1
|
D’Angelo Campos A, Ng SW, McNeel K, Hall MG. How Promising Are "Ultraprocessed" Front-of-Package Labels? A Formative Study with US Adults. Nutrients 2024; 16:1072. [PMID: 38613105 PMCID: PMC11013171 DOI: 10.3390/nu16071072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
High levels of food processing can have detrimental health effects independent of nutrient content. Experts and advocates have proposed adding information about food processing status to front-of-package labeling schemes, which currently exclusively focus on nutrient content. How consumers would perceive "ultraprocessed" labels has not yet been examined. To address this gap, we conducted a within-subjects online experiment with a convenience sample of 600 US adults. Participants viewed a product under three labeling conditions (control, "ultraprocessed" label, and "ultraprocessed" plus "high in sugar" label) in random order for a single product. The "ultraprocessed" label led participants to report thinking more about the risks of eating the product and discouraging them from wanting to buy the product more than the control, despite not grabbing more attention than the control. The "ultraprocessed" plus "high in sugar" labels grabbed more attention, led participants to think more about the risks of eating the product, and discouraged them from wanting to buy the product more than the "ultraprocessed" label alone. "Ultraprocessed" labels may constitute promising messages that could work in tandem with nutrient labels, and further research should examine how they would influence consumers' actual intentions and behaviors.
Collapse
Affiliation(s)
- Aline D’Angelo Campos
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Katherine McNeel
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - Marissa G. Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|
2
|
Vatavuk-Serrati G, Frank SM, Ng SW, Taillie LS. Trends in Sugar From Packaged Foods and Beverages Purchased by US Households Between 2002 and 2020. J Acad Nutr Diet 2024; 124:481-494.e1. [PMID: 37890585 PMCID: PMC10954417 DOI: 10.1016/j.jand.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/23/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Excess sugar consumption is a public health concern in the United States. How sugar purchases have changed over time, whether there are disparities across subpopulations, and the contribution of various food groups are unclear. OBJECTIVE To assess trends in sugar from packaged foods and beverages purchased by US households between 2002 and 2020. DESIGN This is an open cohort study. PARTICIPANTS/SETTING We obtained data from the NielsenIQ U.S. Homescan Consumer Panel, which collects data on household purchases of all consumer packaged goods in 52 metropolitan and 24 non-metropolitan markets across the United States. We assessed data on food and beverage purchases for 1,163,447 household-years. MAIN OUTCOME MEASURES The primary outcomes are the total sugar in grams purchased per capita per day and percentage of calories from sugar, by sociodemographic group. STATISTICAL ANALYSES PERFORMED We used linear regression to estimate trends in total grams of sugar per capita per day, percentage of calories from sugar, and percentage of total sugar purchases by food or beverage group. We estimated means for select years and tested for significance compared with 2002 and with the previous timepoint and calculated the overall P-value for the linear trend using time series regression. RESULTS Total sugar purchases decreased over the study period, both in absolute terms (-37.2 g/capita/day; 95% confidence interval [CI], -38.7, -35.6) and as a percentage of total calories purchased (-5.3 percentage points; 95% CI, -5.5, -5.2). Sugar purchases declined for all sociodemographic groups, but disparities have persisted or widened, particularly among individuals who are non-Hispanic Black, low-income, and with lower educational attainment. Beverages' contributions to sugar purchases decreased 8.1 percentage points (95% CI, -8.4, -7.8). CONCLUSION In the United States, purchases of sugar declined, but disparities by socioeconomic status and race or ethnicity persisted or widened. Policies to further reduce sugar consumption and the burden of diet-related disparities are needed.
Collapse
|
3
|
Valizadeh P, Ng SW. Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income. Am J Prev Med 2024:S0749-3797(24)00076-X. [PMID: 38573260 DOI: 10.1016/j.amepre.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. METHODS The 2017-2018 packaged food purchase data among U.S. households were used to derive household income- and composition-specific demand elasticities across 22 food and beverage categories. Policy simulations, conducted in 2022-2023, assessed the impact of national taxes on unhealthy ultraprocessed food and beverage purchases, both separately and alongside subsidies for minimally processed foods and beverages targeted to low-income households. Resultant nutritional implications are reported on the basis of changes in purchased calories and nutrients of concern. In addition, financial implications for both households and the federal government are projected. RESULTS A sugar-based tax on sugar-sweetened beverages would lower both volume and calories purchased with the largest impact on low-income households without children. Meanwhile, targeted subsidies would increase fruit, vegetable, and healthier drink purchases without substantially increasing calories. Under tax simulations, low-income households would make larger reductions in their absolute volume and calorie purchases of taxed foods and beverages than their higher-income counterparts, suggesting that these policies, if implemented, could help narrow nutritional disparities. CONCLUSIONS Levying national taxes on unhealthy ultraprocessed foods/beverages and offering targeted subsidies for minimally processed foods/beverages could promote healthier food choices among low-income households. Such policies have the potential to benefit low-income households financially and at a relatively low cost for the federal government annually.
Collapse
Affiliation(s)
- Pourya Valizadeh
- Department of Agricultural Economics, Texas A&M University, College Station, Texas
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| |
Collapse
|
4
|
Lowery CM, Roberto CA, Hua SV, Bleich SN, Mitra N, Lawman HG, Taillie LS, Ng SW, Gibson LA. Impact of the Philadelphia Beverage Tax on Perceived Beverage Healthfulness, Tax Awareness, and Tax Opinions. J Nutr Educ Behav 2024:S1499-4046(24)00025-3. [PMID: 38466246 DOI: 10.1016/j.jneb.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/24/2024] [Accepted: 02/04/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To assess the impact of the Philadelphia Beverage Tax on perceived beverage healthfulness, and awareness and opinions of the tax. DESIGN Natural experiment SETTING: Small independent stores in Philadelphia (n = 61) and Baltimore (untaxed control site; n = 65) PARTICIPANTS: Shoppers in Philadelphia (n = 2,731) and Baltimore (n = 4,600) pre- and post-tax implementation. MAIN OUTCOME MEASURES Perceptions of 4 beverages (unhealthy vs healthy/neutral), tax awareness, and tax opinions (oppose vs favor/neutral). ANALYSIS Mixed-effects linear probability models estimated changes in perceived beverage healthfulness in Philadelphia, relative to Baltimore, following a difference-in-differences approach. Mixed-effects linear probability models estimated pre-post changes in tax awareness and opinions in Philadelphia-only. RESULTS The probability of perceiving taxed beverages as unhealthy increased 2-years post-tax relative to Baltimore (regular soda: 5.7% [95% confidence interval (CI), 0.9-10.6], P = 0.02; diet soda: 7.7% [95% CI, 1.5-13.8], P < 0.001; sports drinks: 6.4% [95% CI, 0.4-12.4], P = 0.04), with similar changes at 1-year post-tax, whereas perceived healthfulness of untaxed 100% fruit juice did not change. Tax awareness was high at baseline (72%) and increased post-implementation; however, the probability of opposing the tax (22%) also increased over time. CONCLUSIONS AND IMPLICATIONS Decreases in the perceived healthfulness of taxed beverages suggest the tax had a health-signaling effect. Consumer awareness and health education efforts could complement tax policies to enhance understanding of health risks.
Collapse
Affiliation(s)
- Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Nandita Mitra
- Division of Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hannah G Lawman
- Division of Chronic Disease Prevention and Injury Prevention, Philadelphia Department of Public Health, Philadelphia, PA
| | - Lindsey S Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura A Gibson
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
5
|
Soto Díaz CR, Taillie LS, Higgins ICA, Richter APC, Davis CR, De Marco M, Hall MG, Ng SW, Duffy EW. A Qualitative Exploration of Spanish-Speaking Latina Women's Experiences Participating in WIC Before and During the COVID-19 Pandemic. J Acad Nutr Diet 2024:S2212-2672(24)00112-6. [PMID: 38462129 DOI: 10.1016/j.jand.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND More than one-third of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants identify as Latino, but participation has been declining and individuals who speak predominantly Spanish face additional barriers to participation. During the COVID-19 pandemic, there were changes in WIC eligibility and benefits that may have been differentially accessible to Spanish-speaking Latina participants due to factors such as language barriers and lack of awareness of changes. Understanding Spanish-speaking Latinas' experiences with the WIC program generally and during the pandemic can inform efforts to equitably implement future emergency food response policies and improve the WIC program and Latina participant enrollment more broadly. OBJECTIVE This study aimed to understand the perceptions and experiences of Spanish-speaking Latina WIC participants with the WIC program generally and with COVID-19 pandemic-related policy changes made to the WIC program. DESIGN Qualitative in-depth interviews were conducted virtually in Spanish in August 2022 using a semi-structured guide. PARTICIPANTS/SETTING Study participants were 18 Spanish-speaking Latina adult WIC participants living in North Carolina recruited using convenience sampling. ANALYSIS All interviews were recorded, transcribed, and coded in Spanish. Thematic analysis with inductive coding was used to derive key themes. RESULTS Perceptions about the WIC program in this sample were mixed. Participants felt positively about the healthfulness of foods included in the WIC food packages but expressed concern about the monthly benefit amounts being too low and the cultural appropriateness of food options. Pandemic policy changes, such as remote appointments and the Cash Value Benefit increase were perceived positively; however, barriers to using benefits during this time included limited communication from WIC agencies, food shortages, and concerns about not being granted US citizenship or permanent resident status due to use of WIC (ie, public charge rule). Social networks played an important role in learning about and enrolling in WIC and navigating food shortages during the pandemic. CONCLUSIONS Concerns about the cultural appropriateness of foods provided, communication challenges, and the public charge rule emphasized the need for resources dedicated in the WIC program to improving Spanish-speaking Latina women's experiences with WIC.
Collapse
Affiliation(s)
- Carlos R Soto Díaz
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Isabella C A Higgins
- 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
| | - Ana Paula C Richter
- 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
| | - Cassandra R Davis
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Molly De Marco
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marissa G Hall
- 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; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily W Duffy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| |
Collapse
|
6
|
Duffy EW, Ng SW, Bercholz M, Davis CR, De Marco M, Hall MG, Maselko J, Smith Taillie L. Special Supplemental Nutrition Program for Women, Infants, and Children Participant Grocery Store Purchases during the COVID-19 Pandemic in North Carolina. Curr Dev Nutr 2024; 8:102098. [PMID: 38440362 PMCID: PMC10909627 DOI: 10.1016/j.cdnut.2024.102098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
Background Families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) experienced barriers to accessing healthy food during the COVID-19 pandemic, but we do not yet understand how WIC participant food purchases shifted during the pandemic. Objectives We aimed to describe the association between the initial shock of the pandemic in March 2020 and WIC shoppers' food purchases and changes in purchases before and during the pandemic at a top grocery chain and examine differences in these relationships by duration of WIC use. Methods We used longitudinal food transaction data from WIC shoppers (n = 2,989,116 shopper-month observations from 175,081 unique WIC shoppers) from 496 stores in a top grocery store chain in North Carolina between October 2019 and May 2021. We used an interrupted time series design to describe the following: 1) the relationship between the initial shock of the pandemic and WIC shopper food purchases and 2) differences in purchases before and during the pandemic. To assess differences in purchases between shoppers consistently using WIC electronic benefit transfer (EBT) cards and shoppers starting or stopping WIC EBT use during the pandemic, we used models stratified by WIC group. Primary outcomes were share (%) of total calories purchased from fruits, vegetables, nuts, and legumes (FV), processed foods, and sugar-sweetened beverages (SSBs). Results We observed small decreases in the share of total calories from FV (-0.4%) and small increases in the share of calories from processed food (1.1%) and SSBs (0.5%) purchased at this retailer when comparing the pre and post March 2020 periods. Compared with shoppers that started or stopped using WIC benefits during the pandemic, shoppers that used WIC benefits consistently had slightly higher FV and lower processed food and SSB purchases at this retailer. Conclusions Future studies should examine whether additional supports for nutrient-dense food choices may be needed for families with low incomes in public health emergencies.
