Setting: Communities & Government

Coffee Chat: Exploring the Health Equity Benefits of Sugary Drink Excise Taxes

In this coffee chat hosted by the CHOICES Community of Practice, Matthew Lee, PhD Candidate from the Harvard T.H. Chan School of Public Health and California native who has researched sugary drink trends and the impacts of sugary drink excise taxes in the San Francisco Bay Area, discusses insights from his recent study published in the American Journal of Preventive Medicine that he led along with other researchers from the CHOICES Team. Matt also focuses on the ways in which these taxes, and the potential revenue raised from them, can benefit communities by improving health equity.

View the resource round-up from this coffee chat

Download the January 2024 coffee chat presentation slides

Cost-effectiveness of Improved WIC Food Package for Preventing Childhood Obesity

This study determines the cost-effectiveness of changes to WIC’s nutrition standards in 2009 for preventing obesity and to estimate impacts on socioeconomic and racial/ethnic inequities.

Kenney EL, Lee MM, Barrett JL, Ward ZJ, Long MW, Cradock AL, Williams DR, Gortmaker SL. Cost-effectiveness of Improved WIC Food Package for Preventing Childhood Obesity. Pediatrics. 2024 Jan;153. doi: 10.1542/peds.2023-063182.

Abstract

Background & Objectives

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prevents food insecurity and supports nutrition for more than 3 million low-income young children. Our objectives were to determine the cost-effectiveness of changes to WIC’s nutrition standards in 2009 for preventing obesity and to estimate impacts on socioeconomic and racial/ethnic inequities.

Methods

We conducted a cost-effectiveness analysis to estimate impacts from 2010 through 2019 of the 2009 WIC food package change on obesity risk for children aged 2 to 4 years participating in WIC. Microsimulation models estimated the cases of obesity prevented in 2019 and costs per quality-adjusted-life year gained.

Results

An estimated 14.0 million 2- to 4-year old US children (95% uncertainty interval (UI), 13.7–14.2 million) were reached by the updated WIC nutrition standards from 2010 through 2019. In 2019, an estimated 62 700 (95% UI, 53 900–71 100) cases of childhood obesity were prevented, entirely among children from households with low incomes, leading to improved health equity. The update was estimated to cost $10 600 per quality-adjusted-life year gained (95% UI, $9760–$11 700). If WIC had reached all eligible children, more than twice as many cases of childhood obesity would have been prevented.

Conclusions

Updates to WIC’s nutrition standards for young children in 2009 were estimated to be highly cost-effective for preventing childhood obesity and contributed to reducing socioeconomic and racial/ethnic inequities in obesity prevalence. Improving nutrition policies for young children can be a sound public health investment; future research should explore how to improve access to them.


Funding

This study was supported by the National Institutes of Health (R01HL146625 and K01DK125278), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The authors have indicated they have no potential conflicts of interest to disclose. The findings and conclusions are those of the authors and do not necessarily represent the official position of the National Institutes of Health, the Centers for Disease Control and Prevention, or other funders.

Strategy Report: Fast-Food Restaurant Calorie Labeling

Fast-food restaurant menu board with calories labeled for each menu item

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Fast-Food Restaurant Calorie Labeling Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; December 2023.

The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

Strategy Report: Reducing Exposure to Unhealthy Food and Beverage Advertising

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Reducing Exposure to Unhealthy Food and Beverage Advertising Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

Strategy Report: Counseling in WIC Visits to Reduce TV Viewing

Mom and daughter meeting with counselor at home, while daughter is looking at a handheld screen

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Counseling in WIC Visits to Reduce TV Viewing Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

Strategy Report: Sugary Drink Excise Tax

The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose.

Overview

CHOICES uses cost-effectiveness analysis to compare the costs and outcomes of different policies and programs promoting improved nutrition or increased physical activity in schools, early care and education and out-of-school settings, communities, and clinics. This strategy report describes the projected national population reach, impact on health and health equity, implementation costs, and cost-effectiveness for an effective strategy to improve child health. This information can help inform decision-making around promoting healthy weight. To explore and compare additional strategies, visit the CHOICES National Action Kit 2.0.

Continue reading in the full report.

Contact choicesproject@hsph.harvard.edu for an accessible version of this report.

