While considerable evidence supports and informs the likely benefits of policy innovations within and outside health systems to improve diet and reduce cardiometabolic diseases (CMD), their impacts on health, disparities, costs, and cost-effectiveness are not well established. Because major diet-related disparities persist, assessing effects of such strategies in at-risk subgroups is crucial. Administrative and legal challenges can strongly influence implementation, scale-up, and sustainability of such strategies, but such considerations have not yet been rigorously assessed.
Our specific aims extend our prior analyses of national policies to address crucial questions for health system strategies and state-specific actions and to disseminate this evidence.
The aims are 1) to estimate the health impacts, costs, cost-effectiveness, and effects on disparities of specific health system strategies to improve diet and reduce CMD in the US; 2) to estimate the health impacts, costs, cost-effectiveness, and effects on disparities of specific state-level policies to improve diet and reduce CMD in the US; 3) to assess the administrative and legal challenges and feasibility of specific health system and state strategies to improve diet and reduce CMD in the US; and 4) to disseminate our top findings from the prior period, related grants, and this new work to relevant stakeholders in key legislative, agency, and advocacy positions. Building on our prior experience, we will evaluate health system interventions, state interventions, and administrative/legal feasibility. We will define plausible policy effect sizes and their uncertainty based on reviews of literature and expert contacts; and adopt a micro-costing approach using established methods to assess policy costs including by sectors. We will project costs and CMD benefits of each policy, using established modeling approaches, and quantify comparative efficiency measured by ICER comparing each intervention to a base case. Effects on disparities will be evaluated comparing differences in CMD disparities (difference in difference approach) for each action in key population subgroups. We will conduct in-depth administrative and legal analysis to identify the likely conditions for success and the authorities and obstacles for implementation.

Public Health Relevance

Major aims are 1) to estimate the health impacts, costs, cost-effectiveness, and effects on disparities of specific health system strategies to improve diet and reduce CMD in the US, 2) to estimate the health impacts, costs, cost-effectiveness, and effects on disparities of specific state-level policies to improve diet and reduce CMD in the US, 3) to assess the administrative and legal challenges and feasibility of specific health system and state strategies to improve diet and reduce CMD in the US, and 4) to disseminate our top findings from the prior period, related grants, and this new work to relevant stakeholders in key legislative, agency, and advocacy positions.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
2R01HL115189-06A1
Application #
10047619
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Boyington, Josephine
Project Start
2013-08-15
Project End
2024-07-31
Budget Start
2020-08-01
Budget End
2021-07-31
Support Year
6
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Tufts University
Department
Type
Schools of Nutrition
DUNS #
039318308
City
Boston
State
MA
Country
United States
Zip Code
02111
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Micha, Renata; Karageorgou, Dimitra; Bakogianni, Ioanna et al. (2018) Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis. PLoS One 13:e0194555
Rosettie, Katherine L; Micha, Renata; Cudhea, Frederick et al. (2018) Comparative risk assessment of school food environment policies and childhood diets, childhood obesity, and future cardiometabolic mortality in the United States. PLoS One 13:e0200378
Wilde, Parke Edward; Conrad, Zach; Rehm, Colin D et al. (2018) Reductions in national cardiometabolic mortality achievable by food price changes according to Supplemental Nutrition Assistance Program (SNAP) eligibility and participation. J Epidemiol Community Health 72:817-824
Pearson-Stuttard, Jonathan; Kypridemos, Chris; Collins, Brendan et al. (2018) Estimating the health and economic effects of the proposed US Food and Drug Administration voluntary sodium reformulation: Microsimulation cost-effectiveness analysis. PLoS Med 15:e1002551
Fang Zhang, Fang; Liu, Junxiu; Rehm, Colin D et al. (2018) Trends and Disparities in Diet Quality Among US Adults by Supplemental Nutrition Assistance Program Participation Status. JAMA Netw Open 1:
Afshin, Ashkan; Peñalvo, José L; Del Gobbo, Liana et al. (2017) The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis. PLoS One 12:e0172277
Brown, Alison G M; Houser, Robert F; Mattei, Josiemer et al. (2017) Hypertension among US-born and foreign-born non-Hispanic Blacks: National Health and Nutrition Examination Survey 2003-2014 data. J Hypertens 35:2380-2387
Peñalvo, José L; Cudhea, Frederick; Micha, Renata et al. (2017) The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States. BMC Med 15:208
Pearson-Stuttard, Jonathan; Bandosz, Piotr; Rehm, Colin D et al. (2017) Comparing effectiveness of mass media campaigns with price reductions targeting fruit and vegetable intake on US cardiovascular disease mortality and race disparities. Am J Clin Nutr 106:199-206

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