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Anderson CE, Whaley SE, Goran MI. The neighborhood food environment modifies the association between infant feeding and childhood obesity. BMC Public Health 2024; 24:1264. [PMID: 38720256 PMCID: PMC11080259 DOI: 10.1186/s12889-024-18755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) issues infant formula to infants who are not fully breastfed, and prior research found elevated obesity risk among children receiving lactose-reduced infant formula with corn syrup solids (CSSF) issued by WIC. This study was conducted to evaluate associations between a broader set of specialty infant formulas issued by WIC and child obesity risk, whether neighborhood context (e.g. neighborhood food environment) modifies associations, and whether racial/ethnic disparities in obesity are partly explained by infant formula exposure and neighborhood context. METHODS WIC administrative data, collected from 2013-2020 on issued amount (categorical: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and type of infant formula (standard cow's milk formula, and three specialty formulas: any CSSF, any soy-based formula, and any cow's milk-based formula with added rice starch) and obesity at ages 2-4 years (defined as a Body Mass Index z-score ≥ 95th percentile according to World Health Organization growth standard) were used to construct a cohort (n = 59,132). Associations of infant formula exposures and race/ethnicity with obesity risk were assessed in Poisson regression models, and modification of infant feeding associations with obesity by neighborhood context was assessed with interaction terms. RESULTS Any infant formula exposure was associated with significantly higher obesity risk relative to fully breastfeeding. Receipt of a CSSF was associated with 5% higher obesity risk relative to the standard and other specialty infant formulas (risk ratio 1.05, 95% confidence interval 1.02, 1.08) independent of breastfeeding duration and receipt of other specialty infant formulas. The association between CSSF and obesity risk was stronger in neighborhoods with healthier food environments (10% higher risk) compared to less healthy food environments (null). Racial/ethnic disparities in obesity risk were robust to adjustment for infant formula exposure and neighborhood environment. CONCLUSIONS Among specialty infant formulas issued by WIC, only CSSFs were associated with elevated obesity risk, and this association was stronger in healthier food environments. Future research is needed to isolate the mechanism underlying this association.
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Affiliation(s)
- Christopher E Anderson
- Division of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, a Program of Heluna Health, 13181 Crossroads Parkway N #540, City of Industry, CA, 91746, USA.
| | - Shannon E Whaley
- Division of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, a Program of Heluna Health, 13181 Crossroads Parkway N #540, City of Industry, CA, 91746, USA
| | - Michael I Goran
- Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
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Anderson CE, Goran MI, Whaley SE. Any Infant Formula Amount, but Not Infant Formula Type, Is Associated with Less Healthful Subsequent Beverage Intake among Special Supplemental Nutrition Program for Women, Infants, and Children-Participating Children. Curr Dev Nutr 2024; 8:102094. [PMID: 38419833 PMCID: PMC10897848 DOI: 10.1016/j.cdnut.2024.102094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrition assistance to low-income households, including infant formula for infants not fully breastfeeding. Issuance of lactose-reduced infant formula made with corn syrup solids (CSSF) is associated with elevated risk of obesity in early life, but associations between formula type and dietary intake have not been examined. Objectives To evaluate associations between infant formula (amount and type) issued by WIC with subsequent child diet at ages 12-59 mo. Methods Dietary data from 2014, 2017, and 2020 Los Angeles County WIC Survey respondents (n = 1339 children, 12-59 mo of age) were merged with WIC administrative data on infant feeding (amount and type of infant formula at ages 0-12 mo). Intake frequencies were available for sweetened beverages, sweets, juice, fast food, water, fruit, vegetables, and milk. Infant feeding was categorized by amount of WIC-issued formula (descending: fully formula fed, mostly formula fed, mostly breastfed, fully breastfed) and issuance of a CSSF (any, none). Associations between infant feeding (infant formula amount and type) and child diet were evaluated in multivariable generalized estimating equation negative binomial regression models, stratified by child age (12 to <24 mo, 24 to <60 mo). Results Any infant formula issuance in the first year of life was adversely associated with subsequent dietary intake. This included 21%-23% higher 100% juice intake at 24 to <60 mo and 11%-13% (at 24 to <60 mo) or 20%-22% (at 12 to <24 mo) lower water intake. CSSF receipt compared with only other infant formula was not consistently associated with subsequent child diet. Conclusions Any infant formula amount, but not CSSF receipt compared with other formula types, was associated with less healthful beverage intake patterns among WIC-participating children. WIC nutrition education may have a stronger impact if tailored based on infant feeding practices.
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Affiliation(s)
- Christopher E Anderson
- Division of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, a program of Heluna Health, City of Industry, CA, United States
| | - Michael I Goran
- Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, United States
| | - Shannon E Whaley
- Division of Research and Evaluation, Public Health Foundation Enterprises (PHFE) WIC, a program of Heluna Health, City of Industry, CA, United States
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Caruso OT, McEachern LW, Minaker LM, Gilliland JA. The Influence of the School Neighborhood Food Retail Environment on Unhealthy Food Purchasing Behaviors Among Adolescents: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:145-161. [PMID: 38284954 DOI: 10.1016/j.jneb.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Adolescents are often exposed to food retailers selling unhealthy food items during their lunch breaks and school commutes. This systematic review examines the influence of school neighborhood food retail environments on adolescent food purchasing. METHODS A systematic search of 6 databases. Observational studies published from January 2012 to December 2022 that measured food availability, accessibility, or exposure, measured food purchasing, and focused on adolescents (aged 10-19 years) were eligible for inclusion. RESULTS Twelve studies with 97 findings were included. Thirty-one findings indicated that a school neighborhood with a high density of unhealthy food retail, a school with unhealthy food retail nearby, or exposure to unhealthy food retail on the journey to/from school was associated with higher prevalence and frequency of unhealthy food purchases. DISCUSSION Adolescents' food purchasing behaviors may be meaningfully affected by their school neighborhood food retail environment; however, the included studies have many methodological shortcomings. IMPLICATIONS FOR RESEARCH AND PRACTICE Results identify the need for new studies that measure food purchasing, use comprehensive definitions of food retail environments, and adopt more rigorous methods to approximate exposure to food retail. More robust evidence would strengthen the rationale for policy or program interventions and potentially indicate specific targets for intervention.
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Affiliation(s)
- Olivia T Caruso
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Louise W McEachern
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography and Environment, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Department of Pediatrics, Western University, London, Ontario, Canada; School of Health Studies, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
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Baker K, Burd L, Figueroa R. Consumer nutrition environment measurements for nutrient-dense food availability and food sustainability: a scoping review. Arch Public Health 2024; 82:7. [PMID: 38225657 PMCID: PMC10789067 DOI: 10.1186/s13690-023-01231-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024] Open
Abstract
Consumer nutrition environments are defined as places in which consumers interact with the food they eat; these food choices can impact human and planetary health. Assessment measures for consumer nutrition environments are numerous, and vary widely on what, and how, they assess the food environment. The objective of this scoping review was to synthesize existing evidence on nutrition environment measurements and their capacity to assess nutrient-dense food access and food sustainability capacity. Eligibility criteria were developed to capture relevant peer-reviewed literature about auditing measures designed to assess nutrient-dense foods and food sustainability capacity in the consumer nutrition environment. A search strategy was conducted to collect articles published between January 1, 2002-June 4, 2022, using PubMed, Web of Science, Scopus, PsycINFO and the Cochrane library electronic databases. After screening 2457 manuscripts, 58 met inclusion criteria. Study aims, funding source(s), types of retailers assessed, assessment format and name, constructs measured, food categories measured, assessment of validity and/or reliability, and other relevant data were extracted from each manuscript. Results showed that most measures use checklists, surveys, questionnaires or similar methods to assess availability, quality, and price of select food items as assessment constructs. Most do not assess nutrient-dense food availability, and even fewer assess food sustainability. Development of comprehensive, reliable, and valid consumer nutrition environment measures that assess nutrient-dense food availability and food sustainability is important for research, planning, evaluation and advocacy aimed at improving consumer food environments for human and planetary health.
