SFP) and its associated factors.

DESIGN

A quantitative survey design was used where WTP for a hypothetical SFP was elicited using a double-bounded dichotomous choice elicitation method. We used a double hurdle (logistic and truncated regression) model to examine WTP and positively or negatively associated factors.

SETTING

Saskatoon Public School Division elementary schools situated in high-, mid- or low-median-income neighbourhoods.

PARTICIPANTS

Parents or caregivers of children attending grades 1 to grade 8 in the Saskatoon Public School Division elementary schools.

RESULTS

94 % respondents were willing to participate in a SFP while less than two-thirds of participants were willing to pay for such a program. Over 90 % respondents from all the socio-economic groups were willing to participate. Multiple household income earners, higher household income, higher number of children, household food security status and higher academic attainment of parents'/caregivers predicted greater willingness to pay. Mean willingness to pay was $4·68 (CAN), and households reporting moderate or severe food insecurity were likely to be willing to pay significantly less for a SFP.

CONCLUSION

A cost-shared program might be financially sustainable in Canada if community characteristics such as household food insecurity status, economic participation of women and average household size are kept in mind while determining the price of the program.

Ist Bewegung eine Frage des Geldes? Eine Analyse des Kostengeschehens kommunaler Prävention für Kinder aus Nutzerperspektive

Hintergrund

Kinder mit niedrigem Sozialstatus haben häufiger motorische Defizite, gleichzeitig nehmen sie Angebote zur Bewegungsförderung seltener wahr. Die Gründe dafür sind unklar. Im Zusammenhang mit finanziellen Barrieren ist das objektive Kostengeschehen aus Nutzerperspektive bisher kaum erforscht, insbesondere nicht im Hinblick auf soziale Ungleichheit.

Ziel der Arbeit

Die Studie soll zwei Fragen beantworten: Welche Kosten müssen Eltern für die Bewegungsangebote ihrer Kinder erbringen? Wie erschwinglich sind diese Angebote für sozioökonomisch benachteiligte Familien?

Material und Methoden

Zunächst wurden 36 Angebote freigemeinnütziger Träger in Düsseldorf für Kinder bis 6 Jahre identifiziert. Zu diesen Angeboten wurde jeweils der Preis pro Kurseinheit, pro Zeitstunde und pro Monat berechnet. Für die Bestimmung der Erschwinglichkeit wurden das günstigste und das teuerste Angebot nach Ermäßigung in Relation zum frei verfügbaren Einkommen einer alleinerziehenden Familie mit Arbeitslosengeld(ALG)-II-Bezug gesetzt.

Ergebnisse

Preise für Eltern-Baby-Kurse rangieren zwischen 20,00 und 48,00 € pro Monat, für Eltern-Kind-Kurse zwischen 4,00 und 44,00 € und für Wasser- und Schwimmangebote zwischen 18,00 und 28,86 €. Ermäßigte Kurspreise können zwischen 4,10 und 21,60 % des frei zur Verfügung stehenden Einkommens einer alleinerziehenden Familie mit ALG-II-Bezug ausmachen.

Diskussion

Kommunale Bewegungsangebote werden an die finanziellen Bedürfnisse von Familien angepasst. Für sozioökonomisch benachteiligte Familien sind sie jedoch nicht immer erschwinglich. Weitere Ermäßigungen bei ausgewählten Angeboten könnten die Inanspruchnahme von Kindern mit niedrigem Sozialstatus an Bewegungsangeboten erhöhen.

Sports injury type and psychological factors affect treatment period and willingness-to-pay: Cross-sectional study

This study aimed to describe the sport injuries of elite collegiate athletes, and to examine the influence of career length, past injuries, and psychological factors on the treatment period and willingness to pay (WTP) for treatment.A survey was conducted among students of the Department of Physical Education, Korea National Sport University. Results were interpreted through frequency analysis and multiple linear regression analysis.All students currently in training (n = 624, mean age 21 ± 2 years) participated in this study. 12-month prevalence of sports injuries was 56%. The locations of the most common and severe injuries were the knee, ankle, and back. The most frequent types of common injury were sprain, ruptured ligament, and bruising. The location of injuries varied according to the sports discipline. The treatment period was influenced by sports discipline, career length, location, and type of injury, and fear of further injuries. Treatment period was associated with the reason for fear of injuries, and WTP was influenced by fear of further injuries.Our study suggests that specific management plans for athletes based on disciplines, past injuries, and their emotional responses to previous injuries are required for rehabilitation and return to sports following treatment.

