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1.
Value Health ; 24(3): 336-343, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641766

RESUMO

OBJECTIVES: To model the potential impact on obesity of removing butter, cheese, and sugar subsidies in the Canary Islands. METHODS: A simulation model was applied based on a local data set of subsidies and retail prices (2007-2016), data on own-price elasticity estimates, and representative nutritional and health surveys. We estimated marginal obesity prevalence and population attributable fraction to assess the potential impact of the butter, cheese, and sugar subsidies intervention. RESULTS: The intervention was predicted to avoid 10 363 obese adults over the study period, because of the reduction of the obesity prevalence by -0.7 percentage points. Overall, the predicted effect was largest in elderly and male groups, although females with a low socioeconomic status experienced the greatest decrease in the prevalence. The population attributable fraction predicted that 4.0% of population with obesity were attributable to the existence of these subsidies. CONCLUSIONS: This analysis provides policy makers with the predicted impact on obesity of the butter, cheese, and sugar subsidies disposal, enabling them to incorporate this health impact into decision making across policy areas in the economic and health field. This study aims to model the potential impact on obesity of removing industrial subsidies for butter, cheese and sugar in the Canary Islands.


Assuntos
Assistência Alimentar/estatística & dados numéricos , Alimentos/economia , Obesidade/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Manteiga/economia , Queijo/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Políticas , Fatores Sexuais , Fatores Socioeconômicos , Espanha/epidemiologia , Açúcares/economia , Adulto Jovem
2.
BMJ Open ; 11(1): e039211, 2021 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462095

RESUMO

OBJECTIVE: To examine the impact of cigarette price and smoking environment on allocation of household expenditure and its implication on nutrition consumption. DESIGN: A cross-sectional study was conducted using the 2014 National Socioeconomic Survey (SUSENAS), the 2014 Village Potential Survey (PODES) and the 2013 Basic National Health Survey (RISKESDAS). SUSENAS and PODES data were collected by the Central Bureau of Statistics. RISKESDAS was conducted by National Institute of Health Research and Development (Balitbangkes), Indonesian Ministry of Health (MOH). SETTING AND PARTICIPANTS: The sample covered all districts in Indonesia; with sample size of 285 400 households. These households are grouped into low, medium and high smoking prevalence districts. PRIMARY AND SECONDARY OUTCOME MEASURES: The impact of cigarette price and smoking environment on household consumption of cigarette, share of eight food groups, as well as calorie and protein intake. RESULT: 1% increase in cigarette price will increase the cigarette budget share by 0.0737 points and reduce the budget share for eggs/milk, prepared food, staple food, nuts, fish/meat and fruit, from 0.0200 points (eggs/milk) up to 0.0033 points (fruit). Reallocation of household expenditure brings changes in food composition, resulting in declining calorie and protein intake. A 1% cigarette price increase reduces calorie and protein intake as much as 0.0885% and 0.1052%, respectively. On the other hand, existence of smoke-free areas and low smoking prevalence areas reduces the household budget for cigarettes. CONCLUSION: A pricing policy must be accompanied by non-pricing policies to reduce cigarette budget share.


Assuntos
Comércio , Dietética/economia , Alimentos/economia , Fumar/economia , Impostos , Produtos do Tabaco/economia , Estudos Transversais , Ingestão de Alimentos , Abastecimento de Alimentos/economia , Humanos , Indonésia/epidemiologia , Política Pública , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores Socioeconômicos
3.
PLoS One ; 15(10): e0240009, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002052

RESUMO

OBJECTIVE: Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and families. Due to COVID-19-related school closures, states were under "shelter in place" orders, and Brighter Bites administered a rapid assessment survey to identify social needs among their families. The purpose of this study is to demonstrate the methodology used to identify those with greatest social needs during this time ("high risk"), and to describe the response of Brighter Bites to these "high risk" families. METHODS: The rapid assessment survey was collected in April 2020 across Houston, Dallas, Washington DC, and Southwest Florida. The survey consisted of items on disruption of employment status, financial hardship, food insecurity, perceived health status and sociodemographics. The open-ended question "Please share your greatest concern at this time, or any other thoughts you would like to share with us." was asked at the end of each survey to triage "high risk" families. Responses were then used to articulate a response to meet the needs of these high risk families. RESULTS: A total of 1048 families completed the COVID-19 rapid response survey, of which 71 families were triaged and classified as "high risk" (6.8% of survey respondents). During this time, 100% of the "high risk" participants reported being food insecure, 85% were concerned about their financial stability, 82% concerned about the availability of food, and 65% concerned about the affordability of food. A qualitative analysis of the high-risk group revealed four major themes: fear of contracting COVID19, disruption of employment status, financial hardship, and exacerbated food insecurity. In response, Brighter Bites pivoted, created, and deployed a framework to immediately address a variety of social needs among those in the "high risk" category. Administering a rapid response survey to identify the immediate needs of their families can help social service providers tailor their services to meet the needs of the most vulnerable.


