Various Cardiovascular Diseases (CVDs) can be catastrophic and can lead to irreversible outcomes. Despite improved interventions for CVD prevention awareness, there continues to be discussion and research on diet-related CVD and mortality without addressing the problem. Instead of prioritizing public guidelines and policies, policymakers should understand CVD and address population barriers to adhering to a healthy diet that decreases CVD risk. Therefore, this project aims to analyze federal healthy food incentive policies to promote healthy diet behaviors that reduce CVD risk. The method used was existing data for a comparative policy analysis that included a policy proposal process: phases of progression, measures, and a policy model with data collection and requirements. This analysis compared a current federal food incentive program versus the proposed program. Results of the final analysis derived from the literature review and collected data stated consuming foods from the Mediterranean and other low-fat and low-salt diets reduced CVD risks that also reduced other risks secondary to CVD, such as obesity, diabetes, and Cerebrovascular Accident (CVA). Comparatively, combined healthy food incentives and disincentives were more effective for improving healthy behaviors than, in some cases, even after incentives were removed. Therefore, this policy analysis supports the indication for incentive policy change. However, the lack of federal stakeholders’ response to key policy changes upon proposal submission may require other methods of proposal dissemination. Nonetheless, focusing analysis on various Food Insecurity Nutrition Incentive (FINI) programs instead of one, multi-state program, which may have improved analysis outcomes, was the lesson learned.
References
[1]
Adeoye, O., Nystrom, K.V., Yavagal, D.R., Luciano, J., Nogueira, R.G., Zorowitz, R.D., Khalessi, A.A., Bushnell, C., Barsan, W.G., Panagos, P., Alberts, M.J., Tiner, A.C., Schwamm, L.H. and Jauch, E.C. (2019) Recommendations for the Establishment of Stroke Systems of Care: A 2019 Update: A Policy Statement from the American Stroke Association. Stroke, 50, 187-210. https://doi.org/10.1161/STR.0000000000000173
[2]
Lichtenstein, A.H., Appel, L.J., Vadiveloo, M., Hu, F.B., Kris-Etherton, P.M., Rebholz, C.M., Sacks, F.M., Thorndike, A.N., Van Horn, L. and Wylie-Rosett, J. (2021) 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement from the American Heart Association. Circulation, 144, 472-487.
https://doi.org/10.1161/CIR.0000000000001031
[3]
Vericker, T., Dixit-Joshi, S., Giesen, L., Gearing, M., Manglitz, C., Baier, K., Lee, H. and May, L. (2021, November) Evaluation of the Implementation of Food Insecurity Nutrition Incentives (FINI): Final Report. U.S. Department of Agriculture, Food and Nutrition Service, Washington DC.
https://fns-prod.azureedge.us/sites/default/files/resource-files/FINIReport.pdf
[4]
Mozaffarian, D., Angell, S.Y., Lang, T. and Rivera, J.A. (2018) Role of Government Policy in Nutrition—Barriers to and Opportunities for Healthier Eating. BMJ, 361, k2426. https://www.bmj.com/content/361/bmj.k2426
https://doi.org/10.1136/bmj.k2426
[5]
Kleindorfer, D.O., Towfighi, A., Chaturvedi, S., Cockroft, K.M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W.N., Kittner, S.J., Leira, E.C., Lennon, O., Meschia, J.F, Nguyen, T.N., Pollak, P.M., Santangeli, P., Sharrief, A.Z., Smith Jr., S.C., Turan, T.N. and Williams, L.S. (2021) 2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline from the American Heart Association/American Stroke Association. Stroke, 52, 364-467.
https://doi.org/10.1161/STR.0000000000000375
[6]
Chiu, T., Chang, H.R., Wang, L.Y., Chang, C.C., Lin, M.N. and Lin, C.L. (2020) Vegetarian Diet and Incidence of the Total, Ischemic, and Hemorrhagic Stroke in 2 Cohorts in Taiwan. Neurology, 94, 1112-1121.