Longitudinal changes and determinants of parental willingness to pay for the prevention of childhood overweight and obesity

BACKGROUND

Willingness to Pay (WTP) is an alternative to measure quality-adjusted life years for cost-effectiveness analyses. The aim was to evaluate longitudinal changes and determinants of parental WTP for the prevention of childhood overweight and obesity.

METHODS

Longitudinal data from post- (T2) and follow-up (T3) measurements of a school-based health promotion program in Germany. Parental questionnaires included general WTP and the corresponding amount to reduce incidental childhood overweight and obesity by half. Longitudinal differences were examined with the McNemar test for general WTP and the Wilcoxon signed-rank test for the amount of WTP. Regression analyses were conducted to detect determinants.

RESULTS

General parental WTP significantly decreased from 48.9% to 35.8% (p < 0.001, n = 760). Logistic regression analysis (n = 561) showed that parents with a tertiary education level and a positive general WTP at T2, families with a higher monthly household income, and those with abdominally obese children were significant predictors of general WTP at T3. Median amount of WTP at T3 was €20.00 (mean = €27.96 ± 26.90, n = 274). Assuming a WTP of €0 for those who were generally not willing to pay or did not answer, resulted in a median amount of WTP at T3 of €0 (m = €8.45, sd = €19.58, n = 906). According to linear regression analysis WTP at T2 was the only significant predictor for the amount of WTP at T3 (p = 0.000, n = 181).

CONCLUSIONS

Despite the decline of general WTP, these results are a reflection of the public awareness of the problem and the need for action. Policy makers should recognize this and initiate sustainable public preventive strategies.

TRIAL REGISTRATION

DRKS, DRKS00000494. Registered 25 August 2010, https://www.drks.de/drks_web/.

Parents' Willingness to Pay for Pediatric Weight Management Programs

OBJECTIVE

To examine parents' interest in continuing and willingness to pay (WTP) for 2 pediatric weight management programs following their participation.

METHODS

Participants were parents of 2- to 12-year-old children with body mass index ≥ 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other received EPC plus individualized coaching (EPC+C). At 1 year, we assessed parents' self-reported WTP for a similar program and the maximum amount ($/month) they would pay. We used multivariable regression to examine differences in WTP and WTP amount by intervention arm and by individual and family-level factors.

RESULTS

Of 638 parents who completed the survey, 85% were interested in continuing and 38% of those parents were willing to pay (31% in the EPC group and 45% in the EPC+C group). The median amount parents were willing to pay was $25/month (interquartile range, $15-$50). In multivariable models, the EPC+C parents were more likely to endorse WTP than the EPC parents (odds ratio, 1.53; 95% confidence interval, 1.05-2.22). Parents of children with Hispanic/Latino versus white ethnicity and those reporting higher satisfaction with the program were also more likely to endorse WTP.

CONCLUSIONS

Most parents of children in a weight management program were interested in continuing it after it ended, but fewer were willing to pay out of pocket for it. A greater proportion of parents were willing to pay if the program included individualized health coaching.

Development of an investment case for obesity prevention and control: perspectives on methodological advancement and evidence

This paper opens a discussion on the main features of an investment case for obesity prevention and control, by scanning available evidence on existing approaches and by highlighting contextual considerations and evidence for Latin America and the Caribbean. We call on researchers and analysts in the field to update and broaden existing methods of economic analyses to better reflect the multisectoral nature of an investment case for obesity prevention and control. We also identify research gaps and further work required to advance methods and evidence towards investment cases throughout the Americas.

Cardio-metabolic and socio-environmental correlates of waist-to-height ratio in German primary schoolchildren: a cross-sectional exploration

BACKGROUND

Controversial messages of childhood obesity emerge: Levelling off in terms of body mass index (BMI) is foiled by increases in abdominal obesity. Waist-to-height ratio (WHtR) may be used as a screening tool for abdominal obesity in children. The aim of this study was to investigate clinical and socio-environmental correlates of abdominal obesity in primary schoolchildren.

METHODS

Cross-sectional data from 753 children participating in baseline assessments of the outcome evaluation of a school-based prevention program were analysed. Abdominal obesity was defined as WHtR ≥0.5. According to German age and sex-specific BMI-percentiles, overweight (>90th percentile) and obesity (>97th percentile) were determined. Anthropometric and sonographic measurements, blood pressure and blood samples were taken by clinical staff in a standardized manner. Socio-environmental and lifestyle data were assessed via parental questionnaires. Differences between abdominally obese children and others, and correlations of WHtR with clinical data were tested. Socio-environmental correlates of abdominal obesity were explored in a logistic regression analysis.

