Introducing taxes, subsidies or both: the effects of various food pricing strategies in a web-based supermarket randomized trial

Objective

Fiscal policies may form a solution in improving dietary intake. This study aimed to examine the effectiveness of varying taxing and subsiding schemes to stimulate healthier food purchases.

Methods

A randomized controlled trial with three levels of price reduction on healthy foods (no; 25%; 50%) × three levels of price increase on unhealthy foods (5%; 10%; 25%) factorial design was used. 150 participants were randomized into one of nine conditions and were asked to purchase groceries at a web-based supermarket. Data were collected in the Netherlands in January-February 2010 and analyzed using analysis of covariance.

Results

Subjects receiving 50% discount purchased significantly more healthy foods than subjects receiving no (mean difference = 6.62 items, p < 0.01) or 25% discount (mean difference = 4.87 items, p < 0.05). Moreover, these subjects purchased more vegetables (mean difference = 821 g; p < 0.05 compared to no discount). However, participants with the highest discount also purchased significantly more calories. No significant effects of the price increases on unhealthy foods were found.

Conclusion

Price decreases are effective in stimulating healthy food purchases, but the proportion of healthy foods remains unaffected. Price increases up to 25% on unhealthier products do not significantly affect food purchases. Future studies are important to validate these results in real supermarkets and across different countries.     

Impact of a community-based breast cancer screening program on Hopi women

Objective

To examine changes in breast cancer knowledge, attitudes, beliefs and behaviors following implementation of a tribal run CDC Breast and Cervical Cancer Program (BCCP), we report 2006 survey results from Hopi women and contrast findings with 1993 survey data and BCCP reports.

Methods

Community meetings, focus groups, and researchers jointly developed a culturally appropriate survey instrument. Hopi women randomly selected from Tribal enrollment lists were interviewed in-person by Hopi interviewers; 250 women ≥ age 18 participated (87% response) between June and December, 2006.

Results

Among women 40+, 77.5% reported ever having had a mammogram and 68.9% reported having done so within the past 2 years, an increase from 45.2% and 46% self-reported in 1993. Compared to 1993, more women in 2006 (88.1% vs. 59%) believed that a mammogram can detect cancer and more than 90% now believe that early detection of cancer can save lives. Women reported a preference (60%) for receiving health care at the Hopi BCCP. Survey results were validated using programmatic data which estimated 76.6% of Hopi women had received mammography screening.

Conclusion

Implementation of a tribal run BCCP has resulted in a substantial increase in mammography screening on the Hopi reservation.     

Costs and impact of meningitis epidemics for the public health system in Burkina Faso

Background

Epidemic meningococcal meningitis remains a serious health threat in the African meningitis belt. New meningococcal conjugate vaccines are relatively costly and their efficiency will depend on cost savings realized from no longer having to respond to epidemics.

Methods

We evaluated the cost and impacts to the public health system of the 2007 epidemic bacterial meningitis season in Burkina Faso through a survey at the different level of the health system. A micro-economic approach was used to evaluate direct medical and non medical costs for both the public health system and households, as well as indirect costs for households.

Results

The total national cost was 9.4 million US$ (0.69 US$ per capita). Health system costs were 7.1 million US$ (1.97% of annual national health spending), with 85.6% for reactive vaccination campaigns. The remaining 2.3 million US$ was borne by households of meningitis cases. The mean cost per person vaccinated was 1.45 US$; the mean cost of case management per meningitis case was 116.3 US$ when including household costs and 26.4 US$ when including only health sector costs. Meningitis epidemics disrupted all health services from national to operational levels with the main contributor being a large increase in medical consultations.

Conclusions

Preventive meningococcal conjugate vaccines should contribute to more efficient use of funds dedicated to meningitis epidemics and limit the disruption of routine health services.     

Effects of a physical activity and nutrition program for seniors on body mass index and waist-to-hip ratio: a randomised controlled trial

Objective

To investigate whether a home-based program, physical activity and nutrition for seniors (PANS), made positive changes to central obesity, measured by body mass index (BMI) and waist-to-hip ratio (WHR).

Methods

A 6-month randomised controlled trial was conducted targeting overweight and sedentary older adults aged 60 to 70 years residing in low to medium socio-economic suburbs within metropolitan Perth. Intervention participants (n = 248) received mailed materials and telephone/email support to improve nutrition and physical activity levels. Controls (n = 230) received small incentives to complete baseline and post-intervention questionnaires. Both groups reported anthropometric measures following specific written instructions. Generalised estimating equation models were used to assess repeated outcomes of BMI and WHR over both time points.

Results

176 intervention and 199 controls (response rate 78.5%) with complete data were available for analysis. After controlling for demographic and other confounding factors, the intervention group demonstrated a small (0.02) but significant reduction in WHR (p = 0.03) compared to controls, no apparent change in BMI was evident for both groups. The 0.02 reduction in mean WHR corresponded to a 2.11 cm decrease in waist circumference for a typical hip circumference.

