Session
The Economics of Healthy Nutrition
APHA 2022 Annual Meeting and Expo
Abstract
Health and economic impacts of implementing a national produce prescription program in the US
APHA 2022 Annual Meeting and Expo
Introduction
The potential impact of a national produce prescription program (a nutritional intervention that provides free or discounted healthy produce to eligible patients identified by healthcare providers) on health outcomes, costs, and cost-effectiveness in the US has not been established.
Methods
We used a validated microsimulation model to estimate the potential impact of a national produce prescription program on cardiovascular disease (CVD) events, quality-adjusted life-years (QALYs), healthcare costs, and productivity costs in the US. The program provides free fruits and veggies of $42 value per month to all patients with diabetes and food insecurity. The model incorporated national demographic and dietary data from NHANES, national mortality data, intervention effects on fruits and veggies, HbA1c and BMI, diet-disease effects from meta-analyses, and policy and health-related costs from established sources.
Results
Over the lifetime of 6.5 million eligible US adults aged 40-79 years (mean =58.2 ±10.2 years), the program was estimated to generate 357,743 (95% UI: 162,724, 589,247) CVD events averted, 170,723 (-207,731, 597,231) QALYs gained, $46.8 billion (22.6, 72.9) in healthcare costs saved, and $5.6 billion (1.5, 11.0) in productivity benefits. After accounting for $42.3 billion of implementation costs, the program was cost-saving from both the healthcare and societal perspectives, with net savings of $4.5 billion (-19.8, 31.0) and $10.1 billion (-16.1, 39.0), respectively. The program remained cost-saving at shorter time horizons of five and ten years.
Discussions
Implementing produce prescription programs nationally among patients with diabetes and food insecurity could generate substantial health gains and cost savings in the US.
Abstract
Mixed-Methods, Multi-Level Process Evaluation of Double Up Food Bucks Initiatives in Texas
APHA 2022 Annual Meeting and Expo
Introduction: Food insecurity is a critical public health issue. One strategy to reduce food insecurity is through food assistance incentive programs, such as Double Up Food Bucks (DUFB), which provides food assistance-enrolled customers with double the buying power for fresh produce purchased from participating retailers. Our study aim was to conduct a multi-level, mixed-methods process evaluation of DUFB initiatives in Texas assessing satisfaction and experiences with DUFB.
Methods: Data were collected from October 2020-July 2021 and included phone-based quantitative surveys (n=58) with DUFB customers and qualitative interviews (n=33) with stakeholders engaged in DUFB implementation including farmers (n=10), vendors (n=9), market managers (n=10), and community-based staff (n=4) in Texas. Quantitative data were analyzed via descriptive statistics, and qualitative data were thematically analyzed by trained staff.
Results: Customer-level process evaluation found that the majority of respondents reported DUFB increased the amount (76%) and variety (82%) of fresh produce that their household eats. Also, customers had high satisfaction with DUFB (94%) and most found DUFB easy to use (81%), but greater awareness/marketing of the program is needed. Qualitative stakeholder-level results found participating farmers, vendors, market managers, and community-based staff were very satisfied with the program, but that there were areas for improvement such as more intense marketing, training for staff, available materials, and technological infrastructure/support.
Discussion: DUFB is seen as a helpful program at multiple levels (customer and stakeholder). However, greater training and awareness is needed in order to further expand the program and have the greatest impact.
Abstract
Financial Literacy Attitude is a Predictor of Food Security Status in College Students
APHA 2022 Annual Meeting and Expo
Introduction:
30% of college students are food-insecure and are more susceptible to poor dietary behaviors, exacerbating the risk of chronic diseases. Food-insecure students characteristically come from poor socio-economic backgrounds. In community settings, people with better budgeting skills and higher financial literacy demonstrate stretching food dollars further. Still, few studies have examined financial literacy (FL) attitude’s impact on college students’ food security status (FSS). This study investigated the role of FL attitude on FSS in college students.
Methods:
A cross-sectional convenience sample of college students completed an online survey assessing health behaviors. FSS was measured using the USDA 10-item FSS Module. FL was measured using the College Student FL Survey. Independent t-tests compared FL Attitude between high and low FSS. Linear regression was used to determine if FL Attitude was a predictor of FSS.
Results:
Students (N=887) were an average of 20.9 (±2.3) years old, predominantly White (86.9%) and female (69.6%). Students with high FSS (48.2%) demonstrated higher FL attitude (3.7±0.5, vs. 3.34±0.5, t=-11.403, p<0.001). For the regression, overall macro-level results revealed a medium shared variance effect size, with an R^2 of 0.13 and a significant F(1,885)=142.7, p<0.001. FL attitude was a significant predictor of FSS (β = -0.373), indicating that a greater FL attitude predicts better FSS.
Discussion & Conclusion:
FL attitude was a significant predictor of FSS in college students. These findings imply that programs aiming to improve FSS in college students may benefit from focusing on financial literacy to improve FSS and health behaviors and reduce the burden of chronic diseases.
Abstract
Assessing healthy food environments in dollar stores as compared to grocery stores in Michigan
APHA 2022 Annual Meeting and Expo
Background: Throughout low-income communities nationally, several full-service grocery stores have closed, and are replaced with dollar or convenience stores – which provide limited access to healthy foods. This study examined regional differences and preferences of access, availability, and price of healthful nutrition offerings in retail settings within four major urban centers in Michigan.
Methods: NEMS (Nutrition Environment Measures Surveys) were completed in dollar stores (N=93) and other types of stores (N=296) to assess the availability and price of healthier food options. A one-way ANOVA was used to compare the NEMS scores between dollar and grocery stores. Focus groups were conducted with consumers (N=60), and themes were created using the Constant Comparative Method for Qualitative Analysis.
Results: The total NEMS score for grocery stores (reported range (rr)=0-41, M=21.28, SD=11.61) were significantly higher than those of the dollar stores (rr=-1-12, M=3.10, SD=2.33; F(1,385)=224.87, p <.001). Likewise, availability scores were higher in grocery stores (rr=0-27, M=15.84, SD=.51) than in dollar stores (rr=0-9, M=3.35, SD=.23; F(1, 389)=181.09, p<.001), as were price scores in grocery stores (rr=-6-11, M=1.30, SD=2.49) vs. Dollar (rr=-2-3, M=-.26, SD=.90; F(1, 385)=35.10, p<.001). Consumers perceived dollar stores as a 1) Asset-based, predictable environment, 2) Host to negative experiences, and 3) Convenient but unhealthy environment.
Conclusions: Dollar stores provide a convenient, low-cost option for accessing food offerings. However, healthy foods are unavailable. Given the abundance of dollar stores in urban, low-income communities, it is important to infuse policy and systems change that can drive availability of healthful offerings in these retail environments.