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1.
PLoS One ; 15(2): e0228891, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040526

RESUMO

INTRODUCTION: Large chain restaurants reduced calories in their newly-introduced menu items from 2012 to 2015. The objective of this study was to provide updated calorie trends through 2018 and examine trends in the macronutrient composition of menu items across this time period. METHODS AND FINDINGS: Data were obtained from the MenuStat project and include 66 of the 100 largest revenue generating U.S. chain restaurants (N = 28,238 items) that had data available in all years from 2012 to 2018. Generalized linear models were used to examine per-item calorie and nutrient changes (saturated fat, trans fat, unsaturated fat, sugar, non-sugar carbohydrates, protein, sodium) among (1) items on the menu in all years (common items) and (2) newly introduced items (2013-2018). Overall, there were no significant changes in calories or nutrients among common items from 2012 to 2018. Among all newly introduced items, calories (-120 kcals, -25%, p = 0.01; p-for-trend = 0.02), saturated fat (-3.4g, -41%, p<0.01, p-for-trend = 0.06), unsaturated fat (-4.5g, -37%, p = 0.02; p-for-trend = 0.04), non-sugar carbohydrates (-10.3g, -40%, p = 0.02, p-for-trend = 0.69), and protein (-4.3g, -25%, p = 0.04, p-for-trend = 0.02) declined. CONCLUSION: Newly introduced menu items in large chain restaurants have continued to decline in calories through 2018, which may help to reduce calorie intake. Other changes in macronutrient content were sporadic and not clearly toward improved dietary quality.

2.
J Gen Intern Med ; 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32060717

RESUMO

BACKGROUND: Prior research on the restaurant environment and obesity risk is limited by cross-sectional data and a focus on specific geographic areas. OBJECTIVE: To measure the impact of changes in chain restaurant calories over time on body mass index (BMI). DESIGN: We used a first-difference model to examine whether changes from 2012 to 2015 in chain restaurant calories per capita were associated with percent changes in BMI. We also examined differences by race and county income, restaurant type, and initial body weight categories. SETTING: USA (207 counties across 39 states). PARTICIPANTS: 447,873 adult patients who visited an athenahealth medical provider in 2012 and 2015 where BMI was measured. MAIN OUTCOMES MEASURED: Percent change in objectively measured BMI from 2012 to 2015. RESULTS: Across all patients, changes in chain restaurant calories per capita were not associated with percent changes in BMI. For Black or Hispanic adults, a 10% increase in exposure to chain restaurant calories per capita was associated with a 0.16 percentage-point increase in BMI (95% CI 0.03, 0.30). This translates into a predicted weight increase of 0.89 pounds (or a 0.53% BMI increase) for an average weight woman at the 90th percentile of increases in the restaurant environment from 2012 to 2015 versus an increase 0.39 pounds (or 0.23% BMI increase) at the 10th percentile. Greater increases in exposure to chain restaurant calories also significantly increased BMI for Black or Hispanic adults receiving healthcare services in lower-income counties (0.26, 95% CI 0.04, 0.49) and with overweight/obesity (0.16, 95% CI 0.04, 0.29). LIMITATIONS: Generalizability to non-chain restaurants is unknown and the sample of athenahealth patients is relatively homogenous. CONCLUSIONS: Increased exposure to chain restaurant calories per capita was associated with increased weight gain among Black or Hispanic adults.