Conclusion

PANS appears to improve the WHR of participants. Changes in BMI might require a longer term intervention to take effect, and/or a follow-up study to confirm its sustainability.     

Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008

Objectives

This study aims to estimate human papillomavirus (HPV) vaccine coverage by demographic and sexual behavior characteristics 1-2 years after vaccine licensure in a nationally representative sample of females aged 9-59 years in the United States.

Methods

In 2007-2008, a total of 2775 females aged 9-59 years responded to questions on HPV vaccine receipt in the National Health and Nutrition Examination Survey (NHANES). Demographic and sexual characteristics were evaluated for select age categories in bivariate analyses after adjusting for survey design.

Results

Overall, 15.2% of females aged 11-26 years reported HPV vaccine initiation; vaccine initiation varied significantly by age. We found no significant difference in vaccine initiation by race or poverty level in either 11-18 or 19-26-year olds. Significantly more 19-26-year olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p = 0.04). Among females aged 14-18 years, vaccine initiation was higher in those who ever had sex (28.6%) compared to those who had never had sex (17.8%) (p = 0.05).

Conclusions

These results describe HPV vaccine initiation shortly after vaccine licensure. Vaccine initiation was highest in females aged 14-18 years. Efforts should be made to increase HPV vaccine coverage for the recommended age groups.     

Attitudinal and demographic predictors of measles, mumps and rubella (MMR) vaccine acceptance: development and validation of an evidence-based measurement instrument

Background and objective

Parents’ attitudes toward MMR vaccine and measles, mumps and rubella infections relate to their child's MMR status, therefore improving these attitudes is central to improving current suboptimal MMR uptake. However, no study has yet combined evidence-based, comprehensive and psychometrically validated assessment of these attitudes with reliable objective MMR status data, in order to identify through multivariate analyses the strongest attitudinal predictors of MMR uptake for interventions to target. The present study fills this lacuna by developing and testing a robust evidence-based MMR attitudes measurement instrument.

Design

Cross-sectional self-administered postal/telephone questionnaire with objective behavioural outcome.

Setting and participants

535 parents of children aged 5-18 in London and north-west England, UK (response rate 18.1%). Recruitment via Primary Care Trust records, age-stratified purposive sample with suboptimally immunised cases oversampled.

Main outcome measures

Parents’ responses to evidence-based measurement instrument comprising 20 attitude/previous behaviour items (collapsing to 5 scales) and 7 demographic items, and their children's PCT-recorded 5th birthday status for MMR dose 1 (on-time, late or none) and MMR dose 2 (on-time or none).

Results

The attitudes measurement instrument was psychometrically robust: content valid, and demonstrating good or acceptable internal consistency (Cronbach's alpha = 0.55-0.75 for all scales), test-retest reliability (Pearson's correlation >0.60-0.80, p < 0.01 to <0.001 for all scales and 11 individual items), concurrent/construct validity (t-tests for difference between MMR status groups p < 0.05 for four scales and thirteen individual items), and predictive/criterion validity (OR = 0.66, 95% confidence interval = 0.48-0.92 to OR = 1.97, 95% CI = 1.18-3.31 for three scales and five individual items). Black and minority ethnicity (OR = 1.94, 95% CI = 1.15-3.30 to OR = 4.15, 95% CI = 2.40-7.19), positive MMR attitudes (OR = 1.63, 95% CI = 1.00-2.66 to OR = 1.97, 95% CI = 1.18-1.31), and positive social attitudes (OR = 1.64, 95% CI = 1.23-2.40 to OR = 1.72, 95% CI = 1.13-2.38) independently predicted uptake for both MMR doses. MMR status groups differed most strongly on preference for single measles, mumps and rubella vaccines (6-9% variance in status explained), previous MMR acceptance/rejection (5-9%), and wishing to protect others through vaccinating one's own child (6-8%).

Conclusions

The measurement instrument is robust on multiple validity and reliability dimensions, and is appropriate for use in research and practice as a tool for designing and evaluating interventions. Parents appear to act in line with their attitudes toward MMR vaccine, though attitudes toward measles infection bore little relation to MMR uptake. This study indicates populations and attitudes to be prioritised in MMR uptake improvement interventions.     

Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006

Background and objectives

With vaccine-preventable diseases at record lows, few studies investigate rising parent-claimed exemptions to school immunization requirements. After finding exemption clusters in Oregon, we hypothesized that exemption risk factors may vary among communities. We surveyed parents to identify risk factors for exemptions and evaluated risk factor differences among communities with differing exemption rates.

Design

Retrospective cohort study, multi-staged, population-proportionate sampling.

Setting and participants

Parents of 2004-05 Oregon elementary school children (N = 2900).

Main outcome measure

Parent-reported exemption status.