Assuntos
Infecções por Coronavirus/epidemiologia , Características da Família , Determinação de Necessidades de Cuidados de Saúde , Pneumonia Viral/epidemiologia , Pobreza , Betacoronavirus , Criança , District of Columbia , Emprego , Florida , Alimentos/economia , Abastecimento de Alimentos , Promoção da Saúde , Humanos , Renda , Pandemias , Serviço Social , Inquéritos e Questionários , Texas
4.
PLoS One ; 15(10): e0239576, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33113548

RESUMO

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Assuntos
Betacoronavirus , Doença Crônica/epidemiologia , Infecções por Coronavirus/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Análise de Variância , Criança , Pré-Escolar , Doença Crônica/economia , Comorbidade , Infecções por Coronavirus/economia , Países em Desenvolvimento/economia , Pessoas com Deficiência/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Características da Família , Feminino , Alimentos/economia , Humanos , Lactente , Recém-Nascido , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pobreza , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Inquéritos e Questionários , Adulto Jovem
5.
PLoS One ; 15(8): e0237900, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817693

RESUMO

Drawing on a recent online survey combined with city-level data, this paper examines the impact of the COVID-19 on consumers' online food purchase behavior in the short term. To address the potential endogeneity issues, we adopt an instrumental variable (IV) strategy, using the distance from the surveyed city to Wuhan as the instrumental variable. We show that our IV method is effective in minimizing potential bias. It is found that the share of confirmed COVID-19 cases increases the possibility of consumers purchasing food online. This is more likely to be the case for young people having a lower perceived risk of online purchases and living in large cities. Despite some limitations, this paper has policy implications for China and other countries that have been influenced by the COVID-19 epidemic. Specifically, government support and regulation should focus on (i) ensuring the safety of food sold on the internet, (ii) protecting the carrier from becoming infected, and (iii) providing financial support to the poor since they may have difficulties in obtaining access to food living in small cities. Moreover, how to help those who are unable to purchase food online because of their technical skills (e.g., the elderly who are not familiar with smart phones or the internet) also deserves more attention for the government and the public.


Assuntos
Betacoronavirus , Comércio/métodos , Comportamento do Consumidor/economia , Infecções por Coronavirus/epidemiologia , Alimentos/economia , Pneumonia Viral/epidemiologia , Adulto , China/epidemiologia , Cidades , Infecções por Coronavirus/virologia , Feminino , Apoio Financeiro , Inocuidade dos Alimentos , Governo , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Smartphone , Inquéritos e Questionários , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-32785155

RESUMO

The stability of food supply chains is crucial to the food security of people around the world. Since the beginning of 2020, this stability has been undergoing one of the most vigorous pressure tests ever due to the COVID-19 outbreak. From a mere health issue, the pandemic has turned into an economic threat to food security globally in the forms of lockdowns, economic decline, food trade restrictions, and rising food inflation. It is safe to assume that the novel health crisis has badly struck the least developed and developing economies, where people are particularly vulnerable to hunger and malnutrition. However, due to the recency of the COVID-19 problem, the impacts of macroeconomic fluctuations on food insecurity have remained scantily explored. In this study, the authors attempted to bridge this gap by revealing interactions between the food security status of people and the dynamics of COVID-19 cases, food trade, food inflation, and currency volatilities. The study was performed in the cases of 45 developing economies distributed to three groups by the level of income. The consecutive application of the autoregressive distributed lag method, Yamamoto's causality test, and variance decomposition analysis allowed the authors to find the food insecurity effects of COVID-19 to be more perceptible in upper-middle-income economies than in the least developed countries. In the latter, food security risks attributed to the emergence of the health crisis were mainly related to economic access to adequate food supply (food inflation), whereas in higher-income developing economies, availability-sided food security risks (food trade restrictions and currency depreciation) were more prevalent. The approach presented in this paper contributes to the establishment of a methodology framework that may equip decision-makers with up-to-date estimations of health crisis effects on economic parameters of food availability and access to staples in food-insecure communities.


