Donna R. Miles

Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study

Background Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake. Methods and findings Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015–29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline. Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers’ spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day). Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and independent gas stations (−0.64¢/oz, p = 0.004). Sales-unweighted mean price change from scanner data was +0.67¢/oz (p = 0.00) (sales-weighted, +0.65¢/oz, p = 0.003), with +1.09¢/oz (p < 0.001) for sodas and energy drinks, but a lower change in other categories. Post-tax year 1 scanner data SSB sales (ounces/transaction) in Berkeley stores declined 9.6% (p < 0.001) compared to estimates if the tax were not in place, but rose 6.9% (p < 0.001) for non-Berkeley stores. Sales of untaxed beverages in Berkeley stores rose by 3.5% versus 0.5% (both p < 0.001) for non-Berkeley stores. Overall beverage sales also rose across stores. In Berkeley, sales of water rose by 15.6% (p < 0.001) (exceeding the decline in SSB sales in ounces); untaxed fruit, vegetable, and tea drinks, by 4.37% (p < 0.001); and plain milk, by 0.63% (p = 0.01). Scanner data mean store revenue/consumer spending (dollars per transaction) fell 18¢ less in Berkeley (−

Shifts in the Recent Distribution of Energy Intake among U.S. Children Aged 2–18 Years Reflect Potential Abatement of Earlier Declining Trends

0.36, p < 0.001) than in comparison stores (−

Source of Parental Reports of Child Height and Weight During Phone Interviews and Influence on Obesity Prevalence Estimates Among Children Aged 3-17 Years

0.54, p < 0.001). Baseline and post-tax Berkeley SSB sales and usual dietary intake were markedly low compared to national levels (at baseline, National Health and Nutrition Examination Survey SSB intake nationally was 131 kcal/d and in Berkeley was 45 kcal/d). Reductions in self-reported mean daily SSB intake in grams (−19.8%, p = 0.49) and in mean per capita SSB caloric intake (−13.3%, p = 0.56) from baseline to post-tax were not statistically significant. Limitations of the study include inability to establish causal links due to observational design, and the absence of health outcomes. Analysis of consumption was limited by the small effect size in relation to high standard error and Berkeley’s low baseline consumption. Conclusions One year following implementation of the nation’s first large SSB tax, prices of SSBs increased in many, but not all, settings, SSB sales declined, and sales of untaxed beverages (especially water) and overall study beverages rose in Berkeley; overall consumer spending per transaction in the stores studied did not rise. Price increases for SSBs in two distinct data sources, their timing, and the patterns of change in taxed and untaxed beverage sales suggest that the observed changes may be attributable to the tax. Post-tax self-reported SSB intake did not change significantly compared to baseline. Significant declines in SSB sales, even in this relatively affluent community, accompanied by revenue used for prevention suggest promise for this policy. Evaluation of taxation in jurisdictions with more typical SSB consumption, with controls, is needed to assess broader dietary and potential health impacts.

Estimating usual intakes mainly affects the micronutrient distribution among infants, toddlers and pre-schoolers from the 2012 Mexican National Health and Nutrition Survey

Recent national surveys suggest that child obesity in the United States may have reached a plateau, but corresponding trends in energy intake have not been examined in depth. This article evaluates medium-term trends in childrens reported energy intake by using 4 waves of national dietary surveillance from 2003-2004 to 2009-2010. The analysis uses up to 2 24-h dietary recalls, incorporating methods that address challenges in estimating usual intake, accounting for intraindividual variance and covariates such as the presence of atypical consumption days. Quantile regression was used to assess disparities in intake among sociodemographic subgroups at extremes of the distribution as well as at the median, and the potential influence of misreporting was evaluated. Results indicated that after an initial decline in intakes across all age groups through 2007-2008, there were significant increases of ∼90 kcal/d at the median among adolescents in 2009-2010, whereas intakes in younger children remained steady. Among adolescent boys, the recent increase was larger at the 90th percentile than at the median. Intake trends did not vary by race/ethnic group, among whom intakes were similar at the upper end of the distribution. Misreporting did not influence trends over time, but intakes were lower in younger children and higher in older children after excluding misreporters. Overall, findings suggest that declines in childrens energy intake from 2003-2004 through 2007-2008 were consistent with the obesity plateau observed in most age and gender subgroups through 2009-2010. However, there is evidence of increased intakes among adolescents in 2009-2010, which may threaten the earlier abatement in overweight in this older age group.

