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Aggarwal A.,University of Washington | Monsivais P.,Center for Diet and Activity Research | Cook A.J.,Group Health Research Institute | Cook A.J.,University of Washington | Drewnowski A.,University of Washington
Journal of the Academy of Nutrition and Dietetics | Year: 2014

Shopping at low-cost supermarkets has been associated with higher obesity rates. This study examined whether attitudes toward healthy eating are independently associated with diet quality among shoppers at low-cost, medium-cost, and high-cost supermarkets. Data on socioeconomic status (SES), attitudes toward healthy eating, and supermarket choice were collected using a telephone survey of a representative sample of adult residents of King County, WA. Dietary intake data were based on a food frequency questionnaire. Thirteen supermarket chains were stratified into three categories: low, medium, and high cost, based on a market basket of 100 commonly eaten foods. Diet-quality measures were energy density, mean adequacy ratio, and total servings of fruits and vegetables. The analytical sample consisted of 963 adults. Multivariable regressions with robust standard error examined relations between diet quality, supermarket type, attitudes, and SES. Shopping at higher-cost supermarkets was associated with higher-quality diets. These associations persisted after adjusting for SES, but were eliminated after taking attitudinal measures into account. Supermarket shoppers with positive attitudes toward healthy eating had equally higher-quality diets, even if they shopped at low-, medium-, or high-cost supermarkets, independent of SES and other covariates. These findings imply that shopping at low-cost supermarkets does not prevent consumers from having high-quality diets, as long as they attach importance to good nutrition. Promoting nutrition-education strategies among supermarkets, particularly those catering to low-income groups, can help to improve diet quality. © 2014 Academy of Nutrition and Dietetics.

Goryakin Y.,University of East Anglia | Goryakin Y.,Center for Diet and Activity Research | Roberts B.,London School of Hygiene and Tropical Medicine | McKee M.,London School of Hygiene and Tropical Medicine
European Journal of Health Economics | Year: 2014

In this paper, we estimate price elasticities of demand of several types of alcoholic drinks, using 14 rounds of data from the Russia Longitudinal Monitoring Survey-HSE, collected from 1994 until 2009. We deal with potential confounding problems by taking advantage of a large number of control variables, as well as by estimating community fixed effect models. All in all, although alcohol prices do appear to influence consumption behaviour in Russia, in most cases the size of effect is modest. The finding that two particularly problematic drinks-cheap vodka and fortified wine-are substitute goods also suggests that increasing their prices may not lead to smaller alcohol consumption. Therefore, any alcohol pricing policies in Russia must be supplemented with other measures, such as restrictions on numbers of sales outlets or their opening times. © 2014 Springer-Verlag Berlin Heidelberg.

Seuring T.,University of East Anglia | Archangelidi O.,University College London | Suhrcke M.,University of East Anglia | Suhrcke M.,University of York | Suhrcke M.,Center for Diet and Activity Research
PharmacoEconomics | Year: 2015

Background: There has been a widely documented and recognized increase in diabetes prevalence, not only in high-income countries (HICs) but also in low- and middle-income countries (LMICs), over recent decades. The economic burden associated with diabetes, especially in LMICs, is less clear. Objective: We provide a systematic review of the global evidence on the costs of type 2 diabetes. Our review seeks to update and considerably expand the previous major review of the costs of diabetes by capturing the evidence on overall, direct and indirect costs of type 2 diabetes worldwide that has been published since 2001. In addition, we include a body of economic evidence that has hitherto been distinct from the cost-of-illness (COI) work, i.e. studies on the labour market impact of diabetes. Methods: We searched PubMed, EMBASE, EconLit and IBSS (without language restrictions) for studies assessing the economic burden of type 2 diabetes published from January 2001 to October 2014. Costs reported in the included studies were converted to international dollars ($) adjusted for 2011 values. Alongside the narrative synthesis and methodological review of the studies, we conduct an exploratory linear regression analysis, examining the factors behind the considerable heterogeneity in existing cost estimates between and within countries. Results: We identified 86 COI and 23 labour market studies. COI studies varied considerably both in methods and in cost estimates, with most studies not using a control group, though the use of either regression analysis or matching has increased. Direct costs were generally found to be higher than indirect costs. Direct costs ranged from $242 for a study on out-of-pocket expenditures in Mexico to $11,917 for a study on the cost of diabetes in the USA, while indirect costs ranged from $45 for Pakistan to $16,914 for the Bahamas. In LMICs—in stark contrast to HICs—a substantial part of the cost burden was attributed to patients via out-of-pocket treatment costs. Our regression analysis revealed that direct diabetes costs are closely and positively associated with a country’s gross domestic product (GDP) per capita, and that the USA stood out as having particularly high costs, even after controlling for GDP per capita. Studies on the labour market impact of diabetes were almost exclusively confined to HICs and found strong adverse effects, particularly for male employment chances. Many of these studies also took into account the possible endogeneity of diabetes, which was not the case for COI studies. Conclusions: The reviewed studies indicate a large economic burden of diabetes, most directly affecting patients in LMICs. The magnitude of the cost estimates differs considerably between and within countries, calling for the contextualization of the study results. Scope remains large for adding to the evidence base on labour market effects of diabetes in LMICs. Further, there is a need for future COI studies to incorporate more advanced statistical methods in their analysis to account for possible biases in the estimated costs. © 2015, The Author(s).

