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Hospitals Reducing Sugar

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Looking at Sugar-Sweetened Beverages
from a Health Care Management and Economics Viewpoint

bedassa and kayla
Bedassa Tadesse and Kayla Engebretson

Bedassa Tadesse helped UMD senior Kayla Engebretson take her study of sugar-sweetened beverages (SSBs) in hospitals from a qualitative study in health care management to a quantitative study in economics. It all happened through the Undergraduate Research Opportunities Program (UROP).

Tadesse, an associate professor of economics in the Labovitz School of Business and Economics, said that when Engebretson arrived in his senior seminar, the Economic Research Methodology class, her project was ideal for a UROP. Tadesse said his class examines global economics issues. “It’s important to work with students to do real world research, and Kayla had a project that was relevant in her field,” Tadesse said. He cited several reasons for encouraging UROPs. “It's an opportunity for me as a professor to work one-on-one with a student and that gives me satisfaction. The class also gets to see what a significant research project involves, and the students also have an outstanding addition for their portfolio.”

Engebretson, a double major in health care management and economics, based her project on researching trends in health care management policy to eliminate or reduce Sugar Sweetened Beverages (SSBs).

Tadesse said Engebretson’s project is important and would be a good candidate for a grant to finish the research. Tadesse knows. He is one of the economics faculty members with the most UROP students. “I’ve been an advisor for two to three UROPs a year since 2003,” he said. “Students like Kayla benefit immensely from them.”

Because Engebretson is such a fan of UROPs as well, she presented an informational session to the first-year students. “Most students, even juniors and seniors, don’t even know what they are,” she said.

For her UROP, Engebretson started with facts: In 2009 over 63% of adults in the U.S. were either overweight or obese, and the numbers continue to rise. The Centers for Disease Control and Prevention lists decreasing the consumption of sugar-sweetened beverages as one of its top strategies for preventing and reducing excessive weight and obesity issues. As a health care management major, Engebretson has been interested in a national trend by the health care community, especially hospitals, to combat obesity through policy interventions such as eliminating or reducing the sale of SSBs. Many hospitals are taking SSBs out of their vending machines, out of the cafeteria, and off the patient menus.

Engebretson’s work on SSBs began with an internship in Duluth at the nonprofit organization, the Institute for a Sustainable Future. In 2010, she worked on a qualitative study of SSBs with Executive Director Jamie Harvie, an internationally recognized toxics expert and advocate for sustainable health care food.

Engebretson and Tadesse were then able to gather public data from every hospital in the U.S. about the type of hospital (children, trauma, acute care, etc), how many beds, revenue, region, private or government funded, length of patient stay, as well as a number of other categories.

Finding the answers to three core questions became the main focus for Engebretson's study: Is the hospital taking the initiative to reduce SSBs; is the hospital taking the initiative to eliminate SSBs; and does the hospital have a pouring rights agreement. Tracking down the answers proved to be harder than either Engebretson or Tadesse expected.

Engebretson found it difficult to get the primary data from the hospitals. She e-mailed, mailed, and phoned hospitals. The phone calls were the most difficult. “Sometimes I went through five different people to find out who could answer the question,” she said. “When I did find the right person, they were often out of town, out of the office, or they didn't answer my calls.” Because there are nearly 6,000 hospitals in the U.S., an ideal survey size of about 1,000 hospitals, or 6 percent, would have been statistically relevant. Engebretson was able to gather good data from 131 hospitals.

Engebretson did find interesting trends in her sample. The results revealed that hospitals in the Northeast are more likely to take action and reduce access to SSBs. She found that hospitals are less likely to take action or reduce SSBs if they have a pouring rights contract: an exclusive agreement with an outside beverage vendor which controls the distribution of beverages in the facility.

Engebretson said her two majors work together in research and in a career. “A good health care professional needs a good background in economics,” she said.

Written by Cheryl Reitan, December 2011.

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