Suchergebnisse

OBJECTIVES: This study aimed to assess expert stakeholder perceptions on the impact and feasibility of 21 national, state, and local nutrition policies for cancer prevention in the US. METHODS: We distributed a survey to members of professional groups in the field of nutrition, cancer prevention, and public policy through direct email contact, organizational email/e-newsletter, and listservs. The survey asked participants to rank the health impact and political feasibility of 21 nutrition policies across 5 domains: (a) taxes/subsidies, (b) labeling, (c) nutrition standards, (d) nutrition education, and (e) nutrition promotion in healthcare, based on a Likert scale (1 = least; 5 = most impactful or feasible). We compared the impact and feasibility scores for each policy and by levels of implementation (federal, state, or local). RESULTS: A total of 170 respondents provided complete responses, representing civil service employees (n = 92, 54.1%), employees of advocacy groups (n = 31, 18.2%), researchers (n = 19, 11.2%), healthcare professionals (n = 18, 10.6%), and others (n = 10, 5.9%). For perceived impact, policies with the highest impact scores were Medicare/Medicaid coverage of nutrition counseling for people with chronic conditions at the federal and state levels (mean ± SE: 4.25 ± 0.10); and policy with the lowest impact score was local tax on processed meat (2.90 ± 0.13). For perceived feasibility, policy with the highest feasibility score was federal subsidies on fruits, vegetables, and whole grains in Medicare/Medicaid (4.13 ± 0.09); and policy with the lowest feasibility score was federal tax on processed meat (1.86 ± 0.10). When the impact and feasibility were evaluated jointly, Medicare/Medicaid subsidies for fruits, vegetables, and whole grains and coverage of nutrition counseling received the highest scores, whereas taxes on processed meats or junk food received the lowest scores. CONCLUSIONS: Based on expert stakeholder perceptions, specific federal, state, and local government nutrition policies ...

POLICY POINTS: High‐profile international evidence reviews by the World Health Organization, the World Cancer Research Fund, the American Institute for Cancer Research, and the American Cancer Society concluded that processed meat consumption increases the risk of cancer. The red meat and processed meat industries are influential in the United States and in several other nations. The US federal government supports public‐private partnerships for commodity meat promotion and advertising. Four potential policy options to affect consumption of processed meat are taxation, reduced processed meat quantities in school meal standards, public service announcements, and warning labels. Feasibility of these options would be enhanced by an explicit and science‐based statement on processed meat in the 2020‐2025 Dietary Guidelines for Americans. CONTEXT: The World Health Organization, the World Cancer Research Fund, and the American Cancer Society have each in recent years concluded that processed meats are probable carcinogens. The 2015‐2020 Dietary Guidelines for Americans did not separately evaluate health effects of processed meat, although it mentioned lower processed meat intakes among characteristics of healthy diets. METHODS: We summarized the international scientific literature on meat intake and cancer risk; described the scientific and political processes behind the periodic Dietary Guidelines for Americans; described the US red meat and processed meat industries and the economic structure of government‐supported industry initiatives for advertising and promotion; and reviewed and analyzed specific factors and precedents that influence the feasibility of four potential policy approaches to reduce processed meat intake. FINDINGS: Based on a review of 800 epidemiological studies, the World Health Organization found sufficient evidence in humans that processed meat is carcinogenic, estimating that each 50‐gram increase in daily intake increases the risk of colorectal cancer by 18%. Among the four policy responses we ...

Objectives. To assess stakeholder perceptions of the impact and feasibility of 21 national, state, and local nutrition policies for cancer prevention across 5 domains in the United States. Methods. We conducted an online survey from October through December 2018. Participants were invited to take the survey via direct e-mail contact or an organizational e-newsletter. Results. Federal or state Medicare/Medicaid coverage of nutrition counseling and federal or state subsidies on fruits, vegetables, and whole grains for participants in the Supplemental Nutrition Assistance Program were the policies rated as having the highest perceived impact and feasibility. Overall, the 170 respondents rated policy impact higher than policy feasibility. Polices at the federal or state level had a higher perceived impact, whereas local policies had higher perceived feasibility. Conclusions. Our findings might guide future research and advocacy that can ultimately motivate and target policy actions to reduce cancer burdens and disparities in the United States.

Poor diet increases cardiometabolic disease risk, yet the impact of food service guidelines on employee health and its cost effectiveness is poorly understood. Federal food service guidelines (FFSG) aim to provide United States (U.S.) government employees with healthier food options. Using microsimulation modeling, we estimated changes in the incidence of cardiometabolic disease, related mortality, and the cost effectiveness of implementing FFSG in nationally representative model populations of government and private company employees across 5 years and lifetime. We based estimates on changes in workplace intake of six FFSG dietary targets and showed lifetime reductions of heart attacks (– 107/million), strokes (– 30/million), diabetes (– 134/million), ischemic heart disease deaths (– 56/million), and stroke deaths (– 8/million). FFSG is cost saving overall, with total savings in discounted healthcare costs from $4,611,026 (5 years) to $539,809,707 (lifetime) $U.S. This study demonstrates that FFSG improves health outcomes and is cost saving.