Krenn P.J.,University of Graz | Titze S.,University of Graz | Oja P.,UKK Institute | Jones A.,University of East Anglia | And 2 more authors.
American Journal of Preventive Medicine | Year: 2011

Context: The GPS represents an innovative way to objectively assess the spatial locations of physical activity behavior. The aim of this systematic review was to determine the capability of GPS to collect high-quality data on the location of activities in research on the relationship between physical activity and the environment. Evidence acquisition: Published and unpublished articles identified from seven electronic databases, reference lists, bibliographies, and websites up to March 2010 were systematically searched for, appraised, and analyzed in summer 2010. Included studies used GPS to measure the spatial locations of physical activity and some form of environmental analysis related to the GPS data. The capability of GPS was expressed in terms of data quality, which in turn was defined as the proportion of GPS data lost in each study. Evidence synthesis: 24 studies met the inclusion criteria. Data loss was positively correlated with the measurement period for which participants were asked to wear the GPS device (r=0.81, p<0.001). Major reasons for data loss included signal drop-outs, loss of device battery power, and poor adherence of participants to measurement protocols. Data loss did not differ significantly between children and adults or by study sample size, year of publication, or GPS device manufacturer. Conclusions: GPS is a promising tool for improving understanding of the spatial context of physical activity. The current findings suggest that the choice of an appropriate device and efforts to maximize participant adherence are key to improving data quality, especially over longer study periods. © 2011 American Journal of Preventive Medicine.

Atkin A.J.,Center for Diet and Activity Research | Ekelund U.,Medical Research Council | Ekelund U.,Norwegian School of Sport Sciences | MOller N.C.,University of Southern Denmark | And 5 more authors.
Medicine and Science in Sports and Exercise | Year: 2013

PURPOSE: Accelerometry is increasingly being used to assess sedentary time in epidemiological studies, yet the most appropriate means of processing these data remains uncertain. This cross-sectional study examined the influence of selected accelerometer cut points and nonwear criteria on associations of sedentary time with adiposity and clustered metabolic risk. METHODS: Data were from the European Youth Heart Study, which included assessment of sedentary time by accelerometer. Sixteen sedentary time variables were constructed based on combinations of frequently used cut points (100, 500, 800, and 1100 counts per minute) and nonwear criteria (10-, 20-, 60-, and 100-min consecutive zeros). Adiposity was assessed by sum of four skinfold thickness measures. A clustered metabolic risk score was calculated as the mean of standardized metabolic syndrome components, including blood pressure, insulin resistance, and inverted fasting HDL-cholesterol. Analyses were conducted using multilevel cross-sectional time series regression, adjusted for overall physical activity (accelerometer counts per minute). Meta-analysis was used to obtain pooled estimates of the exposure-outcome association over all processing protocols; meta-regression was used to determine the influence of nonwear and cut point protocol on observed associations. RESULTS: Sedentary time follows a power law with cut point (exponent = 0.27) and zero string (exponent = 0.03), and it was positively associated with clustered metabolic risk (β = 0.0051; 95% confidence interval = 0.0018-0.0085). The association was moderated by cut point, with higher cut points typically producing stronger associations. No significant association between sedentary time and adiposity was observed. CONCLUSIONS: The choice of accelerometer cut point may moderate the association between sedentary time and clustered metabolic risk, suggesting that direct comparisons of associations between studies using different cut points must be made with caution. Copyright © 2013 by the American College of Sports Medicine.

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