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Affiliation(s)
- Katherine Baker
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA.
| | - Laura Burd
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Roger Figueroa
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Gardone DS, Novaes JF, de Albuquerque FM, Filgueiras MDS, Novaes TG, Mendes LL, Pessoa MC. Community food environment and childhood obesity in a medium-sized Brazilian city: An approach to school and neighborhood environments. Am J Hum Biol 2023; 35:e23935. [PMID: 37318148 DOI: 10.1002/ajhb.23935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/12/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE We aimed to analyze the relationship of community food environments with childhood obesity in a medium-sized Brazilian city. METHODS This is a cross-sectional study with 366 schoolchildren aged 8 and 9 years. Children's body mass index (BMI), waist circumference and concentrations of total cholesterol (TC), high cholesterol density lipoprotein (HDL-c), low cholesterol density lipoprotein (LDL-c) and triglycerides (TG) were measured. The parent's nutritional status was assessed by calculating the BMI. All food stores within a 200- and 400-m radius buffers of schools and households were evaluated. The food stores were classified as healthy, unhealthy, and mixed according to the predominance of foods commercialized. Binary logistic regression models were proposed for each category. RESULTS Over seventy percent (70.2%) of the food stores were categorized as "unhealthy". The prevalence of obesity was 15.6%. In the 200-m buffer around schools, there was an inverse and direct association between obesity and the presence of healthy food stores and unhealthy food stores, respectively. Around the households, there was an inverse association between the presence of healthy food stores and obesity in both buffers. CONCLUSION The community food environment may be protective or potentiating childhood obesity, depending on the access and types of food sold.
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Affiliation(s)
- Danielle Soares Gardone
- Departamento de Nutrição, Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Juliana Farias Novaes
- Departamento de Nutrição e Saúde, Programa de Pós Graduação em Ciência da Nutrição, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Fernanda Martins de Albuquerque
- Departamento de Nutrição e Saúde, Programa de Pós Graduação em Ciência da Nutrição, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | - Mariana De Santis Filgueiras
- Departamento de Nutrição e Saúde, Programa de Pós Graduação em Ciência da Nutrição, Universidade Federal de Viçosa (UFV), Viçosa, Brazil
| | | | - Larissa Loures Mendes
- Departamento de Nutrição, Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Milene Cristine Pessoa
- Departamento de Nutrição, Programa de Pós Graduação em Nutrição e Saúde, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Vandevijvere S, Van Dam I, Inaç Y, Smets V. Unhealthy food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium): a detailed assessment. Arch Public Health 2023; 81:154. [PMID: 37608383 PMCID: PMC10463948 DOI: 10.1186/s13690-023-01175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION The supermarket food environment is a key setting for potential public health interventions. This study assessed food availability, prominence and promotion in a representative sample of supermarkets in Flanders (Belgium). METHODS A sample of 55 supermarkets across five chains and 16 Flemish municipalities was selected in 2022, about 64% in the most deprived socioeconomic areas. Healthiness indicators related to food availability (ratio of cumulative linear shelf length for healthy versus unhealthy foods), prominence (proportion of unhealthy foods at check-outs and end-of-aisle endcaps), and promotion (food marketing on food packages) were measured. RESULTS Overall, the average ratio of healthy/unhealthy foods in supermarkets in Flanders was 0.36, meaning that for every 10m of shelf length of unhealthy foods there was 3.6m of healthy foods. There was a large variation in ratio's across supermarket chains. Of all foods available, 97.5% were ultra-processed at the check outs, while 72.2% and 58.5% were ultra-processed at the front and back end-of-aisle end-caps, respectively. Confectionery and sweet biscuits were the food categories with on average the highest number of marketing messages on pack per 10m of shelf length. CONCLUSION Supermarket in-store food environments in Flanders were found generally unhealthy, with those located in low income areas having unhealthier in-store food environments than supermarkets located in medium and high income areas. Despite commitments of all large supermarket chains in Flanders to promote and create healthier in-store food environments, our findings indicate that currently consumers are incentivized to buy unhealthy rather than healthy food products.
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Affiliation(s)
- Stefanie Vandevijvere
- Department of Epidemiology and Public Health, J. Wytsmanstraat 14, 1050, Brussels, Belgium.
| | - Iris Van Dam
- Department of Epidemiology and Public Health, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Yasemin Inaç
- Department of Epidemiology and Public Health, J. Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Vincent Smets
- Department of Epidemiology and Public Health, J. Wytsmanstraat 14, 1050, Brussels, Belgium
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Falbe J, Marinello S, Wolf EC, Solar SE, Schermbeck RM, Pipito AA, Powell LM. Food and Beverage Environments at Store Checkouts in California: Mostly Unhealthy Products. Curr Dev Nutr 2023; 7:100075. [PMID: 37250387 PMCID: PMC10213198 DOI: 10.1016/j.cdnut.2023.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background As the only place in a store where customers must pass through, checkouts may be especially influential over purchases. Research is needed to understand the healthfulness of checkout environments. Objectives The objective of this study was to classify checkout product facings in California food stores. Methods In a cross-sectional study, 102 stores, including chains (dollar stores, drugstores, specialty food stores, supermarkets, and mass merchandisers) and independent supermarkets and grocery stores were sampled from 4 northern California cities. Observational assessments of each checkout product facing were conducted in February 2021 using the Store CheckOUt Tool. Facings were classified by category and healthfulness, defined by meeting Berkeley's Healthy Checkout Ordinance's healthy checkout standards: unsweetened beverages and specific foods containing ≤5 g added sugar and ≤200 mg sodium per serving. Log binomial regressions compared healthfulness by store and checkout characteristics. Results Of 26,758 food and beverage checkout facings, the most common categories were candy (31%), gum (18%), sugar-sweetened beverages (SSBs; 11%), salty snacks (9%), mints (7%), and sweets (6%). Water represented only 3% and fruits and vegetables 1% of these facings. Only 30% of food and beverage facings met Berkeley's healthy checkout standards, with 70% not meeting the standards. The percentage of food and beverage facings not meeting the standards was even higher (89%) among snack-sized packages (≤2 servings/package). Compared with chain supermarkets, mass merchandisers, and specialty food stores (34%-36%), dollar and independent grocery stores had a lower percentage of food and beverage facings that met the healthy checkout standards (18%-20%; P < 0.05). Compared with lane and register areas (35%), endcaps and snaking sections within checkouts had fewer food and beverage facings that met the standards (21%-23%; P < 0.001). Conclusions Most foods and beverages at checkout consisted of candy, SSBs, salty snacks, and sweets and failed to meet the healthy checkout standards.Curr Dev Nutr 2023;xx:xx.
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Affiliation(s)
- Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Samantha Marinello
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Ethan C. Wolf
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
- Public Health Nutrition Program, Community Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, United States
| | - Sarah E. Solar
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Andrea A. Pipito
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
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Mjöberg M, Lissner L, Hunsberger M. Supermarket promotions in Western Sweden are incompatible with Nordic dietary recommendations and differ by area-level socioeconomic index. BMC Public Health 2023; 23:795. [PMID: 37118718 PMCID: PMC10148457 DOI: 10.1186/s12889-023-15729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Large supermarket chains produce weekly advertisements to promote foods and influence consumer purchases. The broad consumer reach of these ads presents an opportunity to promote foods that align with dietary recommendations. Thus, the aim of this study was to investigate the health quality of supermarkets' weekly food promotions in a large region of Sweden with attention to more and less advantaged socioeconomic index areas. METHODS Analysis of weekly advertisements from 122 individual stores, representing seven chains, was carried out in a large region of Sweden from 2-29 March in 2020. Food promotions were divided into categories according to the Nordic Nutrition Recommendations and World Health Organization Regional Office for Europe's nutrient profile model, and defined as 'most healthy', 'healthy', 'unhealthy' and 'most unhealthy'. A mean socioeconomic index was used to classify each store location to determine whether proportions of the 'most unhealthy' foods differed between more advantaged and more disadvantaged socioeconomic index areas. RESULTS In total, 29,958 food items were analyzed. Two-thirds of promotions belonged to the food groups considered 'most unhealthy' and 'unhealthy'. In the 'most unhealthy' food group 'sugar-rich beverages and foods' constituted approximately 23.0% of the promotions. Food promotions had 25% increased odds to be from the 'most unhealthy' group (odds ratio 1.25, confidence interval 1.17, 1.33) in more disadvantaged socioeconomic index areas. This association could be explained by the supermarket chain the stores belonged to. CONCLUSIONS Our findings indicate that Swedish supermarkets promote a large proportion of unhealthy foods as classified by the Nordic Nutrition Recommendations. We also observe that certain national supermarket chains tend to locate their stores in more disadvantaged areas and promote a greater proportion of unhealthy foods in their weekly advertisements compared to the more advantaged areas. There is an urgent need for supermarkets to shift promotions toward healthier food items.