Assuntos
Infecções por Coronavirus/epidemiologia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , Alimentos/economia , Humanos , Fome , Renda , Pandemias , Prevalência
7.
Int J Behav Nutr Phys Act ; 17(1): 98, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746928

RESUMO

BACKGROUND: Evidence on what strategies - or combination of strategies - are most effective and equitable in promoting healthier diets is needed. This study examined the efficacy of nudging and pricing strategies on increasing healthy food purchases and the potential differential effect by socio-economic position (SEP) among Dutch adults in a virtual supermarket. METHODS: A randomized study design was conducted within a virtual supermarket (SN VirtuMart). Participants were exposed to five within-subject study conditions (control, nudging, pricing, price salience and price salience with nudging) and randomized to one of three between-subject study arms (a 25% price increase on unhealthy products, a 25% discount on healthy products, or a 25% price increase and discount). In total, 455 participants of low and high SEP (using either education or income as proxy) were randomized to conduct their weekly shopping in a virtual supermarket for five consecutive weeks. The primary outcome included the percentage of healthy purchases. Data were analyzed using linear mixed models. RESULTS: In total, 346 (76%) adults completed all five shops within the SN VirtuMart. Median age was 32.5, 49.2% had high education and 32.8% had high income. Out of the 12 conditions, four conditions were statistically significantly different from the control condition. Nudging and non-salient pricing strategies alone did not statistically significantly increase healthy food purchases, whereas a combination of salient price increases and discounts led to an increase in the percentage of healthy food purchases (B 4.5, 95%CI 2.6; 6.4). Combining salient pricing and nudging strategies led to increases in the percentage of healthy products in all three pricing arms, with largest effects found in the combined price increase and discount arm (B = 4.0, 95%CI = 2.0; 6.0). Effects were not modified by SEP. CONCLUSIONS: Combining health-related price increases and discounts and combining these salient pricing strategies with nudges in a supermarket setting seems to stimulate healthy food purchases for both low and high SEP populations. However, further research in real-world settings is needed. TRIAL REGISTRATION: This randomized trial ( NTR7293 ) was registered in the Dutch trial registry ( www.trialregister.nl ).


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Dieta Saudável/economia , Preferências Alimentares , Alimentos/economia , Adulto , Comércio , Feminino , Humanos , Masculino , Países Baixos , Classe Social , Realidade Virtual
9.
Artigo em Inglês | MEDLINE | ID: mdl-32854213

RESUMO

In an effort to elucidate an aspirational vision for the food system and explore whether the characteristics of such a system inadvertently set unattainable standards for low-wealth rural communities, we applied discourse analysis to the following qualitative datasets: (1) interviews with food experts and advocates, (2) scholarly and grey literature, (3) industry websites, and (4) email exchanges between food advocates. The analysis revealed eight aspirational food system discourses: production, distribution, and infrastructure; healthy, organic, local food; behavioral health and education; sustainability; finance and investment; hunger relief; demand-side preferences; romanticized, community led transformations. Study findings reveal that of eight discourses, only three encompass the experiences of low-wealth rural residents. This aspirational food system may aggravate the lack of autonomy and powerlessness already experienced by low-wealth rural groups, perpetuate a sense of failure by groups who will be unable to reach the aspirational food vision, silence discourses that might question those that play a role in the inequitable distribution of income while sanctioning discourses that focus on personal or community solutions, and leave out other policy-based solutions that address issues located within the food system. Further research might explore how to draw attention to silenced discourses on the needs and preferences of low-wealth rural populations to ensure that the policies and programs promoted by food system experts mitigate poor diets caused by food insecurity. Further research is needed to inform policies and programs to mitigate food insecurity in low-wealth rural populations.


Assuntos
Abastecimento de Alimentos , Alimentos/normas , Fome , Classe Social , Feminino , Alimentos/economia , Humanos , Renda , Masculino , População Rural
10.
Lancet Public Health ; 5(7): e404-e413, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32619542