https://doi.org/10.1212/WNL.0000000000009093
[7]
Kirzner, R.S., Robbins, I., Privitello, M. and Miserandino, M. (2021) Listen and Learn: Participant Input in Program Planning for a Low-Income Urban Population at Cardiovascular Risk. BMC Public Health, 21, Article No. 504.
https://doi.org/10.1186/s12889-021-10423-6
[8]
Parks, C.A., Stern, K.L., Fricke, H.E., Clausen, W. and Yaroch, A.L. (2020) Healthy Food Incentive Programs: Findings from Food Insecurity Nutrition Incentive Programs across the United States. Health Promotion Practice, 21, 421-429.
https://cfaky.org/wpcontent/uploads/2020/06/1524839919898207.pdf
https://doi.org/10.1177/1524839919898207
[9]
Kris-Etherton, P.M., Petersen, K.S., Velarde, G., Barnard, N.D., Miller, M., Ros, E., O’Keefe, J.H., Williams Sr., K., Van Horn, L., Na, M., Shay, C., Douglass, P., Katz, D.L. and Freeman, A.M. (2020) Barriers, Opportunities, and Challenges in Addressing Disparities in Diet-Related Cardiovascular Disease in the United States. Journal of the American Heart Association, 9, e014433.
https://doi.org/10.1161/JAHA.119.014433
[10]
Moran, A., Thorndike, A., Franckle, R., Boulos, R., Doran, H., Fulay, A., Greene, J., Blue, D., Block, J.P., Rimm, E.B. and Polacsek, M. (2019) Financial Incentives Increase Purchases of Fruit and Vegetables among Lower-Income Households with Children. Health Affairs, 38, 1557-1566. https://doi.org/10.1377/hlthaff.2018.05420
https://community-nutrition-education.extension.org/wp-content/uploads/2020/03/financial-incentives-increase-purchases.pdf
[11]
Parks, C.A., Stern, K.L., Fricke, H.E., Clausen, W. and Yaroch, A.L. (2018) A Qualitative Evaluation of the United States Department of Agriculture’s Food Insecurity Nutrition Incentive Grant Program. Gretchen Swanson Center for Nutrition, Omaha.
https://static1.squarespace.com/static/58a4dda16a49633eac5e02a1/t/5bc8f5d48165f53f52c54799/1539896914855/HER+FINI.pdf
[12]
Kern, D.M., Auchincloss, A.H., Stehr, M.F., Diez Roux, A.V., Moore, L.V., Kanter, G.P. and Robinson, L.F. (2017) Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis. International Journal of Environmental Research and Public Health, 14, Article No. 1394. https://www.mdpi.com/1660-4601/14/11/1394/htm
https://doi.org/10.3390/ijerph14111394
[13]
Johns Hopkins Nursing Evidence-Based Practice (2017) Evidence Level and Quality Guide. https://libguides.ohsu.edu/ld.php?content_id=16277844
[14]
Saulle, R., Lia, L., De Giusti, M. and La Torre, G. (2019) A Systematic Overview of the Scientific Literature on the Association between Mediterranean Diet and the Stroke Prevention. Clinical Therapeutics, 170, 396-408.
http://www.clinicaterapeutica.it/2019/170/5/14_LIA.pdf
[15]
O’Connor, L.E., Li, J., Sayer, R.D., Hennessy, J.E. and Campbell, W.W. (2018) Short-Term Effects of Healthy Eating Pattern Cycling on Cardiovascular Disease Risk Factors: Pooled Results from Two Randomized Controlled Trials. Nutrients, 10, Article 1725. https://www.mdpi.com/2072-6643/10/11/1725/htm
https://doi.org/10.3390/nu10111725
[16]
El-Hajj, M., Salameh, P., Rachidi, S., Al-Hajje, A. and Hosseini, H. (2021) Adherence to the Mediterranean Diet Decreases the Risk of Stroke in the Lebanese Population: A Case-Control Study. Pharmacy Practice, 19, Article No. 2157.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886311/
https://doi.org/10.18549/PharmPract.2021.1.2157
Hendriksen, R.B. and Van Der Gaag, E.J. (2022) Effect of a Dietary Intervention Including Minimal and Unprocessed Foods, High in Natural Saturated Fats, on the Lipid Profile of Children, Pooled Evidence from Randomized Controlled Trials and a Cohort Study. PLOS ONE, 17, e0261446.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261446
https://doi.org/10.1371/journal.pone.0261446
[19]
Lin, C.L. (2021) Stroke and Diets—A Review. Tzu Chi Medical Journal, 33, 238-242.