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Affiliation(s)
- Melissa Mjöberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monica Hunsberger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Winkler LL, Toft U, Glümer C, Bloch P, Buch-Andersen T, Christensen U. Involving supermarkets in health promotion interventions in the Danish Project SoL. A practice-oriented qualitative study on the engagement of supermarket staff and managers. BMC Public Health 2023; 23:706. [PMID: 37072841 PMCID: PMC10111755 DOI: 10.1186/s12889-023-15501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Supermarkets have been suggested as relevant settings for environmental and educational initiatives encouraging healthier shopping and eating decisions, but in the literature, limited attention has been paid to the context, perspectives, and everyday practices of supermarket staff. The aim of this study was to examine the engagement of supermarket staff in a health promotion project from a practice-oriented perspective. METHODS The study was based on qualitative data collected in the supermarket setting of Project SoL; a community-based health promotion project in Denmark. We conducted 26 in-depth interviews with store managers and other key staff members in seven participating supermarkets. In addition, we collected data on planning, implementation, and perceptions of supermarket staff of in-store interventions and other project-related activities. These field data included short telephone interviews, observational notes, photos, and audiotapes of meetings. Data were analysed from the perspective of practice theory. RESULTS Although supermarket staff found community-based health promotion meaningful to engage in, the study observed that their engagement was challenged by a business mindset, practical routines and structural requirements favouring sales promotion over health promotion. Nevertheless, there were also examples of how health promotion activities and ways of thinking were successfully incorporated in everyday staff practices during and after Project SoL. CONCLUSIONS Our findings point to both potentials and challenges for using supermarkets as settings for health promotion. The voluntary engagement of supermarket staff in community-based health projects cannot stand alone but should be supplemented by more long-lasting strategies and policies regulating this and other food environments. Context-sensitive and practice-oriented analyses in local food environments could inform such strategies and policies to make sure they target unwanted elements and practices and not just individual behavior.
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Affiliation(s)
- Lise L Winkler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark.
| | - Ulla Toft
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Charlotte Glümer
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
- Center for Diabetes, Vesterbrogade 121, 3rd floor, København V, 1620, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark
| | - Tine Buch-Andersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, København K, 1123, Denmark
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Thapa K, Rajbhandari-Thapa J, Hanks A, Lee JS, Zhen C. Sugar sweetened beverage restriction or fruit and vegetable purchase incentive in Supplemental Nutrition Assistance Program (SNAP): Participant’s voice and choice behavior. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2023. [DOI: 10.1080/19320248.2023.2179448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- Kiran Thapa
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA
| | | | - Andrew Hanks
- Department of Human Sciences, Ohio State University, Columbus, GA, USA
| | - Jung Sun Lee
- Department of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Chen Zhen
- Department of Agriculture and Applied Economics, University of Georgia, Athens, GA, USA
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Zick CD, Curtis DS, Meeks H, Smith KR, Brown BB, Kole K, Kowaleski-Jones L. The changing food environment and neighborhood prevalence of type 2 diabetes. SSM Popul Health 2023; 21:101338. [PMID: 36691490 PMCID: PMC9860365 DOI: 10.1016/j.ssmph.2023.101338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023] Open
Abstract
In this ecological study, we used longitudinal data to assess if changes in neighborhood food environments were associated with type 2 diabetes mellitus (T2DM) prevalence, controlling for a host of neighborhood characteristics and spatial error correlation. We found that the population-adjusted prevalence of fast-food and pizza restaurants, grocery stores, and full-service restaurants along with changes in their numbers from 1990 to 2010 were associated with 2015 T2DM prevalence. The results suggested that neighborhoods where fast-food restaurants have increased and neighborhoods where full-service restaurants have decreased over time may be especially important targets for educational campaigns or other public health-related T2DM interventions.
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Affiliation(s)
- Cathleen D. Zick
- Department of Family and Consumer Studies, University of Utah, USA,Corresponding author. 225 S. 1400 E. Rm. 228, University of Utah, Salt Lake City, UT, 84112, USA.
| | - David S. Curtis
- Department of Family and Consumer Studies, University of Utah, USA
| | - Huong Meeks
- Department of Pediatrics, University of Utah, USA
| | - Ken R. Smith
- Department of Family and Consumer Studies, University of Utah, USA
| | - Barbara B. Brown
- Department of Family and Consumer Studies, University of Utah, USA
| | - Kyle Kole
- Department of Family and Consumer Studies, University of Utah, USA
| | - Lori Kowaleski-Jones
- Department of Family and Consumer Studies, University of Utah, USA,NEXUS Institute, University of Utah, USA
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12
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Adjei AP, Amevinya GS, Quarpong W, Tandoh A, Aryeetey R, Holdsworth M, Agyemang C, Zotor F, Laar ME, Mensah K, Addo P, Laryea D, Asiki G, Sellen D, Vandevijvere S, Laar A. Availability of healthy and unhealthy foods in modern retail outlets located in selected districts of Greater Accra Region, Ghana. Front Public Health 2022; 10:922447. [PMID: 36438248 PMCID: PMC9682120 DOI: 10.3389/fpubh.2022.922447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Abstract
Background Intake of unhealthy foods is linked to the onset of obesity and diet-related non-communicable diseases (NCDs). Availability of unhealthy (nutritionally poor) foods can influence preference, purchasing and consumption of such foods. This study determined the healthiness of foods sold at modern retail outlets- supermarkets and mini-marts in the Greater Accra Region of Ghana. Methods All modern retail outlets located in six districts of Greater Accra were eligible. Those < 200 m2 of floor area and with permanent structures were categorized as mini-marts; and those ≥200 m2 as supermarkets. Shelf length of all available foods were measured. Healthiness of food was determined using two criteria - the NOVA classification and energy density of foods. Thus, ultra-processed foods or food items with >225 kcal/100 g were classified as unhealthy. The ratio of the area occupied by unhealthy to healthy foods was used to determine the healthiness of modern retail outlets. Results Of 67 retail outlets assessed, 86.6% were mini-marts. 85.0% of the total SHELF area was occupied by foods categorized as unhealthy (ranging from 9,262 m2 in Ashiaman Municipality to 41,892 m2 in Accra Metropolis). Refined grains/grain products were the most available, occupying 30.0% of the total food shelf space, followed by sugar-sweetened beverages (20.1% of total shelf space). The least available food group-unprocessed staples, was found in only one high income district, and occupied 0.1% of the total food shelf space. Retail outlets in two districts did not sell fresh fruits or fresh/unsalted canned vegetables. About two-thirds of food products available (n = 3,952) were ultra-processed. Overall, the ratio of ultra-processed-to-unprocessed foods ranged from 3 to 7 with an average (SD) of 5(2). Thus, for every healthy food, there were five ultra-processed ones in the studied retail outlets. Conclusion This study reveals widespread availability of ultra-processed foods in modern retail outlets within the selected districts. Toward a healthier food retail environment, public health and food regulators, in partnership with other stakeholders need to institute measures that improve availability of healthy foods within supermarkets and mini-marts.
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Affiliation(s)
- Akosua Pokua Adjei
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Gideon Senyo Amevinya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Wilhemina Quarpong
- Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, GA, United States
| | - Akua Tandoh
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Richmond Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Michelle Holdsworth
- UMR MoISA (Montpellier Interdisciplinary Centre on Sustainable Agri-Food Systems), (Univ Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD), Montpellier, France
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Matilda E. Laar
- Department Family and Consumer Sciences, School of Agriculture, University of Ghana, Accra, Ghana
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, University of Ghana, Accra, Ghana
| | - Phyllis Addo
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Dennis Laryea
- Non-Communicable Disease Programme, Ghana Health Service, Accra, Ghana
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Sellen
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Amos Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana,*Correspondence: Amos Laar
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Ortiz-Hernández L, Romo-Avilés M, Rosales Chavez JB. Main Retailers In Which Mexican Households Acquire Their Food Supply. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:718-727. [PMID: 35953123 DOI: 10.1016/j.jneb.2022.04.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the frequency of food and beverages purchased made by Mexican households at different types of grocery retailers. DESIGN A national cross-sectional survey. SETTING Mexico. PARTICIPANTS A representative sample of Mexican households (n = 70,311). MAIN OUTCOME MEASURE(S) Household food and beverages purchases. ANALYSIS The association between amounts of food and beverages supply bought in different food retailers (as outcome) and households' sociodemographic characteristics (as covariates) was assessed using logistic and linear regression models. RESULTS Mexican households acquired their food and beverages primarily from abarrotes stores, followed by supermarkets and mercados and tianguis. Abarrotes stores and supermarkets were sources of unprocessed and processed foods. Specialized stores, mercados, and tianguis were primary sources of unprocessed foods. Households with low socioeconomic status and those in the central or southern regions acquired more foods from abarrotes stores, mercados and tianguis, and specialized stores. Households with high socioeconomic status and living in the northern region acquired more foods from supermarkets and convenience stores. CONCLUSIONS AND IMPLICATIONS Abarrotes stores are the primary source of food and beverages for Mexican households; however, some interventions are needed to increase their supply of unprocessed foods. Public health interventions aiming at increasing access to unprocessed foods could be done through traditional retailers.