3.
Am J Prev Med ; 58(1): 69-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31761517

RESUMO

INTRODUCTION: The Supplemental Nutrition Assistance Program is the largest U.S. federally funded nutrition assistance program, providing food assistance to more than 40 million low-income Americans, half of whom are children. This paper examines trends in sugar-sweetened beverage consumption among U.S. children and adolescents by Supplemental Nutrition Assistance Program participation status. METHODS: Dietary data from 15,645 participants (aged 2-19 years) were obtained from the 2003-2014 National Health and Nutrition Examination surveys. Supplemental Nutrition Assistance Program participation was categorized as: Supplemental Nutrition Assistance Program participant, income-eligible nonparticipant, lower income-ineligible nonparticipant, and higher income-ineligible nonparticipant. Survey-weighted logistic regressions estimated predicted probabilities of daily sugar-sweetened beverage consumption, and negative binomial regressions estimated predicted per capita daily consumption of sugar-sweetened beverage calories. Data were analyzed in 2019. RESULTS: From 2003 to 2014, there were significant declines across all Supplemental Nutrition Assistance Program participation categories for sugar-sweetened beverage consumption (participants: 84.2% to 75.6%, p=0.009; income-eligible nonparticipants: 85.8% to 67.5%, p=0.004; lower income-ineligible nonparticipants: 84.3% to 70.6%, p=0.026; higher income-ineligible nonparticipants: 82.2% to 67.7%, p=0.001) and per capita daily sugar-sweetened beverage calories (participants: 267 to 182 kilocalories, p<0.001; income-eligible nonparticipants: 269 to 168 kilocalories, p<0.001; lower income-ineligible nonparticipants: 249 to 178 kilocalories, p=0.008; higher income-ineligible nonparticipants: 244 to 161 kilocalories, p<0.001). Per capita sports/energy drink consumption increased among Supplemental Nutrition Assistance Program participants (2 to 15 kilocalories, p=0.007). CONCLUSIONS: Sugar-sweetened beverage consumption has declined for children and adolescents in all Supplemental Nutrition Assistance Program participation categories, but current levels remain high. There were fewer favorable trends over time for consumption of sugar-sweetened beverage subtypes among Supplemental Nutrition Assistance Program participants relative to other participant categories.

4.
Public Health Nutr ; 23(2): 348-355, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31796142

RESUMO

OBJECTIVE: To understand price incentives to upsize combination meals at fast-food restaurants by comparing the calories (i.e. kilocalories; 1 kcal = 4·184 kJ) per dollar of default combination meals (as advertised on the menu) with a higher-calorie version (created using realistic consumer additions and portion-size changes). DESIGN: Combination meals (lunch/dinner: n 258, breakfast: n 68, children's: n 34) and their prices were identified from online menus; corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Linear models were used to examine the difference in total calories per dollar between default and higher-calorie combination meals, overall and by restaurant. SETTING: Ten large fast-food chain restaurants located in the fifteen most populous US cities in 2017-2018. PARTICIPANTS: None. RESULTS: There were significantly more calories per dollar in higher-calorie v. default combination meals for lunch/dinner (default: 577 kJ (138 kcal)/dollar, higher-calorie: 707 kJ (169 kcal)/dollar, difference: 130 kJ (31 kcal)/dollar, P < 0·001) and breakfast (default: 536 kJ (128 kcal)/dollar, higher-calorie: 607 kJ (145 kcal)/dollar, difference: 71 kJ (17 kcal)/dollar, P = 0·009). Results for children's meals were in the same direction but were not statistically significant (default: 536 kJ (128 kcal)/dollar, higher-calorie: 741 kJ (177 kcal)/dollar, difference: 205 kJ (49 kcal)/dollar, P = 0·053). Across restaurants, the percentage change in calories per dollar for higher-calorie v. default combination meals ranged from 0·1 % (Dunkin' Donuts) to 55·0 % (Subway). CONCLUSIONS: Higher-calorie combination meals in fast-food restaurants offer significantly more calories per dollar compared with default combination meals, suggesting there is a strong financial incentive for consumers to 'upsize' their orders. Future research should test price incentives for lower-calorie options to promote healthier restaurant choices.

5.
N Engl J Med ; 381(25): 2440-2450, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851800

RESUMO

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).


Assuntos
Obesidade Mórbida/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Previsões , Humanos , Renda , Masculino , Obesidade/etnologia , Obesidade Mórbida/etnologia , Prevalência , Autorrelato , Distribuição por Sexo , Estados Unidos/epidemiologia
6.
Am J Prev Med ; 57(6): 800-807, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31753261