Suggested Citation

CHOICES National Action Kit: Sugary Drink Excise Tax Strategy Report. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; November 2023.

The design for this report and its graphics were developed by Molly Garrone, MA and partners at Burness.

Funding

This work is supported by the National Institutes of Health (R01HL146625), The JPB Foundation, and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders. The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose

For further information, contact choicesproject@hsph.harvard.edu

Strategy Profile: Fast-Food Restaurant Calorie Labeling

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Require fast-food chain restaurants with 20 or more locations nationally to list calories for standard menu items on in-store and drive-thru menu boards along with succinct statements concerning suggested daily caloric intake.

What population benefits?

All youth and adults ages 2 years and older.

What are the estimated benefits?

Relative to not implementing the strategy
Decrease daily energy intake and, in turn, promote healthy weight.

What activities and resources are needed?

Activities Resources Who Leads?
Manage rollout of restaurant calorie menu labeling and communicate policy change to restaurant chains • Time of Food and Drug Administration to manage rollout Food and Drug Administration
Review rule requirements • Time for legal analyst to review rule requirements

 

Restaurant chain
Analyze nutrient content for each menu item • Cost of analyzing menu items by entering recipes in a nutrition database Restaurant chain
Replace menus and menu boards to comply with policy • Cost of designing new menus (if applicable)
• Cost of menu and menu board replacement
Restaurant chain
Monitor compliance with menu labeling policy • Time of public health department inspectors to monitor compliance Local public health department

FOR ADDITIONAL INFORMATION

Dupuis R, Block JP, Barrett JL, Long MW, Petimar J, Ward ZJ, Kenney EL, Musicus AA, Cannuscio CC, Williams DR, Bleich SN, Gortmaker SL. Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S. Am J Prev Med. 2023 Aug 14:S0749- 3797(23)00338-0. doi: 10.1016/j.amepre.2023.08.012.


Suggested Citation

CHOICES Strategy Profile: Fast-Food Restaurant Calorie Labeling. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

©2015 President and Fellows of Harvard College. All rights reserved. The CHOICES name, acronym and logo are marks of the President and Fellows of Harvard College.

Strategy Profile: Reducing Exposure to Unhealthy Food and Beverage Advertising

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Reducing exposure to unhealthy food and beverage advertising is a strategy to eliminate the tax deductibility of television advertising costs for nutritionally poor foods and beverages advertised to children and adolescents ages 2-19.

What population benefits?

All youth and adolescents between the ages of 2 and 19.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce exposure to unhealthy food and beverage advertising on television and, in turn, promote healthy weight.

What activities and resources are needed?

Activities Resources Who Leads?
Process tax statements and conduct audits • Time for the state tax administrator to process tax statements and conduct audits State tax administrator
Prepare tax statements and participate in audits • Time for a private company tax accountant to prepare tax statements and participate in audits Private company tax accountant

FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/chi.2021.0016.


Suggested Citation

CHOICES Strategy Profile: Reducing Exposure to Unhealthy Food and Beverage Advertising. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; September 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

©2015 President and Fellows of Harvard College. All rights reserved. The CHOICES name, acronym and logo are marks of the President and Fellows of Harvard College.

Cost-Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S.

This study evaluates the cost-effectiveness of calorie labeling at large U.S. fast-food chains.

Dupuis R, Block JP, Barrett JL, Long MW, Petimar J, Ward ZJ, Kenney EL, Musicus AA, Cannuscio CC, Williams DR, Bleich SN, Gortmaker SL. Cost Effectiveness of Calorie Labeling at Large Fast-Food Chains Across the U.S. Am J Prev Med. 2024 Jan;66(1):128-137. doi: 10.1016/j.amepre.2023.08.012. Epub 2023 Aug 14. PubMed PMID: 37586572; NIHMSID:NIHMS1929380.

Abstract

Introduction

Calorie labeling of standard menu items has been implemented at large restaurant chains across the United States since 2018. The objective of this study was to evaluate the cost-effectiveness of calorie labeling at large U.S. fast-food chains.

