Publications by authors named "Mark J Soto"

9 Publications

  • Page 1 of 1

Association of a Sweetened Beverage Tax With Purchases of Beverages and High-Sugar Foods at Independent Stores in Philadelphia.

JAMA Netw Open 2021 Jun 1;4(6):e2113527. Epub 2021 Jun 1.

Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia.

Importance: The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items.

Objective: To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores.

Design, Setting, And Participants: This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties.

Main Outcomes And Measures: Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods.

Results: Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001).

Conclusions And Relevance: This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.13527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207239PMC
June 2021

Trends and patterns in sugar-sweetened beverage consumption among children and adults by race and/or ethnicity, 2003-2018.

Public Health Nutr 2021 Jun 12;24(9):2405-2410. Epub 2021 Apr 12.

Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 429, Boston, MA 02115, USA.

Objective: Sugar-sweetened beverage (SSB) consumption has declined steadily. This study uses the latest national data to examine trends in SSB consumption among children and adults by race and/or ethnicity and to document whether long-standing disparities in intake remain.

Design: Trend analyses of demographic and dietary data measured by 24-h dietary recall from the National Health and Nutrition Examination Survey (NHANES).

Setting: Data from the 2003-2004 through 2017-2018 NHANES survey cycles were analysed in 2020.

Participants: The study sample included 21 156 children aged 2-19 years and 32 631 adults aged 20+ years.

Results: From 2003-2004 to 2017-2018, the prevalence of drinking any amount of SSB on a given day declined significantly among all race and/or ethnicity groups for children (non-Hispanic (NH) White: 81·6 % to 72·7 %; NH Black: 83·2 % to 74·8 %, Hispanic: 86·9 % to 77·2 %) and most race and/or ethnicity groups for adults (NH White: 72·3 % to 65·3 %; Hispanic: 84·6 % to 77·8 %). Consumption declined at a higher rate among NH Black and Hispanic children aged 12-19 years compared with their NH White peers; among NH Black children aged 6-11 years, the rate of decline was lower. Despite significant declines in per capita SSB energy consumption from soda and fruit drinks, consumption of sweetened coffee/tea beverages increased among older children and nearly all adults and consumption of sweetened milk beverages increased among NH White and Hispanic children.

Conclusions: SSB consumption has declined steadily for children and adults of all race and/or ethnicity groups, but disparities persist, and overall intake remains high.
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http://dx.doi.org/10.1017/S1368980021001580DOI Listing
June 2021

Availability and Nutrient Composition of Vegetarian Items at US Fast-Food Restaurants.

J Acad Nutr Diet 2021 Jul 26;121(7):1306-1311.e8. Epub 2021 Mar 26.

Background: Consumer demand for vegetarian options is growing. Fast-food restaurants have responded by adding high-profile vegetarian offerings, but little is known about the overall availability or nutrient profile of vegetarian options at these establishments, or how these items compare with nonvegetarian items.

Objective: The purpose of this study was to quantify trends in the availability and nutrient profile of vegetarian items in US fast-food restaurants from 2012 to 2018.

Design: This study was a longitudinal analysis of secondary data. We used nutrient data from the MenuStat database for menu offerings at 36 large US fast-food chain restaurants (2012 to 2018). Vegetarian items were identified through automated key word searches and item description hand-coding.

Outcome Measures: Annual counts and proportions of vegetarian and nonvegetarian items by category, and annual trends and differences in predicted mean calories; saturated, unsaturated, and trans fats; sugar; nonsugar carbohydrates; protein; sodium between and within vegetarian and nonvegetarian items.

Statistical Analysis Performed: We report counts and proportions of vegetarian items by menu category, then use Tobit regression models to examine annual trends and differences in predicted mean nutrients between and within vegetarian and nonvegetarian items. Sensitivity analyses were calorie-adjusted.

Results: The annual proportion of vegetarian items remained consistent (approximately 20%), and counts increased (2012, n = 601; 2018, n = 713). Vegetarian items had significantly fewer calories (2018: -95 kcal) and, even after adjustment for calories, lower saturated fat (-1.6 g), unsaturated fat (-1.8 g), protein (-3.8 g), and sodium (-62 mg) annually (P < .05) compared with nonvegetarian items. Vegetarian items were significantly higher in sugar (2018: +2.0 g; P < .01) and nonsugar carbohydrates (2018: +9.7 g; P < .01), after calorie adjustment, compared with nonvegetarian items.

