Factors affecting Food Choice and Childhood Health

项目摘要 提高含糖饮料和高能量低热量食品的相对价格， 营养密度被认为是预防不健康体重和相关慢性病的关键策略。 儿童疾病。然而，关于这些价格的变化与体重指数（BMI）的关系的证据是 混合的，没有研究表明是否有可能改变慢性疾病的风险，如2型 糖尿病（T2 D）或青年高血压。我们建议使用新的价格数据来研究这些关系， 墨西哥接受IMSS（墨西哥研究所）医疗保健的所有儿童（2-18岁）的临床记录 del Seguro Social（墨西哥最大的公共医疗保健提供商），2012年至2016年。我们通过利用 在此期间，食品和饮料价格大幅调整，部分原因是墨西哥的 对SSB和每100克热量超过275卡路里的非基本高热量食品征税 （高热量食品，或HCFs）在2014年1月1日，叠加在食品价格的变化，由于 天气和商品价格冲击。 我们的建议有三个具体目标： 目标1：研究饮料和食品价格与青年健康状况之间是否存在关系。 a）描述征税SSB和HCF的价格变化如何与客观测量的BMI变化相关， 血压和葡萄糖，诊断为T2 D或高血压，以及超过2000年的处方数量 使用2012-2016年2-18岁墨西哥人的价格，生物标志物和处方数据。 B）探讨这些关系如何因儿童而异： ·预先存在的健康状况（血糖、血压水平或BMI，均在首次门诊访视时记录）， 年龄、性别以及两者的相互作用; * 2012年地方贫困指数;使用国家社会发展评估理事会的数据 2012年墨西哥营养和健康调查（ENSANUT）。 目标2：通过解决反向关联的问题，加强对目标（1）中关联的因果解释 因果关系、测量误差、遗漏变量偏倚、虚假相关和回归平均效应。 目标3：预测在20年期间在价格变动情况下按性别、年龄和收入分列的健康结果的变化 场景，使用目标（1）和（2）中的参数。

PROJECT SUMMARY Increasing the relative prices of sugar sweetened beverages (SSBs) and of foods with high-energy but low nutritional density has been proposed as a key strategy to prevent unhealthy weight and related chronic diseases in children. However, evidence on how changes in these prices relate to body mass index (BMI) is mixed, and no study has shown whether there may be changes in risk for chronic disease such as Type 2 diabetes (T2D) or hypertension in youth. We propose to study these relationships using novel price data and clinical records for all children (ages 2-18) in Mexico who received healthcare from IMSS (Instituto Mexicano del Seguro Social; Mexico's largest public healthcare provider) between 2012 and 2016. We do so by exploiting a large adjustment in prices of foods and beverages during this period, driven in part by Mexico's implementation of a tax on SSBs and non-basic, high-calorie foods with more than 275 calories per 100 grams (high-calorie foods, or HCFs henceforth) on January 1, 2014, superposed on variation in food prices due to weather and commodity price shocks. Our proposal has three specific aims: Aim 1: Examine if there is a relationship between beverage and food prices and health status of youth. a) Describe how changes in prices of taxed SSBs and HCFs relate to changes in objectively measured BMI, blood pressure and glucose, diagnosed T2D or hypertension, and the number of filled prescriptions over time; using 2012-2016 price, biomarker and prescription data for Mexicans aged 2-18. b) Explore how these relationships vary by children's:  pre-existing health status (glucose, blood pressure levels, or BMI, all recorded at the first clinic visit),  age, sex and the interaction of both; and  local poverty index in 2012; using data from the National Council for the Evaluation of Social Development Policy (CONEVAL) and the 2012 Mexican Nutritional and Health Survey (ENSANUT). Aim 2: Strengthen the causal interpretation of associations from Aim (1) by addressing the concern of reverse causality, measurement error, omitted variable bias, spurious correlations, and regression to the mean effect. Aim 3: Project changes in health outcomes by sex, age and income over 20 years under alternate price change scenarios, using parameters from Aims (1) and (2).