• Katie A Meyer, David K Guilkey, Shu Wen Ng, Kiyah J Duffey, Barry M Popkin, Catarina I Kiefe, Lyn M Steffen, James M Shikany, and Penny Gordon-Larsen.
• Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill.
• JAMA Intern Med. 2014 Mar 1; 174 (3): 434-42.

ImportanceFiscal food policies (eg, taxation) are increasingly proposed to improve population-level health, but their impact on health disparities is unknown.ObjectiveTo estimate subgroup-specific effects of fast food price changes on fast food consumption and cardiometabolic outcomes.Design, Setting, And ParticipantsTwenty-year follow-up (5 examinations) in a biracial US prospective cohort: Coronary Artery Risk Development in Young Adults (CARDIA) (1985/1986-2005/2006, baseline N = 5115). Participants were aged 18 to 30 years at baseline; design indicated equal recruitment by race (black vs white), educational attainment, age, and sex. Community-level price data from the Council for Community and Economic Research were temporally and geographically linked to study participants' home address at each examination.Main Outcomes And MeasuresParticipant-reported number of fast food eating occasions per week, body mass index (BMI), and homeostasis model assessment insulin resistance (HOMA-IR) from fasting glucose and insulin concentrations. Covariates included individual-level and community-level social and demographic factors.ResultsIn repeated measures regression analysis, multivariable-adjusted associations between fast food price and consumption were nonlinear (quadratic, P < .001), with significant inverse estimated effects on consumption at higher prices; estimates varied according to race (interaction P = .04), income (P = .07), and education (P = .03). At the 10th percentile of price ($1.25/serving), blacks and whites had mean fast food consumption frequency of 2.20 (95% CI, 2.07-2.33) and 1.55 (1.45-1.65) times/wk, respectively, whereas at the 90th percentile of price ($1.53/serving), respective mean consumption estimates were 1.86 (1.75-1.97) and 1.50 (1.41-1.59) times/wk. We observed differential price effects on HOMA-IR (inverse for lower educational status only [interaction P = .005] and at middle income only [interaction P = .02]) and BMI (inverse for blacks, less education, and middle income; positive for whites, more education, and high income [all interaction P < .001]).Conclusions And RelevanceWe found greater fast food price sensitivity on fast food consumption and insulin resistance among sociodemographic groups that have a disproportionate burden of chronic disease. Our findings have implications for fiscal policy, particularly with respect to possible effects of fast food taxes among populations with diet-related health disparities.

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