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Affiliation(s)
- Luis Ortiz-Hernández
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Ciudad de México, México.
| | - Mariana Romo-Avilés
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Ciudad de México, México
| | - Jose B Rosales Chavez
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ
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Rummo P, Sze J, Elbel B. Association Between a Policy to Subsidize Supermarkets in Underserved Areas and Childhood Obesity Risk. JAMA Pediatr 2022; 176:646-653. [PMID: 35532919 PMCID: PMC9086932 DOI: 10.1001/jamapediatrics.2022.1153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The establishment and renovation of supermarkets may promote healthy diet practices among youth by increasing retail infrastructure for fresh foods. OBJECTIVE To estimate the association between the Food Retail Expansion to Support Health (FRESH) program and the weight status of children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Using a difference-in-differences (DiD) design and including 12 months before and after a FRESH supermarket opened, data were analyzed for residentially stable public school students in kindergarten through 12th grade with objectively measured height and weight data from the academic years 2009 through 2016. Of the 8 FRESH-subsidized supermarkets in residential neighborhoods in New York City, New York, 5 were new and 3 were renovation projects between December 2011 and June 2014. Data were analyzed from June 2021 to January 2022. INTERVENTIONS The treatment group included students who resided within 0.50 miles of a FRESH-subsidized supermarket and had at least 1 body mass index (BMI) measurement within 12 months before and 3 to 12 months after the month a FRESH supermarket opened (n = 22 712 student-year observations). A 2-stage matching-weighting approach was used to construct a control group of students who resided more than 0.50 miles from a FRESH supermarket in a FRESH-eligible area (n = 86 744 student-year observations). MAIN OUTCOMES AND MEASURES BMI z score was calculated using objectively measured height and weight data from FITNESSGRAM, an annual, school-based, standardized fitness assessment of every New York City public school student. Obesity was defined as 95th percentile or greater of the BMI z score using Centers for Disease Control and Prevention growth charts. RESULTS The treatment group in the analytic sample had 11 356 students (22 712 student-year observations), and the control group had 43 372 students (86 744 student-year observations). The students were predominately Black (18.8%) and Hispanic and Latino (68.5%) and eligible for free or reduced-priced lunch (84.6%). There was a significant decrease in BMI z score among students who resided within 0.50 miles of a FRESH supermarket (vs control group students) in the 3- to 12-month follow-up period (DiD, -0.04; 95% CI, -0.06 to -0.02). This was true for those exposed to supermarkets that were either new (DiD, -0.07; 95% CI, -0.11 to -0.03) or renovated (DiD, -0.03; 95% CI, -0.06 to -0.01). A statistically significant decrease was also observed in the likelihood of obesity (DiD, -0.01; 95% CI, -0.02 to -0.002). CONCLUSIONS AND RELEVANCE Government-subsidized supermarkets may contribute to a small decrease in obesity risk among children residing near those supermarkets, if part of a comprehensive policy approach.
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Affiliation(s)
- Pasquale Rummo
- New York University Grossman School of Medicine, Department of Population Health, New York
| | - Jeremy Sze
- New York University Grossman School of Medicine, Department of Population Health, New York
| | - Brian Elbel
- New York University Grossman School of Medicine, Department of Population Health, New York,Wagner Graduate School of Public Service, New York University, New York
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15
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Huang H. A Spatial Analysis of Obesity: Interaction of Urban Food Environments and Racial Segregation in Chicago. J Urban Health 2021; 98:676-686. [PMID: 34264475 PMCID: PMC8280681 DOI: 10.1007/s11524-021-00553-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
The obesity rate in Chicago has increased up to more than 30% in the last two decades. Obesity is a major problem in Chicago, where 36% of the city's high school students and 61% of adults in the metropolitan area are overweight or obese. Simultaneously, Chicago remains highly segregated by race-a phenomenon that begs for spatial analysis of health. Extant work exploring associations between the food retail environment and obesity has provided mixed findings, and virtually, none of this work has been done with the effects of the interaction between racial segregation and the food retail environment on obesity, where obesity rates are among the highest in the segregation area for the city defined by racial segregation. This study explores whether being overweight or obese is associated with urban food environments, such as access to different types of food retail outlets, and how its associations interact with racial factors, at the community level. This study uses the 2016-2018 data from the Healthy Chicago Survey to investigate the spatial variations in obesity and their association with food environments in Chicago. Also, this study examines the moderating effects of racial segregation on associations between obesity and access to food retail outlets. Using spatial statistics and regression models with interaction terms, this study assesses how the urban food environment can interact with racial segregation to explain the spatial distribution of obesity. The results indicate that the obesity population is highly concentrated in the African American community. In Chicago, each additional convenience store in a community is associated with a 0.42% increase in the obesity rate. Fast food restaurant access is predictive of a greater obesity rate, and grocery store access is predictive of less obesity rate in a community with a higher percentage of African American population. Findings can be used to promote equitable access to food retail outlets, which may help reduce broader health inequities in Chicago.
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Affiliation(s)
- Hao Huang
- Department of Social Sciences, Lewis College of Science and Letters, Illinois Institute of Technology, IL, Chicago, USA.
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Ajenikoko A, Ide N, Shivashankar R, Ge Z, Marklund M, Anderson C, Atun A, Thomson A, Henry ME, Cobb LK. Core Strategies to Increase the Uptake and Use of Potassium-Enriched Low-Sodium Salt. Nutrients 2021; 13:nu13093203. [PMID: 34579080 PMCID: PMC8466693 DOI: 10.3390/nu13093203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022] Open
Abstract
Excess sodium consumption and insufficient potassium intake contribute to high blood pressure and thus increase the risk of heart disease and stroke. In low-sodium salt, a portion of the sodium in salt (the amount varies, typically ranging from 10 to 50%) is replaced with minerals such as potassium chloride. Low-sodium salt may be an effective, scalable, and sustainable approach to reduce sodium and therefore reduce blood pressure and cardiovascular disease at the population level. Low-sodium salt programs have not been widely scaled up, although they have the potential to both reduce dietary sodium intake and increase dietary potassium intake. This article proposes a framework for a successful scale-up of low-sodium salt use in the home through four core strategies: availability, awareness and promotion, affordability, and advocacy. This framework identifies challenges and potential solutions within the core strategies to begin to understand the pathway to successful program implementation and evaluation of low-sodium salt use.
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Affiliation(s)
- Adefunke Ajenikoko
- Resolve to Save Lives, Vital Strategies, New York, NY 10005, USA; (A.A.); (N.I.); (R.S.); (Z.G.); (A.T.)
| | - Nicole Ide
- Resolve to Save Lives, Vital Strategies, New York, NY 10005, USA; (A.A.); (N.I.); (R.S.); (Z.G.); (A.T.)
| | - Roopa Shivashankar
- Resolve to Save Lives, Vital Strategies, New York, NY 10005, USA; (A.A.); (N.I.); (R.S.); (Z.G.); (A.T.)
- Indian Council of Medical Research (ICMR), New Delhi 110029, India
| | - Zeng Ge
- Resolve to Save Lives, Vital Strategies, New York, NY 10005, USA; (A.A.); (N.I.); (R.S.); (Z.G.); (A.T.)
| | - Matti Marklund
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21087, USA; (M.M.); (M.E.H.)