Collapse
Affiliation(s)
- Emily W Duffy
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
| | | | - Cassandra R Davis
- Carolina Population Center, Chapel Hill, NC, United States
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Molly De Marco
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States
| | - Joanna Maselko
- Carolina Population Center, Chapel Hill, NC, United States
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Carolina Population Center, Chapel Hill, NC, United States
| |
Collapse
|
7
|
Chapman LE, Berkowitz SA, Ammerman A, De Marco M, Ng SW, Zimmer C, Caspi CE. Examining Changes in Food Security, Perceived Stress, and Dietary Intake in a Cohort of Low-Wage Workers Experiencing an Increase in Hourly Wage. Health Promot Pract 2024; 25:263-273. [PMID: 36373653 PMCID: PMC10183054 DOI: 10.1177/15248399221128005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether an increase in hourly wages was associated with changes in food security and perceived stress among low-wage workers. We also determined whether changes in food security and stress were associated with changes in diet. SETTING Wages is a prospective cohort study following 974 low-wage workers in Minneapolis, MN, where an ordinance is incrementally increasing minimum wage to US$15/hr from 2018 to 2022, and a comparison community with no minimum wage ordinance (Raleigh, NC). Interaction models were estimated using generalized estimating equations. PARTICIPANTS Analyses used two waves of data (2018 [baseline], 2019) and included 219 and 321 low-wage workers in Minneapolis and Raleigh (respectively). RESULTS Average hourly wages increased from US$9.77 (SD US$1.69) to US$11.67 (SD US$4.02). Changes in wages were not associated with changes in food security (odds ratio = 1.05, 95% confidence interval [CI] [0.89, 1.23], p = .57) or stress (β = -0.01, 95% CI [-0.04, 0.03], p = .70) after 1 year of policy implementation. Changes in food security were not associated with changes in diet. However, we found significant changes in the frequency of fruit and vegetable intake across time by levels of stress, with decreased intake from Wave 1 to 2 at low levels of stress, and increased intake at high levels of stress (incidence rate ratio = 1.17, 95% CI [1.05, 1.31], p = .01). CONCLUSIONS Changes in wages were not associated with changes in food security or stress in a sample of low-wage workers. Future research should examine whether full implementation of a minimum wage increase is associated with changes in these outcomes.
Collapse
Affiliation(s)
| | - Seth A. Berkowitz
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alice Ammerman
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Molly De Marco
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Zimmer
- The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | |
Collapse
|
8
|
Frank T, Ng SW, Lowery CM, Thow AM, Swart EC. Dietary intake of low-income adults in South Africa: ultra-processed food consumption a cause for concern. Public Health Nutr 2024; 27:e41. [PMID: 38204376 PMCID: PMC10882538 DOI: 10.1017/s1368980023002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Given the rapidly changing food environment and proliferation of ultra-processed foods (UPF) in South Africa (SA), this study aimed to critically evaluate dietary quality and adequacy of low-income adults using the Nova classification system and WHO and World Cancer Research Fund dietary guidelines. DESIGN Secondary household data and 1-d 24-h recalls were analysed from two cross-sectional studies conducted in 2017-2018. Foods consumed were classified according to the Nova classification system. Compliance with WHO dietary guidelines and UPF consumption trends were evaluated. SETTING Three low-income areas (Langa, Khayalitsha and Mount Frere) in SA were included. PARTICIPANTS In total, 2521 participants (18-50 years) were included in the study. RESULTS Participants had a mean energy intake of 7762 kJ/d. Most participants were within the acceptable WHO guideline range for saturated fat (80·4 %), total fat (68·1 %), Na (72·7 %) and free sugar (57·3 %). UPF comprised 39·4 % of diets among the average adult participant. Only 7·0 % of all participants met the WHO guideline for fruit and vegetables and 18·8 % met the guideline for fibre. Those within the highest quartile of share of energy from UPF consumed statistically higher amounts of dietary components to limit and were the highest energy consumers overall. CONCLUSIONS Low-income adults living in SA are consuming insufficient protective dietary components, while UPF consumption is prevalent. Higher UPF consumers consume larger amounts of nutrients linked to increased chronic disease risk. Policy measures are urgently needed in SA to protect against the proliferation of harmful UPF and to promote and enable consumption of whole and less UPF.
Collapse
Affiliation(s)
- Tamryn Frank
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, Cape Town7535, South Africa
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, Chapel Hill, USA
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa
- DSI/NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
9
|
Smith NR, Hassmiller Lich K, Ng SW, Hall MG, Trogdon JG, Frerichs L. Implementation costs of sugary drink policies in the United States. J Public Health Policy 2023; 44:566-587. [PMID: 37714964 PMCID: PMC10841536 DOI: 10.1057/s41271-023-00435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/17/2023]
Abstract
To support implementation of important public health policies, policymakers need information about implementation costs over time and across stakeholder groups. We assessed implementation costs of two federal sugar-sweetened beverage (SSB) policies of current policy interest and with evidence to support their effects: excise taxes and health warning labels. Our analysis encompassed the entire policy life cycle using the Exploration, Preparation, Implementation, and Sustainment framework. We identified implementation actions using key informant interviews and developed quantitative estimates of implementation costs using published literature and government documents. Results show that implementation costs vary over time and among stakeholders. Explicitly integrating implementation science theory and using mixed methods improved the comprehensiveness of our results. Although this work is specific to federal SSB policies, the process can inform how we understand the costs of many public health policies, providing crucial information for public health policy making.
Collapse
Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
10
|
Salgado Hernandez JC, Ng SW, Stearns SC, Trogdon JG. Cost-benefit analysis of alternative tax policies on sugar-sweetened beverages in Mexico. PLoS One 2023; 18:e0292276. [PMID: 37788248 PMCID: PMC10547152 DOI: 10.1371/journal.pone.0292276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
In 2014, Mexico implemented a tax on sugar-sweetened beverages (SSB) equivalent to one Mexican peso (MP) per liter to address the high obesity prevalence. This tax has effectively reduced SSB purchases and yielded healthcare savings; however, it remains unknown whether SSB taxes lead to net benefits at the societal level in Mexico. Moreover, public health experts recommend increasing the tax. The objective of this study is to estimate the net benefits of SSB taxes compared to a scenario of no tax in urban Mexico. Taxes include the one-MP tax and alternative higher taxes (two and three MP per SSB liter). Thus, we conducted a cost-benefit analysis from the perspective of the government, producers, and consumers for a simulated closed cohort of adults in a life-table model. We defined net benefits as the difference between economic benefits (the value of statistical life, healthcare savings, and tax revenue) and costs (consumer surplus and profit losses). We found that, at the societal level, all simulated taxes will eventually generate benefits that surpass costs within ten years. Overall net benefits can reach USD 7.1 billion and 15.3 billion for the one-MP and the three-MP tax, respectively. Hence, these benefits increased at a declining rate compared to taxes. The government and consumers will experience overall positive net benefits among society's members. Policymakers should consider time horizons and tradeoffs between health gains and economic outcomes across different society members.
Collapse
Affiliation(s)
- Juan Carlos Salgado Hernandez
- National Institute of Public Health, National Council of Humanities, Science and Technology, Mexico and Center for Research in Nutrition and Health, Cuernavaca, Mexico
| | - Shu Wen Ng
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sally C. Stearns
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Justin G. Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
11
|
Duffy E, Ng SW, Hall MG, Bercholz M, Rebolledo N, Musicus A, Taillie LS. Sociodemographic disparities in purchases of fruit drinks with policy relevant front-of-package nutrition claims. Public Health Nutr 2023; 26:1585-1595. [PMID: 37211358 PMCID: PMC10410375 DOI: 10.1017/s1368980023000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Our objectives were to describe sociodemographic characteristics associated with the purchase of (1) any fruit drinks and (2) fruit drinks with specific front-of-package (FOP) nutrition claims. DESIGN Cross-sectional. SETTING USA. PARTICIPANTS We merged fruit drink purchasing data from 60 712 household-months from 5233 households with children 0-5 years participating in Nielsen Homescan in 2017 with nutrition claims data. We examined differences in predicted probabilities of purchasing any fruit drinks by race/ethnicity, income and education. We constructed inverse probability (IP) weights based on likelihood of purchasing any fruit drinks. We used IP-weighted multivariable logistic regression models to examine predicted probabilities of purchasing fruit drinks with specific FOP claims. RESULTS One-third of households with young children purchased any fruit drinks. Non-Hispanic (NH) Black (51·6 %), Hispanic (36·3 %), lower-income (39·3 %) and lower-educated households (40·9 %) were more likely to purchase any fruit drinks than NH White (31·3 %), higher-income (25·8 %) and higher-educated households (30·3 %) (all P < 0·001). In IP-weighted analyses, NH Black households were more likely to purchase fruit drinks with 'Natural' and fruit or fruit flavour claims (6·8 % and 3·7 %) than NH White households (4·5 % and 2·7 %) (both P < 0·01). Lower- and middle-income (15·0 % and 13·8 %) and lower- and middle-educated households (15·4 % and 14·5 %) were more likely to purchase fruit drinks with '100 % Vitamin C' claims than higher-income (10·8 %) and higher-educated households (12·9 %) (all P < 0·025). CONCLUSIONS We found a higher likelihood of fruit drink purchases in lower-income, lower-educated, NH Black and Hispanic households. Experimental studies should determine if nutrition claims may be contributing to disparities in fruit drink consumption.