RESUMO

BACKGROUND: One possible policy response to the burden of diet-related disease is food taxes and subsidies, but the net health gains of these approaches are uncertain because of substitution effects between foods. We estimated the health and cost impacts of various food taxes and subsidies in one high-income country, New Zealand. METHODS: In this modelling study, we compared the effects in New Zealand of a 20% fruit and vegetable subsidy, of saturated fat, sugar and salt taxes (each set at a level that increased the total food price by the same magnitude of decrease from the fruit and vegetable subsidy), and of an 8% so-called junk food tax (on non-essential, energy-dense food). We modelled the effect of price changes on food purchases, the consequent changes in fruit and vegetable and sugar-sweetened beverage purchasing, nutrient risk factors, and body-mass index, and how these changes affect health status and health expenditure. The pre-intervention intake for 340 food groups was taken from the New Zealand National Nutrition Survey and the post-intervention intake was estimated using price and expenditure elasticities. The resultant changes in dietary risk factors were then propagated through a proportional multistate lifetable (with 17 diet-related diseases) to estimate the changes in health-adjusted life years (HALYs) and health system expenditure over the 2011 New Zealand population's remaining lifespan. FINDINGS: Health gains (expressed in HALYs per 1000 people) ranged from 127 (95% uncertainty interval 96-167; undiscounted) for the 8% junk food tax and 212 (102-297) for the fruit and vegetable subsidy, up to 361 (275-474) for the saturated fat tax, 375 (272-508) for the salt tax, and 581 (429-792) for the sugar tax. Health expenditure savings across the remaining lifespan per capita (at a 3% discount rate) ranged from US$492 (334-694) for the junk food tax to $2164 (1472-3122) for the sugar tax. INTERPRETATION: The large magnitude of the health gains and cost savings of these modelled taxes and subsidies suggests that their use warrants serious policy consideration. FUNDING: Health Research Council of New Zealand.


Assuntos
Assistência Alimentar , Alimentos/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Impostos , Adulto , Feminino , Frutas/economia , Humanos , Masculino , Modelos Estatísticos , Nova Zelândia , Verduras/economia
11.
Int J Behav Nutr Phys Act ; 17(1): 80, 2020 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-32571334

RESUMO

BACKGROUND: The perception that healthy foods are more expensive than unhealthy foods has been reported widely to be a key barrier to healthy eating. However, assessment of the relative cost of healthy and unhealthy foods and diets is fraught methodologically. Standardised approaches to produce reliable data on the cost of total diets and different dietary patterns, rather than selected foods, are lacking globally to inform policy and practice. METHODS: This paper reports the first application, in randomly selected statistical areas stratified by socio-economic status in two Australian cities, of the Healthy Diets Australian Standardized Affordability and Pricing (ASAP) method protocols: diet pricing tools based on national nutrition survey data and dietary guidelines; store sampling and location; determination of household incomes; food price data collection; and analysis and reporting. The methods were developed by the International Network on Food and Obesity/NCD Research, Monitoring and Action Support (INFORMAS) as a prototype of an optimum approach to assess, compare and monitor the cost and affordability of diets across different geographical and socio-economic settings and times. RESULTS: Under current tax policy in Australia, healthy diets would be 15-17% less expensive than current (unhealthy) diets in all locations assessed. Nevertheless, healthy diets are likely to be unaffordable for low income households, costing more than 30% of disposable income in both cities surveyed. Households spent around 58% of their food budget on unhealthy food and drinks. Food costs were on average 4% higher in Canberra than Sydney, and tended to be higher in high socioeconomic locations. CONCLUSIONS: Health and fiscal policy actions to increase affordability of healthy diets for low income households are required urgently. Also, there is a need to counter perceptions that current, unhealthy diets must be less expensive than healthy diets. The Healthy Diets ASAP methods could be adapted to assess the cost and affordability of healthy and unhealthy diets elsewhere.


Assuntos
Dieta Saudável , Alimentos , Território da Capital Australiana , Custos e Análise de Custo/economia , Custos e Análise de Custo/estatística & dados numéricos , Dieta Saudável/economia , Dieta Saudável/estatística & dados numéricos , Alimentos/economia , Alimentos/estatística & dados numéricos , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/estatística & dados numéricos , Humanos , Renda , New South Wales , Inquéritos Nutricionais
12.
Am J Clin Nutr ; 111(6): 1278-1285, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32412583