- The George Institute for Global Health, University of New South Wales, Sydney 2042, Australia
| | - Cheryl Anderson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, CA 92093, USA; (C.A.); (A.A.)
| | - Amy Atun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, CA 92093, USA; (C.A.); (A.A.)
| | - Alexander Thomson
- Resolve to Save Lives, Vital Strategies, New York, NY 10005, USA; (A.A.); (N.I.); (R.S.); (Z.G.); (A.T.)
| | - Megan E. Henry
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21087, USA; (M.M.); (M.E.H.)
| | - Laura K. Cobb
- Resolve to Save Lives, Vital Strategies, New York, NY 10005, USA; (A.A.); (N.I.); (R.S.); (Z.G.); (A.T.)
- Correspondence: ; Tel.: +1-212-500-5729
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Wallace LA, Paul R, Gholizadeh S, Zadrozny W, Webster C, Mayfield M, Racine EF. Neighborhood disadvantage and the sales of unhealthy products: alcohol, tobacco and unhealthy snack food. BMC Public Health 2021; 21:1361. [PMID: 34243730 PMCID: PMC8272253 DOI: 10.1186/s12889-021-11442-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals may use unhealthy coping mechanisms such as alcohol, tobacco, and unhealthy snack consumption. The purpose of this study was to assess how neighborhood disadvantage is associated with sales of alcohol, tobacco, and unhealthy snacks at stores of a discount variety store chain. METHODS Alcohol, tobacco, and unhealthy snack sales were measured monthly for 20 months, 2017-2018, in 16 discount variety stores in the United States. Mixed effects linear regressions adjusted for population size, with store-specific random effects, to examine the relationship of weekly unit sales with three outcome variables and neighborhood disadvantage, measured using the Area Deprivation Index (ADI). RESULTS The discount variety stores were located in neighborhoods where the median ADI percentile was 87 [interquartile range 83,89], compared to the median ADI percentile of 50 for all US communities, indicating that the stores were located in substantially disadvantaged neighborhoods. For every 1% increase in ADI, weekly unit sales of unhealthy snack food increased by 43 [95% confidence interval, CI 28-57], and weekly unit sales of tobacco products increased by 11.5 [95% CI 5-18] per store. No significant relationship between neighborhood disadvantage and the weekly unit sales of alcohol products was identified. CONCLUSIONS The positive relationship between neighborhood disadvantage and the sale of tobacco and snack foods may help explain the pathway between neighborhood disadvantage and poor health outcomes. It would be useful for future research to examine how neighborhood disadvantage influences resident health-related behaviors.
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Affiliation(s)
- Lauren A Wallace
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - Rajib Paul
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Shafie Gholizadeh
- College of Computing and Informatics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Wlodek Zadrozny
- College of Computing and Informatics, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Caitlan Webster
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Melanie Mayfield
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
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Gómez-Donoso C, Sacks G, Vanderlee L, Hammond D, White CM, Nieto C, Bes-Rastrollo M, Cameron AJ. Public support for healthy supermarket initiatives focused on product placement: a multi-country cross-sectional analysis of the 2018 International Food Policy Study. Int J Behav Nutr Phys Act 2021; 18:78. [PMID: 34127002 PMCID: PMC8201822 DOI: 10.1186/s12966-021-01149-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food retail environments have an influential role in shaping purchasing behavior and could contribute to improving dietary patterns at a population level. However, little is known about the level of public support for different types of initiatives to encourage healthy food choices in supermarkets, and whether this varies across countries or context. The current study aimed to explore the level of support for three potential supermarket initiatives focused on product placement across five countries, and factors that may influence this support. METHODS A total of 22,264 adults from Australia, Canada, Mexico, the United Kingdom and the United States (US) provided information on support for three supermarket initiatives related to product placement (targeting product positioning: 'checkouts with only healthy products', 'fewer end-of-aisle displays containing unhealthy foods or soft drinks' or availability: 'more shelf space for fresh and healthier foods') as part of the online 2018 International Food Policy Study. The proportion of respondents that supported each initiative was assessed across countries, and multivariable logistic regression analyses were conducted to evaluate the influence of sociodemographic factors on support. RESULTS The initiative that received the highest support was 'more shelf space for fresh and healthier foods': 72.0% [95% CI 71.3-72.7], whereas 'checkouts with only healthy products' received the lowest support: 48.6% [95% CI 47.8-49.4]. The level of support differed between countries (p < 0.001 for all initiatives), with the US generally showing the lowest support and Mexico the highest. Noteworthy, in the overall sample, there was not much opposition to any of the initiatives (2.5-14.2%), whereas there was a large proportion of neutral responses (25.5-37.2%). Respondents who were older, female, highly educated, and those who reported having more nutrition knowledge tended to be more supportive, with several differences between countries and initiatives. CONCLUSIONS Most people in the assessed five countries showed a generally high level of support for three placement initiatives in supermarkets to encourage healthy food choices. Support varied by type of initiative (i.e., product positioning or availability) and was influenced by several factors related to country context and sociodemographic characteristics. This evidence could prompt and guide retailers and policy makers to take stronger action to promote healthy food choices in stores.
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Affiliation(s)
- Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia
| | - Lana Vanderlee
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels, École de nutrition, Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia.
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Elorriaga N, Moyano DL, López MV, Cavallo AS, Gutierrez L, Panaggio CB, Irazola V. Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030944. [PMID: 33499044 PMCID: PMC7908167 DOI: 10.3390/ijerph18030944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/06/2023]
Abstract
There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.
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Affiliation(s)
- Natalia Elorriaga
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- National Scientific and Technical Research Council (CONICET), Center for Research on Epidemiology and Public Health (CIESP-IECS), Ciudad Autónoma de Buenos Aires C1414CPV, Argentina
- Escuela de Nutrición, Universidad de Buenos Aires (UBA), Ciudad Autónoma de Buenos Aires C1121ABG, Argentina
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
- Correspondence: ; Tel.: +54-011-4777-8767
| | - Daniela L. Moyano
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
| | - María V. López
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
| | - Ana S. Cavallo
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
| | - Camila B. Panaggio
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- National Scientific and Technical Research Council (CONICET), Center for Research on Epidemiology and Public Health (CIESP-IECS), Ciudad Autónoma de Buenos Aires C1414CPV, Argentina
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Association between Neighborhood Food Environment and Body Mass Index among Older Adults in Beijing, China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207658. [PMID: 33092232 PMCID: PMC7589694 DOI: 10.3390/ijerph17207658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the association between the neighborhood food environment and body mass index (BMI) among Chinese older adults. METHODS A multi-stage stratified random sampling method was used to recruit participants from 12 communities in Beijing, China, in 2019. Participants (n = 1764, 1034 women) in this study were older adults aged 65 to 80. We collected the participants' basic information, measured their height and weight, and calculated their BMI. Neighborhood food environments were measured by the density of and proximity to different food outlets using the Baidu Map Application Programming Interface. Adjusted multiple linear regression was performed to estimate the association between the food environment and BMI. RESULTS Participants had a mean age of 69.7 ± 4.32 years old and an average BMI of 26.3 ± 3.50 kg/m2. Among the three types of stores, convenience stores had the easiest access, followed by greengrocers and supermarkets. Sit-down restaurants had the best access among different restaurants, followed by Chinese fast-food restaurants, and western fast-food restaurants had the worst access. Easier access to greengrocers (β = 0.281, p < 0.001) and sit-down restaurants (β = 0.304, p < 0.001) was associated with higher BMI in the 250 m buffer zone. More supermarkets were associated with higher BMI in the 500 m buffer zone (β = 0.593, p < 0.001). Access to convenience stores was positively associated with BMI in the 800 m buffer zone (β = 0.057, p < 0.001). Better access to Chinese fast-food restaurants was associated with higher BMI (β = 0.071, p = 0.001), and better access to western fast- food restaurants was associated with lower BMI (β = -0.400, p < 0.001) in the 1000 m buffer zone. There was a negative association between the nearest distance to greengrocers and BMI (β = -0.004, p < 0.001). CONCLUSION Although we found some significant associations between the neighborhood food environment and obesity, the current results are not strong enough to draw specific conclusions. Policymakers will need to rely on more evidence to derive concrete policy recommendations.
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A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207591. [PMID: 33086537 PMCID: PMC7589434 DOI: 10.3390/ijerph17207591] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022]
Abstract
The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research; yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience; describes individual, interpersonal, and household characteristics that affect customer purchasing; highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave; and addresses the wide-ranging outcomes produced by RFEs and customers, including: population health, food security, food justice, environmental sustainability, and business sustainability. We believe the proposed conceptualization helps to (1) provide broad implications for future research and (2) further highlight the need for transdisciplinary collaborations to ultimately improve a range of critical population outcomes.