Collapse
Affiliation(s)
- Emily Duffy
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, and UNC Lineberger Comprehensive Cancer Center, School of Medicine, Chapel Hill, NC, USA
| | | | - Natalia Rebolledo
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| | - Aviva Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| |
Collapse
|
12
|
Lo AE, Duffy EW, Ng SW. Differences in a Chain Supermarket's Sales to SNAP Shoppers Before and Since the COVID-19 Pandemic. J Nutr Educ Behav 2023; 55:343-353. [PMID: 37164550 PMCID: PMC10228633 DOI: 10.1016/j.jneb.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study 1) compares grocery sales to Supplemental Nutrition Assistance Program (SNAP) shoppers in rural and urban grocery stores and 2) estimates changes in sales to SNAP shoppers in North Carolina (NC) since the pandemic. DESIGN Weekly transaction data among loyalty shoppers at a large grocery chain across NC from October 2019 to December 2020 (n = 32; 182 store weeks) to assess nutritional outcomes. SETTING North Carolina large chain grocery stores. PARTICIPANTS Large chain grocery store/SNAP shoppers. INTERVENTION Rural/urban status of the stores and COVID-19 pandemic onset. MAIN OUTCOME MEASURES Share of total calories sold from fruits, vegetables, nuts, and legumes (FVNL) with and without additives, sugar-sweetened beverages (SSB), less healthful foods (LHF), and processed meats (PM). ANALYSIS Multivariate random effects models with robust standard errors to examine the association of rural/urban status before and since coronavirus disease 2019 with the share of calories sold to SNAP shoppers from each food category. We controlled for county-level factors (eg, sociodemographic composition, food environment) and store-level factors. RESULTS We did not find significant rural-urban differences in the composition of sales to SNAP shoppers in adjusted models. There was a significant decrease in the mean share of total calories from sugar-sweetened beverages (-0.43%) and less healthful food (-1.32%) and an increase in the share from processed meats (0.09%) compared with before the pandemic (P < 0.05). CONCLUSIONS AND IMPLICATIONS Urban-rural definitions are insufficient to understand nuances in food environments, and more support is needed to ensure healthy food access.
Collapse
Affiliation(s)
- Amy Elizabeth Lo
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily Welker Duffy
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| |
Collapse
|
13
|
Boachie MK, Goldstein S, Kruger P, Ng SW, Hofman KJ, Thsehla E. Beverage industry's advertising expenditures and airtimes in South Africa from 2013 to 2019 target children and families. J Public Health Res 2023; 12:22799036231168207. [PMID: 37122639 PMCID: PMC10134126 DOI: 10.1177/22799036231168207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
With the growing burden of non-communicable diseases (NCDs), countries across the globe are finding ways to reduce the consumption of ultra-processed food and drinks including sugar-sweetened beverages (SSBs). South Africa implemented a health promotion levy (HPL) in April 2018 as one strategy to reduce sugar intake. Such efforts are frequently countered or mitigated by industry action in various ways, including through marketing and advertising strategies. To better understand trends in the extent of advertising, this paper analyses advertising expenditures and exposure of children to SSB advertisements in South Africa. Using Nielsen's monthly data on advertising expenditure before and after the introduction of the HPL, for the period January 2013 to April 2019, the results show that manufacturers spent ZAR 3683 million to advertise their products. Advertising expenditure on carbonated drinks accounted for over 60% (ZAR 2220 million) of the total expenditure on SSBs. The results also show that companies spend less in advertising powdered SSBs (an average of ZAR 0.05 million per month). Based on expenditure patterns, television (TV) was the preferred medium of advertisements, with companies prioritizing what is often considered children's and family viewing time. Urgent mandatory regulations are needed to prevent child-directed marketing.
Collapse
Affiliation(s)
- Micheal Kofi Boachie
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Micheal Kofi Boachie, SAMRC/Wits Centre for
Health Economics and Decision Science – PRICELESS SA, School of Public Health,
Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193,
South Africa.
| | - Susan Goldstein
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Petronell Kruger
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shu Wen Ng
- Department of Nutrition, Gillings
School of Global Public Health, University of North Carolina, Chapel Hill, NC,
USA
| | - Karen J Hofman
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelyn Thsehla
- SAMRC/Wits Centre for Health Economics
and Decision Science – PRICELESS SA, School of Public Health, Faculty of Health
Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
14
|
Rebolledo N, Bercholz M, Adair L, Corvalán C, Ng SW, Taillie LS. Sweetener Purchases in Chile before and after Implementing a Policy for Food Labeling, Marketing, and Sales in Schools. Curr Dev Nutr 2023; 7:100016. [PMID: 37180088 PMCID: PMC10111599 DOI: 10.1016/j.cdnut.2022.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/08/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Chile's landmark food labeling and advertising policy led to major reductions in sugar purchases. However, it is unclear whether this led to increases in the purchases of nonnutritive sweeteners (NNS). Objectives The objective of this study was to assess the changes in NNS and caloric-sweetened (CS) products purchased after the law's first phase. Methods Longitudinal data on food and beverage purchases from 2,381 households collected from January 1, 2015 to December 31, 2017, were linked to nutritional information and categorized into added sweetener groups (unsweetened, NNS-only, CS-only, or NNS with CS). Logistic random-effects models and fixed-effects models were used to compare the percentage of households purchasing products and the mean volume purchased by sweetener category to a counterfactual based on pre-regulation trends. Results Compared with the counterfactual, the percentage of households purchasing any NNS beverages (NNS-only or NNS with CS) increased by 4.2 percentage points (pp) (95% CI: 2.8, 5.7; P < 0.01). This increase was driven by households purchasing NNS-only beverages (12.1 pp, 95% CI: 10.0, 14.2; P < 0.01). The purchased volume of beverages with any NNS increased by 25.4 mL/person/d (95% CI: 20.1, 30.7; P < 0.01) or 26.5%. Relative to the counterfactual, there were declines of -5.9 pp in households purchasing CS-only beverages (95% CI: -7.0, -4.7; P < 0.01). Regarding the types of sweeteners purchased, we found significant increases in the amounts of sucralose, aspartame, acesulfame K, and steviol glycosides purchased from beverages. Among foods, differences were minimal. Conclusions The first phase of Chile's law was associated with an increase in the purchases of beverages containing NNS and decreases in beverages containing CS, but virtually no changes in foods.
Collapse
Affiliation(s)
- Natalia Rebolledo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linda Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Macul, Chile
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
15
|
Duffy EW, Lo A, Hall MG, Taillie LS, Ng SW. Prevalence and demographic correlates of online grocery shopping: results from a nationally representative survey during the COVID-19 pandemic. Public Health Nutr 2022; 25:3079-3085. [PMID: 35983641 PMCID: PMC9464506 DOI: 10.1017/s1368980022001756] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 05/29/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the prevalence of online grocery shopping in a nationally representative sample and describe demographic correlates with online grocery shopping. DESIGN The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen National Consumer Panel participants in July 2020. We used survey weighted-multivariable logistic regression to examine demographic correlates of having ever online grocery shopped. SETTING Online survey. PARTICIPANTS 18 598 Nielsen National Consumer Panel participants in the USA. RESULTS Thirty-nine percent of respondents had purchased groceries online, and among prior purchasers, 89 % indicated that they would continue to online grocery shop in the next month. Canned/packaged foods were the most shopped for grocery category online, followed by beverages, fresh foods and lastly frozen foods. In adjusted analyses, younger respondents (39 years or less) were more likely (47 %) to have ever shopped for groceries online than older age groups (40-54 years, 55-64 years and 65+ years) (29 %, 22 % and 23 %, respectively, all P < 0·001). Those with greater than a college degree were more likely to have ever grocery shopped online (45 %) than respondents with some college education (39 %) and with a high school education or less (32 %) (both P < 0·001). Having children, having a higher income and experiencing food insecurity, particularly among higher income food-insecure households, were also associated with a higher probability of prior online grocery shopping. CONCLUSIONS The COVID-19 pandemic accelerated the transition to online grocery shopping. Future research should explore the nutrition implications of online grocery shopping.
Collapse
Affiliation(s)
- Emily W Duffy
- Department of Nutrition, University of North Carolina, Chapel Hill Gillings School of Global Public Health, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC27516, USA
| | - Amy Lo
- Department of Nutrition, University of North Carolina, Chapel Hill Gillings School of Global Public Health, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC27516, USA
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina, Chapel Hill Gillings School of Global Public Health, Carolina Population Center, UNC Lineberger Comprehensive Cancer Center, School of Medicine, Chapel Hill, NC, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina, Chapel Hill Gillings School of Global Public Health, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC27516, USA
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina, Chapel Hill Gillings School of Global Public Health, Carolina Population Center, 123 W Franklin St., Chapel Hill, NC27516, USA
| |
Collapse
|
16
|
Lowery CM, Henderson R, Curran N, Hoeffler S, De Marco M, Ng SW. Grocery Purchase Changes Were Associated With A North Carolina COVID-19 Food Assistance Incentive Program. Health Aff (Millwood) 2022; 41:1616-1625. [PMID: 36343315 PMCID: PMC10191414 DOI: 10.1377/hlthaff.2022.00902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many low-income Americans experience food insecurity, which may have been exacerbated by economic instability during the early stages of the COVID-19 pandemic in 2020. In this study we assessed the impact of Healthy Helping, a short-term fruit and vegetable incentive program aimed at alleviating food insecurity and improving diet quality for Supplemental Nutrition Assistance Program participants, on grocery purchases, using transaction data from a large supermarket chain in North Carolina. We compared Healthy Helping participants' purchases of key food groups before and during the program with purchases by control shoppers participating in federal food assistance programs during the same period. Healthy Helping enrollment was associated with a $26.95 increase in monthly spending on fruit, vegetables, nuts, and legumes-an increase of 2.5 grams of fiber per 1,000 kilocalories purchased-and other shifts in the composition of food purchases, relative to control shoppers. These findings suggest that the program increased healthy food purchases while also increasing dollar sales at participating retailers. On average, participants did not use the full benefit; future research should explore factors associated with non- or underuse of benefits, to inform program design and outreach.
Collapse
Affiliation(s)
- Caitlin M Lowery
- Caitlin M. Lowery, University of North Carolina, Chapel Hill, North Carolina
| | | | - Neal Curran
- Neal Curran, Reinvestment Partners, Durham, North Carolina
| | | | | | - Shu Wen Ng
- Shu Wen Ng , University of North Carolina
| |
Collapse
|
17
|
Rebolledo N, Bercholz M, Corvalán C, Ng SW, Taillie LS. Did the sweetness of beverages change with the Chilean Food Labeling and Marketing Law? A before and after study. Front Nutr 2022; 9:1043665. [DOI: 10.3389/fnut.2022.1043665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
There has been a rapid proliferation of policies around the globe to reduce sugar consumption, yet there is little understanding as to whether these policies have led to changes in the overall sweetness of products, which is essential for understanding long-term effects on food preferences and intake. For example, the implementation of Chile’s Law on Food Labeling and Advertising led to decreases in the sugar content of non-alcoholic packaged beverages and increases in non-nutritive sweeteners (NNS) use in these beverages. Given that NNS have greater sweetness intensity than sugars, it is unclear what was the net effect of these changes on the sweetness of purchased beverages. Using longitudinal household purchase data (n > 2,000 households), we measured the changes in the sweetness of beverage purchases after implementing the first phase of the Chilean law and examine if there were differences by key family sociodemographic variables. We developed three sweetness indices: (1) NNS sweetness, including the sweetness of the six NNS most consumed by Chileans; (2) total sugars sweetness, including the sweetness from total sugars; and (3) total sweetness, combining the sweetness from NNS and sugars. Using fixed-effects models, we compared the observed post-law purchases to a counterfactual based on pre-law trends. We found that NNS sweetness increased relative to the counterfactual, while total sugars sweetness decreased after the law. However, the absolute changes in NNS sweetness were almost entirely offset by the decreases in total sugar sweetness, leading to no change in the total sweetness of beverage purchases. Additionally, there were no differences in the sweetness changes by family sociodemographics. Our findings indicate that Chilean consumers are exposed to similar sweetness levels in their beverages after the law. Future research should explore whether sweetness also remained consistent in dietary intake.