RESUMO

INTRODUCTION: The Supplemental Nutrition Assistance Program provides financial assistance for food and beverage purchases to approximately 1 in 7 Americans, with benefits distributed once monthly. Most Supplemental Nutrition Assistance Program benefits are spent early in the month, leading to decreased caloric intake later in the month. The effects of this early benefit depletion on the types of foods and beverages purchased over the course of the month is unclear. METHODS: Using individually tracked sales data from 950 participants enrolled in 2 supermarket-based RCTs in Maine (October 2015-April 2016 and October 2016-June 2017), purchases of selected food categories by Supplemental Nutrition Assistance Program participants (n=248) versus nonparticipants (n=702) in the first 2 weeks compared with the last 2 weeks of the Supplemental Nutrition Assistance Program benefit month were examined. Analyses were completed in 2019. RESULTS: For Supplemental Nutrition Assistance Program participants, adjusted mean food spending decreased 37% from the first 2 weeks to the last 2 weeks of the Supplemental Nutrition Assistance Program benefit month (p<0.0001) compared with a 3% decrease (p=0.02) for nonparticipants. The decline in spending by Supplemental Nutrition Assistance Program participants occurred in all examined categories: vegetables (-25%), fruits (-27%), sugar-sweetened beverages (-30%), red meat (-37%), convenience foods (-40%), and poultry (-48%). Difference-in-difference estimators comparing Supplemental Nutrition Assistance Program participants with nonparticipants were statistically significant (p<0.05) for all examined categories. CONCLUSIONS: In the second half of the Supplemental Nutrition Assistance Program benefit month, individuals reduced purchases of all examined categories. More research is needed to understand the impact of these fluctuations in spending patterns on the dietary quality of Supplemental Nutrition Assistance Program participants.

7.
BMJ ; 367: l5837, 2019 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666218

RESUMO

OBJECTIVE: To evaluate whether calorie labeling of menus in large restaurant chains was associated with a change in mean calories purchased per transaction. DESIGN: Quasi-experimental longitudinal study. SETTING: Large franchise of a national fast food company with three different restaurant chains located in the southern United States (Louisiana, Texas, and Mississippi) from April 2015 until April 2018. PARTICIPANTS: 104 restaurants with calorie information added to in-store and drive-thru menus in April 2017 and with weekly aggregated sales data during the pre-labeling (April 2015 to April 2017) and post-labeling (April 2017 to April 2018) implementation period. MAIN OUTCOME MEASURES: Primary outcome was the overall level and trend changes in mean purchased calories per transaction after implementation of calorie labeling compared with the counterfactual (ie, assumption that the pre-intervention trend would have persisted had the intervention not occurred) using interrupted time series analyses with linear mixed models. Secondary outcomes were by item category (entrees, sides, and sugar sweetened beverages). Subgroup analyses estimated the effect of calorie labeling in stratums defined by the sociodemographic characteristics of restaurant census tracts (defined region for taking census). RESULTS: The analytic sample comprised 14 352 restaurant weeks. Over three years and among 104 restaurants, 49 062 440 transactions took place and 242 726 953 items were purchased. After labeling implementation, a level decrease was observed of 60 calories/transaction (95% confidence interval 48 to 72; about 4%), followed by an increasing trend of 0.71 calories/transaction/week (95% confidence interval 0.51 to 0.92) independent of the baseline trend over the year after implementation. These results were generally robust to different analytic assumptions in sensitivity analyses. The level decrease and post-implementation trend change were stronger for sides than for entrees or sugar sweetened beverages. The level decrease was similar between census tracts with higher and lower median income, but the post-implementation trend in calories per transaction was higher in low income (change in calories/transaction/week 0.94, 95% confidence interval 0.67 to 1.21) than in high income census tracts (0.50, 0.19 to 0.81). CONCLUSIONS: A small decrease in mean calories purchased per transaction was observed after implementation of calorie labeling in a large franchise of fast food restaurants. This reduction diminished over one year of follow-up.


Assuntos
Ingestão de Energia/fisiologia , Fast Foods/efeitos adversos , Rotulagem de Alimentos , Obesidade/prevenção & controle , Restaurantes/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Fast Foods/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Estudos Longitudinais , Ensaios Clínicos Controlados não Aleatórios como Assunto , Obesidade/epidemiologia , Obesidade/etiologia , Prevalência , Sudeste dos Estados Unidos/epidemiologia
8.
Health Serv Res ; 54 Suppl 2: 1409-1418, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667831

RESUMO

OBJECTIVE: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. PRINCIPAL FINDINGS: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. CONCLUSIONS: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
9.
Health Serv Res ; 54 Suppl 2: 1442-1453, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31663120

RESUMO

OBJECTIVE: To examine reported experiences of gender discrimination and harassment among US women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. METHODS: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. PRINCIPAL FINDINGS: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. CONCLUSIONS: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.