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Association between Neighborhood Food Access, Household Income, and Purchase of Snacks and Beverages in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207517. [PMID: 33076500 PMCID: PMC7602560 DOI: 10.3390/ijerph17207517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Abstract
Considerable research on the risk factors of obesity and chronic diseases has focused on relationships between where people live, where they shop, and the types of food they purchase. Rarely have investigators used a national sample and explicitly addressed the amount of energy-dense and nutrient-poor foods purchased in different types of neighborhood food stores. Even more rarely have studies accounted for the characteristics of the broader built environment in which food stores are located and which affect the convenience of using neighborhood food stores. We used a large population-based cohort of predominantly white U.S. households from the Nielsen Homescan Consumer Panel 2010 dataset to examine whether there were positive cross-sectional associations between availability of neighborhood convenience stores and supermarkets and self-reported household annual expenditures for snacks and beverages. We examined this relationship separately for poor and non-poor households as defined by the 2010 U.S. federal poverty threshold. We used mixed error-component regression models to examine associations between availability of neighborhood food stores and the expenditures on snacks and beverages, controlling for regional destination accessibility, availability and diversity of neighborhood destinations, and neighborhood street connectivity. In multivariate analyses, we observed that poor households in neighborhoods with few convenience stores purchased more snacks than poor households in neighborhoods with many convenience stores (b = -0.008, p < 0.05). Non-poor households in neighborhoods with many convenience stores and fewer supermarkets purchased more snacks than non-poor households in neighborhoods with few convenience stores and many supermarkets (b = 0.002, p < 0.05 for convenience stores; b = -0.027, p < 0.05 for supermarkets). Increase in number of convenience stores decreased the purchase of snacks by poor households, but increased in non-poor households. On other hand, increase in number of supermarkets discouraged purchase of snacks by non-poor households but had no effect on the purchasing behavior of the poor-households.Therefore, evaluation of access to energy-dense and nutrient-poor foods should include a consideration of geographic proximity. Local governments should consider strategies to expand the availability and access to nutrient-rich food and beverage products in convenience stores for consumers.
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Cole S, Dominick JK, Balcetis E. Out of Reach and Under Control: Distancing as a Self-Control Strategy. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2020; 47:939-952. [PMID: 32900272 DOI: 10.1177/0146167220949813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a world where they are inundated with potential temptations, how are successful dieters able to resist the urge to give in to unhealthy foods? Four studies suggest distance is one tool that may enable people to forego temptation. People with strong goals to eat healthy preferred to be farther away from unhealthy foods (Study 1a), which was associated with feeling less tempted by and less likely to give in to them (Study 1b). In addition, successful self-regulators with goals to restrict unhealthy eating perceptually represented the distance to unhealthy foods as greater than the distance to healthy foods (Study 2). Moreover, in a week-long food diary study, distancing from temptations helped people make healthier food choices (Study 3). The studies suggest that successful self-regulators' motivations to avoid unhealthy foods are reflected in the way they structure and perceive the world. Distancing may allow people space to make healthier choices.
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Availability and placement of healthy and discretionary food in Australian supermarkets by chain and level of socio-economic disadvantage. Public Health Nutr 2020; 24:203-214. [PMID: 32792022 DOI: 10.1017/s1368980020002505] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The current study aimed to investigate availability and placement of healthy and discretionary (less healthy) food in supermarkets in Victoria, Australia, and examine variation by supermarket chain and area-level socio-economic disadvantage. DESIGN Cross-sectional supermarket audit. Measures included: (i) proportion of shelf space (in square metres) allocated to selected healthy and discretionary food and beverages; (ii) proportion of end-of-aisle, checkout and island bin displays containing discretionary food and beverages and (iii) proportion of space within end-of-aisle, checkout and island bin displays devoted to discretionary food and beverages. SETTING Metropolitan areas of Melbourne and Geelong, Australia. Assessment: June-July 2019. PARTICIPANTS Random sample of 104 stores, with equal numbers from each supermarket group (Coles, Woolworths, Aldi and Independent stores) within strata of area-level socio-economic position. RESULTS Proportion of shelf space devoted to selected discretionary foods was greater for Independent stores (72·7 %) compared with Woolworths (65·7 %), Coles (64·8 %) and Aldi (63·2 %) (all P < 0·001). Proportion of shelf space devoted to selected discretionary food for all Coles, Woolworths and Aldi stores was 9·7 % higher in the most compared with the least disadvantaged areas (P = 0·002). Across all stores, 90 % of staff-assisted checkout displays and 50 % of end-of-aisle displays included discretionary food. Aldi was less likely to feature discretionary food in end-of-aisle and checkout displays compared with other supermarket groups. CONCLUSIONS Extensive marketing of discretionary food in all Australian supermarket chains was observed, which is likely to strongly influence purchasing patterns and population diets. Findings should be used to inform private and public sector policies to reduce marketing of discretionary food in supermarkets.
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Using Zoning as a Public Health Tool to Reduce Alcohol Outlet Oversaturation, Promote Compliance, and Guide Future Enforcement: a Preliminary Analysis of Transform Baltimore. J Urban Health 2020; 97:568-582. [PMID: 32632795 PMCID: PMC7392963 DOI: 10.1007/s11524-020-00453-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Alcohol outlet oversaturation often exacerbates negative public health outcomes. Recently, Baltimore City passed an extensive zoning rewrite ("TransForm Baltimore") that sought to give local government and residents a tool to reduce alcohol outlet oversaturation through land use regulation. The present investigation evaluated the outlet and neighborhood characteristics of stores impacted by two components of TransForm Baltimore: (1) a requirement that taverns licensed for on-premise consumption in addition to off-premise, carryout sales generate at least 50% of their business from on-premise sales, and (2) a requirement to close, repurpose, or relocate all package stores (i.e., off-premise alcohol outlets) that have been operating as "non-conforming" in residential zones since 1971. Research assistants visited every off-premise alcohol outlet in the city (n = 685) to complete an observational assessment. Approximately 77% (n = 530) of these off-premise alcohol outlets were open, including 292 taverns and 238 package stores. t tests and chi-square tests were used to compare neighborhood characteristics (neighborhood disadvantage, median household income, and racial segregation) of sham taverns (i.e., taverns with less than 50% space dedicated for on-premise sales that were primarily operating as a package store) and non-conforming package stores. Of the 292 taverns accessible during the study, the remainder were chronically closed (n = 130); 24 (8.2%) were deemed sham taverns. Sham taverns were more likely to be located in communities with more economic disadvantage and lower median household income (t test; p < 0.05). Compared to taverns, a lower proportion of sham taverns had visible dance floor space, patrons drinking, and menus available (chi-square test; p < 0.001). There were 80 residentially zoned, non-conforming alcohol outlets. These non-conforming alcohol outlets were disproportionately distributed in predominately poor and African American communities (t test; p < 0.05). As compared to conforming alcohol outlets, more non-conforming alcohol outlets sold sex paraphernalia and healthy foods (chi-square test; p < 0.05). With active enforcement, TransForm Baltimore offers the opportunity for local government and residents to improve public health and increase health equity in vulnerable and marginalized neighborhoods.
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Odunitan-Wayas FA, Okop KJ, Dover RV, Alaba OA, Micklesfield LK, Puoane T, Levitt NS, Battersby J, Meltzer ST, Lambert EV. Food purchasing behaviour of shoppers from different South African socio-economic communities: results from grocery receipts, intercept surveys and in-supermarkets audits. Public Health Nutr 2020; 24:1-12. [PMID: 32611454 DOI: 10.1017/s1368980020001275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify factors associated with food purchasing decisions and expenditure of South African supermarket shoppers across income levels. DESIGN Intercept surveys were conducted, grocery receipts collated and expenditure coded into categories, with each category calculated as percentage of the total expenditure. In-supermarket food quality audit and shelf space measurements of foods such as fruits and vegetables (F&V) (healthy foods), snacks and sugar-sweetened beverages (SSB) (unhealthy foods) were also assessed. Shoppers and supermarkets were classified by high-, middle- and low-income socio-economic areas (SEA) of residential area and location, respectively. Shoppers were also classified as "out-shoppers" (persons shopping outside their residential SEA) and "in-shoppers" (persons shopping in their residential SEA). Data were analysed using descriptive analysis and ANOVA. SETTING Supermarkets located in different SEA in urban Cape Town. PARTICIPANTS Three hundred ninety-five shoppers from eleven purposively selected supermarkets. RESULTS Shelf space ratio of total healthy foods v. unhealthy foods in all the supermarkets was low, with supermarkets located in high SEA having the lowest ratio but better quality of fresh F&V. The share expenditure on SSB and snacks was higher than F&V in all SEA. Food secure shoppers spent more on food, but food items purchased frequently did not differ from the food insecure shoppers. Socio-economic status and food security were associated with greater expenditure on food items in supermarkets but not with overall healthier food purchases. CONCLUSION Urban supermarket shoppers in South Africa spent substantially more on unhealthy food items, which were also allocated greater shelf space, compared with healthier foods.
