Economic and Health Policy Research Program

Atlanta, United States

Economic and Health Policy Research Program

Atlanta, United States
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Shuval K.,Physical Activity and Nutrition Research | Drope J.,Economic and Health Policy Research Program | Katz D.L.,Yale University | Patel A.V.,Epidemiology Research Program | Maitin-Shepard M.,Senior Policy Analyst
CA Cancer Journal for Clinicians | Year: 2017

Physical inactivity has reached epidemic proportions in modern society. Abundant evidence points to a causal link between physical inactivity and increased risk for numerous noncommunicable diseases, such as some types of cancer and heart disease, as well as premature mortality. Yet, despite this overwhelming evidence, many individuals do not meet the recommended amount of physical activity required to achieve maximum health benefits. Because primary care physicians' advice is highly regarded, clinicians have the unique opportunity to play an important role in enabling patients to modify their behavior at the point of care with the goal of guiding patients to adopt and maintain an active lifestyle. In the current study, the authors evaluate pertinent literature from the fields of medicine/public health and economics/psychology to suggest a comprehensive approach to physical activity counseling at the primary care level. They first examine the public health approach to physical activity counseling, and then proceed to offer insights from behavioral economics, an emerging field that combines principles from psychology and economics. The application of key behavioral economics tools (eg, precommitment contracts, framing) to physical activity counseling in primary care is elaborated. © 2017 American Cancer Society.


Shuval K.,Economic and Health Policy Research Program | Li Q.,Economic and Health Policy Research Program | Gabriel K.P.,University of Texas Health Science Center at Houston | Tchernis R.,Georgia State University
Preventive Medicine | Year: 2017

The present study examines the association between income and physical activity intensity along the entire continuum using accelerometry in a nationally representative sample of U.S. adults. Specifically, we assessed the relationship between annual household income, sedentary behavior, light, and moderate-vigorous intensity physical activity, and meeting physical activity guidelines over a brief, 2-day period (‘weekend warrior’), and during the entire week. The sample consisted of 5206 National Health and Examination Survey adult participants (2003–2006) who wore accelerometers and completed pertinent survey questions. Ordinary Least Square models were computed to examine the relationship between income and the dependent variables (sedentary behavior, light, and moderate to vigorous intensity activity) adjusting for covariates. Logistic regression was employed to examine the association between income and meeting physical activity guidelines during a 2-day and 7-day time-period. Results indicate that individuals with an annual income of ≥$75,000 engaged in 4.6 more daily minutes of moderate to vigorous activity (p-value < 0.01), in comparison to the reference group (<$20,000 annual income). Those in the high-income strata were 1.6 and 1.9 times more likely to meet physical activity guidelines during a 2 and 7-day period (respectively) than their lower income counterparts (p < 0.05 for both). Further, those in the high-income strata spent 11.8 more minutes daily being sedentary than their lower income counterparts (p-value < 0.01). In conclusion, higher annual household income is related to more intense, less frequent (per week) patterns of physical activity and more daily sedentary time. © 2017 Elsevier Inc.


Stevens V.L.,Epidemiology Research Program | Diver W.R.,Epidemiology Research Program | Stoklosa M.,Economic and Health Policy Research Program | Flanders W.D.,Emory University | And 5 more authors.
Cancer Epidemiology Biomarkers and Prevention | Year: 2017