Collapse
|
18
|
Abstract
INTRODUCTION Simulation modeling methods are an increasingly common tool for projecting the potential health effects of policies to decrease sugar-sweetened beverage (SSB) intake. However, it remains unknown which SSB policies are understudied and how simulation modeling methods could be improved. To inform next steps, we conducted a scoping review to characterize the (1) policies considered and (2) major characteristics of SSB simulation models. METHODS We systematically searched 7 electronic databases in 2020, updated in 2021. Two investigators independently screened articles to identify peer-reviewed research using simulation modeling to project the impact of SSB policies on health outcomes. One investigator extracted information about policies considered and key characteristics of models from the full text of included articles. Data were analyzed in 2021-22. RESULTS Sixty-one articles were included. Of these, 50 simulated at least one tax policy, most often an ad valorem tax (e.g., 20% tax, n = 25) or volumetric tax (e.g., 1 cent-per-fluid-ounce tax, n = 23). Non-tax policies examined included bans on SSB purchases (n = 5), mandatory reformulation (n = 3), warning labels (n = 2), and portion size policies (n = 2). Policies were typically modeled in populations accounting for age and gender or sex attributes. Most studies focused on weight-related outcomes (n = 54), used cohort, lifetable, or microsimulation modeling methods (n = 34), conducted sensitivity or uncertainty analyses (n = 56), and included supplementary materials (n = 54). Few studies included stakeholders at any point in their process (n = 9) or provided replication code/data (n = 8). DISCUSSION Most simulation modeling of SSB policies has focused on tax policies and has been limited in its exploration of heterogenous impacts across population groups. Future research would benefit from refined policy and implementation scenario specifications, thorough assessments of the equity impacts of policies using established methods, and standardized reporting to improve transparency and consistency.
Collapse
Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
| | - Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, United States of America
- Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
- Carolina Population Center, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Sarah Towner Wright
- Health Sciences Library, UNC Chapel Hill, Chapel Hill, NC, United States of America
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| |
Collapse
|
19
|
Bopape M, De Man J, Taillie LS, Ng SW, Murukutla N, Swart R. Effect of different front-of-package food labels on healthfulness perception of ultraprocessed food and intention to purchase the products- A randomised controlled trial. Appetite 2022; 179:106283. [PMID: 36027994 DOI: 10.1016/j.appet.2022.106283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to evaluate the effect of different labels on participants: identifying products high in nutrients of concern; identifying unhealthy products, and intention to purchase unhealthy products. This blinded randomised controlled trial included a representative sample of South African households (n = 1951). Per household we selected a member primarily responsible for food purchases. Participants were randomised into the Warning Label (WL), Guideline Dietary Amounts (GDA) or Multiple Traffic Light (MTL) arms. Each participant answered questions in a no label condition (control) followed by same questions in the label condition (experiment). Complete data were collected and analysed for 1948 participants (WL = 33.7%, GDA = 32.1% and MTL = 34.2%). The probability of correctly identifying products high in nutrients of concern and identifying products as being unhealthy was higher with the WL compared to the GDA or MTL for most items. There was no difference in performance between the GDA and the MTL when considering all items together. A higher percentage of participants reported a lower intention to purchase an unhealthy product after exposure to the WL compared to MTL for 5 out of 6 products; 2 out of 6 products for the WL compared to GDA and 2 out of 6 products for GDA compared to MTL. Compared to the control condition, exposure to each of the labels resulted in better identification of nutrients of concerns, unhealthy products and a lower intention to purchase when considering all specific outcome items together. The WL showed a higher potential to enable South African consumers to identify products high in nutrients of concern, identify unhealthy products and discourage purchasing of unhealthy products.
Collapse
Affiliation(s)
- Makoma Bopape
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, University of Limpopo, South Africa; Faculty of Community and Health Sciences, School of Public Health, University of the Western Cape, South Africa.
| | - Jeroen De Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
| | - Lindsey Smith Taillie
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - Shu Wen Ng
- Carolina Population Center and Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | | | - Rina Swart
- Department of Dietetics and Nutrition, Faculty of Community and Health Sciences, University of the Western Cape, South Africa.
| |
Collapse
|
20
|
Lu I, Sheppard B, Ng SW, Burstein S, Charles E, Williams T, De Marco M. Did A Fruit and Vegetable Incentive Program Support low-income Households in North Carolina during the COVID-19 Pandemic? A Mixed Methods Assessment of the Healthy Helping Program and Other Pandemic-Related Food Assistance. Journal of Hunger & Environmental Nutrition 2022. [DOI: 10.1080/19320248.2022.2108742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Isabel Lu
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brett Sheppard
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah Burstein
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emile Charles
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Taylor Williams
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Molly De Marco
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
21
|
Bercholz M, Ng SW, Stacey N, Swart EC. Decomposing consumer and producer effects on sugar from beverage purchases after a sugar-based tax on beverages in South Africa. Econ Hum Biol 2022; 46:101136. [PMID: 35358759 PMCID: PMC9288974 DOI: 10.1016/j.ehb.2022.101136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 02/05/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Growing global concern about obesity and diet-related non-communicable diseases has raised interest in fiscal policy as a tool to reduce this disease burden and its social costs, especially excise taxes on sugar-sweetened beverages (SSBs). Of particular interest have been nutrient-based taxes to improve diet quality. These can incentivize producers to reformulate existing products and introduce healthier alternatives into their ranges. In 2018, South Africa adopted a sugar-based tax on SSBs, the Health Promotion Levy (HPL). Early findings suggest that purchases of higher-sugar taxable beverages fell and purchases of no- and lower-sugar beverages increased, alongside significant reductions in the sugar content of overall beverage purchases. However, underlying these changes are consumption shifts as well as product reformulation and changes in producers' product portfolios. Drawing on a household scanner dataset, this study employed a descriptive approach to decompose changes in the sugar content of households' non-alcoholic beverage purchases into producer factors (reformulation and product entry and exit) and consumer factors (product switching and volume changes as a result of price changes, changing preferences, or other factors). We look at these factors as the tax was announced and implemented across a sample of over 3000 South African households, and then by Living Standard Measures (LSM) groups (middle vs. high). The sugar content of beverage purchases fell by 4.9 g/capita/day overall, a 32% decrease. Taken in isolation, consumer switching and volume changes together led to a reduction equivalent to 71% of the total change, while reformulation accounted for a decrease equal to 34% of that change. Middle-LSM households experienced larger reductions than high-LSM households due to larger changes on the consumer side. For both LSM groups, reformulation-led reductions mostly occurred after implementation, and most changes came from taxable beverage purchases. As sugary drink tax designs evolve with broader implementation globally, understanding both supply- and demand-side factors will help to better assess the population and equity potential of these policies.
Collapse
Affiliation(s)
- Maxime Bercholz
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United Sates.
| | - Nicholas Stacey
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
22
|
Duffy EW, Vest DA, Davis CR, Hall MG, De Marco M, Ng SW, Taillie LS. "I Think That's the Most Beneficial Change That WIC Has Made in a Really Long Time": Perceptions and Awareness of an Increase in the WIC Cash Value Benefit. Int J Environ Res Public Health 2022; 19:8671. [PMID: 35886526 PMCID: PMC9324401 DOI: 10.3390/ijerph19148671] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
During the COVID-19 pandemic, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Cash Value Benefit (CVB) for fruits and vegetables increased by roughly USD 25/month/person. We sought to understand WIC participant perceptions of this change and barriers and facilitators to using the CVB. We conducted 10 virtual focus groups (5 rural, 5 urban/suburban) with WIC participants (n = 55) in North Carolina in March 2022. Focus groups were recorded and transcribed. We open-coded the content and used thematic analysis to uncover consistencies within and between sampled groups. Participants expressed favorable perceptions of the CVB increase and stated the pre-pandemic CVB amount was insufficient. Barriers to using the increased CVB were identifying WIC-approved fruits and vegetables in stores and insufficient supply of fruits and vegetables. Barriers were more pronounced in rural groups. Facilitators of CVB use were existing household preferences for fruits and vegetables and the variety of products that can be purchased with CVB relative to other components of the WIC food package. Participants felt the CVB increase allowed their families to eat a wider variety of fruits and vegetables. The CVB increase may improve fruit and vegetable intake, particularly if made permanent, but barriers to CVB and WIC benefit use may limit the potential impact.
Collapse
Affiliation(s)
- Emily W. Duffy
- Carolina Population Center, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.W.N.); (L.S.T.)
| | - Daniele A. Vest
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Cassandra R. Davis
- Carolina Population Center, Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Marissa G. Hall
- Carolina Population Center, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Molly De Marco
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Shu Wen Ng
- Carolina Population Center, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.W.N.); (L.S.T.)
| | - Lindsey Smith Taillie
- Carolina Population Center, Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (S.W.N.); (L.S.T.)
| |
Collapse
|
23
|
Golden SD, Ng SW, Trangenstein PJ. Excise Taxes as a Policy Lever for Reaching Healthy North Carolina 2030 Targets. N C Med J 2022; 83:253-256. [PMID: 35817458 DOI: 10.18043/ncm.83.4.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Excise taxes can raise the price of unhealthy products, reducing consumption and associated health risks and costs. Raising state excise taxes on tobacco, alcohol, and sugary drinks and allowing local governments to do the same are win-win strategies for achieving three Healthy North Carolina 2030 health behavior targets while increasing state revenues.