RESULTS

At the time of the examination children were 7.57 ± 0.42 years old. Abdominal obesity was observed in 132 (17.5%) children. According to BMI-percentiles, 22.9% of these children were obese, 38.2% overweight, and 38.2% normal weight. Affected children more often used screen media and less often participated in club sports. Abdominal obesity was associated with higher blood pressure, lower HDL- and higher LDL-cholesterol. WHtR significantly correlated with intra-abdominal fat thickness (IAF). The logistic regression model revealed migration background (odds ratio (OR) 2.12, 95% confidence interval (CI) [1.41, 3.19]), smoking during pregnancy (OR 2.30, 95% CI [1.37, 3.86]), parental obesity (OR 1.95, 95% CI [1.22, 3.10]) and higher educational level (OR 0.64, 95% CI [0.42, 0.98]) to be significantly associated with abdominal obesity in children.

CONCLUSION

WHtR correlates strongly with IAF. Abdominal obesity in primary schoolchildren is associated with cardio-metabolic risk factors and also occurs in otherwise normal weight children. Against the background of rising numbers of abdominal obesity in children, targeted preventive measures are long overdue. The focus of such measures should be used on children with migration background and involve parents, especially those who are obese and those with lower educational levels.

Feasibility and willingness to pay for dengue vaccine in the threat of dengue fever outbreaks in Vietnam

BACKGROUND

The escalation of dengue fever (DF) cases in recent years and the occurrence of a large-scale DF outbreak in 2017 underline the importance of dengue vaccines in Vietnam. Given the potential benefits of the dengue vaccines and the need for copayment by the private sector, this study aims to evaluate the willingness to pay (WTP) for the dengue vaccines in patients with DF in Northern Vietnam.

METHODS

A cross-sectional study was conducted on 330 in-and-out patients with DF admitted to the Bach Mai Hospital. We used the contingent valuation method to evaluate the WTP for dengue vaccines. Socioeconomic and clinical characteristics were also investigated. Multivariate interval and logistic regression models were used to estimate the average amount of WTP and identify the factors associated with the WTP.

RESULTS

Around 77.3% patients were willing to pay an average amount of US$ 67.4 (95% CI=57.4-77.4) for the vaccine. People of higher ages, those having health insurance, those traveling in the past 15 days or suffering from anxiety/depression were less likely to be willing to pay for the dengue vaccine. However, people having a longer duration of DF or having problems with mobility were positively associated with WTP for the dengue vaccine. Patients educated to more than high school levels (Coeff.=31.31; 95% CI=3.26-59.35), those in the richest quintile (Coeff.=62.76; 95% CI=25.40; 100.13), or those having a longer duration of the disease (Coeff.=6.18; 95% CI=0.72-11.63) were willing to pay a higher amount.

CONCLUSION

This study highlights a relatively high rate and amount of WTP for the dengue vaccine among patients with DF. Psychological counseling services as well as educational campaigns should be undertaken to improve the WTP for the vaccine. Moreover, government subsidies should be given to increase the coverage of the vaccine in the future, especially for the poor.

Parents' willingness to invest in their children's oral health

OBJECTIVES

This study aimed to evaluate parents' Willingness to Invest (WTI) in their children's oral health in terms of money, visits to a dental practice, and brushing minutes. Objectives were to assess the association between parents' WTI and a) children's dental caries experience, b) children's oral hygiene behavior (OHB), and c) maternal education level and ethnic background.

METHODS

A sample of 630 five to six-year-old-children was recruited from pediatric dental centers in the Netherlands. Children's dmft scores were extracted from personal dental records. Parental questionnaires were used to collect data on parents' WTI, children's OHB, maternal education level and ethnicity.

RESULTS

On average, parents were willing to spend a maximum of €37 per month, 3.0 dental visits per year, and 4.5 brushing minutes per day to maintain good oral health for their child. The mean dmft was significantly higher in children whose parents were willing to pay more money and visit the dentist more often (P = 0.028 and P = 0.002, respectively), while the mean dmft was significantly lower in children of parents who were willing to invest more brushing minutes (P < 0.001). Parental WTI in terms of money and brushing minutes was higher in native and higher-educated parents, and was associated with more favorable OHB of children.

CONCLUSIONS

Parents' WTI in their children's oral health is related to children's dental caries status and reported OHB. Results suggest that children are better off when parents are willing to invest in self-care, rather than in money or dental visits.

Costs and effects of a state-wide health promotion program in primary schools in Germany - the Baden-Württemberg Study: A cluster-randomized, controlled trial

AIM

To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program "Join the Healthy Boat" in primary schools in Germany.

METHODS

Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated.

RESULTS

The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group.

CONCLUSION

This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: DRKS00000494.