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Affiliation(s)
- Feyisayo A Odunitan-Wayas
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kufre J Okop
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Robert Vh Dover
- Departamento de Antropología, Universidad de Antioquia, Medellin, Colombia
| | - Olufunke A Alaba
- Health Economics Division, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lisa K Micklesfield
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, Western Province, South Africa
| | - Naomi S Levitt
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jane Battersby
- African Centre for Cities, University of Cape Town, Cape Town, Western Province, South Africa
| | - Shelly T Meltzer
- Sports Science Institute of South Africa, Cape Town, South Africa
| | - Estelle V Lambert
- Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Sports Science Institute of South Africa, Cape Town, South Africa
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Anderson CE, Crespi CM, Wang MC, Whaley SE, Chaparro MP. The neighborhood food environment modifies the effect of the 2009 WIC food package change on childhood obesity in Los Angeles County, California. BMC Public Health 2020; 20:678. [PMID: 32404069 PMCID: PMC7222567 DOI: 10.1186/s12889-020-08779-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background Food packages provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were revised in 2009 to better align them with the Dietary Guidelines for Americans. This study was conducted to evaluate whether the effect of the food package change on childhood obesity varied by the food environment in the neighborhoods where WIC-participating children live. Methods Administrative data from participating children in Los Angeles County, California (2003–2016) were merged with geocoded food vendor information by neighborhood of residence. Obesity risk at age 4 was compared between children receiving old (2003–2009) and new (2010–2016) WIC food packages using sex-stratified Poisson regression models, with interaction terms between WIC package and neighborhood density (number per square mile) of healthy and unhealthy food outlets. Results The new food package was associated with a significant decrease in obesity risk. Among boys, the new food package was associated with 8 to 18% lower obesity risk at all healthy and unhealthy food outlet densities, and the association was not modified by neighborhood food outlet density. Among girls, the association of the new food package with obesity risk was protective in neighborhoods with high healthy and low unhealthy food outlet densities, and adverse in neighborhoods with high unhealthy and low healthy food outlet densities. The effect of the new food package among girls was modified by unhealthy food outlet density, with significantly smaller (p-value = 0.004) decreases in obesity risk observed in neighborhoods with higher unhealthy food outlet density. Conclusions The impact of the food package change was modified by the neighborhood food environment among girls only. Future policy changes should incorporate consideration of ways to mitigate potentially inequitable geographic distribution of the health benefits of policy changes.
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Affiliation(s)
- Christopher E Anderson
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2000, New Orleans, LA, 70112, USA
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (UCLA), 650 Charles E. Young Dr. South, Box 951772, Los Angeles, CA, 90095, USA
| | - May C Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), 650 Charles E. Young Dr. South, 26-051B CHS, Los Angeles, CA, 90095, USA
| | - Shannon E Whaley
- Public Health Foundation Enterprises (PHFE) WIC, 12781 Schabarum Ave, Irwindale, CA, 91706, USA
| | - M Pia Chaparro
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2200, New Orleans, LA, 70112, USA.
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Hook CJ, Rose Markus H. Health in the United States: Are Appeals to Choice and Personal Responsibility Making Americans Sick? PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 15:643-664. [DOI: 10.1177/1745691619896252] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The United States suffers high rates of preventable lifestyle disease despite widespread calls for people to take responsibility for their health. The United States also stands out in its rejection of government action to guide industry practices and consumer choices. Why? We examine how deeply rooted cultural narratives about “free choice” and “personal responsibility” infuse policymaking, advertising, media, social norms, and individual attitudes about health in the United States. We argue that these narratives contribute to ill health in the United States: They encourage stress and worry over health, blame and stigmatization of the unhealthy, widened health disparities, and the failure to adopt policies that could save lives. Psychologists can play a major role in expanding narratives about health so that they include the role of personal choice and responsibility but also reflect current science about the physical, social, and cultural drivers of health. These broader narratives can be used to promote a more comprehensive understanding of health and to better inform the design, communication, and implementation of effective health-supportive policies.
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Walker BB, Shashank A, Gasevic D, Schuurman N, Poirier P, Teo K, Rangarajan S, Yusuf S, Lear SA. The Local Food Environment and Obesity: Evidence from Three Cities. Obesity (Silver Spring) 2020; 28:40-45. [PMID: 31774254 PMCID: PMC6972660 DOI: 10.1002/oby.22614] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/10/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study aimed to identify the association between the food environment and obesity. METHODS BMI and waist circumference (WC) were measured in 8,076 participants from three cities. The number of fast-food restaurants, full-service restaurants, bars/pubs, markets, and liquor stores within 500 m of each participant was documented. The association between the food environment (ratio of fast-food to full-service restaurants, ratio of bars/pubs to liquor stores, and presence of markets) with obesity (BMI ≥ 30 kg/m2 ) and abdominal obesity (WC ≥ 102 cm for males or WC ≥ 88 cm for females) was investigated, adjusted for age, sex, education level, neighborhood deprivation, neighborhood type, and total hours per week of walking and taking into account city-level clustering. RESULTS The ratios of fast-food to full-service restaurants and of bars/pubs to liquor stores were positively associated with obesity (OR = 1.05 [CI: 1.02-1.09] and OR = 1.08 [CI: 1.04-1.13], respectively). The ratio of bars/pubs to liquor stores was positively associated with abdominal obesity (OR = 1.10 [CI: 1.05-1.14]). There was no association between markets and either obesity or abdominal obesity. CONCLUSIONS Features of the food environment have varying associations with obesity. These features have an additive effect, and future studies should not focus on only one feature in isolation.
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Affiliation(s)
| | - Aateka Shashank
- Department of GeographySimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Danijela Gasevic
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Nadine Schuurman
- Department of GeographySimon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Paul Poirier
- Institut de cardiologie et de pneumologie de QuébecUniversité LavalQuébec CityQuébecCanada
| | - Koon Teo
- Population Health Research InstituteHamiltonOntarioCanada
| | | | - Salim Yusuf
- Population Health Research InstituteHamiltonOntarioCanada
| | - Scott A. Lear
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada
- Division of CardiologyProvidence Health CareVancouverBritish ColumbiaCanada
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Rybarczyk G, Taylor D, Brines S, Wetzel R. A Geospatial Analysis of Access to Ethnic Food Retailers in Two Michigan Cities: Investigating the Importance of Outlet Type within Active Travel Neighborhoods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010166. [PMID: 31881710 PMCID: PMC6982187 DOI: 10.3390/ijerph17010166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/14/2019] [Accepted: 12/21/2019] [Indexed: 11/16/2022]
Abstract
To date, the research that examines food accessibility has tended to ignore ethnic food outlets. This void leaves us with a limited understanding of how such food stores may, or may not, impact food security. The study discussed herein addressed this by conducting a geospatial assessment of ethnic food outlet accessibility in two U.S. cities: Flint and Grand Rapids, Michigan. We used Geographic Information Systems (GIS) tools to create a revealed accessibility index for each food outlet, and used the index to determine access within active travel service areas. We utilized an ordinary least squares regression (OLS), and two local models: spatial autoregression (SAR) and geographically weighted regression (GWR) to enhance our understanding of global and localized relationships between outlet accessibility and type (while controlling for known covariates). The results show that the local models outperformed (R2 max = 0.938) the OLS model. The study found that there was reduced access to ethnic restaurants in all service areas of Grand Rapids. However, in Flint, we observed this association in the bicycling areas only. Also notable were the influences that demographic characteristics had on access in each city. Ultimately, the findings tell us that nuanced planning and policy approaches are needed in order to promote greater access to ethnic food outlets and reduce overall food insecurity.