Collapse
Affiliation(s)
- Shelley D Golden
- Department of Health Behavior, UNC Gillings School of Global Public Health and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.
| | - Shu Wen Ng
- Department of Nutrition, UNC Gillings School of Global Public Health and Carolina Population Center, Chapel Hill, North Carolina
| | - Pamela J Trangenstein
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina; scientist, Alcohol Research Group, Public Health Institute, Emeryville, California
| |
Collapse
|
24
|
Rebolledo N, Reyes M, Popkin BM, Adair L, Avery CL, Corvalán C, Ng SW, Taillie LS. Changes in nonnutritive sweetener intake in a cohort of preschoolers after the implementation of Chile's Law of Food Labelling and Advertising. Pediatr Obes 2022; 17:e12895. [PMID: 35088571 DOI: 10.1111/ijpo.12895] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/10/2021] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The first phase of Chile's Law of Food Labelling and Advertising showed important declines in the sugar content of packaged foods, but it is unknown whether the law led to an increase in nonnutritive sweetener (NNS) intake, particularly among preschool children. OBJECTIVES Estimate the changes in preschoolers' NNS intake after the first phase of the Chilean law. METHODS We used 24-h dietary recalls collected in 2016 (pre-law) and 2017 (post-law) from a cohort of preschoolers (n = 875). The primary caretaker was the respondent of the recalls. Information on NNS was obtained from nutrition facts panels collected annually and linked to dietary data. We used logistic regression to estimate the changes in the proportion of preschoolers who consume NNS and two-part models to estimate the changes in mean intake. We determined the percentage of children that surpassed the acceptable daily intake (ADI) of each NNS using the National Cancer Institute method. RESULTS The proportion of consumers of at least one NNS increased from 77.9% to 92.0% (p-value < 0.01). The mean intake increased for sucralose, aspartame, acesulfame-K and steviol glycosides (+20.3, +15.1, +6.1 and +3.3 mg/day, respectively). In addition, NNS dietary sources changed for sucralose and steviol glycosides, becoming industrialized juices and dairy beverages more relevant while tabletop NNS became less relevant. None of the children surpassed the ADI. CONCLUSIONS NNS intake increased in preschoolers after the first phase of a national policy that promoted sugar reformulation.
Collapse
Affiliation(s)
- Natalia Rebolledo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Marcela Reyes
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christy L Avery
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
25
|
Duffy E, Taillie LS, Ng SW. Estimating the Effects of COVID-19 on WIC Participant Food Purchases. Curr Dev Nutr 2022. [PMCID: PMC9193492 DOI: 10.1093/cdn/nzac048.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Emergency changes to food assistance programs such as WIC can prevent widening nutritional disparities during societal shocks such as pandemics. However, to understand the potential impact of emergency policy changes, it is first essential to understand whether COVID altered the nutritional quality of WIC participant food purchases. We describe the relationship between the societal shock induced by COVID and WIC participant food purchases. Methods We used a longitudinal dataset from October 2019 to December 2020 of loyalty-card linked food purchasing data from a large grocery store chain in North Carolina with 496 stores in 86 counties. This dataset includes all items purchased and tender type(s) used in transactions. WIC participants are identified by using WIC tender types. Our sample includes about one million loyalty card shoppers in a typical month, about 10% of whom are WIC participants. Food items have been grouped into nutritionally relevant food groups. To control for seasonality, we compared mean calories purchased per shopper per day for all food groups in the same 3-month period pre-COVID (Oct-Dec 2019) and during COVID (Oct 2020-Dec 2020) among WIC shoppers and non-WIC shoppers using t-tests and unadjusted difference-in-difference (DID) models. Results Mean calories purchased from all food groups increased in both WIC and non-WIC shoppers during COVID (all p < 0.01). WIC shoppers purchased more calories from all food groups than non-WIC shoppers both pre-COVID and during COVID (all p < 0.01). Comparing pre-COVID to during COVID purchases, WIC shoppers’ total purchases increased by 294 calories per day, compared to non-WIC shoppers which increased by 197 calories per day. Increases in purchases of all food groups during COVID were similar except for the junk food and sugar sweetened beverage groups which increased more among WIC shoppers (59 and 26 calories per day, respectively) than non-WIC shoppers (36 and 13 calories per day, respectively). Future analyses will adjust for potential confounders and incorporate propensity score weighting. Conclusions Understanding how food purchasing patterns shift in response to societal shocks is vital for ensuring future emergency food response efforts improve existing diet-related disparities. Funding Sources National Institutes of Health.
Collapse
Affiliation(s)
- Emily Duffy
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| | - Lindsey Smith Taillie
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| | - Shu Wen Ng
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health
| |
Collapse
|
26
|
Lo A, Ng SW, Duffy EW. Urban and Rural Purchase Patterns of SNAP Participants in North Carolina. Curr Dev Nutr 2022. [PMCID: PMC9193644 DOI: 10.1093/cdn/nzac059.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Urban and rural environments have different economic and social factors that influence un/healthy food access. SNAP participants are at greater risk for diet related chronic disease compared to non-SNAP participants and it is unclear whether rurality amplifies or alleviates these risks. This study examines grocery sales to SNAP participants from rural vs urban stores to provide insights into geographical disparities in the prevalence of chronic disease.
Methods
We used de-identified store-week level transaction data from a large grocery chain with >490 stores across North Carolina from Oct 2019-Dec 2020 (n = 32,182 store weeks), classifying stores as urban or rural based on USDA definitions (main exposure). We identified SNAP sales from payment mode and defined SNAP participation as having used a SNAP EBT card within the last 3 months. Products are classified into nutritionally meaningful categories: fruits, vegetables, nuts, and legumes (FVNL), sugar sweetened beverages (SSB), junk food (JF) and processed meats (PM), linked to nutrition data. We used multivariate random effects models with robust standard errors to examine the association of rural/urban stores with the share of calories of food categories purchased (main outcomes). We controlled for annual county level factors (socio-demographic composition, food environment) and weekly store level factors (composition of sales among SNAP vs non-SNAP).
Results
127 stores were classified as rural and 369 stores were urban. Adjusting for covariates, an average of 13.12% of total calories sold from rural stores were from FVNL, compared to an average of 13.27% of total calories sold from urban stores. Rural stores’ sales to SNAP participants had small but significantly higher share of total calories sold from SSBs (10.34% vs 9.36%), JF (30.68% vs 30.36%) and PM (5.7% vs 5.64%) compared to urban stores’ sales to SNAP participants.
Conclusions
Rural store sales to SNAP participants appear to be marginally different from urban store sales to SNAP participants which support concerns around the need to improve healthy food access and limit unhealthy food access in rural settings.
Funding Sources
National Institutes of Health (U48DP006374, NIH P2C HD050924).
Collapse
Affiliation(s)
- Amy Lo
- University of North Carolina at Chapel Hill
| | - Shu Wen Ng
- University of North Carolina at Chapel Hill
| | | |
Collapse
|
27
|
Ross A, Swart EC, Frank T, Lowery CM, Ng SW. South Africa's Health Promotion Levy on Pricing and Acquisition of Beverages in Local Spazas and Supermarkets. Public Health Nutr 2022; 25:1-26. [PMID: 35249582 PMCID: PMC9991735 DOI: 10.1017/s1368980022000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In response to concern over rising sugar-sweetened beverage (SSB) consumption, in April 2018, South Africa became the first Sub-Saharan African country to implement an SSB tax. We assess changes in pricing and acquisition of beverages from local supermarkets and small stores among 18-39 year old adults living in one township in the Western Cape, before and after tax implementation. This study is among the first evaluations of an SSB tax on the local food environment in a low-income township. DESIGN Store beverage pricing and participant surveys were cross-sectional, analyzed 1 month before and 11 months after implementation of the tax (March 2018 and March 2019). SETTING Langa, Western Cape, South Africa. PARTICIPANTS Surveyed participants were residents of Langa between 18-39 years old (N=2,693 in 2018 and N=2,520 in 2019). RESULTS Prices of taxed SSBs increased significantly among small shops and supermarkets between 2018 and 2019. There were non-significant decreases in prices of untaxed beverages in small shops, but prices of untaxed beverages increased in supermarkets. Across all store types, there was a 9 percentage point decrease in the probability of purchasing regular soda weekly pre/post-implementation. Reductions in purchasing were larger in small shops than supermarkets. CONCLUSIONS We found some differential impacts of the levy on pricing and acquisition of beverages by retailer type in one low-income township. As other Sub-Saharan African countries consider similar fiscal policies to curb soda consumption, obesity and related diseases, this work can be used to understand the implications of these policies in the retail setting.
Collapse
Affiliation(s)
- Alexandra Ross
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa
- DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tamryn Frank
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Caitlin M Lowery
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina, Chapel Hill, NC27599-8120, USA
| |
Collapse
|
28
|
Frank T, Ng SW, Miles DR, Swart EC. Applying and comparing various nutrient profiling models against the packaged food supply in South Africa. Public Health Nutr 2022; 25:1-31. [PMID: 35168688 PMCID: PMC9378746 DOI: 10.1017/s1368980022000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profiling model (NPM) to the food supply in South Africa (SA) and compare its performance against existing NPMs as an indication of suitability for use to underpin food policies targeted at discouraging consumption of products high in nutrients associated with poor health. DESIGN Cross-sectional analysis of the SA packaged food supply comparing the CAM to three other NPMs: SA health and nutrition claims (SA HNC), Chilean warning octagon (CWO) 2019, and Pan-American Health Organization (PAHO) NPM. SETTING The SA packaged food supply based on products stocked by supermarkets in Cape Town, SA. PARTICIPANTS Packaged foods and beverages (N=6474) available in 2018 were analyzed. RESULTS 49% of products contained excessive amounts of nutrients of concern (considered non-compliant) according to the criteria of all four models. Only 10.9% of products were not excessive in any nutrients of concern (considered compliant) according to all NPMs evaluated. The CAM had an overall non-compliance level of 73.2%, and was comparable to the CWO 2019 for foods (71.2% and 71.1% respectively). The CAM was the strictest NPM for beverages (80.4%) due to the criteria of non-sugar sweeteners and free sugars. The SA HNC was the most lenient with non-compliance at 52.9%. This was largely due to the inclusion of nutrients to encourage, which is a criterion for this NPM. CONCLUSION For the purpose of discouraging products high in nutrients associated with poor health in SA, the CAM is a suitable NPM.
Collapse
Affiliation(s)
- Tamryn Frank
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina Chapel Hill, United States of America;
| | - Donna R Miles
- Carolina Population Center, The University of North Carolina Chapel Hill, United States of America;
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, South Africa,
| |
Collapse
|
29
|
Valizadeh P, Popkin BM, Ng SW. Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor. Am J Clin Nutr 2022; 115:244-255. [PMID: 34610088 PMCID: PMC8755035 DOI: 10.1093/ajcn/nqab330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/27/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. OBJECTIVES We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and combinations of SSB taxes with fruit and vegetable (FV) subsidies targeted to low-income households on SSB and FV purchases of lower and higher SSB purchasers. METHODS We considered a 1-cent-per-ounce SSB tax and 2 FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan data. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies' differential effects. RESULTS Higher-SSB-purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 compared with 0.5 oz/day at percentile 25; P < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households, regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. CONCLUSIONS SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels before policy implementation. Expanding taxes beyond SSBs, providing larger FV subsidies, or offering subsidies beyond FVs, particularly for low-income households with children, may be more effective.
Collapse
Affiliation(s)
- Pourya Valizadeh
- Agricultural & Food Policy Center, Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
- Department of Agricultural Economics, Texas A&M University, College Station, TX, USA
| | - Barry M Popkin
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
30
|
Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
Collapse
Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
31
|
Abstract
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, political, and public health needs; and emerging science is critical.
