Comparing effectiveness of mass media campaigns with price reductions targeting fruit and vegetable intake on US cardiovascular disease mortality and race disparities

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ABSTRACT

Background

A low intake of fruits and vegetables (F&Vs) is a major risk factor for cardiovascular disease (CVD) in the United States. Both mass media campaigns (MMCs) and economic incentives may increase F&V consumption. Few data exist on their comparative effectiveness.

Objective

We estimated CVD mortality reductions potentially achievable by price reductions and MMC interventions targeting F&V intake in the US population.

Design

We developed a US IMPACT Food Policy Model to compare 3 policies targeting F&V intake across US adults from 2015 to 2030: national MMCs and national F&V price reductions of 10% and 30%. We accounted for differences in baseline diets, CVD rates, MMC coverage, MMC duration, and declining effects over time. Outcomes included cumulative CVD (coronary heart disease and stroke) deaths prevented or postponed and life-years gained (LYGs) over the study period, stratified by age, sex, and race.

Results

A 1-y MMC in 2015 would increase the average national F&V consumption by 7% for 1 y and prevent ∼18,600 CVD deaths (95% CI: 17,600, 19,500), gaining ∼280,100 LYGs by 2030. With a 15-y MMC, increased F&V consumption would be sustained, yielding a 3-fold larger reduction (56,100; 95% CI: 52,400, 57,700) in CVD deaths. In comparison, a 10% decrease in F&V prices would increase F&V consumption by ∼14%. This would prevent ∼153,300 deaths (95% CI: 146,400, 159,200), gaining ∼2.51 million LYGs. For a 30% price decrease, resulting in a 42% increase in F&V consumption, corresponding values would be 451,900 CVD deaths prevented or postponed (95% CI: 433,100, 467,500) and 7.3 million LYGs gained. Effects were similar by sex, with a smaller proportional effect and larger absolute effects at older ages. A 1-y MMC would be 35% less effective in preventing CVD deaths in non-Hispanic blacks than in whites. In comparison, price-reduction policies would have equitable proportional effects.

Conclusion

Both national MMCs and price-reduction policies could reduce US CVD mortality, with price reduction being more powerful and sustainable.

Key Words

cardiovascular disease
disparities
food policy
nutrition
fruits and vegetables

ABBREVIATIONS

CAD
coronary artery disease
CVD
cardiovascular disease
DPP
death prevented or postponed
F&V
fruit and vegetable
LYG
life-year gained
MMC
mass media campaign

Cited by (0)

Supported by NIH grant R01HL115189.

The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license (or nonexclusive for government employees) on a worldwide basis to the American Journal of Clinical Nutrition. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No ethical approval was required for secondary analysis of publicly available data. This research was not registered in a clinical trial.

DM and MO contributed equally to this work.