Food policy to prevent harm or improve health
Lubar, Debra Robyn
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Obesity is a risk factor for major chronic diseases, making reduction of obesity a major public health goal. With approximately two-thirds of adult Americans classified as overweight, addressing the problem as an individual failing seems overwhelming and likely unproductive by itself, putting policy interventions to change the food environment at the center of public health efforts. This study examines one major government initiative—Communities Putting Prevention to Work (CPPW)—to better understand community food policy choices and their implications. Using prospect theory, community policy choices and their implications were examined according to community characteristics, community policy frame choices, community response, and policy passage. Prospect theory predicts that communities with less favorable health status and food environments will favor policy choices that emphasize harm reduction (loss frames) rather than health improvements (gain frames), and that these frames will affect community response. Prospect theory also predicts different effects for mandatory policies with outcomes that are certain, rather than voluntary policies whose outcomes are uncertain (certainty frame). These frames are hypothesized to have implications for community responses to policy change efforts, and ultimately to policy passage. This study used multiple regression to analyze secondary data from a variety of sources, including US Census data, the Behavioral Risk Factor Surveillance System (BRFSS), the US Department of Agriculture (USDA) Food Atlas, and Centers for Disease Control and Prevention (CDC) program monitoring data. The study examined the combination of policies chosen by communities to help guide real world decisions that involve a suite of interventions. While community characteristics did not predict loss framing, they did predict certainty frames. The percentage of mandatory policies in communities varied directly with CPPW tobacco funding (funded or not funded), rates of high blood pressure, and soda prices. These variables represent three constructs that were hypothesized to affect certainty scores: community characteristics, health status, and food environment. In addition, certainty scores predicted changes in news coverage, with higher certainty scores associated with larger increases in newspaper hits on obesity policy topics. Several non-significant findings are consistent with the hypotheses of this study, and should be examined in a larger sample with more power to detect statistically significant effects.