RESUMO

BACKGROUND: Many lower-income communities in the United States lack a full-line grocery store. There is evidence that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increases the availability of healthy foods in stores. One national discount variety store chain (DVS) that is often located in low-income neighborhoods became an authorized WIC vendor in 8 pilot stores. OBJECTIVES: The objective of this study was to evaluate how implementing WIC in DVS pilot stores affected sales of healthy, WIC-eligible foods. METHODS: We used DVS sales data and difference-in-differences regression to evaluate how WIC authorization affected sales of WIC-eligible foods in 8 DVS pilot stores, compared with 8 matched comparison stores. RESULTS: DVS added 18 new WIC-approved foods to become an authorized vendor. Results indicate that becoming a WIC vendor significantly increased sales of healthy, WIC-eligible foods that DVS carried before authorization. WIC implementation in DVS led to a 31-unit increase in sales of the original WIC foods per week on average (P < 0.01). Lower socioeconomic status, assessed using a summary measure, is associated with increased sales of WIC foods. Yet sales of non-WIC eligible foods (e.g., salty snack foods, candy bars, soda, and processed meats) were not affected by WIC authorization. CONCLUSIONS: Encouraging DVS stores to become WIC-authorized vendors has the potential to modestly increase DVS sales and the availability of healthy foods in low-income neighborhoods. If WIC authorization is financially viable for small-format variety stores, encouraging similar small-format variety stores to become WIC-authorized has the potential to improve food access.


Assuntos
Assistência Alimentar/economia , Abastecimento de Alimentos/economia , Alimentos/economia , Setor Privado/economia , Comércio/legislação & jurisprudência , Feminino , Assistência Alimentar/legislação & jurisprudência , Abastecimento de Alimentos/legislação & jurisprudência , Promoção da Saúde/economia , Humanos , Masculino , Pobreza , Autorização Prévia , Setor Privado/legislação & jurisprudência , Estados Unidos
14.
Cochrane Database Syst Rev ; 4: CD012333, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32270494

RESUMO

BACKGROUND: Global prevalence of overweight and obesity are alarming. For tackling this public health problem, preventive public health and policy actions are urgently needed. Some countries implemented food taxes in the past and some were subsequently abolished. Some countries, such as Norway, Hungary, Denmark, Bermuda, Dominica, St. Vincent and the Grenadines, and the Navajo Nation (USA), specifically implemented taxes on unprocessed sugar and sugar-added foods. These taxes on unprocessed sugar and sugar-added foods are fiscal policy interventions, implemented to decrease their consumption and in turn reduce adverse health-related, economic and social effects associated with these food products. OBJECTIVES: To assess the effects of taxation of unprocessed sugar or sugar-added foods in the general population on the consumption of unprocessed sugar or sugar-added foods, the prevalence and incidence of overweight and obesity, and the prevalence and incidence of other diet-related health outcomes. SEARCH METHODS: We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase and 15 other databases and trials registers on 12 September 2019. We handsearched the reference list of all records of included studies, searched websites of international organisations and institutions, and contacted review advisory group members to identify planned, ongoing or unpublished studies. SELECTION CRITERIA: We included studies with the following populations: children (0 to 17 years) and adults (18 years or older) from any country and setting. Exclusion applied to studies with specific subgroups, such as people with any disease who were overweight or obese as a side-effect of the disease. The review included studies with taxes on or artificial increases of selling prices for unprocessed sugar or food products that contain added sugar (e.g. sweets, ice cream, confectionery, and bakery products), or both, as intervention, regardless of the taxation level or price increase. In line with Cochrane Effective Practice and Organisation of Care (EPOC) criteria, we included randomised controlled trials (RCTs), cluster-randomised controlled trials (cRCTs), non-randomised controlled trials (nRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) studies. We included controlled studies with more than one intervention or control site and ITS studies with a clearly defined intervention time and at least three data points before and three after the intervention. Our primary outcomes were consumption of unprocessed sugar or sugar-added foods, energy intake, overweight, and obesity. Our secondary outcomes were substitution and diet, expenditure, demand, and other health outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently screened all eligible records for inclusion, assessed the risk of bias, and performed data extraction.Two review authors independently assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We retrieved a total of 24,454 records. After deduplicating records, 18,767 records remained for title and abstract screening. Of 11 potentially relevant studies, we included one ITS study with 40,210 household-level observations from the Hungarian Household Budget and Living Conditions Survey. The baseline ranged from January 2008 to August 2011, the intervention was implemented on September 2011, and follow-up was until December 2012 (16 months). The intervention was a tax - the so-called 'Hungarian public health product tax' - on sugar-added foods, including selected foods exceeding a specific sugar threshold value. The intervention includes co-interventions: the taxation of sugar-sweetened beverages (SSBs) and of foods high in salt or caffeine. The study provides evidence on the effect of taxing foods exceeding a specific sugar threshold value on the consumption of sugar-added foods. After implementation of the Hungarian public health product tax, the mean consumption of taxed sugar-added foods (measured in units of kg) decreased by 4.0% (standardised mean difference (SMD) -0.040, 95% confidence interval (CI) -0.07 to -0.01; very low-certainty evidence). The study was at low risk of bias in terms of performance bias, detection bias and reporting bias, with the shape of effect pre-specified and the intervention unlikely to have any effect on data collection. The study was at unclear risk of attrition bias and at high risk in terms of other bias and the independence of the intervention. We rated the certainty of the evidence as very low for the primary and secondary outcomes. The Hungarian public health product tax included a tax on sugar-added foods but did not include a tax on unprocessed sugar. We did not find eligible studies reporting on the taxation of unprocessed sugar. No studies reported on the primary outcomes of consumption of unprocessed sugar, energy intake, overweight, and obesity. No studies reported on the secondary outcomes of substitution and diet, demand, and other health outcomes. No studies reported on differential effects across population subgroups. We could not perform meta-analyses or pool study results. AUTHORS' CONCLUSIONS: There was very limited evidence and the certainty of the evidence was very low. Despite the reported reduction in consumption of taxed sugar-added foods, we are uncertain whether taxing unprocessed sugar or sugar-added foods has an effect on reducing their consumption and preventing obesity or other adverse health outcomes. Further robustly conducted studies are required to draw concrete conclusions on the effectiveness of taxing unprocessed sugar or sugar-added foods for reducing their consumption and preventing obesity or other adverse health outcomes.


