Inas Rashad Kelly

Exposure to food advertising on television: Associations with children's fast food and soft drink consumption and obesity

There is insufficient research on the direct effects of food advertising on childrens diet and diet-related health, particularly in non-experimental settings. We employ a nationally-representative sample from the Early Childhood Longitudinal Survey-Kindergarten Cohort (ECLS-K) and the Nielsen Company data on spot television advertising of cereals, fast food restaurants and soft drinks to children across the top 55 designated-market areas to estimate the relation between exposure to food advertising on television and childrens food consumption and body weight. Our results suggest that soft drink and fast food television advertising is associated with increased consumption of soft drinks and fast food among elementary school children (Grade 5). Exposure to 100 incremental TV ads for sugar-sweetened carbonated soft drinks during 2002-2004 was associated with a 9.4% rise in childrens consumption of soft drinks in 2004. The same increase in exposure to fast food advertising was associated with a 1.1% rise in childrens consumption of fast food. There was no detectable link between advertising exposure and average body weight, but fast food advertising was significantly associated with body mass index for overweight and obese children (≥85th BMI percentile), revealing detectable effects for a vulnerable group of children. Exposure to advertising for calorie-dense nutrient-poor foods may increase overall consumption of unhealthy food categories.

The Benefits of Breastfeeding Across the Early Years of Childhood

There has been much scrutiny recently of the choice to breast-feed rather than formula-feed an infant, yet key identification issues remain to be resolved. This study uses the Early Childhood Longitudinal Survey—Birth Cohort to explore the causal effect of breast feeding on child development. Using simultaneous equations models and propensity score measures and adjusting for confounding factors, we examine health, physical, and cognitive outcomes and relate these to a set of breast feeding and formula feeding intensities measures. Our results indicate that breast feeding is protective against obesity and improves cognitive outcomes at 24 months and 54 months. Furthermore, not being formula-fed at birth is associated with higher motor scores.

From Cradle to Classroom: High Birth Weight and Cognitive Outcomes

While the effects of low birth weight have long been explored, the literature on the effects of high birth weight is sparse. However, with increasing obesity rates in the United States, high birth weight has become a potential concern, and has been associated in the medical literature with an increased likelihood of becoming an overweight child, adolescent, and subsequently an obese adult. Overweight and obesity, in turn, are associated with a host of negative effects, including lower test scores in school and lower labor market prospects when adults. If studies only focus on low birth weight, they may underestimate the effects of ensuring that mothers receive adequate support during pregnancy. This study finds that cognitive outcomes are adversely affected not only by low birth weight (<2500 grams) but also by high birth weight (>4500 grams). Our results have policy implications in terms of provision of support for pregnant women.

Early education and health outcomes of a 2001 U.S. Birth Cohort

This paper looks at health outcomes, health behaviors, and health screening with respect to participation in Early Childhood Care and Education. With information on health status at multiple periods in time, we are able to look at whether healthier children select into early childhood education (as measured by center-based preschool care and Head Start), as well as whether early childhood education has immediate and near-term effects on a range of health status measures. There is some evidence that child obesity is ameliorated by participation in center-based preschool or Head Start and this finding is supported by clear evidence of improved nutrition and increased levels of health screening. Effects on other health outcomes such as asthma, ear infections, and respiratory problems may be partially masked by unobserved heterogeneity.

Nutrient intake: A cross-national analysis of trends and economic correlates

Nutrition is a key input in the health production function, and a better understanding of how we eat can aid in guiding effective policy change towards better population health. This study documents prevalence rates, trends in, and potential correlates of nutrient intake for panels of countries, categorized by geographical regions and levels of development. We assemble data from 209 countries, spanning 51 years (1961-2011), based on original data compilations using 960 country-years for BMI, 370 country-years for glucose, and 321 country-years for cholesterol. Our estimates inform the nature and scope of nutrient intake on a global scale, and contribute towards an understanding of the drivers of the general upward trend in food intake and obesity. The cross-national trends, across countries spanning the spectrum of economic development and geographic regions, suggest that simply analyzing aggregate caloric intake masks the heterogeneity in trends for the various food groups. Food groups analyzed include cereals, sugars and sweeteners, vegetable oils, meat, starch, milk, fruits, animal fats, alcoholic beverages, oil crops, pulses, vegetables, fish, and eggs. Fixed effects regression analyses reveal that caloric intake is strongly associated with hunger depth, body mass index, cholesterol levels, and glucose levels. Moreover, changes in real GDP per capita, labor force participation, and health care inputs in a nation can partly explain the increase in caloric intake. We note that substantial heterogeneity remains.