https://doi.org/10.4103/tcmj.tcmj_168_20
[20]
Wright, N., Wilson, L., Smith, M., Duncan, B. and McHugh, P. (2017) The BROAD Study: A Randomised Controlled Trial Using a Whole Food Plant-Based Diet in the Community for Obesity, Ischaemic Heart Disease or Diabetes. Nutrition & Diabetes 7, e256. https://www.nature.com/articles/nutd20173
https://doi.org/10.1038/nutd.2017.3
[21]
Bechthold, A., Boeing, H., Schwedhelm, C., Hoffmann, G., Knüppel, S., Idqbal, K., De Henauw, S., Michels, N., Devleesschauwer, B., Schlesinger, S. and Schwingshackl, L. (2017) Food Groups and Risk of Coronary Heart Disease, Stroke, and Heart Failure: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Critical Reviews in Food Science and Nutrition, 59, 1071-1090.
https://doi.org/10.1080/10408398.2017.1392288
[22]
Guasch-Ferré, M., Satija, A., Blondin, S.A., Janiszewski, M., Emlen, E., O’Connor, L.E., Campbell, W.W., Hu, F.B., Willett, W.C. and Stampfer, M.J. (2019) Meta-Analysis of Randomized Controlled Trials of Red Meat Consumption in Comparison with Various Comparison Diets on Cardiovascular Risk Factors. Circulation, 139, 1828-1845.
https://doi.org/10.1161/CIRCULATIONAHA.118.035225
[23]
Hu, Y., Hu, F.B. and Manson, J.E. (2019) Marine Omega-3 Supplementation and Cardiovascular Disease: An Updated Meta-Analysis of 13 Randomized Controlled Trials Involving 127,477 Participants. Journal of the American Heart Association, 8, e013543. https://doi.org/10.1161/JAHA.119.013543
[24]
Ebbeling, C.B., Feldman, H.A., Steltz, S.K., Quinn, N.L., Robinson, L.M. and Ludwig, D.S. (2020) Effects of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Beverages on Cardiometabolic Risk Factors, Body Composition, and Sweet Taste Preference: A Randomized Controlled Trial. Journal of the American Heart Association, 9, e015668. https://doi.org/10.1161/JAHA.119.015668
[25]
Vericker, T., Dixit-Joshi, S., Giesen, L., Gearing, M., Manglitz, C., Baier, K., Lee, H. and May, L. (2019, May) The Evaluation of Food Insecurity Nutrition Incentives (FINI) Interim Report. Westat, Inc., Rockville.
https://fns-prod.azureedge.us/sites/default/files/resource-files/FINI-AppendixI-L_1.pdf
[26]
Gardiner, C.K. and Bryan, A.D. (2017) Monetary Incentive Interventions Can Enhance Psychological Factors Related to Fruit and Vegetable Consumption. Annals of Behavioral Medicine, 51, 599-609.