Collapse
Affiliation(s)
- James Krieger
- Healthy Food America, Seattle, Washington 98122, USA.,Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195, USA;
| | - Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Stephanie Scarmo
- American Heart Association, National Center, Dallas, Texas 75231, USA;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27516, USA;
| |
Collapse
|
32
|
Dunford EK, Miles DR, Popkin B, Ng SW. Whole Grain and Refined Grains: An Examination of US Household Grocery Store Purchases. J Nutr 2021; 152:550-558. [PMID: 34718663 PMCID: PMC8826838 DOI: 10.1093/jn/nxab382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 10/26/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The health benefits related to intake of whole grain foods are well established. Consumption of whole grains in the US population is low, and whole grain content can vary greatly depending upon the specific products that are purchased. OBJECTIVES To examine the proportion of products purchased by US households containing whole grain and refined grain ingredients using time-specific food composition data, and examine whether purchases differ between income, race or ethnicity, and household make-up. METHODS Nationally representative Nielsen Homescan 2018 data were used. Each barcoded product captured in Nielsen Homescan 2018 was linked with ingredient information using commercial nutrition databases in a time-relevant manner. Packaged food products containing whole grain ingredients, refined grain ingredients, neither, or both were identified. The percentage of packaged food products containing whole grain and refined grain ingredients purchased by US households was determined overall, by demographic subgroup, and by food category. RESULTS The proportion of packaged food purchases containing refined grain ingredients was significantly higher than whole grain ingredients (30.9% compared with 7.9%; P < 0.0001). Lower income households and households with children purchased a significantly higher proportion of products containing refined grain ingredients, with no nutritionally meaningful racial or ethnic differences observed. Concerningly, across all demographic subgroups >90% of bread purchases contained refined grain ingredients, and the 5 categories with the largest proportion of whole grain ingredients contributed to <20% of overall US household packaged food purchases. CONCLUSIONS US households are purchasing a significantly higher proportion of packaged food products containing refined grain ingredients than whole grain ingredients. Future policy changes are needed to provide incentives and information (e.g., front-of-pack labels) to aid in encouraging manufacturers to increase whole grain product offerings while decreasing refined grain offerings, and to encourage consumers to substitute away from refined grain products toward whole grain products.
Collapse
Affiliation(s)
| | - Donna R Miles
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Barry Popkin
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
33
|
Abstract
Over 45 jurisdictions globally have implemented sweetened beverage taxes. Researchers and policymakers need to assess whether and how these taxes change beverage demand and supply, their intended and unanticipated health, economic and equity impacts. Lessons from such evaluations can maximise the policies' success and impact on non-communicable disease prevention globally. We discuss key theoretical, design and methodological considerations to help policymakers, funders and researchers commission and conduct rigorous evaluations of these policies and related disease prevention efforts. We encourage involving the perspectives of various stakeholders on what evaluations are needed given the specific context, what data and methods are appropriate, readily available or can be collected within time and budget constraints. A logic model /conceptual system map of anticipated implications across sectors and scales should help identify optimal study design, analytical techniques and measures. These models should be updated when synthesising findings across diverse methods and integrating findings across subpopulations using similar methods.
Collapse
Affiliation(s)
- Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, CB #8120, 137 East Franklin Street, Chapel Hill, NC, 27516, USA.
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB#7461, UNC-Chapel Hill, Chapel Hill, NC, 27599-7461, USA.
| | - M Arantxa Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Universidad No 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, CP, 62100, Cuernavaca, Morelos, Mexico
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
34
|
Hofman KJ, Stacey N, Swart EC, Popkin BM, Ng SW. South Africa's Health Promotion Levy: Excise tax findings and equity potential. Obes Rev 2021; 22:e13301. [PMID: 34060197 PMCID: PMC8349837 DOI: 10.1111/obr.13301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/26/2022]
Abstract
In 2016, the South African government proposed a 20% sugar-sweetened beverage (SSB) tax. Protracted consultations with beverage manufacturers and the sugar industry followed. This resulted in a lower sugar-based beverage tax, the Health Promotion Levy (HPL), of approximately 10% coming into effect in April 2018. We provide a synthesis of findings until April 2021. Studies show that despite the lower rate, purchases of unhealthy SSBs and sugar intake consumption from SSBs fell. There were greater reductions in SSB purchases among both lower socioeconomic groups and in subpopulations with higher SSB consumption. These subpopulations bear larger burdens from obesity and related diseases, suggesting that this policy improves health equity. The current COVID-19 pandemic has impacted food and nutritional security. Increased pandemic mortality among people with obesity, diabetes, and hypertension highlight the importance of intersectoral public health disease-prevention policies like the HPL, which should be strengthened.
Collapse
Affiliation(s)
- Karen J Hofman
- SAMRCCentre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa
| | - Nicholas Stacey
- SAMRCCentre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Republic of South Africa.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, Republic of South Africa.,DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, Republic of South Africa
| | - Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
35
|
Abstract
In response to the high prevalence of overweight and obesity, Mexico implemented a volumetric tax of one Mexican peso (MP) per liter of sugar-sweetened beverage (SSB) in 2014. In contrast to Mexico's volumetric tax design, the United Kingdom (UK) and South Africa (ZA) implemented SSB taxes based on sugar density. This kind of tax is likely to yield larger health benefits than volumetric taxes by imposing a larger tax burden on high-sugar SSB and/or encouraging reformulation. However, sugar-density taxes might yield lower tax revenues. This study aims to simulate the effect of sugar-density taxes as those in the UK and ZA on SSB purchases (in terms of volume and sugar), SSB prices, and tax revenue in Mexico and compare this effect to its counterpart under the current volumetric SSB tax. Additionally, we simulate the effect of sugar-density taxes under different scenarios of reformulation. We conducted all these simulations based on a structural model of demand and supply using household purchase data for 2012-2015 in urban Mexico. We found that the current volumetric one-MP tax led to an SSB purchase reduction of 19% for both volume and sugar and an SSB price increases by MP $1.24. We simulated similar effects under the UK and ZA sugar-density taxes when these taxes were equivalent to the volumetric one-MP tax, and there was no reformulation. When assuming reformulation, the sugar reduction under the sugar-density taxes was up to twice larger than the volumetric one-MP tax. However, we found that the volumetric one-MP tax yielded the largest tax revenue across all tax designs. From a public health perspective, sugar-density taxes are likely to be more effective in tackling the overweight and obesity prevalence in Mexico; however, tax revenue might be lower under these taxes.
Collapse
Affiliation(s)
- Juan Carlos Salgado Hernández
- Center for Research in Health Systems, National Institute of Public Health, Cuernavaca, Mexico
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
36
|
Berkowitz SA, Curran N, Hoeffler S, Henderson R, Price A, Ng SW. Association of a Fruit and Vegetable Subsidy Program With Food Purchases by Individuals With Low Income in the US. JAMA Netw Open 2021; 4:e2120377. [PMID: 34379125 PMCID: PMC8358732 DOI: 10.1001/jamanetworkopen.2021.20377] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Food insecurity is associated with a less healthy diet. The Supplemental Nutrition Assistance Program (SNAP) is associated with reduced food insecurity, but benefit levels may be insufficient for beneficiaries to afford healthy foods. OBJECTIVE To evaluate whether participation in SuperSNAP, a program that provides an additional $40 per month for the purchase of fruits and vegetables with no added sugar, sodium, or fat to SNAP beneficiaries, is associated with changes in food purchasing. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from transaction records of a large supermarket chain with approximately 500 stores located across North Carolina from October 2019 to April 2020. Participants were SNAP beneficiaries. EXPOSURE SuperSNAP participation. MAIN OUTCOMES AND MEASURES Monthly spending on all fruits, vegetables, legumes, and nuts (primary outcome); spending on less healthy food categories; and spending on sugar-sweetened beverages as 1 category of less healthy foods. Monthly data on purchases by SNAP beneficiaries before and during SuperSNAP participation were compared with data from SNAP beneficiaries not enrolled in the program who shopped at the same stores. Overlap weighting (a propensity score-based method) was used to account for confounding, and linear mixed-effects models were fitted with random effects to account for repeated measures and clustering by store. RESULTS The study included 667 SuperSNAP participants and 33 246 SNAP beneficiaries who did not use SuperSNAP but shopped in the same stores; 436 SuperSNAP participants had preintervention data and were included in the main analysis. SuperSNAP participation was associated with increased monthly purchases of fruits, vegetables, nuts, and legumes ($31.84; 95% CI, $31.27-$32.42; P < .001; 294.52 oz; 95% CI, 288.84-300.20 oz; P < .001). Only a small increase in spending on less healthy food categories compared with the SNAP beneficiaries who did not use SuperSNAP ($1.60; 95% CI, $0.67-$2.53; P < .001) was observed. As total spending increased, the proportion of total food and beverage spending on less healthy foods significantly decreased (difference, 4.51%; 95% CI, 4.27%-4.74%; P < .001). Monthly spending on sugar-sweetened beverages decreased (difference, $1.83; 95% CI, $1.30-$2.36; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, participation in SuperSNAP was associated with meaningful increases in healthy food purchasing. Subsequent studies should investigate whether healthy food incentive programs improve health outcomes.
Collapse
Affiliation(s)
- Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
- Center for Health Equity Research, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Neal Curran
- Reinvestment Partners, Durham, North Carolina
| | | | - Richard Henderson
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Ashley Price
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
37
|
Roberto CA, Ng SW, Ganderats-Fuentes M, Hammond D, Barquera S, Jauregui A, Taillie LS. The Influence of Front-of-Package Nutrition Labeling on Consumer Behavior and Product Reformulation. Annu Rev Nutr 2021; 41:529-550. [PMID: 34339293 DOI: 10.1146/annurev-nutr-111120-094932] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of (a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and (b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improve population health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and Nutri-Score systems are promising but that systems with warning labels like the one in Chile are likely to produce the largest public health benefits. Expected final online publication date for the Annual Review of Nutrition, Volume 41 is September 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Christina A Roberto
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA; ,
| | - Montserrat Ganderats-Fuentes
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; ,
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada;
| | - Simon Barquera
- Department of Nutrition Policy Research, National Institute of Public Health, 62100 Cuernavaca, Mexico;
| | - Alejandra Jauregui
- Department of Physical Activity and Healthy Lifestyles, National Institute of Public Health, 62100 Cuernavaca, Mexico;
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27516, USA; ,
| |
Collapse
|
38
|
Frank T, Thow AM, Ng SW, Ostrowski J, Bopape M, Swart EC. A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa. Nutrients 2021; 13:nu13082584. [PMID: 34444744 PMCID: PMC8401225 DOI: 10.3390/nu13082584] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
South Africa (SA) is facing a rising prevalence of obesity and diet-related chronic diseases. The government is seeking to develop effective, evidence-based policy measures to address this. A well-designed, fit-for-purpose nutrient profiling model (NPM) can aid policy development. The aim of this study was to develop a fit-for-purpose NPM in SA. Steps included: (1) determining the purpose and target population; (2) selecting appropriate nutrients and other food components to include; (3) selecting a suitable NPM type, criteria and base; and (4) selecting appropriate numbers and thresholds. As part of the evaluation, the nutritional composition of packaged foods containing nutritional information (n = 6747) in the SA food supply chain was analyzed, a literature review was undertaken and various NPMs were evaluated. Our findings indicated that it is most appropriate to adapt an NPM and underpin regulation with a restrictive NPM that limits unhealthy food components. The Chile 2019 NPM was identified as suitable to adapt, and total sugar, saturated fat, sodium and non-sugar sweetener were identified as appropriate to restrict. This NPM has the potential to underpin restrictive policies, such as front-of-package labelling and child-directed marketing regulations in SA. These policies will support the fight against obesity and NCDs in the country.
