Taxes and subsidies are increasingly being considered as potential policy instruments to incentivize consumers to improve their food and beverage consumption patterns and related health outcomes. This study provided a systematic review of recent U.S. studies on the price elasticity of demand for sugar-sweetened beverages (SSBs), fast food and fruits and vegetables as well as the direct associations of prices/taxes with body weight outcomes. Based on the recent literature, the price elasticity of demand for SSBs, fast food, fruits and vegetables was estimated to be −1.21, −0.52, −0.49 and −0.48, respectively. The studies that linked soda taxes to weight outcomes showed minimal impacts on weight; however, they were based on existing state-level sales taxes that were relatively low. Higher fast-food prices were associated with lower weight outcomes particularly among adolescents suggesting that raising prices would potentially impact weight outcomes. Lower fruit and vegetable prices were generally found to be associated with lower body weight outcomes among both low-income children and adults suggesting that subsidies that would reduce the cost of fruits and vegetables for lower-socioeconomic populations may be effective in reducing obesity. Pricing instruments should continue to be considered and evaluated as potential policy instruments to address public health risks.

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BackgroundSince their introduction in 2007, electronic cigarette (‘e-cigarette’) awareness and use has grown rapidly. Little is known about variation in e-cigarette availability across areas with different levels of tobacco taxes and smoke-free air policies. This paper looks at US retail availability of e-cigarettes and factors at the store, neighbourhood and policy levels associated with it.MethodsIn-person store audit data collected in 2012 came from two national samples of tobacco retailers in the contiguous US. Study 1 collected data from a nationally representative sample of tobacco retailers (n=2165). Study 2 collected data from tobacco retailers located in school enrolment zones for nationally representative samples of 8th, 10th and 12th grade public school students (n=2526).ResultsIn 2012, e-cigarette retail availability was 34% in study 1 and 31% in study 2. Tobacco, pharmacy and gas/convenience stores were more likely to sell e-cigarettes than beer/wine/liquor stores. Retail availability of e-cigarettes was more likely in neighbourhoods with higher median household income (study 1), and lower percent of African–American (studies 1 and 2) and Hispanic residents (study 2). Price of traditional cigarettes was inversely related to e-cigarette availability. Stores in states with an American Lung Association Smoke-Free Air grade of F (study 1) or D (study 2) compared with A had increased likelihood of having e-cigarettes.ConclusionsCurrently, e-cigarette availability appears more likely in areas with weak tax and smoke-free air policies. Given the substantial availability of e-cigarettes at tobacco retailers nationwide, states and localities should monitor the sales and marketing of e-cigarettes at point of sale (POS).

Evidence‐based interventions differ for increasing hypertension awareness, treatment, and control and should be targeted for specific patient panels. This study developed a hypertension control cascade to identify patients with a usual source of care represented at each level of the cascade using the 2007–2012 National Health and Nutrition Examination Survey. Overall, 10.7 million adults in the United States were unaware of their condition, 3.8 million were aware but untreated, and 15.8 million were treated but uncontrolled. The results also suggest that failure to attain hypertension control because of lack of awareness or lack of treatment despite awareness occurs mainly among younger individuals and those with no annual healthcare visits, while the elderly and minorities are more likely to remain uncontrolled when aware and treated. Opportunities to leverage population health management functions in electronic health information systems to align the specific patient subgroups facing barriers to hypertension control at each level of the cascade with targeted hypertension management interventions are discussed.

This study highlights the importance of increasing primary care provider awareness of and referrals to the CDC-recognized lifestyle change program.

Fast food consumption is a dietary factor associated with higher prevalence of childhood obesity in the United States. The association between food prices and consumption of fast food among 5th and 8th graders was examined using individual-level random effects models utilizing consumption data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998-99 (ECLS-K), price data from American Chamber of Commerce Researchers Association (ACCRA), and contextual outlet density data from Dun and Bradstreet (D&B). The results found that contextual factors including the price of fast food, median household income, and fast food restaurant outlet densities were significantly associated with fast food consumption patterns among this age group. Overall, a 10% increase in the price of fast food was associated with 5.7% lower frequency of weekly fast food consumption. These results suggest that public health policy pricing instruments such as taxes may be effective in reducing consumption of energy-dense foods and possibly reducing the prevalence of overweight and obesity among US children and young adolescents.

The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.

This study examined the relationships between exposure to food and beverage product television advertisements and consumption and obesity outcomes among youth. Individual-level data on fast-food and soft drink consumption and body mass index (BMI) for young adolescents from the Early Childhood Longitudinal Study – Kindergarten Cohort (1998–1999) and adiposity measures for children from the U.S. National Health and Nutrition Examination Survey (2003–2004) were combined with designated market area (DMA) Nielsen media advertising ratings data. To account for unobserved individual-level and DMA-level heterogeneity, various fixed- and random-effects models were estimated. The results showed that exposure to soft drink and sugar-sweetened beverage advertisements are economically and statistically significantly associated with higher frequency of soft drink consumption among youth even after controlling for unobserved heterogeneity, with elasticity estimates ranging from 0.4 to 0.5. The association between fast-food advertising exposure and fast-food consumption disappeared once we controlled for unobservables. Exposure to cereal advertising was significantly associated with young adolescents’ BMI percentile ranking but exposures to fast-food and soft drink advertisements were not. The results on adiposity outcomes revealed that children’s exposure to cereal advertising was associated with both percent body and trunk fatness; fast-food advertising was significantly associated with percent trunk fatness and marginally significantly associated with percent body fatness; and, exposure to SSB advertising was marginally significantly associated with percent body and trunk fatness. The study results suggest that continued monitoring of advertising is important and policy debates regarding the regulation of youth-directed marketing are warranted.