Background: Cigarette price increases effectively prevent smoking initiation and reduce cigarette consumption among young smokers. However, the impact of cigarette prices on smoking cessation among older smokers is less clear, particularly for those aged 65 years and older, a group that is at highest risk of smokingrelated disease and will almost double in the United States between 2012 and 2050. Methods: Biennial questionnaires administered between 1997 and 2013 assessed smoking status for 9,446 Cancer Prevention Study-II Nutrition Cohort participants who were 50 years old and lived in Washington, DC, and 48 states. For each interval between biennial questionnaires, change in price per pack and average price level per pack were calculated. The separate associations between these price variables and smoking cessation during the same time interval were determined. Results: In multivariable-adjusted models, each 1.00 price increase was associated with a 9% higher rate of quitting [rate ratio (RR) 1.09; 95% confidence interval (CI), 1.04-1.14). Each 1.00 increase in average price was associated with a 6% higher rate of quitting (RR 1.06; 95% CI, 1.02-1.10). The association with average price was strongest among smokers aged 65 years and older (RR 1.07; 95% CI, 1.04-1.11) and, for price change, for smokers with no major prevalent disease (RR 1.13; 95% CI, 1.07-1.19). Conclusions: These results suggest that increasing cigarette prices will promote quitting even among smokers aged 65 years and older. Impact: Increasing cigarette prices through higher taxes could reduce smoking rates among older adults and decrease risk of smoking-related cancers and diseases in this high-risk group. © 2017 American Association for Cancer Research.


Nguyen B.T.,Economic and Health Policy Research Program | Shuval K.,Economic and Health Policy Research Program | Bertmann F.,South HeroVT | Yaroch A.L.,Gretchen Swanson Center for Nutrition
American Journal of Public Health | Year: 2015

Objectives. We examined whether Supplemental Nutrition Assistance Program (SNAP) participation changes associations between food insecurity, dietary quality, and weight among US adults. Methods. We analyzed adult dietary intake data (n = 8333) from the 2003 to 2010 National Health and Nutrition Examination Survey. Bivariate and multivariable methods assessed associations of SNAP participation and 4 levels of food security with diet and weight. Measures of dietary quality were the Healthy Eating Index 2010, total caloric intake, empty calories, and solid fat; weight measures were body mass index (BMI), overweight, and obesity. Results. SNAP participants with marginal food security had lower BMI (1.83 kg/m2; P < .01) and lower probability of obesity (9 percentage points; P < .05). SNAP participants with marginal (3.46 points; P < .01), low (1.98 points; P < .05), and very low (3.84 points; P < .01) food security had better diets, as illustrated by the Healthy Eating Index. Associations between SNAP participation and improved diet and weight were stronger among Whites than Blacks and Hispanics. Conclusions. Our research highlights the role of SNAP in helping individuals who are at risk for food insecurity to obtain a healthier diet and better weight status.


PubMed | Economic and Health Policy Research Program, University of California at Irvine, The Gretchen Swanson Center for Nutrition and University of Massachusetts Amherst
Type: | Journal: Preventive medicine | Year: 2016

To examine the relationship between economic time preferences and frequency of fast food and full-service restaurant consumption among U.S. adults.Participants included 5871U.S. adults who responded to a survey conducted in 2011 pertaining to the lifestyle behaviors of families and the social context of these behaviors. The primary independent variable was a measure of time preferences, an intertemporal choice assessing delay discounting. This was elicited via responses to preferences for an immediate dollar amount or a larger sum in 30 (30-day time horizon) or 60days (60-day time horizon). Outcomes were the frequency of fast food and full-service restaurant consumption. Ordered logistic regression was performed to examine the relationship between time preferences and food consumption while adjusting for covariates (e.g. socio-demographics).Multivariable analysis revealed that higher future time preferences were significantly related to less frequent fast food intake for both the 30- and 60-day time horizon variables (P for linear trend <0.05; both). Notably, participants with the highest future time preference were significantly less likely to consume fast food than those with very low future time preferences (30-day: OR=0.74, 95%CI: 0.62-0.89; and 60-day: OR=0.86, 95%CI: 0.74-1.00). In comparison, higher future time preferences were not significantly associated with full-service restaurant intake (30-day: p for linear trend=0.73; 60-day: p for linear trend=0.83).Higher future time preferences were related to a lower frequency of fast food consumption. Utilizing concepts from behavioral economics (e.g. pre-commitment contracts) to facilitate more healthful eating is warranted using experimental studies.