Results

The response rate was 55%. Compared to vaccinators, exemptors were significantly more likely to have: strong vaccine concerns (weighted adjusted odds ratio (aOR) = 15.3, 95% CI 6.4-36.7); “vaccine-hesitant” concerns (aOR = 2.3; 95% CI 1.0-5.0); >1 childbirth(s) at a non-hospital, alternative setting (aOR = 3.6; 95% CI 1.6-8.0); distrust of local doctors (aOR = 2.7; 95% CI 1.0-7.5); reported chiropractic healthcare for their youngest school-age child (aOR = 3.9; 95% CI 1.8-8.5); and reported knowledge of someone with a vaccine-hurt child (aOR = 1.8; 95% CI 0.9-3.4). Exemptors were less likely to have “pro-vaccine” beliefs (aOR = 0.2; 95% CI 0.0-0.6) and less likely to report relying on print materials (aOR = 0.4; 95% CI 0.2-0.8).The strengths of association differed significantly for those with strong vaccine concerns and those reporting knowledge of someone with a vaccine-hurt child, depending on residence in exemption-rate areas, e.g., exemptors in medium-rate areas were more likely to have strong vaccine concerns (aOR = 13.5; 95% CI 5.4-34.0) than those in high-rate areas (aOR = 9.7; 95% CI 3.7-25.4).

Conclusions

Vaccine beliefs were important risk factors. That differing community-level exemption use modified the effects of several individual-level factors suggests that communities also influence parent decisions. Therefore, understanding community contexts and norms may be important when designing interventions.     

Viral interference induced by live attenuated virus vaccine (OPV) can prevent otitis media

Background

The goal of this study was to evaluate whether a live attenuated poliovirus vaccine (OPV) has clinically relevant interfering effect with non-polio infections causing otitis media in young children.

Methods

Open trial in which the intervention group (64 children) received OPV at the age of 2, 3, 6 and 12 months. The control group (250 children) received IPV (inactivated polio vaccine) at the age of 6 and 12 months. Clinical symptoms were recorded by a questionnaire at the age of 3, 6, 12, 18 and 24 months.

Results

Otitis media episodes were less frequent in the OPV than in the control group. A significant difference was seen at the age of 6-18 months (IRR = 0.76 [95% CI 0.59-0.94], P = 0.011) and was particularly clear among children, who attended daycare (IRR 0.37 [95% CI 0.19-0.71], P = 0.003).

Conclusions

OPV provides some protection against otitis media. This effect may be mediated by viral interference with non-polio viruses.     

Parent awareness of young children's physical activity

Objective

Parents who overestimate their child's physical activity (PA) level may not encourage their children to increase their PA. We assessed parental awareness of child PA, and investigated potential correlates of overestimation.

Method

Child PA (accelerometer) and parent-classified child PA [‘active’ ≥ 60 min/day vs. ‘inactive’ < 60 min/day moderate and vigorous PA (MVPA)] were measured over 7 days [n = 329, 44% male, 39% Latino; mean (SD) 9.1 (0.7) years] in an obesity prevention study in San Diego (Project MOVE). Agreement between date-matched objective MVPA and parent-classified child PA was assessed; % days parental overestimation was the outcome variable. Associations between parental overestimation and potential correlates were investigated using three-level mixed‐effects linear regression.

Results

Children met the PA guidelines on 43% of days. Parents overestimated their children's PA on 75% of days when children were inactive. Most parents (80%) overestimated their child's PA on ≥ 1 measurement day. Parental support for child PA (transport, encouragement and participation with child) (p < 0.01) was positively associated with higher overestimation. Parents of girls showed more overestimation than parents of boys (p = 0.04).

Conclusion

Most parents incorrectly classified their child as active when their child was inactive. Strategies addressing parental overestimation may be important in PA promotion.     

Effect of a lifestyle intervention on adiposity and fitness in socially disadvantaged subgroups of preschoolers: a cluster-randomized trial (Ballabeina)

Objective

A multidimensional lifestyle intervention performed in 652 preschoolers (72% of migrant, 38% of low educational level (EL) parents) reduced body fat, but not BMI and improved fitness. The objective of this study is to examine whether the intervention was equally effective in children of migrant and/or low EL parents.

Methods

Cluster-randomized controlled single blinded trial, conducted in 2008/09 in 40 randomly selected preschools in Switzerland. The culturally tailored intervention consisted of a physical activity program and lessons on nutrition, media use and sleep. Primary outcomes included BMI and aerobic fitness. Secondary outcomes included %body fat, waist circumference and motor agility.

Results

Children of migrant parents benefitted similarly from the intervention compared to their counterparts (p for interaction ≥ 0.09). However, children of low EL parents benefitted less, although these differences did not reach statistical significance (p for interaction ≥ 0.06). Average intervention effect sizes for BMI were − 0.10, − 0.05, − 0.11 and 0.04 kg/m² and for aerobic fitness were 0.55, 0.20, 0.37 and − 0.05 stages for children of non-migrant, migrant, middle/high EL and low EL parents, respectively.

Conclusions

This intervention was similarly effective among preschoolers of migrant parents compared to their counterparts, while children of low EL parents benefitted less.