Online Program

284359
Impact and cost-effectiveness of childcare center policy changes on BMI and healthcare costs in the United States


Tuesday, November 5, 2013 : 11:30 a.m. - 11:50 a.m.

Davene R. Wright, PhD, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
Erica L. Kenney, ScD, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
Catherine M. Giles, MPH, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
Michael W. Long, SD, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
Zachary Ward, MPH, Center for Health Decision Science, Harvard School of Public Health, Boston, MA
Stephen Resch, Ph.D., Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA
Marj Moodie, Dr.PH, Deakin Health Economics, Deakin Population Health, Deakin University, Burwood, Victoria, Australia
Robert Carter, Ph.D., Deakin Health Economics, Deakin Population Health, Deakin University, Burwood, Victoria, Australia
Y. Claire Wang, MD, ScD, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
Gary Sacks, PhD, WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
Boyd Swinburn, PhD, WHO Collaborating Centre for Obesity Prevention, Deakin University, Burwood, Victoria, Australia
Angie L. Cradock, ScD, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
Steven L. Gortmaker, PhD, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
Introduction: Childcare facilities influence nutrition and physical activity behaviors, making them ideal for obesity prevention. We quantified the health and economic impact of a multi-component regulatory intervention in licensed U.S. childcare facilities. Methods: Using data from published research, we estimated the one-year costs and changes in body mass index (BMI) resulting from changes in beverage consumption, physical activity, and screen time viewing regulations among 6.2 million 3-5 year olds in childcare facilities. We used the U.S. Assessing Cost Effectiveness model to simulate the impact of one-year BMI changes in the 2005 U.S. population on lifetime healthcare expenditures and Disability-Adjusted Life Years (DALYs), assuming the maintenance of intervention effects. We simulated uncertainty intervals (UI) around outcomes and discounted outcomes at a 3.5% annual rate. Results: Regulatory changes would lead to children, on average, watching 28 hours less television, exercising for 58 more hours, and consuming four fewer 12-ounce servings of sugar-sweetened beverages annually. National implementation would lead to a one-year BMI decrease of 0.02 kg/m2 (95% UI: [0.01 kg/m2, 0.03 kg/m2]) and cost $6.4 million. Intervention effects were modeled to yield 4,470 (95% UI: [1,692, 8992]) lifetime DALYs averted in the total population. The intervention was cost saving, with a net cost of -$26.2 million (95% UI: [-$4.2 million, -$57.9 million]) over the population's lifetime. Effects were due to changes in sugar sweetened beverage consumption and screen time. The intervention would save $5 per intervention dollar spent. Discussion: Changing childcare facility regulations can improve health and reduce long-term healthcare expenditures.

Learning Areas:

Biostatistics, economics
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Describe healthful policies related to nutrition, physical activities, and screen time viewing in licensed U.S. childcare facilities. Identify 2-3 strategies that can be used to reduce costs and improve health behaviors in the childcare setting. Assess potential costs associated with implementing nationwide changes to childcare facility regulations.

Keyword(s): Child Care, Cost-Effectiveness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a PhD in Health Policy with a concentration in Decision Sciences. My research to date has been focused on childhood obesity treatment and prevention. My specific research interests are in pediatric health economics and cost-effectiveness research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.