Collapse
Affiliation(s)
- Tamryn Frank
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town 7535, South Africa
- Correspondence: ; Tel.: +27-084-782-9035
| | - Anne-Marie Thow
- Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina, Chapel Hill, NC 27599-7400, USA; (S.W.N.); (J.O.)
| | - Jessica Ostrowski
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, The University of North Carolina, Chapel Hill, NC 27599-7400, USA; (S.W.N.); (J.O.)
| | - Makoma Bopape
- Department of Human Nutrition and Dietetics, Faculty of Health Sciences, University of Limpopo, Polokwane 0727, South Africa;
| | - Elizabeth C. Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town 7535, South Africa;
- DSI/NRF Centre of Excellence in Food Security, University of the Western Cape, Cape Town 7535, South Africa
| |
Collapse
|
39
|
Sobers NP, Bishop L, Ng SW, Soares-Wynter S, Greaves NS, Murphy MM. Understanding the need for a whole-of-society approach in school nutrition policy implementation: a qualitative analysis. Implement Sci Commun 2021; 2:79. [PMID: 34274014 PMCID: PMC8285724 DOI: 10.1186/s43058-021-00184-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Only three of twenty Caribbean Community (CARCICOM) countries have mandatory school nutrition policies despite one third of the region's children being overweight or obese. In Barbados, there are nutrition guidelines which lack the legal mandate of a formal policy. We aim to assess the comprehensiveness of current national nutrition guidelines and to understand the factors operating in the inner and outer school setting that may influence the implementation of a mandatory school nutrition policy from the perspectives of school administrators. METHODS A documentary analysis of existing nutritional guidelines was conducted along with qualitative semi-structured interviews in primary (elementary) and secondary (high) schools in Barbados. We purposively sampled six primary and four secondary school administrators (principals, deputy principals or senior teachers) to explore their knowledge and views on the National School Nutrition Guidelines. The deterministic implementation paradigm, Consolidated Framework for Implementation (CFIR), was used to explore the complexities within the inner and outer settings of schools. Documentary analysis used a theory-based framework informed by the Wellness School Assessment Tool-school policy analysis questionnaire. Interview transcripts were team coded using thematic analysis with constant comparison facilitated by NVIVO software version12. RESULTS School administrators were unaware of the existing National School Nutrition Guidelines which documentary analysis found to be restrictive and weak for implementation. Administrators envisioned a government-led (outer setting), whole of society approach as the most effective strategy for the development and implementation of a proposed mandatory school nutrition policy. School administrators identified lack of financial and human resources as barriers to nutrition policy implementation. Formal and informal food vendors are institutionalized in schools and are influential determinants of the school food environment. Schools have individually reached into the outer setting to work with civil society organizations and private individuals to provide financial support and nutrition expertise to their institutions. Mass media campaigns in the outer setting may influence child and parental food choices. CONCLUSION School administrators describe that government-led, CSO supported policy development using a whole-of-society approach has implications for improving nutrition policy implementation. Our findings demonstrate the use of a deterministic implementation framework in the pre-implementation phase of school nutrition policy development.
Collapse
Affiliation(s)
- Natasha P Sobers
- George Alleyne Chronic Disease Research Unit, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados.
| | - Lisa Bishop
- George Alleyne Chronic Disease Research Unit, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
| | - Shu Wen Ng
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Suzanne Soares-Wynter
- Tropical Metabolism Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Kingston, Jamaica
| | - Natalie S Greaves
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados
| | - Madhuvanti M Murphy
- George Alleyne Chronic Disease Research Unit, Caribbean Institute for Health Research, University of the West Indies, Cave Hill, Barbados
| |
Collapse
|
40
|
Dunford EK, Popkin B, Ng SW. Junk Food Intake Among Adults in the United States. J Nutr 2021; 152:492-500. [PMID: 34224563 PMCID: PMC8826924 DOI: 10.1093/jn/nxab205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND There is no consensus on how to define "junk food." In 2016, Chile implemented the most comprehensive set of obesity-preventive regulations in the world, including criteria to define unhealthy foods. OBJECTIVES The objective of this study was to examine the amount of energy, sodium, sugar, and saturated fat consumed by US adults defined as junk food using the Chilean criteria. METHODS We used 2 nationally representative surveys of food intake in 10,001 US adults: NHANES 2015-2016 and NHANES 2017-2018. The main outcome measures were the contributions of energy, total sugars, saturated fat, and sodium deriving from junk food sources. Mean intake and proportion of energy, sugar, saturated fat, and sodium for junk food overall and each food category were calculated. RESULTS Overall, 47% of energy, 75% of total sugar, 46% of sodium, and 48% of saturated fat consumed by US adults derived from junk food sources. Sugar-sweetened beverages (SSBs) were responsible for more than 40% of total sugar intake deriving from junk foods. Non-Hispanic black adults had the highest mean energy, total sugar, and sodium intake deriving from junk foods, with non-Hispanic white adults having the highest saturated fat intake. Non-Hispanic black adults had the highest intake of total sugar deriving from junk food sources of SSBs (26.7 g/d), with SSBs representing >40% of total sugar intake deriving from junk food sources for all race/ethnic groups. CONCLUSIONS Foods that meet the Chilean criteria for junk food provide approximately half or more daily energy and food components to limit in the diet of US adults, with important differences observed between race/ethnic groups. Policy efforts to reduce junk food intake, particularly the intake of SSBs, must be expanded to improve the cardiometabolic health equitably in the United States.
Collapse
Affiliation(s)
| | - Barry Popkin
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings Global School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
41
|
Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
Collapse
Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
42
|
Abstract
Objectives COVID-19 has created a new normal, affecting food purchasing behaviors, moving a portion of them online. It is unknown how these behavioral shifts may differ by sociodemographic characteristics and whether shifts may widen or diminish existing diet-related disparities. To fill these gaps, we use nationally-representative Consumer Panel survey data to examine shifts in online grocery shopping by sociodemographic characteristics. Methods The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen Homescan panel participants in March-April 2020 (n = 17,262 households (HH)). We describe survey-weighted HH sociodemographic characteristics and reasons for online shopping. Survey weighted-multivariable logistic regression was used to examine sociodemographic correlates of reported increases in online food shopping. Results One third (34%) of our survey-weighted sample said they shopped for groceries online more since COVID-19, and 60% of these HH reported planning to continue shopping online after COVID-19. In adjusted analyses, all age groups (40–54 y, 55–64y, 65 + y) had lower odds of online shopping than heads of HH 39 years or younger (all OR = 0.7, P < 0.001). Lower educated (high school or less) HH had lower odds of online shopping compared to higher educated (college or more) HH (OR = 0.7, P < 0.001). HH in the South had higher odds of online shopping than those in the Northeast (OR = 1.2, P = 0.006). Compared to Non-Hispanic (NH) white HH, Hispanic HH had higher odds of online shopping (OR = 1.2, P = 0.02), and NH Asian HH had lower odds of online shopping (OR = 0.8, P = 0.02). HH with children had higher odds of online shopping compared to households without children (OR = 1.4, P < 0.001). Of those who said they would increase the amount of online shopping they did for everyday items including food (37%), the top reasons were to avoid public germs and COVID-19 (81%), to take advantage of the convenience (44%) and to access a better selection (17%). Conclusions There are disparities in shifts in online shopping behaviors due to COVID-19. Understanding these disparities can inform public health nutrition interventions related to online food shopping. We will assess the August 2020 survey as the pandemic may further change food shopping habits. Funding Sources Arnold Ventures & National Institutes of Health
Collapse
Affiliation(s)
- Amy Lo
- University of North Carolina at Chapel Hill
| | | | - Shu Wen Ng
- University of North Carolina at Chapel Hill
| |
Collapse
|
43
|
Abstract
Sugar-sweetened beverage (SSB) taxes have been proposed to discourage excessive sugar consumption, but it is unclear how high- vs. low-SSB purchasers respond to such taxes. We first examine heterogeneity in the purchase and financial effects of a national SSB tax across different types of households buying varying amounts of SSBs. We find high-SSB purchasers are less responsive to SSB price changes than low purchasers but make larger absolute reductions in SSB purchases in response to the tax, given their notably greater purchase levels prior to the tax. Nonetheless, the economic burden of the tax falls more heavily on high-SSB purchasers who are more likely comprised of lower-income households. We then investigate whether the income regressivity of the tax will be mitigated if low-income households are targeted by fruit and vegetable (FV) subsidies. We show that depending on the tax pass-through and subsidy rates, FV subsidies can fully offset high-SSB purchasers' tax burdens, and subsidy transfers are distributed relatively uniformly across the SSB purchase distribution of low-income households. Therefore, FV subsidy transfers would be financially more beneficial to low- and moderate-SSB purchasers because they bear smaller shares of the tax burden than high-SSB purchasers.
Collapse
Affiliation(s)
| | - Shu Wen Ng
- Department of Nutrition at the University of North Carolina at Chapel Hill and a faculty fellow at Carolina Population Center
| |
Collapse
|
44
|
Lacko A, Delamater P, Gordon-Larsen P, Wen Ng S. Geographic patterns and socioeconomic differences in the nutritional quality of household packaged food purchases in the United States. Health Place 2021; 69:102567. [PMID: 33930729 DOI: 10.1016/j.healthplace.2021.102567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 03/22/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND It is unclear whether dietary quality varies by geography in the US. PURPOSE Assess patterns in packaged food purchases (PFPs). METHODS We characterized variation in PFP quality from 2008 to 2018 by 1) examining geographic clustering and 2) using regression analysis to control for household characteristics. RESULTS Lower quality purchases clustered in the Southeast and Appalachia, whereas higher quality purchases clustered in the West and Northeast. Spatial patterns were similar for low socioeconomic households but not high socioeconomic households. Geographic differences in quality remained after controlling for demographic composition. CONCLUSION This analysis should inform research into systemic drivers of PFP quality.