https://academic.oup.com/abm/article/51/4/599/4643248
https://doi.org/10.1007/s12160-017-9882-4
[27]
Shavit, Y., Roth, Y. and Teodorescu, K. (2021) Promoting Healthy Eating Behaviors by Incentivizing Exploration of Healthy Alternatives. Frontiers in Nutrition, 8, Article 658793. https://www.frontiersin.org/articles/10.3389/fnut.2021.658793/full
https://doi.org/10.3389/fnut.2021.658793
[28]
French, S.A., Rydell, S.A., Mitchell, N.R., Michael Oakes, J., Elbel, B. and Harnack, L. (2017) Financial Incentives and Purchase Restrictions in a Food Benefit Program Affect the Types of Foods and Beverages Purchased: Results from a Randomized Trial. The International Journal of Behavioral Nutrition and Physical Activity, 14, Article No. 127. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602848/
https://doi.org/10.1186/s12966-017-0585-9
[29]
Vadiveloo, M., Guan, X., Parker, H.W., Perraud, E., Buchanan, A., Atlas, S. and Thorndike, A.N. (2021) Effect of Personalized Incentives on Dietary Quality of Groceries Purchased: A Randomized Crossover Trial. JAMA Network Open, 4, e2030921.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776097
https://doi.org/10.1001/jamanetworkopen.2020.30921
[30]
Olstad, D.L., Crawford, D.A., Abbott, G., McNaughton, S.A., Nd Le, H., Mhurchu, C.N., Pollard, C. and Ball, K. (2017) The Impact of Financial Incentives on Participants’ Food Purchasing Patterns in a Supermarket-Based Randomized Controlled Trial. International Journal of Behavioral Nutrition and Physical Activity, 14, Article No. 115. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0573-0
https://doi.org/10.1186/s12966-017-0573-0
[31]
Nagatomo, W., Saito, J. and Kondo, N. (2019) Effectiveness of a Low-Value Financial-Incentive Program for Increasing Vegetable-Rich Restaurant Meal Selection and Reducing Socioeconomic Inequality: A Cluster Crossover Trial. International Journal of Behavioral Nutrition and Physical Activity, 16, Article No. 81.
https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-019-0830-5
https://doi.org/10.1186/s12966-019-0830-5
[32]
De Buisonjé, D., Van Der Geer, J., Keesman, M., Van Der Vaart, R., Reijnders, T., Wentzel, J., Kemps, H., Kraaijenhagen, R., Janssen, V. and Evers, A. (2021) Financial Incentives for Healthy Living for Patients with Cardiac Disease from the Perspective of Health Care Professionals: Interview Study. JMIR Cardiology, 5, e27867.
https://cardio.jmir.org/2021/2/e27867
https://doi.org/10.2196/27867
[33]
Valluri, S., Mason, S.M., Peterson, H.H., French, S.A. and Harnack, L.J. (2021) The Impact of Financial Incentives and Restrictions on Cyclical Food Expenditures among Low-Income Households Receiving Nutrition Assistance: A Randomized Controlled Trial. International Journal of Behavioral Nutrition and Physical Activity, 18, Article No. 157. https://doi.org/10.1186/s12966-021-01223-7
https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-021-01223-7
[34]
Kalousova, L., Levy, D., Titus, A.R., Meza, R., Thrasher, J.F., Elliott, M.R. and Fleischer, N.L. (2020) Cigarette Taxes, Prices, and Disparities in Current Smoking in the United States. SSM—Population Health, 12, Article ID: 100686.
https://www.sciencedirect.com/science/article/pii/S2352827320303232
https://doi.org/10.1016/j.ssmph.2020.100686
Ritchey, M.D., Wall, H.K., Owens, P.L. and Wright, J.S. (2018) Vital Signs: State-Level Variation in Nonfatal and Fatal Cardiovascular Events Targeted for Prevention by Million Hearts 2022. Morbidity and Mortality Weekly Report, 67, 974-982.
https://www.cdc.gov/mmwr/volumes/67/wr/mm6735a3.htm?s_cid=mm6735a3_w#
https://doi.org/10.15585/mmwr.mm6735a3
[37]
Birger, M., Kaldjian, A.S., Roth, G.A., Moran, A.E., Dieleman, J.L. and Bellows, B.K. (2021) Spending on Cardiovascular Disease and Cardiovascular Risk Factors in the United States: 1996 to 2016. Circulation, 144, 271-282.
https://doi.org/10.1161/CIRCULATIONAHA.120.053216
[38]
Pelletier, L.R. and Beaudin, C.L. (2018) HQ Solutions Resource for the Healthcare Quality Professional. 4th Edition, Wolters Kluwer, Alphen aan den Rijn.