Assuntos
Disparidades em Assistência à Saúde , Sexismo , Assédio Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Saúde da Mulher , Adolescente , Adulto , Idoso , Emprego , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Sexismo/etnologia , Sexismo/estatística & dados numéricos , Assédio Sexual/etnologia , Assédio Sexual/estatística & dados numéricos , Inquéritos e Questionários , Telefone , Estados Unidos
10.
Health Serv Res ; 54 Suppl 2: 1399-1408, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31663124

RESUMO

OBJECTIVE: To examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 802 non-Hispanic black and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of blacks reporting discrimination in several domains, including health care. We used logistic regression to compare the black-white difference in odds of discrimination, and among blacks only to examine variation by socioeconomic status, gender, and neighborhood racial composition. PRINCIPAL FINDINGS: About one-third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A majority of black adults reported experiencing discrimination in employment (57 percent in obtaining equal pay/promotions; 56 percent in applying for jobs), police interactions (60 percent reported being stopped/unfairly treated by police), and hearing microaggressions (52 percent) and racial slurs (51 percent). In adjusted models, blacks had significantly higher odds than whites of reporting discrimination in every domain. Among blacks, having a college degree was associated with higher odds of experiencing overall institutional discrimination. CONCLUSIONS: The extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black-white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Afro-Americanos/psicologia , Idoso , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
11.
Am J Prev Med ; 57(3): e77-e85, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31377086

RESUMO

INTRODUCTION: The nutrient profile of combination meals in large chain restaurants is not well understood. METHODS: Combination meals from 34 U.S. fast food and fast casual restaurants (lunch/dinner, n=1,113; breakfast, n=366) were identified from online menus in 2017-2018 and corresponding nutrition information for each menu item was obtained from a restaurant nutrition database (MenuStat). Three options for each combination meal were analyzed: (1) default (as advertised on menu), (2) minimum (low-calorie option), and (3) maximum (high-calorie option). In 2018, meal nutrient composition was compared with the Healthier Restaurant Meal Guidelines, and linear models examined to what extent each meal component (entrée, side, beverage) drove differences in nutrients across meal options. RESULTS: There was substantial variation across the default, minimum, and maximum options of lunch/dinner combination meals for calories (default,: 1,193 kilocalories;, minimum,: 767 kilocalories;, maximum,: 1,685 kilocalories), saturated fat (14 g, 11 g, 19 g), sodium (2,110 mg, 1,783 mg, 2,823 mg), and sugar (68 g, 10 g, 117 g). Most default meals exceeded the Healthier Restaurant Meal Guidelines for calories (97%) and sodium (99%); fewer exceeded the standards for saturated fat (50%) and total sugar (6%). Comparing the maximum and default lunch/dinner combination meals, beverages were the largest driver of differences in calories (178 kilocalories, 36% of difference) and sugar (46 g, 93% of difference), and entrées were the largest driver of differences in saturated fat (3 g, 59% of difference) and sodium (371 g, 52% of difference). Results were similar for breakfast meals. CONCLUSIONS: Combination meals offered by large U.S. chain restaurants are high in calories, sodium, saturated fat, and sugar, with most default meals exceeding recommended limits for calories and sodium.

12.
Prev Med Rep ; 15: 100932, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31338279

RESUMO

The aim of this study was to describe trends in calories among food items sold in U.S. convenience stores and pizza restaurant chains from 2013 to 2017 - a period leading up to the implementation of the federal menu labeling mandate. Using data from the MenuStat project, we conducted quantile regression analyses in 2018 to estimate the predicted median per-item calories among menu items available at convenience stores (n = 1522) and pizza restaurant chains (n = 2085) - two retailers that have been openly resistant to implementing menu labeling - and assessed whether core food items were reformulated during the study period. We also compared calories in food items available for sale on convenience store and pizza restaurant menus to calories in items that were newly added or dropped. We found that leading up to the national menu labeling implementation date, convenience stores showed a significant decreasing trend in median calories of overall menu items (390 kcals in 2013 vs. 334 kcals in 2017, p-value for trend <0.01) and among appetizers and sides (367 kcals in 2013 vs. 137 kcals in 2017, p-value for trend = 0.02). Pizza restaurants introduced lower-calorie pizza options in 2017, but no other significant changes in calories were observed. Going forward, it will be important to track calorie changes in convenience stores and pizza restaurant chains as both food establishments represent significant sources of calories for Americans.