Powell L.M.,University of Illinois at Chicago | Nguyen B.T.,Economic and Health Policy Research Program | Dietz W.H.,George Washington University
Pediatrics | Year: 2015

BACKGROUND AND OBJECTIVE: Pizza consumption is a top contributor to children's and adolescents' caloric intake. The objective of this study was to examine children's and adolescents' pizza consumption patterns and its impact on their energy and nutrient intake. METHODS: Twenty-four-hour dietary recall data for children aged 2 to 11 and adolescents aged 12 to 19 were drawn from the 2003-2004, 2005-2006, 2007-2008, and 2009-2010 National Health and Nutrition Examination Survey. We tested changes in consumption patterns, including by race/ethnicity, income, meal occasion, and source. Individual-level fixed effects regression models estimated the impact of pizza consumption on total energy intake (TEI) and intakes of sugar, saturated fat, and sodium. RESULTS: From 2003-2004 to 2009-2010, overall energy intake from pizza declined 25% among children (110 to 83 kcal, P ≤ .05). Among adolescents, although caloric intake from pizza among those who consumed pizza fell (801 to 624 kcal, P ≤ .05), overall pizza intake remained unchanged due to slightly higher pizza consumption prevalence. For children and adolescents, pizza intake fell (P ≤ .05) at dinner time and from fast food. For children and adolescents, respectively, pizza consumption was significantly associated with higher net daily TEI (84 kcal and 230 kcal) and higher intakes of saturated fat (3 g and 5 g) and sodium (134 mg and 484 mg) but not sugar intake, and such affects generally did not differ by sociodemographic characteristics. Pizza consumption as a snack or from fast-food restaurants had the greatest adverse impact on TEI. CONCLUSIONS: The adverse dietary effects of pizza consumption found in this study suggest that its consumption should be curbed and its nutrient content improved. Copyright © 2015 by the American Academy of Pediatrics


Nguyen B.T.,Economic and Health Policy Research Program | Shuval K.,Economic and Health Policy Research Program | Njike V.Y.,Yale University | Katz D.L.,Yale University
Mayo Clinic Proceedings | Year: 2014

Objective: To examine the association of the Supplemental Nutrition Assistance Program (SNAP) and diet quality among low-income adults. Patients and Methods: We examined US nationally representative data from the National Health and Nutrition Examination Surveys 2003-2004, 2005-2006, 2007-2008, and 2009-2010. The data were analyzed from October 7, 2013, to March 1, 2014. The analytic sample consisted of 4211 low-income adults aged 20 to 64 years, of whom 1830 participate in SNAP. We adhered to the National Cancer Institute method in calculating the Healthy Eating Index 2010 and other dietary indicators, such as empty calorie intake. Bivariate and multivariable regression was used to compare SNAP participants and income-eligible nonparticipants among the full sample and subsamples of age, sex, race/ethnicity, and food insecurity. Results: Compared with low-income nonparticipants, adjusted analyses reveal that SNAP participants had lower dietary quality scores overall (42.58 vs 44.36, P≤.0001) and lower scores for fruits and vegetables, seafood and plant proteins (1.55 vs 1.77, P≤.0022), and empty calories (9.03 vs 9.90, P≤.0001), but they exhibited comparable scores on whole grain, refined grain, total dairy, total protein, fatty acid, and sodium intakes. The association between SNAP participation and lower dietary quality was statistically significant among women, Hispanics, young adults, and individuals who were food secure. Conclusion: Our analyses suggest that SNAP participants have lower dietary quality than their income-eligible nonparticipant counterparts. Although SNAP has an important role in providing nutrition assistance to eligible low-income individuals, interventions are warranted to improve the dietary quality of participants. © 2014 Mayo Foundation for Medical Education and Research.