[39]
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, N., Foy, R. and Michie, S. (2017) A Guide to Using the Theoretical Domains Framework of Behaviour Change to Investigate Implementation Problems. Implementation Science, 12, Article No. 77. https://doi.org/10.1186/s13012-017-0605-9
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0605-9
[40]
Pender, N.J., Murdaugh, C.L. and Parsons, M.A. (2011) Health Promotion in Nursing Practice. 6th Edition, Pearson, Boston.
https://deepblue.lib.umich.edu/bitstream/handle/2027.42/85350/HEALTH_PROMOTION_MANUAL_Rev_5-2011.pdf
[41]
Khatti-Dizabadi, F., Yazdani-Charati, J., Amani, R. and Mostafavi, F. (2022) Validation of an Instrument for Perceived Factors Affecting Fruit and Vegetable Intake Based on Pender’s Health Promotion Model. Journal of Nutritional Science, 11, E7.
https://www.cambridge.org/core/journals/journal-of-nutritional-science/article/validation-of-an-instrument-for-perceived-factors-affecting-fruit-and-vegetable-intake-based-on-penders-health-promotion-model/05A637AFA22F7EB329D4F48F06D717D4
[42]
Bardach, E.S. and Patashnik, E.M. (2020) A Practical Guide for Policy Analysis: The Eightfold Path. 6th Edition, Sage, London.
[43]
CDC (2021) Policy Strategy and Development.
https://www.cdc.gov/policy/polaris/policyprocess/strategy-development/index.html
[44]
Harris, J., De Steenhuijsen Piters, B., McMullin, S., Bajwa, B., De Jager, I. and Brouwer, I.D. (2021) Fruits and Vegetables for Healthy Diets: Priorities for Food System Research and Action. United Nations, New York.
https://sc-fss2021.org/wp-content/uploads/2021/04/FSS_Brief_Fruits_Vegetables.pdf
[45]
Husereau, D., Drummond, M., Augustovski, F., De Bekker-Grob, E., Briggs, A.H., Carswell, C., Caulley, L., Chaiyakunapruk, N., Greenberg, D., Loder, E., Mauskopf, J., Mullins, C.D., Petrou, S., Pwu, R.-F. and Staniszewska, S. (2022) Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations. BMC Medical, 20, Article No. 23. https://doi.org/10.1186/s12916-021-02204-0
[46]
Jacksonville University Institutional Review Board (2018) Standard Operating Procedures of the Institutional Review Board: Jacksonville University.
https://www.ju.edu/sponsoredprograms/compliance/institutionalreviewboard/docs/18.06.04_JU_IRB_SOP-Final2.pdf
[47]
Rajagopal, S., Barnhill, A. and Sharfstein, J.M. (2018) The Evidence—and Acceptability—of Taxes on Unhealthy Foods. Israel Journal of Health Policy Research, 7, Article No. 68. https://ijhpr.biomedcentral.com/articles/10.1186/s13584-018-0264-6
https://doi.org/10.1186/s13584-018-0264-6
[48]
Rogers, E.M., Singhal, A. and Quinlan, M. (2003) Diffusion of Innovations. 5th Edition, Free Press, New York, 5.
https://utminers.utep.edu/asinghal/Reports/EMR-Singhal-Quinlan-june19-07-DOI-Word-file-Stack-Salwen[1].pdf
[49]
Dang, D., Dearholt, S.L., Bissett, K., Ascenzi, J. and Whalen, M. (2022) Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals. 4th Edition, Sigma Theta Tau International, Indianapolis.