Assuntos
Açúcares da Dieta/economia , Obesidade/prevenção & controle , Impostos , Açúcares da Dieta/efeitos adversos , Açúcares da Dieta/provisão & distribução , Alimentos/economia , Manipulação de Alimentos , Humanos , Hungria , Análise de Séries Temporais Interrompida , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Sobrepeso/prevenção & controle , Prevalência
15.
Public Health Nutr ; 23(8): 1460-1471, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32157974

RESUMO

OBJECTIVE: To identify key school-level contexts and mechanisms associated with implementing a provincial school food and beverage policy. DESIGN: Realist evaluation. Data collection included semi-structured interviews (n 23), structured questionnaires (n 62), participant observation at public events (n 3) and scans of school, school district and health authority websites (n 67). The realist heuristic, context + mechanism → outcome configuration was used to conduct the analysis. SETTING: Public schools in five British Columbia (BC), Canada school districts. PARTICIPANTS: Provincial and regional health and education staff, private food vendors and school-level stakeholders. RESULTS: We identified four mechanisms influencing the implementation of BC's school food and beverage sales policy. First, the mandatory nature of the policy triggered some actors' implementation efforts, influenced by their normative acceptance of the educational governance system. Second, some expected implementers had an opposite response to the mandate where they ignored or 'skirted' the policy, influenced by values and beliefs about the role of government and school food. A third mechanism related to economics demonstrated ways vendors' responses to school demand for compliance with nutritional Guidelines were mediated by beliefs about food preferences of children, health and food. The last mechanism demonstrated how resource constraints and lack of capacity led otherwise motivated stakeholders to not implement the mandatory policy. CONCLUSION: Implementation of the food and beverage sales policy at the school level is shaped by interactions between administrators, staff, parent volunteers and vendors with contextual factors such as varied motivations, responsibilities and capacities.


Assuntos
Comércio , Serviços de Alimentação/economia , Política Nutricional , Instituições Acadêmicas , Bebidas/economia , Colúmbia Britânica , Criança , Alimentos/economia , Serviços de Alimentação/normas , Humanos , Entrevistas como Assunto , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Inquéritos e Questionários
16.
Cien Saude Colet ; 25(3): 1129-1135, 2020 Mar.
Artigo em Português | MEDLINE | ID: mdl-32159680

RESUMO

Nutrient deficiency is one of the major problems of the human population today. Studies indicate that consumers consider that the price of food is more relevant than its nutritional value. Therefore, this work sought to compare the costs of nutrients provided by typical foods found in the Brazilian diet. Food prices available in virtual markets were collected, and the costs to meet 30% of the daily recommendations for a healthy adult were calculated for eight nutrients. Poultry was found to be the cheapest source of protein. Cereal fiber had the lowest cost for both fiber and iron. The cheapest sources of calcium were Ovaltine and dairy products, whereas cow`s liver was the best ranked food for vitamin A. Vitamin C was found to be the cheapest nutrient in the Brazilian diet, with acerola juice being the cheapest source of this nutrient. Dairy products occupied the first six positions in the ranking of vitamin D, while nuts and seeds were the cheapest sources of vitamin E. The results showed that Brazilian consumers can meet the recommended intake of critical nutrients at a low cost through the purchase of the best ranked foods. However, this ranking should be weighted according to the food quality, as recommended in the New Dietary Guidelines for the Brazilian Population.