13.
Am J Prev Med ; 57(2): 231-240, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31326007

RESUMO

INTRODUCTION: Although beverages comprise one third of all menu items at large chain restaurants, no prior research has examined trends in their calorie and nutrient content. METHODS: Beverages (n=13,879) on the menus of 63 U.S. chain restaurants were the final analytic sample obtained from a restaurant nutrition database (MenuStat, 2012-2017). For each beverage type, cluster-bootstrapped mixed-effects regressions estimated changes in mean calories, sugar, and saturated fat for beverages available on menus in all years and for newly introduced beverages. Data were analyzed in 2018. RESULTS: Traditional sugar-sweetened beverages, sweetened teas, and blended milk-based beverages (e.g., milkshakes) were significantly higher in calories from 2012 to 2017 for newly introduced beverages (p-value for trend <0.004). For all newly introduced sweetened beverages, sugar increased significantly (2015, +7.9 g; 2016, +8.2 g; p<0.004) whereas saturated fat declined (2016, -2.3 g; 2017, -1.6 g; p<0.004). For beverages on menus in all years, saturated fat declined significantly (p<0.001), whereas mean calories and sugar remained relatively constant. Significant declines were observed for sweetened coffees (-10 kcal, -0.5 g saturated fat, p<0.001), teas (-2.6 g sugar, p=0.001), and blended milk-based beverages (-28 kcal, -4.2 g sugar, -0.8 g saturated fat, p<0.001). From 2012 to 2017, the total number of beverage offerings increased by 155%, with 82% of this change driven by sweetened beverages. CONCLUSIONS: Sweetened beverages available in large chain restaurants were consistently high in calories, sugar, and saturated fat and substantially increased in quantity and variety from 2012 to 2017.

15.
JAMA ; 321(18): 1799-1810, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31087022

RESUMO

Importance: Policy makers have implemented beverage taxes to generate revenue and reduce consumption of sweetened drinks. In January 2017, Philadelphia, Pennsylvania, became the second US city to implement a beverage excise tax (1.5 cents per ounce). Objectives: To compare changes in beverage prices and sales following the implementation of the tax in Philadelphia compared with Baltimore, Maryland (a control city without a tax) and to assess potential cross-border shopping to avoid the tax in neighboring zip codes. Design, Setting, and Participants: This study used a difference-in-differences approach and analyzed sales data to compare changes between January 1, 2016, before the tax, and December 31, 2017, after the tax. Differences by store type, beverage sweetener status, and beverage size were examined. The commercial retailer sales data included large chain store sales in Philadelphia, Baltimore, and the Pennsylvania zip codes bordering Philadelphia. These data reflect approximately 25% of the ounces of taxed beverages sold in Philadelphia. Exposures: Philadelphia's tax on sugar-sweetened and artificially sweetened beverages. Main Outcomes and Measures: Change in taxed beverage prices and volume sales. Results: A total of 291 stores (54 supermarkets, 20 mass merchandise stores, 217 pharmacies) were analyzed. The mean price per ounce of taxed beverages in Philadelphia increased from 5.43 cents in 2016 to 6.24 cents in 2017 at supermarkets; from 5.28 cents to 6.24 cents at mass merchandise stores, and from 6.60 cents to 8.28 cents at pharmacies. The mean price per ounce in Baltimore increased from 5.33 cents in 2016 to 5.50 cents in 2017 at supermarkets, from 6.34 cents to 6.52 cents at mass merchandise stores, and from 6.76 cents to 6.93 cents at pharmacies. The mean per-ounce difference in price between the 2 cities was 0.65 cents (95% CI, 0.60 cents-0.69 cents; P<.001) at supermarkets; 0.87 cents (95 % CI, 0.72 cents-1.02 cents; P<.001) at mass merchandise stores, and 1.56 cents (95% CI, 1.50 cents-1.62 cents; P<.001) at pharmacies. Total volume sales of taxed beverages in Philadelphia decreased by 1.3 billion ounces (from 2.475 billion to 1.214 billion) or by 51.0% after tax implementation. Volume sales in the Pennsylvania border zip codes, however, increased by 308.2 million ounces (from 713.1 million to 1.021 billion), offsetting the decrease in Philadelphia's volume sales by 24.4%. In Philadelphia, beverage volume sales in ounces per 4-week period between before and after tax periods decreased from 4.85 million to 1.99 million at supermarkets, from 2.98 million to 1.72 million at mass merchandise stores, and from 0.16 million to 0.13 million at pharmacies. In Baltimore, the beverage volume sales in ounces decreased from 2.83 million to 2.81 million at supermarkets, from 1.05 million to 1.00 million at mass merchandise stores, and from 0.14 million to 0.13 million at pharmacies. This was a 58.7% reduction at supermarkets (difference-in-differences, -2.85 million ounces; 95% CI, -4.10 million to -1.60 million ounces; P < .001), 40.4% reduction at mass merchandise stores (difference-in-differences, -1.20 million ounces; 95% CI, -2.04 million to -0.36 million ounces; P = .001), and 12.6% reduction in pharmacies (difference-in-differences, -0.02 million ounces; 95% CI, -0.03 million to -0.01 million ounces; P < .001). Conclusions and Relevance: In Philadelphia in 2017, the implementation of a beverage excise tax on sugar-sweetened and artificially sweetened beverages was associated with significantly higher beverage prices and a significant and substantial decline in volume of taxed beverages sold. This decrease in taxed beverage sales volume was partially offset by increases in volume of sales in bordering areas.