Methods

This study evaluated the national implementation of calorie labeling at large fast-food chains from a modified societal perspective and projected its cost-effectiveness over a ten-year period (2018-2027) using the Childhood Obesity Intervention Cost-Effectiveness Study microsimulation model. Using evidence from over 67 million fast-food restaurant transactions between 2015 and 2019, the impact of calorie labeling on calorie consumption and obesity incidence was projected. Benefits were estimated across all racial, ethnic, and income groups. Analyses were performed in 2022.

Results

Calorie labeling is estimated to be cost-saving, prevent 550,000 cases of obesity in 2027 alone (95% uncertainty interval (UI): 518,000; 586,000), including 41,500 (95% UI: 33,700; 50,800) cases of childhood obesity, and save $22.60 in health care costs for every $1 spent by society in implementation costs. Calorie labeling is also projected to prevent cases of obesity across all racial and ethnic groups (range between 126-185 cases per 100,000 people) and all income groups (range between 152-186 cases per 100,000 people).

Conclusions

Calorie labeling at large fast-food chains is estimated to be a cost-saving intervention to improve long-term population health. Calorie labeling is a low-cost intervention that is already implemented across the U.S. in large chain restaurants.


Funding

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute under Award Number R01HL146625, by the National Institute of Diabetes and Digestive and Kidney Diseases under Award Number R01DK115492, by the Centers for Disease Control and Prevention under Award Number U48DP006376, and by the JPB Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The funders had any role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication.

Strategy Profile: Counseling in WIC Visits to Reduce TV Viewing

Loving Mother Holding Newborn Baby At Home In Loft Apartment

The information in this resource is intended only to provide educational information. This profile describes the estimated benefits, activities, resources, and leadership needed to implement a strategy to improve child health. This information can be useful for planning and prioritization purposes.

  • Incorporating television time counseling into required Special Supplemental Nutrition program for Women, Infants, and Children (WIC) certification visits among WIC participants with children ages 2-4 through the inclusion of relevant assessment items within the existing screening assessment tools regularly used by WIC clinical staff.

What population benefits?

Children ages 2-4 who participate in the WIC program.

What are the estimated benefits?

Relative to not implementing the strategy
Reduce child daily television time which can help promote healthy child weight.

What activities and resources are needed?

Activities Resources Who Leads?
Coordinate planning and delivery of virtual training and educational materials for WIC clinicians and monitor program status • Time for National WIC Coordinator to coordinate and monitor the program National WIC Coordinator
Develop virtual training and educational materials for WIC clinicians • Time for national WIC agency staff to develop virtual training and educational materials National WIC Agency Staff
Add relevant assessment items to measure television viewing within tools, tracking, and monitoring systems regularly used by WIC clinicians • Time to update database, tools, and tracking systems State WIC Agency Information Systems Staff
Train WIC clinicians in using relevant screening tools and motivational interviewing techniques • Time for state WIC agency staff to prepare for and deliver trainings
• Time for state WIC clinicians to attend trainings
State WIC Program Staff

FOR ADDITIONAL INFORMATION

Kenney EL, Mozaffarian RS, Long MW, Barrett JL, Cradock AL, Giles CM, Ward ZJ, Gortmaker SL. Limiting television to reduce childhood obesity: cost-effectiveness of five population strategies. Child Obes. 2021 Oct;17(7):442-448. doi: 10.1089/chi.2021.0016.

Selected CHOICES research brief including cost-effectiveness metrics:

Adams B, Sutphin B, Looney R, Rollins N, Balamurugan A, Kim H, Bolton A, Reiner J, Barrett J, Gortmaker SL, Cradock AL. Arkansas: Women, Infants, and Children (WIC) Television Time Reduction {Issue Brief}. Arkansas Department of Health, Little Rock, AR, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. Available at: https://choicesproject.org/ publications/brief-wic-st-arkansas


Suggested Citation

CHOICES Strategy Profile: Counseling in WIC Visits to Reduce TV Viewing. CHOICES Project Team at the Harvard T.H. Chan School of Public Health, Boston, MA; August 2023.

Funding

This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The information provided here is intended to be used for educational purposes. Links to other resources and websites are intended to provide additional information aligned with this educational purpose. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.

Adapted from the TIDieR (Template for Intervention Description and Replication) Checklist

©2015 President and Fellows of Harvard College. All rights reserved. The CHOICES name, acronym and logo are marks of the President and Fellows of Harvard College.