OBJECTIVES: Meta-analyses have identified obesity as an independent risk factor for 13 cancers and added sugars as a contributor to obesity. In 2016, the new Nutrition Facts label on US packaged foods mandated the inclusion of added sugar content. We assessed the health outcomes, costs, and cost-effectiveness of this policy on obesity-related cancer burdens among 250 million US adults over their lifetime. METHODS: We populated the Diet Cancer Outcome Model (DiCOM), a probabilistic cohort-state transitional model, to evaluate two effects of the policy on (a) consumer behavior alone; and (b) consumer behavior plus industry reformulation. Policy effect on consumer behavior was derived from a meta-analysis of calorie labeling; and on industry reformulation, from the FDA's regulatory impact analysis and the UK sugar reformulation strategy. Effects of added sugar on obesity and obesity on cancer incidence were derived from meta-analyses and published literature. Cost-effectiveness was evaluated as net costs with 3% annual discounting, under both government affordability and societal perspectives. RESULTS: We estimated that, based on consumer responses alone, the added sugar labeling would prevent 35,500 new cancer cases (95% uncertainty interval [UI]: 12,300 to 65,800) and 16,700 cancer deaths (95% UI: 5720 to 31,400) and gain 113,000 quality-adjusted life years (QALYs) (95% UI: 38,800 to 210,000) over a lifetime. Adding potential additional effects on industry reformulation, corresponding values were 79,700 new cancer cases (95% UI: 28,100 to 140,000), 37,500 cancer deaths (95% UI: 13,200 to 66,000), and 253,000 QALYs (95% UI: 89,600 to 444,000). Policy would result in estimated net cost savings of $8600 M (95% UI: $6900 M to $11,000 M) from governmental affordability and $7500 M ($5400 M to $9900 M) from societal perspectives based on consumer responses alone. With industry reformulation, net savings were $19,000 (95% UI: $15,000 M to $23,000 M) and $16,000 M (95% UI: $12,000 M to $20,000 M), respectively. ...

OBJECTIVES: Sugar sweetened beverage (SSB) intake is pervasive in the U.S. and a critical risk factor for weight gain and obesity. Obesity is a preventable factor associated with 13 types of cancers. While SSB taxes can lower SSB intake, the potential impact on cancer outcomes, health costs, and cost-effectiveness in the U.S. is lacking. We aimed to evaluate the health outcomes, costs, and cost-effectiveness of a national SSB tax policy for reducing obesity-related cancer in the U.S. METHODS: We used the Diet Cancer Outcome Model (DiCOM), a probabilistic cohort state-transition model, to project the effect of a national $0.01 per oz SSB excise tax on 13 obesity-associated cancers among U.S. adults age 20+ years over their lifetime. Model inputs included national demographic and dietary data from the National Health and Nutrition Examination Survey (NHANES) 2013–2016, policy effects, diet-BMI effects, and BMI-cancer effects from meta-analyses, and policy and cancer costs from established sources. Cost-effectiveness was evaluated as net costs with 3% annual discounting, under both government affordability and societal perspectives. Probabilistic sensitivity analyses jointly incorporated uncertainty in model inputs using 1000 simulations. RESULTS: The SSB tax policy was estimated to prevent 20,545 (95% uncertainty interval [UI]: 12,586 to 32,000) new cancers cases and 10,181 (6362 to 16,000) cancer deaths and add 67,100 (41,100 to 104,505) quality-adjusted life years (QALYs) over lifetime. Largest health benefits were seen for endometrial, kidney, and liver cancer. The SSB tax was estimated to generate $1.17 billion industry compliance costs, $1.20 billion in government implementation costs, and $5.4 billion in lifetime medical savings for the 13 types of cancer. The SSB tax was net cost saving from a societal perspective and government affordability perspective, at $3.2 billion (95% UI: $2.4 to $4.1) and $4.1 billion (95% UI: $3.4 to $4.9), respectively, not including the $6.6 billion generated from tax revenues. ...

BACKGROUND: Sugar-sweetened beverage (SSB) consumption contributes to obesity, a risk factor for 13 cancers. Although SSB taxes can reduce intake, the health and economic impact on reducing cancer burdens in the United States are unknown, especially among low-income Americans with higher SSB intake and obesity-related cancer burdens. METHODS: We used the Diet and Cancer Outcome Model, a probabilistic cohort state-transition model, to project health gains and economic benefits of a penny-per-ounce national SSB tax on reducing obesity-associated cancers among US adults aged 20 years and older by income. RESULTS: A national SSB tax was estimated to prevent 22 075 (95% uncertainty interval [UI] = 16 040-28 577) new cancer cases and 13 524 (95% UI = 9841-17 681) cancer deaths among US adults over a lifetime. The policy was estimated to cost $1.70 (95% UI = $1.50-$1.95) billion for government implementation and $1.70 (95% UI = $1.48-$1.96) billion for industry compliance, while saving $2.28 (95% UI = $1.67-$2.98) billion cancer-related healthcare costs. The SSB tax was highly cost-effective from both a government affordability perspective (incremental cost-effectiveness ratio [ICER] = $1486, 95% UI = -$3516-$9265 per quality-adjusted life year [QALY]) and a societal perspective (ICER = $13 220, 95% UI = $3453-$28 120 per QALY). Approximately 4800 more cancer cases and 3100 more cancer deaths would be prevented, and $0.34 billion more healthcare cost savings would be generated among low-income (federal poverty-to-income ratio [FPIR] ≤ 1.85) than higher-income individuals (FPIR > 1.85). CONCLUSIONS: A penny-per-ounce national SSB tax is cost-effective for cancer prevention in the United States, with the largest health gains and economic benefits among low-income Americans.