August 2011 HEALTH HOT TOPICS

RAND Research on Obesity Examines Consequences and Prevention Strategies

Over the past three decades, obesity rates have increased dramatically in the United States. An estimated one in five U.S. adults is now obese. A series of RAND studies have examined the causes of obesity and its economic and health consequences, as well as the potential benefits of prevention and the relative effectiveness of various prevention strategies. RAND research has found that

• Obesity increases the risk for a variety of diseases, including diabetes, heart disease, cancer, and arthritis. In fact, the health consequences of obesity are worse than those of smoking and problem drinking.
• Obesity also increases health care costs by 25 to 100 percent over the costs for persons of normal weight. Lowering obesity rates to their 1978 level by the year 2030 would decrease rates of diabetes, hypertension, and heart disease; increase longevity and years of disability-free life; and cut Medicare and Medicaid costs.
• Community and school-based prevention programs are among the most cost-effective for increasing physical activity.
• Residential neighborhood environments are associated with lower obesity rates, likely due to enhanced access to healthy foods and greater opportunities for physical activity.
• Improving the nutritional quality of school meals may help curb childhood obesity, but not if food outlets surrounding schools make unhealthy food easy to get.
• Substantially raising the price of junk food and soda may be a powerful way to discourage consumption of discretionary calories. However, existing soda taxes, which have increased the price of soda by a maximum of 4 percent, have had little effect on soda consumption or obesity rates.

Current RAND Health research continues to examine the potential for changes in the food environment, food intake, and exercise to prevent and control obesity. For example, one study is evaluating a comprehensive school-based prevention program under way in the Los Angeles Unified School District. The results of this and similar research should prove vital in shaping policies to prevent obesity.

READ THE RESEARCH BRIEF: Preventing Obesity and Its Consequences: Highlights of RAND Health Research

Improving the Accuracy of Electronic Prescribing

Electronic prescribing (e-prescribing) systems hold the potential to prevent errors in prescribing and dispensing drugs. However, these systems are not working as well as they should because there has been no standard way of precisely identifying the drug that the prescriber intends.

A recent RAND study examined RxNorm, a drug nomenclature that describes drugs at a clinical level, capturing the way that prescribers think about drugs. The RAND analysis tested RxNorm's potential to improve the accuracy of ambulatory e-prescribing for new prescriptions, refill requests, and drug coverage information. The study compared RxNorm with the nomenclature most widely used, which represents each drug company's products separately. RxNorm better reflects a physician's intent in prescribing because it omits overly specific details--coding for a specific product from a specific company--not intended by the prescriber. Overspecification can cause confusion among pharmacists and sometimes requires pharmacies to recontact prescribers to clarify what was intended.

The RAND study found that RxNorm was complete, accurate, and usable in live tests between prescribers and pharmacies. The findings suggest that using RxNorm could improve the accuracy of the data that pharmacists receive, thereby improving communication between prescribers and pharmacies and boosting both parties' confidence in the system. Based on the results, the RAND team recommends that RxNorm be adopted as the primary drug identifier in e-prescribing systems.

READ THE RESEARCH BRIEF: How Should Drugs be Identified in Electronic Prescribing Systems?

Older Women in Higher-Poverty Neighborhoods Are More Likely to Have Worse Cognitive Functioning

Older women who live in higher-poverty neighborhoods are more likely to exhibit worse cognitive functioning than women who live in more affluent neighborhoods, according to a new RAND study. Researchers analyzed information from 6,137 women across the United States who were surveyed as part of the Women's Health Initiative Memory Study. Women from 39 locations who were at least 65 years old and free of dementia were enrolled in the memory study from May 1996 to December 1999. The women were given a standard test that measures cognitive function by assessing items such as memory, reasoning, and spatial ability.

The study found that after controlling for key demographic, behavioral, clinical, and psychosocial factors such as income, education, coronary heart disease, physical activity, and depressive symptoms, neighborhood socioeconomic status was still strongly related to older women's cognitive functioning. This study provides the best evidence to date that living in a neighborhood with lower socioeconomic standing in later life can harm women's cognitive abilities. The study also found that nonwhites may be particularly vulnerable to these effects. The researchers did not find, however, that an individual's income level or education had any effect on the relationship between neighborhood socioeconomic status and cognitive functioning.

Poor cognitive function late in life has been linked to steeper declines in cognitive function over time, which increases the risk of dementia, including Alzheimer's disease. The results suggest that policies intended to improve neighborhood socioeconomic status or public health interventions that target risk factors such as poor health behaviors and facilitate social support among women in lower-income neighborhoods may also provide some protection against harmful neighborhood effects on cognitive functioning.

READ MORE: Older Women More Likely to Have Lower Cognitive Function if They Live in Low-Income Neighborhoods

RAND Health conducts objective research on health, health behavior, and health policy. Access to all RAND Health research is available at www.rand.org/health.html.

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