Who Pays the Bar Tab? Beer Consumption and Economic Growth in the United States

Few studies explore the linkages between health behaviors and macroeconomic outcomes. This study uses 1971–2007 state‐level data from the United States to estimate the impact of beer consumption on economic growth. We document that beer consumption has negative effects on economic growth measures once the endogeneity of beer consumption is addressed. Our estimates are robust to a range of specification checks. These findings run parallel to a large body of literature documenting substantial social and economic costs stemming from alcohol use.

Advertising as a Determinant of Health in the USA

This article discusses the role of advertising and promotion as determinants of health, while providing a conceptual and empirical framework through which to study the economics of advertising in markets for healthcare inputs. Implications for public health generally depend on whether advertising raises ‘selective’ or brand-specific demand versus ‘primary’ or industry-wide demand. This article summarizes the evidence for various markets including alcohol, cigarettes, food and beverages, and prescription drugs. The consumers demand response and the effects of advertising on market price are discussed with an underlying focus on public health. The article concludes with new promising directions for advertising research.

Work as Mental Health-promoting or Mental Health-depreciating?

The pure investment form of Grossman’s seminal demand-for-health model proposes that people invest in health to raise productivity and earnings; thus there would be little point to investing in one’s health postretirement, and the health stock is predicted to experience a sharp decline. Yet, as Grossman also points out, health has consumptive aspects. One has an incentive to invest in one’s health even postretirement because, as economists would say, health directly enters the utility function. Put more simply, it makes one happy to be healthy. So perhaps retirees have a reason to care about their health after all, although the net effect on health may depend on which effect dominates. In the absence of unambiguous theoretical predictions, the question of whether retirement has an adverse effect on mental and physical health remains an empirical one, and one that several studies have recently attempted to address. The question has important policy implications as we witness a trend toward earlier retirement in most developed nations, along with rising life expectancy and higher health care costs. In this issue of EPIDEMIOLOGY, Oksanen and colleagues carefully analyze the effect of retirement on mental health as measured by antidepressant use 4 years before and 4 years after retirement among a longitudinal cohort of Finnish employees. Finland had a low average retirement age of 59 years in 2004. However, the Finnish Pension Reform of 2005 made the retirement age more flexible and encouraged postponing retirement, with the increase in labor supply purported to lead to beneficial welfare effects. Oksanen et al suggest otherwise, at least with respect to mental health. Accounting for timeinvariant factors such as socioeconomic status, sex, geographic area, and type of employer, and analyzing those who retired due to poor mental or physical health separately, the authors find some evidence that retirement may be beneficial for mental health. They also conclude that those who retired due to mental health issues showed postretirement improvements, in that they reported less antidepressant drug use. Diabetes medications, presumed not to be directly influenced by retirement, are used as a counterfactual. (No effects are found for diabetes drugs, as expected.) The literature on this issue has been fragmented. In another study from Finland, Salokangas and Joukamaa also noted mental health improvements among retirees, but no clear effect on physical health. In contrast, Szinovacz and Davey found that depressive symptoms increases in women after retirement, especially if retirement is perceived as abrupt or forced. The effect is reinforced by the presence of a spouse with functional limitations. Oksanen and colleagues acknowledge that “the reasons for the se inconsistencies ... may be due to differences in study design.” For one thing, the ways health is measured can lead to vast differences in results. Although the use of a more objective measure such as prescription drug use in the Oksanen study may bypass some misreporting issues, there are nonetheless concerns with this measure, particularly as a proxy for underlying mental health, for which reported measures (such as the DSM-III and CESD scales of depression)