Sociodemographic differences in fast food price sensitivity.

Academic Article

Abstract

  • IMPORTANCE: Fiscal food policies (eg, taxation) are increasingly proposed to improve population-level health, but their impact on health disparities is unknown. OBJECTIVE: To estimate subgroup-specific effects of fast food price changes on fast food consumption and cardiometabolic outcomes. DESIGN, SETTING, AND PARTICIPANTS: Twenty-year follow-up (5 examinations) in a biracial US prospective cohort: Coronary Artery Risk Development in Young Adults (CARDIA) (1985/1986-2005/2006, baseline N = 5115). Participants were aged 18 to 30 years at baseline; design indicated equal recruitment by race (black vs white), educational attainment, age, and sex. Community-level price data from the Council for Community and Economic Research were temporally and geographically linked to study participants' home address at each examination. MAIN OUTCOMES AND MEASURES: Participant-reported number of fast food eating occasions per week, body mass index (BMI), and homeostasis model assessment insulin resistance (HOMA-IR) from fasting glucose and insulin concentrations. Covariates included individual-level and community-level social and demographic factors. RESULTS: In repeated measures regression analysis, multivariable-adjusted associations between fast food price and consumption were nonlinear (quadratic, P < .001), with significant inverse estimated effects on consumption at higher prices; estimates varied according to race (interaction P = .04), income (P = .07), and education (P = .03). At the 10th percentile of price ($1.25/serving), blacks and whites had mean fast food consumption frequency of 2.20 (95% CI, 2.07-2.33) and 1.55 (1.45-1.65) times/wk, respectively, whereas at the 90th percentile of price ($1.53/serving), respective mean consumption estimates were 1.86 (1.75-1.97) and 1.50 (1.41-1.59) times/wk. We observed differential price effects on HOMA-IR (inverse for lower educational status only [interaction P = .005] and at middle income only [interaction P = .02]) and BMI (inverse for blacks, less education, and middle income; positive for whites, more education, and high income [all interaction P < .001]). CONCLUSIONS AND RELEVANCE: We found greater fast food price sensitivity on fast food consumption and insulin resistance among sociodemographic groups that have a disproportionate burden of chronic disease. Our findings have implications for fiscal policy, particularly with respect to possible effects of fast food taxes among populations with diet-related health disparities.
  • Published In

    Keywords

  • Adolescent, Adult, African Americans, Commerce, Diet, European Continental Ancestry Group, Fast Foods, Feeding Behavior, Female, Healthcare Disparities, Humans, Income, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Risk Factors, Socioeconomic Factors
  • Digital Object Identifier (doi)

    Author List

  • Meyer KA; Guilkey DK; Ng SW; Duffey KJ; Popkin BM; Kiefe CI; Steffen LM; Shikany JM; Gordon-Larsen P
  • Start Page

  • 434
  • End Page

  • 442
  • Volume

  • 174
  • Issue

  • 3