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Testing combinations of population interventions to encourage healthy eating

测试人口干预措施的组合以鼓励健康饮食

基本信息

批准号：
10380041
负责人：
DEAN SCHILLINGER
金额：
$ 74.08万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-06-20 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10380041
关键词：
Accounting Address Affect Alcohols Area Beverages California Calories Cardiovascular Diseases Cities Computer Simulation Consumption County Data Demography Diabetes prevention Disease Distant Eating Behavior Economics Effectiveness of Interventions Employee Evaluation Experimental Designs Food Frequencies Geography Goals Healthy Eating Incentives Income Individual Intake Intervention Lead Los Angeles Low Income Population Marketing Methods Natural experiment Non-Insulin-Dependent Diabetes Mellitus Obesity Pattern Policies Population Population Intervention Predisposition Questionnaires Race Recommendation Recording of previous events Research Risk Behaviors Sales San Francisco Selection Bias Site Smoking Statistical Methods Supermarket Surveys Taxes Testing Time Tobacco United States United States National Institutes of Health Workplace base cost effectiveness design ethnic disparity experimental study farmers markets follow-up food consumption food environment food insecurity fruits and vegetables improved indexing innovation lower income families models and simulation multi-component intervention novel nutrition obesity prevention primary outcome programs prospective secondary outcome socioeconomic disparity socioeconomics sugar sweetened beverage theories therapy design urban setting voucher

项目摘要

ABSTRACT Population-level interventions to encourage healthy eating—which involve changing food environments or purchasing conditions—have been extensively discussed for the prevention of obesity and type 2 diabetes. Preliminary data suggest that population interventions introduced in isolation (such as an SSB tax) can have a modest effect, but multi-faceted interventions should be introduced in combination, to produce large and meaningful improvements in healthy eating. Studying combinations of population interventions is difficult, as such interventions are rare. We propose to rigorously assess a rare set of nested natural experiments in the two largest, most diverse urban settings in California (CA): Los Angeles and the San Francisco Bay Area. We will identify the complementarities among major population-level interventions to encourage healthy eating. In Aim 1, we will conduct a prospective evaluation of a population-wide SSB tax in both tax-affected and matched unaffected CA counties. We will identify changes to both beverage and food consumption and purchasing, food substitution patterns, spillover to neighboring areas, effects of marketing, and any regressive economic effects for low-income populations. The longer-term follow-up period enabled by our design will test the hypothesis that a SSB tax produces sustained declines in SSB consumption rather than merely short-term effects followed by a return to pre-tax consumption. Uniquely, we will then test complementarity between the tax and other interventions in Aims 2 and 3. In Aim 2, we will examine the complementarity of the SSB tax with a fruit and vegetable voucher program. Some SSB tax-affected and distant tax-unaffected counties have introduced fresh fruit and vegetable purchasing vouchers, which enable low-income families facing food insecurity to purchase fruits and vegetables at major supermarkets and corner stores in the area, not just at farmer’s markets. We will test the hypothesis, supported by our preliminary data, that pairing the purchasing penalty of an SSB tax with a purchasing incentive of a fruit and vegetable voucher improves upon the modest effect of either intervention alone. In Aim 3, we will identify the complementarity between the SSB tax and a workplace SSB purchasing ban, implemented in some workplaces but not others during tax-affected and -unaffected periods. We will test the hypothesis, consistent with our preliminary data, that workplace bans disproportionately reduce SSB consumption in the lowest-income employees, neutralizing the economically-regressive effect of a SSB tax. We will evaluate these interventions using innovative methods that advance the study of natural experiments in obesity and diabetes prevention. Specifically, we will use a synthetic control statistical method, which adjusts for unmeasured confounders such as differences in culture among the intervention and control areas. Second, we will input our results into validated computer simulation models of obesity, type 2 diabetes, and cardiovascular disease, allowing us to project the generalizable impact and cost-effectiveness of the interventions for reducing long-term national race/ethnic and socioeconomic disparities.

摘要人口层面的干预措施，以鼓励健康饮食-这涉及改变食品环境或购买条件-已经广泛讨论了预防肥胖和2型糖尿病。初步数据表明，单独采取的人口干预措施（如SSB税）可能会产生效果不大，但应结合采用多方面的干预措施，在健康饮食方面有意义的改善。研究人口干预措施的组合是困难的，因为这种干预很少。我们建议严格评估一组罕见的嵌套自然实验，加州（CA）两个最大、最多样化的城市环境：洛杉矶和旧金山弗朗西斯科湾区。我们将确定主要人口干预措施之间的互补性，以鼓励健康饮食。在目标1，我们将对全民SSB税进行前瞻性评估，包括税收影响和匹配未受影响的县我们将确定饮料和食品消费以及购买，食品替代模式、对邻近地区的溢出效应、市场营销效应以及任何回归经济效应低收入人群。我们设计的长期随访期将检验这一假设 SSB税产生SSB消费的持续下降，而不仅仅是短期影响回到税前消费。独特的是，我们将测试税收和其他之间的互补性，目标2和目标3中的干预措施。在目标2中，我们将研究SSB税与水果的互补性，蔬菜券计划。一些SSB税收影响和遥远的税收未受影响的县已经引入了新的水果和蔬菜购买券，使面临粮食无保障的低收入家庭能够购买水果和蔬菜在该地区的主要超市和街角商店，而不仅仅是在农贸市场。我们将测试假设，我们的初步数据支持，配对购买惩罚的SSB税与水果和蔬菜券的购买激励改善了任何一种干预措施的适度效果一个人在目标3中，我们将确定SSB税和工作场所SSB采购之间的互补性禁令，在某些工作场所实施，但在受税收影响和不受影响的时期，其他工作场所则不实施。我们将测试假设，与我们的初步数据一致，工作场所禁止不成比例地减少SSB 最低收入雇员的消费，中和SSB税的经济累退效应。我们将使用创新的方法来评估这些干预措施，这些方法将促进自然实验的研究，肥胖和糖尿病预防。具体来说，我们将使用一种综合控制统计方法，对于不可测量的混杂因素，如干预和对照区域之间的文化差异。第二、我们将把我们的结果输入到肥胖、2型糖尿病和糖尿病的有效计算机模拟模型中，心血管疾病，使我们能够项目的普遍影响和成本效益的采取干预措施，减少长期的国家种族/族裔和社会经济差距。