A Genetic Epidemiological Mega Analysis of Smoking Initiation in Adolescents

Objective. We compared parental reports of childrens height and weight when the values were estimated vs parent-measured to determine how these reports influence the estimated prevalence of childhood obesity. Methods. In the 2007 and 2008 North Carolina Child Health Assessment and Monitoring Program surveys, parents reported height and weight for children aged 3–17 years When parents reported the values were not measured (by doctor, school, or home), they were asked to measure their child and were later called back. We categorized body mass index status using standard CDC definitions, and we used Chi-square tests and the Stuart-Maxwell test of marginal homogeneity to examine reporting differences. Results. About 80% (n=509) of the 638 parents who reported an unmeasured height and/or weight participated in a callback and provided updated measures. Children originally classified as obese were subsequently classified as obese (67%), overweight (13%), and healthy weight (19%) An estimated 28% of younger children (<10 years of age) vs. 6% of older children (aged ≥10 years) were reclassified on callback. Having parents who guessed the height and weight of their children and then reported updated values did not significantly change the overall population estimates of obesity. Conclusion. Our findings demonstrate that using parent-reported height and weight values may be sufficient to provide reasonable estimates of obesity prevalence Systematically asking the source of height and weight information may help improve how it is applied to research of the prevalence of childhood obesity when gold-standard measurements are not available.

An Approach to Monitor Food and Nutrition from "Factory to Fork"

Objective To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children. Design In order to obtain usual nutrient intakes, the National Cancer Institute’s method was used to correct the first 24 h dietary recall collected in the entire sample (n 2045) with a second 24 h recall collected in a sub-sample (n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na. Setting 2012 Mexican National Health and Nutrition Survey. Subjects A total of 2045 children were included: 0–5·9 months old (n 182), 6–11·9 months old (n 228), 12–23·9 months old (n 537) and 24–47·9 months old (n 1098). From these, 178 provided an additional dietary recall. Results Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v. usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake (P<0·05). Compared with usual intake, estimates from one day yielded overestimated prevalences of inadequate micronutrient intakes but underestimated prevalences of excessive intakes among children aged >6 months. Conclusions There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used.

Genetic and Environmental Influences on Smoking Behavior across Adolescence and Young Adulthood in the Virginia Twin Study of Adolescent Behavioral Development and the Transitions to Substance Abuse Follow-Up

Introduction Previous studies in adolescents were not adequately powered to accurately disentangle genetic and environmental influences on smoking initiation (SI) across adolescence. Methods Mega-analysis of pooled genetically informative data on SI was performed, with structural equation modeling, to test equality of prevalence and correlations across cultural backgrounds, and to estimate the significance and effect size of genetic and environmental effects according to the classical twin study, in adolescent male and female twins from same-sex and opposite-sex twin pairs (N = 19 313 pairs) between ages 10 and 19, with 76 358 longitudinal assessments between 1983 and 2007, from 11 population-based twin samples from the United States, Europe, and Australia. Results Although prevalences differed between samples, twin correlations did not, suggesting similar etiology of SI across developed countries. The estimate of additive genetic contributions to liability of SI increased from approximately 15% to 45% from ages 13 to 19. Correspondingly, shared environmental factors accounted for a substantial proportion of variance in liability to SI at age 13 (70%) and gradually less by age 19 (40%). Conclusions Both additive genetic and shared environmental factors significantly contribute to variance in SI throughout adolescence. The present study, the largest genetic epidemiological study on SI to date, found consistent results across 11 studies for the etiology of SI. Environmental factors, especially those shared by siblings in a family, primarily influence SI variance in early adolescence, while an increasing role of genetic factors is seen at later ages, which has important implications for prevention strategies. Implications This is the first study to find evidence of genetic factors in liability to SI at ages as young as 12. It also shows the strongest evidence to date for decay of effects of the shared environment from early adolescence to young adulthood. We found remarkable consistency of twin correlations across studies reflecting similar etiology of liability to initiate smoking across different cultures and time periods. Thus familial factors strongly contribute to individual differences in who starts to smoke with a gradual increase in the impact of genetic factors and a corresponding decrease in that of the shared environment.