Assuntos
Bebidas/economia , Açúcares da Dieta , Edulcorantes , Impostos , Baltimore , Bebidas/estatística & dados numéricos , Custos e Análise de Custo , Regulamentação Governamental , Humanos , Philadelphia
16.
Am J Prev Med ; 56(6): 827-833, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31005465

RESUMO

INTRODUCTION: Energy drinks refer to non-alcoholic beverages that contain caffeine, amino acids, herbs, and vitamins. Although energy drinks are marketed to reduce fatigue and improve physical/mental performance, frequent consumption of these beverages has been linked to negative health consequences. The purpose of this study is to provide timely, national estimates of the percentage of energy drink consumers in the U.S. and to analyze trends in energy drink intake between 2003 and 2016. METHODS: A total of 9,911 adolescents (aged 12-19 years); 12,103 young adults (aged 20-39 years); and 11,245 middle-aged adults (aged 40-59 years) were assessed using dietary data from the 2003-2016 National Health and Nutrition Examination Surveys. For each age group (adolescents, young adults, and middle-aged adults), logistic regression was used to estimate the proportion of energy drink consumers, and negative binomial regression was used to estimate per capita energy drink consumption, adjusting for covariates. Differences in total caffeine intake between energy drink consumers and non-consumers were examined by pooling all survey years together and using negative binomial regression. Analyses were conducted in 2018. RESULTS: From 2003 to 2016, the prevalence of energy drink consumption increased significantly for adolescents (0.2% to 1.4%, p=0.028); young adults (0.5% to 5.5%, p<0.001); and middle-aged adults (0.0% to 1.2%, p=0.006). Per capita consumption of energy drinks increased significantly from 2003 to 2016 only for young adults (1.1 to 9.7 calories, p<0.001). Pooled across years, energy drink consumers had significantly higher total caffeine intake compared with non-consumers for adolescents (227.0 mg vs 52.1 mg, p<0.001); young adults (278.7 mg vs 135.3 mg, p<0.001); and middle-aged adults (348.8 mg vs 219.0 mg, p<0.001). CONCLUSIONS: These findings indicate that consumption of energy drinks has grown substantially and that these drinks are a major source of caffeine among those who consume them.

17.
PLoS One ; 14(3): e0213218, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30917140

RESUMO

OBJECTIVES: Possible adverse economic impacts of sweetened drink taxes are a key concern for numerous stakeholders. This study examined changes in unemployment benefit claims filings in Philadelphia compared to its neighboring counties two years prior to and 14 months post implementation of a 1.5 cents per ounce excise tax on sugar- and artificially-sweetened beverages. METHODS: Data were obtained from the Pennsylvania Department of Labor. Interrupted time series analysis was used to determine if there was a change in new monthly unemployment claims filings post-tax implementation in Philadelphia compared to surrounding counties in supermarkets, select potentially affected industries, and in total claims filings across all industries combined. RESULTS: Results showed there were no statistically significant changes to unemployment claims in Philadelphia compared to neighboring counties for supermarkets (ß = -9.45, 95% CI = -98.11, 79.22), soft drink manufacturers (ß = -0.13, 95% CI = -9.13, 8.88), across other potentially affected industries (ß = 9.16, 95% CI = -488.29, 506.60), or across all industries (ß = -445.85, 95% CI = -4272.39, 3380.68) following implementation of the beverage tax. Unemployment declined similarly in Philadelphia compared to surrounding counties. CONCLUSIONS: Public reports of increased unemployment within the first year following the implementation of the Philadelphia beverage tax are not supported by this analysis. Future work should examine employment outcomes and include longer follow-up periods.


