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

Jonathan Pearson-Stuttard, Piotr Bandosz, Colin D. Rehm, Ashkan Afshin, Jose L. Penalvo, Laurie Whitsel, Goodarz Danaei, Renata Micha, Tom Gaziano, Ffion Lloyd-Williams, Simon Capewell, Dariush Mozaffarian, Martin O'Flaherty

    Research output: Contribution to journalA1: Web of Science-articlepeer-review


    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 similar to 18,600 CVD deaths (95% CI: 17,600, 19,500), gaining similar to 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 similar to 14%. This would prevent similar to 153,300 deaths (95% CI: 146,400, 159,200), gaining similar to 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.

    Original languageEnglish
    JournalAmerican Journal of Clinical Nutrition
    Issue number1
    Pages (from-to)199-206
    Number of pages8
    Publication statusPublished - 2017


    • cardiovascular disease
    • disparities
    • food policy
    • nutrition
    • fruits and vegetables
    • STROKE
    • UPDATE


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