Awareness Is Not Enough The Need to Increase Meningococcal Vaccine Uptake

BACKGROUND Accurate, adequate, and timely food and nutrition information is necessary in order to monitor changes in the US food supply and assess their impact on individual dietary intake. OBJECTIVE Our aim was to develop an approach that links time-specific purchase and consumption data to provide updated, market representative nutrient information. METHODS We utilized household purchase data (Nielsen Homescan, 2007-2008), self-reported dietary intake data (What We Eat in America [WWEIA], 2007-2008), and two sources of nutrition composition data. This Factory to Fork Crosswalk approach connected each of the items reported to have been obtained from stores from the 2007-2008 cycle of the WWEIA dietary intake survey to corresponding food and beverage products that were purchased by US households during the equivalent time period. Using nutrition composition information and purchase data, an alternate Crosswalk-based nutrient profile for each WWEIA intake code was created weighted by purchase volume of all corresponding items. Mean intakes of daily calories, total sugars, sodium, and saturated fat were estimated. RESULTS Differences were observed in the mean daily calories, sodium, and total sugars reported consumed from beverages, yogurts, and cheeses, depending on whether the Food and Nutrient Database for Dietary Studies 4.1 or the alternate nutrient profiles were used. CONCLUSIONS The Crosswalk approach augments national nutrition surveys with commercial food and beverage purchases and nutrient databases to capture changes in the US food supply from factory to fork. The Crosswalk provides a comprehensive and representative measurement of the types, amounts, prices, locations and nutrient composition of consumer packaged goods foods and beverages consumed in the United States. This system has potential to be a major step forward in understanding the consumer packaged goods sector of the US food system and the impacts of the changing food environment on human health.

Non-nutritive sweeteners in the packaged food supply—an assessment across 4 countries

Little is known regarding the underlying relationship between smoking initiation and current quantity smoked during adolescence into young adulthood. It is possible that the influences of genetic and environmental factors on this relationship vary across sex and age. To investigate this further, the current study applied a common causal contingency model to data from a Virginia-based twin study to determine: (1) if the same genetic and environmental factors are contributing to smoking initiation and current quantity smoked; (2) whether the magnitude of genetic and environmental factor contributions are the same across adolescence and young adulthood; and (3) if qualitative and quantitative differences in the sources of variance between males and females exist. Study results found no qualitative or quantitative sex differences in the relationship between smoking initiation and current quantity smoked, though relative contributions of genetic and environmental factors changed across adolescence and young adulthood. More specifically, smoking initiation and current quantity smoked remain separate constructs until young adulthood, when liabilities are correlated. Smoking initiation is explained by genetic, shared, and unique environmental factors in early adolescence and by genetic and unique environmental factors in young adulthood; while current quantity smoked is explained by shared environmental and unique environmental factors until young adulthood, when genetic and unique environmental factors play a larger role.

Health and educational status of children raised by a caregiver with a disability

Objective. Adolescent meningococcal vaccine uptake remains low. We examined vaccine awareness among parents of adolescents and uptake. Methods. Parents of adolescents aged 11 to 17 years (n = 1281) participated in a statewide survey. Logistic regression with weighted data provided population-based estimates. Results. In all, 65% had heard of meningococcal vaccine; parents more likely to report awareness had adolescents aged 16 to 17 years, in private school, or with health insurance. In total, 44% of aware parents reported vaccination; vaccinated teens were more likely to be black (odds ratio [OR] = 2.17), had a preventive checkup within 12 months (OR = 3.03), or resided with another child ≤18 years (OR = 1.83). Many parents of unvaccinated adolescents (38.5%) did not plan to vaccinate them within 12 months. The most common reasons for not vaccinating were providers not recommending it and believing adolescents did not need it. Conclusion. Many parents aware of meningococcal vaccine did not vaccinate their adolescents. Interventions that include increasing provider recommendation and annual visits may increase uptake.