Conclusions: Vegetarian items were generally lower in several overconsumed nutrients of public health concern (eg, sodium and saturated fat) than nonvegetarian items, but nutrient changes suggest surveillance remains important as vegetarian options increase in popularity.
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http://dx.doi.org/10.1016/j.jand.2021.01.010DOI Listing
July 2021

Prevalence and nutrient composition of menu offerings targeted to customers with dietary restrictions at US fast casual and full-service restaurants.

Public Health Nutr 2021 Apr 12;24(6):1240-1247. Epub 2021 Jan 12.

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Objective: To examine the prevalence and nutrient composition of menu offerings targeted to customers with dietary restrictions at US fast casual and full-service chain restaurants.

Design: We used 2018 data from MenuStat, a database of nutrient information for menu items at large US chain restaurants. Five alternative diets were examined: gluten-free, low-calorie, low-carbohydrate, low-fat and vegetarian. Diet offerings were identified by searching MenuStat item descriptions and reviewing online menus. For each diet, we reported counts and proportions. We used bootstrapped multilevel models to examine differences in predicted mean kilojoules, saturated fat, Na and sugars between diet and non-diet menu items.

Setting: Forty-five US fast casual and full-service chain restaurants in 2018 (including 6419 items in initial analytic sample across small plates, salads and main dishes).

Participants: None.

Results: The most prevalent diets were gluten-free (n 631, 9·8 % of menu items), low-calorie (n 306, 4·8 %) and vegetarian (n 230, 3·6 %). Compared with non-diet counterparts, low-calorie main dishes had significantly lower levels of all nutrients examined and vegetarian main dishes had significantly lower levels of all nutrients except saturated fat. Gluten-free small plates had significantly fewer kilojoules, grams of saturated fat and milligrams of Na compared with non-diet small plates.

Conclusions: A small proportion of fast casual and full-service restaurant menus are targeted towards customers with dietary restrictions. Compared with non-diet items, those classified as gluten-free, low-calorie or vegetarian generally have healthier nutrient profiles, but overall nutrient values are still too high for most menu items, regardless of dietary label.
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http://dx.doi.org/10.1017/S1368980021000112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235923PMC
April 2021

Association of Chain Restaurant Advertising Spending With Obesity in US Adults.

JAMA Netw Open 2020 10 1;3(10):e2019519. Epub 2020 Oct 1.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Importance: Restaurants spend billions of dollars on marketing. However, little is known about the association between restaurant marketing and obesity risk in adults.

Objective: To examine associations between changes in per capita county-level restaurant advertising spending over time and changes in objectively measured body mass index (BMI) for adult patients.

Design, Setting, And Participants: This cohort study used regression models with county fixed effects to examine associations between changes in per capita county-level (370 counties across 44 states) restaurant advertising spending over time with changes in objectively measured body mass index (BMI) for US adult patients from 2013 to 2016. Different media types and restaurant types were analyzed together and separately. The cohort was derived from deidentified patient data obtained from athenahealth. The final analytic sample included 5 987 213 patients, and the analysis was conducted from March 2018 to November 2019.

Exposure: Per capita county-level chain restaurant advertising spending.

Main Outcomes And Measures: Individual-level mean BMI during the quarter.

Results: The included individuals were generally older (37.1% older than 60 years), female (56.8%), and commercially insured (53.5%). For the full population of 29 285 920 person-quarters, there was no association between changes in all restaurant advertising per capita (all media types, all restaurants) and changes in BMI. However, restaurant advertising spending was positively associated with weight gain for patients in low-income counties but not in high-income counties. A $1 increase in quarterly advertising per capita across all media and restaurant types was associated with a 0.053-unit increase in BMI (95% CI, 0.001-0.102) for patients in low-income counties, corresponding to a 0.12% decrease in BMI at the 10th percentile of changes in county advertising spending vs a 0.12% increase in BMI at the 90th percentile.

