Factors affecting Food Choice and Childhood Health

项目总结 提高含糖饮料(SSB)和高能量低热量食品的相对价格 营养密度已被认为是预防不健康体重和相关慢性病的关键策略 儿童的疾病。然而，这些价格的变化如何与身体质量指数(BMI)相关的证据是 好坏参半，而且还没有研究表明是否存在患慢性疾病(如2型)风险的变化 青少年患有糖尿病(T2D)或高血压。我们建议使用新的价格数据来研究这些关系 墨西哥所有接受IMSS(墨西哥研究所)医疗保健的儿童(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)在2012至2016年间。我们这样做是通过剥削 在此期间食品和饮料价格的大幅调整，部分原因是墨西哥的 对SSB和每100克热量超过275卡路里的非基本高卡路里食品征税 (高热量食品，下称高热量食品)2014年1月1日，叠加食品价格变化，原因是 天气和大宗商品价格冲击。 我们的建议有三个具体目标： 目的1：研究饮料和食品价格与青少年健康状况之间是否存在关系。 A)描述征税的SSB和HCF的价格变化与客观测量的BMI变化之间的关系； 血压和血糖，诊断为T2D或高血压，以及处方数量超过 时间；使用2012-2016年间墨西哥2-18岁人群的价格、生物标记物和处方数据。 B)探索这些关系如何因孩子的不同而不同： 先前的健康状况(血糖、血压水平或体重指数，均在第一次就诊时记录)， 年龄、性别以及两者的相互作用；以及 2012年地方贫困指数；使用国家社会经济评估委员会的数据 发展政策(Conval)和2012年墨西哥营养与健康调查(ENSANUT)。 目标2：通过解决逆转的关切，加强对目标(1)中的关联的因果解释 因果关系、测量误差、忽略的变量偏差、虚假相关性和回归到平均效应。 目标3：交替价格变化下按性别、年龄和收入分列的项目在20年内的健康结果变化 场景，使用AIMS(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).