Assuntos
Análise Custo-Benefício , Alimentos/economia , Valor Nutritivo , Brasil , Humanos , Recomendações Nutricionais
17.
PLoS One ; 15(3): e0221838, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160192

RESUMO

Larval mosquitoes are aquatic omnivorous scavengers which scrape food from submerged surfaces and collect suspended food particles with their mouth brushes. The composition of diets that have been used in insectaries varies widely though necessarily provides sufficient nutrition to allow colonies to be maintained. Issues such as cost, availability and experience influence which diet is selected. One component of larval diets, essential fatty acids, appears to be necessary for normal flight though deficiencies may not be evident in laboratory cages and are likely more important when mosquitoes are reared for release into the field in e.g. mark-release-recapture and genetic control activities. In this study, four diets were compared for rearing Anopheles gambiae and Aedes aegypti, all of which provide these essential fatty acids. Two diets were custom formulations specifically designed for mosquitoes (Damiens) and two were commercially available fish foods: Doctors Foster and Smith Koi Staple Diet and TetraMin Plus Flakes. Development rate, survival, dry weight and adult longevity of mosquitoes reared with these four diets were measured. The method of presentation of one diet, Koi pellets, was additionally fed in two forms, pellets or a slurry, to determine any effect of food presentation on survival and development rate. While various criteria might be selected to choose 'the best' food, the readily-available Koi pellets resulted in development rates and adult longevity equal to the other diets, high survival to the adult stage and, additionally, this is available at low cost.


Assuntos
Aedes/crescimento & desenvolvimento , Anopheles/crescimento & desenvolvimento , Dieta/métodos , Larva/crescimento & desenvolvimento , Animais , Peso Corporal , Dieta/economia , Ácidos Graxos Essenciais , Feminino , Alimentos/economia , Abrigo para Animais/economia , Longevidade , Masculino , Taxa de Sobrevida , Temperatura , Água
18.
Public Health Nutr ; 23(8): 1281-1296, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32209142

RESUMO

OBJECTIVE: There are concerns that price promotions encourage unhealthy dietary choices. This review aims to answer the following research questions (RQ1) what is the prevalence of price promotions on foods in high-income settings, and (RQ2) are price promotions more likely to be found on unhealthy foods? DESIGN: Systematic review of articles published in English, in peer-review journals, after 1 January 2000. SETTING: Included studies measured the prevalence of price promotions (i.e. percentage of foods carrying a price promotion out of the total number of foods available to purchase) in retail settings, in upper-mid to high-income countries. PARTICIPANTS: 'Price promotion' was defined as a consumer-facing temporary price reduction or discount available to all customers. The control group/comparator was the equivalent products without promotions. The primary outcome for this review was the prevalence of price promotions, and the secondary outcome was the difference between the proportions of price promotions on healthy and unhealthy foods. RESULTS: Nine studies (239 344 observations) were included for the meta-analysis for RQ1, the prevalence of price promotions ranged from 6 % (95 % CI 2 %, 15 %) for energy-dense nutrient-poor foods to 15 % (95 % CI 9 %, 25 %) for cereals, grains, breads and other starchy carbohydrates. However, the I-squared statistic was 99 % suggesting a very high level of heterogeneity. Four studies were included for the analysis of RQ2, of which two supported the hypothesis that price promotions were more likely to be found on unhealthy foods. CONCLUSIONS: The prevalence of price promotions is very context specific, and any proposed regulations should be supported by studies conducted within the proposed setting(s).


Assuntos
Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Alimentos/estatística & dados numéricos , Comportamento do Consumidor , Dieta/economia , Dieta/estatística & dados numéricos , Dieta Saudável/economia , Dieta Saudável/estatística & dados numéricos , Alimentos/economia , Abastecimento de Alimentos/economia , Humanos , Marketing/estatística & dados numéricos , Valor Nutritivo , Prevalência
19.
PLoS One ; 15(3): e0230506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32214329