Conclusions And Relevance: The results of this study suggest that restaurant advertising is associated with modest weight gain among adult patients in low-income counties. To date, there has been no public policy action or private sector action to limit adult exposure to unhealthy restaurant advertising. Efforts to decrease restaurant advertising in low-income communities should be intensified and rigorously evaluated to understand their potential for increasing health equity.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.19519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542328PMC
October 2020

Decreasing Trends in Heavy Sugar-Sweetened Beverage Consumption in the United States, 2003 to 2016.

J Acad Nutr Diet 2020 12 24;120(12):1974-1985.e5. Epub 2020 Sep 24.

Background: Although previous studies have documented declines in intake from sugar-sweetened beverages (SSB) in the United States, it is important to examine whether heavy SSB intake (≥500 kcal/day) is decreasing in parallel. Examining the intake patterns of heavy SSB consumers is imperative because these individuals face the greatest health risks and thus may benefit the most from targeted policy and programmatic efforts to reduce intake.

Objective: To provide the most recent national estimates for trends in heavy SSB intake among children and adults in the United States between 2003-2004 and 2015-2016, to examine whether these trends differ by sociodemographic characteristics, and to describe where SSB are acquired and consumed by the heaviest SSB consumers.

Design: Trend analyses of demographic and 24-hour dietary recall data in the 2003-2004 to 2015-2016 National Health and Nutrition Examination Survey.

Participants/setting: Participants were 21,783 children (aged 2 to 19 years) and 32,355 adults (aged ≥20 years).

Main Outcome Measures: Heavy SSB intake (≥500 kcal/day).

Statistical Analysis: Survey-weighted logistic regression was used to estimate the proportion of heavy SSB consumers, overall and by age group, race/ethnicity, sex, and income status (lower income = <130% Federal Poverty Level). Proportions were used to summarize where SSB are most often acquired and consumed.

Results: Between 2003-2004 and 2015-2016, the prevalence of heavy SSB intake declined significantly among children (10.9% to 3.3%) and adults (12.7% to 9.1%). For children, these declines were observed across age group, sex, family income status, and most races/ethnicities. For adults, these significant declines were observed among 20- to 39-year olds, most races/ethnicities, and higher-income adults. However, there was a significant increase in heavy SSB intake among adults aged ≥60 years and no significant change among 40- to 59-year olds and non-Mexican Hispanic adults. The majority of energy intake from SSB consumed by heavy SSB drinkers was from products acquired from stores and was consumed at home.

Conclusions: Heavy SSB intake is declining, but attention must be paid to certain subgroups with high intake for whom trends are not decreasing, particularly 40- to 59-year olds and non-Mexican Hispanic adults.
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http://dx.doi.org/10.1016/j.jand.2020.07.012DOI Listing
December 2020

Facilitators and barriers to bikeshare use among users and non-users in a socioeconomically diverse urban population.

Prev Med Rep 2020 Dec 21;20:101185. Epub 2020 Aug 21.

Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Public bike sharing programs are becoming increasingly popular worldwide. While there is a growing body of literature exploring participation and facilitators among bike share users, little is known about the views of people who have not enrolled in bikeshare programs and how they differ from current users. This knowledge is critical to expand bikeshare ridership, particularly among low-income populations who typically have lower participation levels. We developed a cross-sectional survey to assess perceived barriers and facilitators to bikeshare use among users and non-users of the Bluebikes bikeshare program in Boston, Massachusetts. Survey respondents were recruited from lower-income Boston neighborhoods via flyers, social media, Craigslist, and in-person between June 12-July 31, 2019. A total of 512 people completed the survey (277 bikeshare users and 235 non-users). Bikeshare users in our sample differed significantly from non-users with respect to age, sex, and race. Barriers and facilitators of bikeshare use were largely similar between users and non-users, as well as among users stratified by household income. The most frequently cited barriers included: safety concerns, lack of a helmet, proximity to stations, trouble with renting/returning a bike, and weather. The main facilitators included: convenience, proximity to stations, environmental benefits, economic benefits, fun, and health benefits. Salience of many of the most frequent barriers and facilitators increased with frequency of ridership. Barriers identified by users and non-users of bikeshare programs suggest key areas of program improvements and/or areas of focus for future recruitment efforts. Likewise, potential facilitators noted by non-users may represent key marketing opportunities for bikeshare programs that are seeking to expand in socioeconomically diverse urban settings.
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http://dx.doi.org/10.1016/j.pmedr.2020.101185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490554PMC
December 2020

Impact of Changes in Chain Restaurant Calories over Time on Obesity Risk.

