. 2020 Jun;23(9):1609-1617.

doi: 10.1017/S1368980019003999. Epub 2020 Mar 19.

The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis

Krycia Cowling¹, Elizabeth A Stuart², Roni A Neff³, Jon Vernick⁴, Daniel Magraw⁵, Keshia Pollack Porter⁶

Affiliations

¹ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD21205, USA.
² Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 839, Baltimore, MD21205, USA.
³ Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Room W7010, 615 N. Wolfe Street, Baltimore, MD21205, USA.
⁴ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 594, Baltimore, MD21205, USA.
⁵ Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Room 417, 1619 Massachusetts Avenue NW, Washington, DC20036, USA.
⁶ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 380A, Baltimore, MD21205, USA.

PMID: 32188524
PMCID: PMC10200605
DOI: 10.1017/S1368980019003999

The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis

Krycia Cowling et al. Public Health Nutr. 2020 Jun.

. 2020 Jun;23(9):1609-1617.

doi: 10.1017/S1368980019003999. Epub 2020 Mar 19.

Authors

Krycia Cowling¹, Elizabeth A Stuart², Roni A Neff³, Jon Vernick⁴, Daniel Magraw⁵, Keshia Pollack Porter⁶

Affiliations

¹ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Baltimore, MD21205, USA.
² Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 839, Baltimore, MD21205, USA.
³ Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Room W7010, 615 N. Wolfe Street, Baltimore, MD21205, USA.
⁴ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 594, Baltimore, MD21205, USA.
⁵ Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, Room 417, 1619 Massachusetts Avenue NW, Washington, DC20036, USA.
⁶ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Hampton House 380A, Baltimore, MD21205, USA.

PMID: 32188524
PMCID: PMC10200605
DOI: 10.1017/S1368980019003999

Abstract

Objective: To examine changes in sales of highly processed foods, including infant formulas, in countries joining free trade agreements (FTAs) with the US.

Design: Annual country-level data for food and beverage sales come from Euromonitor International. Analyses are conducted in a comparative interrupted time-series (CITS) framework using multivariate random-effects linear models, adjusted for key confounders: gross domestic product (GDP) per capita, percent of the population living in urban areas and female labor force participation rate. Memberships in other FTAs and investment treaties are also explored as possible confounders.

Setting: Changes are assessed between 2002 and 2016.

Participants: Ten countries joining US FTAs are compared with eleven countries without US FTAs in force; countries are matched on national income level, world region and World Trade Organization membership.

Results: After countries join a US FTA, sales are estimated to increase by: 0·89 (95 % CI 0·16, 1·6; P = 0·016) kg per capita per annum for ultra-processed products, 0·81 (95 % CI 0·47, 1·1; P < 0·001) kg per capita per annum for processed culinary ingredients and 0·17 (95 % CI 0·052, 0·29; P = 0·005) kg per capita under age 5 per annum for baby food. No significant change is estimated for minimally processed foods. In statistical models, large unexplained variations in country-specific trends suggest additional unmeasured country-level factors also impact sales trends following entry into US FTAs.

Conclusions: These findings strongly support the conclusion that joining US FTAs can contribute to detrimental changes in national dietary consumption that increase population risk of non-communicable diseases.

Keywords: Diet; Natural experiment; Noncommunicable diseases; Processed foods; Trade.

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Figures

**Fig. 1**
Annual mean per capita sales volumes (unadjusted for covariates) in exposed countries, all unexposed countries and matched unexposed countries (weighted), 2002–2016: (a) minimally processed foods, (b) processed culinary ingredients, (c) ultra-processed products and (d) baby foods. , exposed mean; , matched unexposed mean; , all unexposed mean. FTA, free trade agreements

formula image — **Fig. 1**
Annual mean per capita sales volumes (unadjusted for covariates) in exposed countries, all unexposed countries and matched unexposed countries (weighted), 2002–2016: (a) minimally processed foods, (b) processed culinary ingredients, (c) ultra-processed products and (d) baby foods. , exposed mean; , matched unexposed mean; , all unexposed mean. FTA, free trade agreements

See this image and copyright information in PMC

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References

1. Drewnowski A & Popkin BM (1997) The nutrition transition: new trends in the global diet. Nutr Rev 55, 31–43. - PubMed
1. Popkin BM (2006) Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. Am J Clin Nutr 84, 289–298. - PubMed
1. Lim SS, Vos T, Flaxman AD et al.. (2013) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2224–2260. - PMC - PubMed
1. Moodie R, Stuckler D, Monteiro C et al.. (2013) Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet 381, 670–679. - PubMed
1. Poti JM, Braga B & Quin B (2017) Ultra-processed food intake and obesity: what really matters for health – processing or nutrient content? Curr Obes Rep 6, 420–431. - PMC - PubMed

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The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis

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The relationship between joining a US free trade agreement and processed food sales, 2002-2016: a comparative interrupted time-series analysis

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