RESUMO

BACKGROUND: Food taxes and subsidies are one intervention to address poor diets. Price elasticity (PE) matrices are commonly used to model the change in food purchasing. Usually a PE matrix is generated in one setting then applied to another setting with differing starting consumptions and prices of foods. This violates econometric assumptions resulting in likely mis-estimation of total food consumption. In this paper we demonstrate this problem, canvass possible options for rescaling all consumption after applying a PE matrix, and illustrate the use of a total food expenditure elasticity (TFEe; the expenditure elasticity for all food combined given the policy-induced change in the total price of food). We use case studies of: NZ$2 per 100g saturated fat (SAFA) tax, NZ$0.4 per 100g sugar tax, and a 20% fruit and vegetable (F&V) subsidy. METHODS: We estimated changes in food purchasing using a NZ PE matrix applied conventionally, and then with TFEe adjustment. Impacts were quantified for pre- to post-policy changes in total food expenditure and health adjusted life years (HALYs) for the total NZ population alive in 2011 over the rest of their lifetime using a multistate lifetable model. RESULTS: Two NZ studies gave TFEe's of 0.68 and 0.83, with international estimates ranging from 0.46 to 0.90 (except a UK outlier of 0.04). Without TFEe adjustment, total food expenditure decreased with the tax policies and increased with the F&V subsidy-implausible directions of shift given economic theory and the external TFEe estimates. After TFEe adjustment, HALY gains reduced by a third to a half for the two taxes and reversed from an apparent health loss to a health gain for the F&V subsidy. With TFEe adjustment, HALY gains (in 1000's) were: 1,805 (95% uncertainty interval 1,337 to 2,340) for the SAFA tax; 1,671 (1,220 to 2,269) for the sugar tax; and 953 (453 to 1,308) for the F&V subsidy. CONCLUSIONS: If PE matrices are applied in settings beyond where they were derived, additional scaling is likely required. We suggest that the TFEe is a useful scalar, but we also encourage other researchers to examine this issue and propose alternative options.


Assuntos
Comportamento do Consumidor/economia , Alimentos/economia , Gastos em Saúde , Marketing , Modelos Econômicos , Impostos/economia , Humanos
20.
Ciênc. Saúde Colet ; 25(3): 1129-1135, mar. 2020. tab
Artigo em Português | LILACS | ID: biblio-1089467

RESUMO

Resumo Um dos maiores problemas atuais da população é a deficiência de nutrientes. Estudos indicam que consumidores consideram o preço dos alimentos mais relevante do que os valores nutricionais. Assim, este trabalho objetivou comparar o custo dos nutrientes de alimentos típicos da dieta brasileira, realizando coletas de preços em mercados virtuais e calculando o custo para se atingir 30% das necessidades diárias de um adulto saudável para oito nutrientes. A carne de frango foi a fonte mais barata de proteína. A fibra de cereal teve o menor custo para fibra e ferro. As fontes mais baratas de cálcio foram o Ovomaltine e os lácteos, e o fígado bovino foi o alimento melhor ranqueado para vitamina A. A vitamina C foi o nutriente mais barato na dieta brasileira, e o suco de acerola a fonte mais barata deste nutriente. Os lácteos ocuparam as seis primeiras posições no "ranking" da vitamina D, e nozes e sementes apresentaram o menor custo para vitamina E. Os resultados mostraram que os consumidores brasileiros podem alcançar a ingestão recomendada de nutrientes considerados críticos a um baixo custo por meio da aquisição dos alimentos melhor ranqueados. No entanto, esse ranqueamento deve ser ponderado em função da qualidade do alimento, conforme preconiza o Novo Guia Alimentar para a População Brasileira.


Abstract Nutrient deficiency is one of the major problems of the human population today. Studies indicate that consumers consider that the price of food is more relevant than its nutritional value. Therefore, this work sought to compare the costs of nutrients provided by typical foods found in the Brazilian diet. Food prices available in virtual markets were collected, and the costs to meet 30% of the daily recommendations for a healthy adult were calculated for eight nutrients. Poultry was found to be the cheapest source of protein. Cereal fiber had the lowest cost for both fiber and iron. The cheapest sources of calcium were Ovaltine and dairy products, whereas cow`s liver was the best ranked food for vitamin A. Vitamin C was found to be the cheapest nutrient in the Brazilian diet, with acerola juice being the cheapest source of this nutrient. Dairy products occupied the first six positions in the ranking of vitamin D, while nuts and seeds were the cheapest sources of vitamin E. The results showed that Brazilian consumers can meet the recommended intake of critical nutrients at a low cost through the purchase of the best ranked foods. However, this ranking should be weighted according to the food quality, as recommended in the New Dietary Guidelines for the Brazilian Population.


Assuntos
Humanos , Análise Custo-Benefício , Alimentos/economia , Valor Nutritivo , Brasil , Recomendações Nutricionais
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