Nguyen B.T.,Economic and Health Policy Research Program | Powell L.M.,University of Illinois at Chicago
Preventive Medicine | Year: 2015

Introduction: This paper examined patterns in adults' sugar-sweetened beverage (SSB) consumption and caloric intake by Supplemental Nutrition Assistance Program (SNAP) participation status and by source of purchases in the United States (US). Method: Cross-sectional analysis of consumption of SSBs by source of purchases using 24-hour dietary recall data obtained from the US National Health and Nutrition Examination Survey 2003-2010 (N = 17,891). Bivariate analysis and multivariable regressions were used to examine the association between SNAP participation and SSB calories consumed overall and by source. Results: SSBs account for approximately 12% of total daily caloric intake (258. kcal) among SNAP participants, higher than that of SNAP-eligible nonparticipants (9% total daily intake, 205. kcal) and SNAP-ineligible nonparticipants (6% total daily intake, 153. kcal). Among income-eligible adults, participating in SNAP is associated with 28.9 additional SSB calories, of which most were obtained from a store. From 2003-04 to 2009-10, SSB prevalence and caloric intake were flat among SNAP participants while it declined among both SNAP-eligible and SNAP-ineligible nonparticipants; this pattern held for all sources of SSBs except for those purchased from fast-food restaurants, which were not statistically reduced among nonparticipants. Conclusion: SNAP participants consumed more SSB calories compared to SNAP-eligible nonparticipants; and their SSB prevalence and caloric intake trend was flat over the 2003-04 to 2009-10 period. SNAP-Education interventions that focus on improving access to healthy food in poor neighborhoods may benefit SNAP participants. © 2015 Elsevier Inc.


PubMed | Economic and Health Policy Research Program and University of Illinois at Chicago
Type: | Journal: Preventive medicine | Year: 2015

This paper examined patterns in adults sugar-sweetened beverage (SSB) consumption and caloric intake by Supplemental Nutrition Assistance Program (SNAP) participation status and by source of purchases in the United States (US).Cross-sectional analysis of consumption of SSBs by source of purchases using 24-hour dietary recall data obtained from the US National Health and Nutrition Examination Survey 2003-2010 (N=17,891). Bivariate analysis and multivariable regressions were used to examine the association between SNAP participation and SSB calories consumed overall and by source.SSBs account for approximately 12% of total daily caloric intake (258 kcal) among SNAP participants, higher than that of SNAP-eligible nonparticipants (9% total daily intake, 205 kcal) and SNAP-ineligible nonparticipants (6% total daily intake, 153 kcal). Among income-eligible adults, participating in SNAP is associated with 28.9 additional SSB calories, of which most were obtained from a store. From 2003-04 to 2009-10, SSB prevalence and caloric intake were flat among SNAP participants while it declined among both SNAP-eligible and SNAP-ineligible nonparticipants; this pattern held for all sources of SSBs except for those purchased from fast-food restaurants, which were not statistically reduced among nonparticipants.SNAP participants consumed more SSB calories compared to SNAP-eligible nonparticipants; and their SSB prevalence and caloric intake trend was flat over the 2003-04 to 2009-10 period. SNAP-Education interventions that focus on improving access to healthy food in poor neighborhoods may benefit SNAP participants.


PubMed | Economic and Health Policy Research Program, Universiti Sains Malaysia and Southeast Asian Tobacco Control Alliance SEATCA
Type: Journal Article | Journal: Tobacco control | Year: 2015

To monitor and analyse impacts of the interaction between tobacco excise tax policy and industry price strategy, on the price level and variation of cigarettes sold in five Southeast Asian countries (Indonesia, Cambodia, Lao PDR, the Philippines and Vietnam).Prices of cigarette sold by sticks and packs were collected through an in-person survey of retailers during 2011. Mean cigarette prices and price variation were calculated in each study country for single cigarettes, whole packs and brand groups.Price variation of whole packs was greater in countries with ad-valorem excise tax structures (Cambodia, Lao PDR and Vietnam) than in countries with multitiered specific excise taxes (Indonesia and the Philippines). The price variation for single sticks appeared to be driven by local currency denomination. Cigarettes sold individually cost more per stick than cigarettes sold in whole packs in every brand group except for Indonesias domestic brands.Tobacco industry strategy and excise tax structure drove the price level and variation of cigarettes sold in packs, while currency denominations influence the selling price of single sticks. To maximise the effectiveness of tobacco tax policies, countries should adopt specific excise tax structures to decrease cigarette price variation, which would minimise opportunities for smokers to trade down to a cheaper brand to avoid a tax-driven price increase.

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