J Gen Intern Med 2020 06 14;35(6):1743-1750. Epub 2020 Feb 14.

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: Prior research on the restaurant environment and obesity risk is limited by cross-sectional data and a focus on specific geographic areas.

Objective: To measure the impact of changes in chain restaurant calories over time on body mass index (BMI).

Design: We used a first-difference model to examine whether changes from 2012 to 2015 in chain restaurant calories per capita were associated with percent changes in BMI. We also examined differences by race and county income, restaurant type, and initial body weight categories.

Setting: USA (207 counties across 39 states).

Participants: 447,873 adult patients who visited an athenahealth medical provider in 2012 and 2015 where BMI was measured.

Main Outcomes Measured: Percent change in objectively measured BMI from 2012 to 2015.

Results: Across all patients, changes in chain restaurant calories per capita were not associated with percent changes in BMI. For Black or Hispanic adults, a 10% increase in exposure to chain restaurant calories per capita was associated with a 0.16 percentage-point increase in BMI (95% CI 0.03, 0.30). This translates into a predicted weight increase of 0.89 pounds (or a 0.53% BMI increase) for an average weight woman at the 90th percentile of increases in the restaurant environment from 2012 to 2015 versus an increase 0.39 pounds (or 0.23% BMI increase) at the 10th percentile. Greater increases in exposure to chain restaurant calories also significantly increased BMI for Black or Hispanic adults receiving healthcare services in lower-income counties (0.26, 95% CI 0.04, 0.49) and with overweight/obesity (0.16, 95% CI 0.04, 0.29).

Limitations: Generalizability to non-chain restaurants is unknown and the sample of athenahealth patients is relatively homogenous.

Conclusions: Increased exposure to chain restaurant calories per capita was associated with increased weight gain among Black or Hispanic adults.
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http://dx.doi.org/10.1007/s11606-020-05683-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300171PMC
June 2020

Calorie and nutrient trends in large U.S. chain restaurants, 2012-2018.

PLoS One 2020 10;15(2):e0228891. Epub 2020 Feb 10.

Department of Population Medicine, Harvard Medical School, Boston, MA, United States of America.

Introduction: Large chain restaurants reduced calories in their newly-introduced menu items from 2012 to 2015. The objective of this study was to provide updated calorie trends through 2018 and examine trends in the macronutrient composition of menu items across this time period.

Methods And Findings: Data were obtained from the MenuStat project and include 66 of the 100 largest revenue generating U.S. chain restaurants (N = 28,238 items) that had data available in all years from 2012 to 2018. Generalized linear models were used to examine per-item calorie and nutrient changes (saturated fat, trans fat, unsaturated fat, sugar, non-sugar carbohydrates, protein, sodium) among (1) items on the menu in all years (common items) and (2) newly introduced items (2013-2018). Overall, there were no significant changes in calories or nutrients among common items from 2012 to 2018. Among all newly introduced items, calories (-120 kcals, -25%, p = 0.01; p-for-trend = 0.02), saturated fat (-3.4g, -41%, p<0.01, p-for-trend = 0.06), unsaturated fat (-4.5g, -37%, p = 0.02; p-for-trend = 0.04), non-sugar carbohydrates (-10.3g, -40%, p = 0.02, p-for-trend = 0.69), and protein (-4.3g, -25%, p = 0.04, p-for-trend = 0.02) declined.

Conclusion: Newly introduced menu items in large chain restaurants have continued to decline in calories through 2018, which may help to reduce calorie intake. Other changes in macronutrient content were sporadic and not clearly toward improved dietary quality.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228891PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010289PMC
May 2020
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