Collapse
Affiliation(s)
- Allison Lacko
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Nutrition, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, United States.
| | - Paul Delamater
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Geography, College of Arts and Sciences at the University of North Carolina at Chapel Hill, United States.
| | - Penny Gordon-Larsen
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Nutrition, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, United States.
| | - Shu Wen Ng
- Carolina Population Center at the University of North Carolina at Chapel Hill, Carolina Square, 123 W Franklin Street, Building C, Suite 310, Chapel Hill, NC, 27516, United States; Department of Nutrition, Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, United States.
| |
Collapse
|
45
|
Stacey N, Edoka I, Hofman K, Swart EC, Popkin B, Ng SW. Changes in beverage purchases following the announcement and implementation of South Africa's Health Promotion Levy: an observational study. Lancet Planet Health 2021; 5:e200-e208. [PMID: 33838735 PMCID: PMC8071067 DOI: 10.1016/s2542-5196(20)30304-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND In 2016, South Africa announced an intention to levy a tax on sugar-sweetened beverages (SSBs). In 2018, the country implemented an SSB tax of approximately 10%, known as the Health Promotion Levy (HPL). We aimed to assess changes in the purchases of beverages before and after the HPL announcement and implementation. METHODS We used Kantar Europanel data on monthly household purchases between January, 2014, and March, 2019, among a sample of South African households (n=113 653 household-month observations) from all nine provinces to obtain per-capita sugar, calories, and volume from taxable and non-taxable beverages purchased before and after the HPL announcement and implementation. We describe survey-weighted means for each period, and regression-controlled predictions of outcomes and counterfactuals based on pre-HPL announcement trends, with bootstrapped 95% CIs, and stratify results by socioeconomic status. FINDINGS Mean sugar from taxable beverage purchases fell from 16·25 g/capita per day (95% CI 15·80-16·70) to 14·26 (13·85-14·67) from the pre-HPL announcement to post-announcement period, and then to 10·63 g/capita per day (10·22-11·04) in the year after implementation. Mean volumes of taxable beverage purchases fell from 518·99 mL/capita per day (506·90-531·08) to 492·16 (481·28-503·04) from pre-announcement to post announcement, and then to 443·39 mL/capita per day (430·10-456·56) after implementation. Across these time periods, there was a small increase in the purchases of non-taxable beverages, from 283·45 mL/capita per day (273·34-293·56) pre-announcement to 312·94 (296·29-329·29) post implementation. When compared with pre-announcement counterfactual trends, reductions in taxable beverage purchase outcomes were significantly larger than the unadjusted survey-weighted observed reductions. Households with lower socioeconomic status purchased larger amounts of taxable beverages in the pre-announcement period than did households with higher socioeconomic status, but demonstrated bigger reductions after the tax was implemented. INTERPRETATION The announcement and introduction of South Africa's HPL were followed by reductions in the sugar, calories, and volume of beverage purchases. FUNDING Bloomberg Philanthropies, International Development Research Centre, South African Medical Research Council, and the US National Institutes of Health.
Collapse
Affiliation(s)
- Nicholas Stacey
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Ijeoma Edoka
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS SA, Wits School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elizabeth C Swart
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa; DST/NRF Center of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Barry Popkin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.
| |
Collapse
|
46
|
Valizadeh P, Ng SW. The New school food standards and nutrition of school children: Direct and Indirect Effect Analysis. Econ Hum Biol 2020; 39:100918. [PMID: 32992091 PMCID: PMC7718326 DOI: 10.1016/j.ehb.2020.100918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 made sweeping changes to school nutritional standards. We estimate the impacts of shifts in school nutritional standards on dietary quality as well as dietary quantity of children's food intakes from school and away-from-school food sources. We find the average effect of consuming school food, rather than away-from-school food, on children's overall dietary quality significantly increased from the pre- to post-HHFKA implementation period. This effect was solely driven by substantial improvements in the dietary quality of foods acquired at school, mainly among older and higher-income children. Our indirect effect analysis indicated that children shifted towards consuming lower-quality diets at home in the post-HHFKA period, thereby partially offsetting the positive effects of the HHFKA on their overall dietary quality. Indirect impacts were primarily driven by a subset of children consuming more than a third of their daily calories from school food. Additionally, we find suggestive evidence of a modest decrease in daily calorie intake, particularly among older and higher-income children. Together, our findings imply that the HHFKA, despite its unintended negative indirect effects, led children to consume more-nutritious, less-energy-dense diets.
Collapse
Affiliation(s)
- Pourya Valizadeh
- Carolina Population Center, University of North Carolina at Chapel Hill, Carolina Population Center, CB #8120 University Square. 123 West Franklin Street, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516-3997, United States.
| | - Shu Wen Ng
- Carolina Population Center, University of North Carolina at Chapel Hill, Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
47
|
Bleich SN, Chriqui J, Ng SW. Implementation Science Is Important for Understanding and Advancing Beverage Taxes. Am J Public Health 2020; 110:1266-1267. [PMID: 32783741 PMCID: PMC7427245 DOI: 10.2105/ajph.2020.305840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 08/14/2023]
Affiliation(s)
- Sara N Bleich
- Sara N. Bleich is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Jamie Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago. Shu Wen Ng is with the Department of Nutrition, Gilling School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jamie Chriqui
- Sara N. Bleich is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Jamie Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago. Shu Wen Ng is with the Department of Nutrition, Gilling School of Global Public Health, University of North Carolina at Chapel Hill
| | - Shu Wen Ng
- Sara N. Bleich is with the Department of Health Policy and Management, Harvard School of Public Health, Boston, MA. Jamie Chriqui is with the Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago. Shu Wen Ng is with the Department of Nutrition, Gilling School of Global Public Health, University of North Carolina at Chapel Hill
| |
Collapse
|
48
|
Dunford EK, Miles DR, Ng SW, Popkin B. Types and Amounts of Nonnutritive Sweeteners Purchased by US Households: A Comparison of 2002 and 2018 Nielsen Homescan Purchases. J Acad Nutr Diet 2020; 120:1662-1671.e10. [PMID: 32739278 DOI: 10.1016/j.jand.2020.04.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/06/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Purchases of foods containing nonnutritive sweetener (NNS) alone or in combination with caloric sweeteners (CS) has increased in recent years in the United States. At the same time clinical evidence is emerging of different cardiometabolic effects of each NNS type. OBJECTIVE To examine the prevalence and volume purchased of commonly consumed types of NNS in packaged food and beverage products comparing 2002 and 2018 using data from nationally representative samples of US households. PARTICIPANTS/SETTING Nielsen Homescan Consumer Panels (The Nielsen Company); 2002 and 2018. MAIN OUTCOME MEASURES Prevalence and volume of foods and beverages purchased containing CS, NNS, both CS and NNS, or neither CS nor NNS, as well as prevalence and volume of products containing specific NNS types. STATISTICAL ANALYSES PERFORMED Differences examined using Student t test, P value of <.05 considered significant. RESULTS Volume of products purchased containing CS decreased comparing 2002 and 2018 (436.6 ± 1.6 to 362.4 ± 1.3 g/d; P < .05), yet increased for products containing both CS and NNS (10.8-36.2 g/d; P < .05). Regarding specific types of NNS, changes were noted in the prevalence of households purchasing products containing saccharin (1.3%-1.1%; P < .05), aspartame (60.0%-49.4%; P < .05), rebaudioside A (0.1%-25.9%) and sucralose (38.7%-71.0%). Non-Hispanic whites purchased twice the volume of products containing NNS compared to Hispanics and non-Hispanic blacks in both years. Beverages were predominantly responsible for larger volume per capita purchases of products containing only NNS as well as both CS and NNS. CONCLUSIONS A decline in purchases of products containing CS occurred in tandem with an increase in purchases of products containing both CS and NNS, along with a large shift in the specific types of NNS being purchased by US households. New NNS types enter the market regularly, and it is important to monitor changes in the amount of NNS and products containing NNS that consumers purchase.
Collapse
|
49
|
Dunford EK, Popkin BM, Ng SW. Recent Trends in Junk Food Intake in U.S. Children and Adolescents, 2003-2016. Am J Prev Med 2020; 59:49-58. [PMID: 32334953 PMCID: PMC7311250 DOI: 10.1016/j.amepre.2020.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In the U.S., there is no consensus of how to define junk food. Strict regulations on what constitutes junk food denoted by front-of-package labels can serve as the basis for statutory actions. Chile was the first country to adopt this approach, and several countries have followed suit. This study examined the proportion of calories and nutrients of concern consumed by U.S. children and adolescents defined as junk food using the Chilean label criteria and the changes between 2003 and 2016. METHODS Data were obtained from 4 nationally representative food intake surveys in 13,016 U.S. children and adolescents: National Health and Nutrition Examination Survey 2003-2004, 2005-2006, 2013-2014, and 2015-2016, with analysis performed in 2019. Nutritional content of each consumed food was compared with nutrient thresholds from the Chilean regulation for energy, saturated fat, total sugars, and sodium per 100 g. RESULTS Between 2003 and 2016, there was a 10 percentage point decrease (71.1%-61.3%, p<0.01) in the proportion of foods consumed that were classified as junk food. A significant decrease was seen in mean intake of calories (1,610-1,367 kcal/day, p<0.01), total sugar (88.8-64.2 g/day, p<0.01), saturated fat (22.6-20.5 g/day, p<0.01), and sodium (2,306-2,044 mg/day, p<0.01). CONCLUSIONS Although junk food intake has decreased since 2003-2006, diets of U.S. children and adolescents remain dominated by less-healthy foods. These results can help guide policy regulations regarding foods and beverages accessible in schools and marketed to children, adolescents, and their caregivers.
Collapse
Affiliation(s)
- Elizabeth K Dunford
- Food Policy Division, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Nutrition, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Barry M Popkin
- Department of Nutrition, Gillings Global School of 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
| | - Shu Wen Ng
- Department of Nutrition, Gillings Global School of 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
| |
Collapse
|
50
|
Jilcott Pitts SB, Ng SW, Blitstein JL, Gustafson A, Kelley CJ, Pandya S, Weismiller H. Perceived Advantages and Disadvantages of Online Grocery Shopping among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participants in Eastern North Carolina. Curr Dev Nutr 2020; 4:nzaa076. [PMID: 32399508 PMCID: PMC7204786 DOI: 10.1093/cdn/nzaa076] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022] Open
Abstract
This study's purpose was to qualitatively examine perceived advantages and disadvantages of online grocery shopping among participants (n = 7) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Initial in-depth, qualitative interviews were conducted, after which participants completed an episode of online grocery shopping, picked up the online order at the store, and completed an in-store shopping episode and a follow-up in-depth interview. Interviews were audio-recorded, transcribed verbatim, and analyzed deductively. Participants stated that in-store impulse purchases occurred at the check-out and cookie aisles and included chips and candy, but sometimes healthier foods such as fruit. Advantages of online grocery shopping included ease, convenience, and saving time. Disadvantages included inadequate substitutions, the online shopping fee, lack of control over selection of perishable goods, and inability to find good deals online versus in the store. Further research is needed to determine how to encourage healthy grocery purchases online.
Collapse
Affiliation(s)
- Stephanie B Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA
| | - Jonathan L Blitstein
- RTI International, Social Policy, Health, and Economic Research Unit, Research Triangle Park, NC, USA
| | | | - Casey J Kelley
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Shivani Pandya
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Hillary Weismiller
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| |
Collapse
|