Assuntos
Bebidas , Impostos/economia , Desemprego/estatística & dados numéricos , Humanos , Indústrias/economia , Indústrias/estatística & dados numéricos , Philadelphia
18.
J Nutr Educ Behav ; 51(4): 505-509, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30819655

RESUMO

Until recently, lawfully present noncitizens participating in the US Department of Agriculture Supplemental Nutrition Assistance Program (formerly Food Stamps) faced no immigration consequences. However, in September, 2018, the Trump Administration proposed a more expansive public charge rule in the Federal Register that would deny lawfully present noncitizens a path to citizenship if they had participated in certain federal safety net programs, including Supplemental Nutrition Assistance Program. This perspective discusses the proposed rule's implications, particularly for those with professional interests in promoting effective nutrition education and healthy behavior through research, policy, and practice among individuals who will potentially be affected.

19.
J Obes ; 2019: 9192340, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30729042

RESUMO

Introduction: Parents play a critical role in their children's weight. This paper examines parents' perceptions about the challenges to helping their kids maintain or achieve a healthy weight. Methods: We analyzed data in 2017 from a U.S. telephone poll conducted during October-November 2012 among parents or caregivers of children aged 2-17 years using a nationally representative sample of households. It included 667 White, 123 Black, and 167 Hispanic parents. Multiple logistic regressions were used to examine parent perceptions about the individual- and environmental-level challenges to helping their children maintain or achieve a healthy weight. Results: Overall, 45% of children have parents who reported challenges helping the child eat to maintain or achieve a healthy weight, and 35% have parents who reported challenges for exercise. According to parents, most children consumed snacks between 3 pm and bedtime during the school week (83%), and 63% of those children had an unhealthy snack. Parents did not express much concern about unhealthy snacks; 80% of children had parents who said that they did not mind since their child generally ate healthy food. Children with Hispanic and Black parents were more likely than those with White parents to have parents reporting environment challenges, such as unhealthy foods in schools. Conclusions: Helping children maintain a healthy weight through diet is a problem for many parents, regardless of their race or ethnicity. Differences by race/ethnicity in parent perceptions of food environment challenges to helping their child maintain or achieve a healthy weight suggest possible areas for future interventions.

20.
Obesity (Silver Spring) ; 27(2): 339-348, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30609301

RESUMO

OBJECTIVE: This study aimed to describe beverages purchased in restaurants among a nationally representative sample of US households. METHODS: Data were obtained from the US Department of Agriculture National Household Food Acquisition and Purchase Survey, 2012 to 2013. Survey-weighted multiple regressions assessed correlates of purchasing a sugar-sweetened beverage (SSB), purchasing a low-calorie beverage, and per capita beverage calories and grams of sugar among purchases from US restaurants (n = 14,669). RESULTS: Dining at a top fast-food chain (odds ratio = 1.9 [95% CI = 1.6, 2.3] vs. small chain or independent restaurants) and ordering a combination meal (2.8 [1.3, 3.3]) or from the kids' menu (2.1 [1.2, 3.4]) were positively associated with purchasing an SSB. Age (young adult and adolescent vs. older adult; 0.7 [0.5, 0.9] and 0.4 [0.3, 0.7], respectively), race (Black vs. White; 0.4 [0.3, 0.6]), ethnicity (Hispanic vs. non-Hispanic; 0.8 [0.6, 0.9]), and household food security (very low vs. high; 0.7 [0.5, 0.8]) were associated with purchasing a low-calorie beverage. Caloric beverage purchases contained the most calories and grams of sugar per capita when purchased by Hispanic and non-Hispanic Black adolescents. CONCLUSIONS: US households purchase a considerable amount of SSBs from the nation's largest chain restaurants, particularly when combination meals or kids' menu items are ordered, and there are disparities by age, race/ethnicity, and household food security.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , /efeitos adversos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Restaurantes , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
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