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Affiliation(s)
- Greg Rybarczyk
- Department of Geography, Planning and Environment, University of Michigan-Flint, Flint, MI 48502, USA;
- The Michigan Institute for Data Science (MIDAS), Ann Arbor, MI 48108, USA
- The Centre for Urban Design and Mental Health, London SW9 7QF, UK
- Correspondence: ; Tel.: +1-810-762-3355
| | - Dorceta Taylor
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI 48108, USA; (D.T.); (S.B.)
| | - Shannon Brines
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI 48108, USA; (D.T.); (S.B.)
| | - Richard Wetzel
- Department of Geography, Planning and Environment, University of Michigan-Flint, Flint, MI 48502, USA;
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Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010065. [PMID: 31861788 PMCID: PMC6981808 DOI: 10.3390/ijerph17010065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.
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Abildso CG, Bias TK, Coffman J. Adoption and Reach of a statewide policy, systems, and environment intervention to increase access to fresh fruits and vegetables in West Virginia. Transl Behav Med 2019; 9:847-856. [PMID: 31570923 DOI: 10.1093/tbm/ibz095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Local public health professionals’ consistency, connections, and presence at meetings were critical to making changes in schools, farmers markets, and retail food stores to improve access to fruits and vegetables in rural, low-income food deserts.
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Affiliation(s)
| | - Thomas K Bias
- West Virginia University School of Public Health, Morgantown, USA
| | - Jessica Coffman
- West Virginia University Health Research Center, Morgantown, USA
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Elgaard Jensen T, Kleberg Hansen AK, Ulijaszek S, Munk AK, Madsen AK, Hillersdal L, Jespersen AP. Identifying notions of environment in obesity research using a mixed-methods approach. Obes Rev 2019; 20:621-630. [PMID: 30550640 DOI: 10.1111/obr.12807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/30/2018] [Accepted: 10/03/2018] [Indexed: 11/27/2022]
Abstract
The recent rise of computation-based methods in social science has opened new opportunities for exploring qualitative questions through analysis of large amounts of text. This article uses a mixed-methods design that incorporates machine reading, network analysis, semantic analysis, and qualitative analysis of 414 highly cited publications on obesogenic environments between 2001 and 2015. The method produces an elaborate network map exhibiting five distinct notions of environment, all of which are currently active in the field of obesity research. The five notions are institutional, built, food, family, and bodily environments. The network map is proposed as a navigational tool both for policy actors who wish to coordinate efforts between a variety of stakeholders and for researchers who wish to understand their own research and research plans in light of different positions in the field. The final part of the article explores how the network map may also initiate a broader set of reflections on the configuration, differentiation, and coherence of the field of obesity research.
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Affiliation(s)
- Torben Elgaard Jensen
- The Techno-Anthropology Research Group/ TANTlab, Department of Learning and Philosophy, Aalborg University Copenhagen, Copenhagen, Denmark
| | - Anne K Kleberg Hansen
- Copenhagen Centre for Health Research in the Humanities, The Saxo Institute, University of Copenhagen, Copenhagen, Denmark
| | - Stanley Ulijaszek
- Unit for Biocultural Variation and Obesity, School of Anthropology,, University of Oxford, Oxford, UK
| | - Anders K Munk
- The Techno-Anthropology Research Group/ TANTlab, Department of Learning and Philosophy, Aalborg University Copenhagen, Copenhagen, Denmark
| | - Anders K Madsen
- The Techno-Anthropology Research Group/ TANTlab, Department of Learning and Philosophy, Aalborg University Copenhagen, Copenhagen, Denmark
| | - Line Hillersdal
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Astrid P Jespersen
- Copenhagen Centre for Health Research in the Humanities, The Saxo Institute, University of Copenhagen, Copenhagen, Denmark
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Bringing Healthy Retail to Urban "Food Swamps": a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco. J Urban Health 2018; 95:850-858. [PMID: 29633226 PMCID: PMC6286287 DOI: 10.1007/s11524-018-0234-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In urban "food swamps" like San Francisco's Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin's multi-method case study analysis, we examined the partnership's processes and contributions to the ordinance within the framework of Kingdon's three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a "ripple effect," through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.
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Appraisal of short and long versions of the Nutrition Environment Measures Survey (NEMS-S and NEMS-R) in Australia. Public Health Nutr 2018; 22:564-570. [PMID: 30375297 DOI: 10.1017/s1368980018002732] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research has begun to take a more ecological view of eating behaviour, examining multiple levels of influence: personal, social and environmental. The food environment is a major influence on eating behaviour, attracting the attention of researchers who have measured it in a number of ways. The present paper examines the short-form version, in comparison to the long-form version, of the Nutrition Environment Measures Survey (NEMS) - an observational food outlet audit tool. DESIGN Both the short-form and long-form were examined to qualitatively appraise the dimensions of the food environment assessed by each measure. Data from 135 food outlets in Australia were then used to compare results obtained using the short-form with the results from the long-form method, to consider the utility of the short-form measure. SETTING The retail food environment in Australia.ParticipantsOne hundred and thirty-five food outlets in Australia. RESULTS Results indicate that the short-form predominantly assessed availability of healthful foods (one aspect of the food environment). Several critical dimensions of the food environment known to influence eating behaviour were not assessed. For this data set, the short-form produced scores inconsistent with the longer version of the measure, delivering inflated estimates for stores and deflated estimates for restaurants. CONCLUSIONS Scores between the long-form and short-form versions were not comparable in this Australian study. Further development of food environment measures is recommended and must balance instrument brevity with the need to accurately capture important aspects of the food environment known to influence eating behaviour.
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Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores. Nutrients 2018; 10:nu10111569. [PMID: 30360538 PMCID: PMC6266756 DOI: 10.3390/nu10111569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. Results: Controlling for gender, HMI was negatively associated with SSBs (β = −0.859) and %kcal/fat (β = −1.057) and positively with whole-grains (β = 0.186) and fruits/vegetables intake (β = 0.267); %Kcal/fat was positively (β = 0.098) and fruits/vegetables intake (β = −0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (β = 0.214, β = 0.129) and directly/negatively to BMI (β = −2.657, β = −1.124). Conclusions: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.
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Evenhuis IJ, Wezenbeek NLWJ, Vyth EL, Veldhuis L, Poelman MP, Wolvers D, Seidell JC, Renders CM. Development of the 'Canteen Scan': an online tool to monitor implementation of healthy canteen guidelines. BMC Public Health 2018; 18:1109. [PMID: 30200919 PMCID: PMC6131796 DOI: 10.1186/s12889-018-5974-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/16/2018] [Indexed: 11/23/2022] Open
Abstract
Background To improve the availability and accessibility of healthier food and drinks in schools, sports and worksites canteens, national Guidelines for Healthier Canteens were developed by the Netherlands Nutrition Centre. Until now, no tool was available to monitor implementation of these guidelines. This study developed and assessed the content validity and usability of an online tool (the ‘Canteen Scan’) that provides insight into and directions for improvement of healthier food products in canteens. Methods The Canteen Scan was developed using a three-step iterative process. First, preliminary measures and items to evaluate adherence to the guidelines were developed based on literature, and on discussions and pre-tests with end-users and experts from science, policy and practice. Second, content validity of a paper version of the Canteen Scan was assessed among five end-users. Third, the online Canteen Scan was pilot tested among end-users representing school canteens. Usability was measured by comprehensibility, user-friendliness, feasibility, time investment, and satisfaction. Results The content validity of the Canteen Scan was ensured by reaching agreement between stakeholders representing science, policy and practice. The scan consists of five elements: 1) basic conditions (e.g. encouragement to drink water and availability of policy regarding the guidelines), 2) product availability offered on displays (counter, shelf) and 3) in vending machines, 4) product accessibility (e.g. promotion and placement of products), and 5) an overall score based on the former elements and tailored feedback for creating a healthier canteen. The scan automatically classifies products into healthier or less healthy products. Pilot tests indicated good usability of the tool, with mean scores of 4.0–4.6 (5-point Likert scale) on the concepts comprehensibility, user-friendliness and feasibility. Conclusion The Canteen Scan provides insight into the extent to which canteens meet the Dutch Guidelines for Healthier Canteens. It also provides tailored feedback to support adjustments towards a healthier canteen and with the scan changes over time can be monitored. Pilot tests show this tool to be usable in practice.
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Affiliation(s)
- I J Evenhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081, HV, Amsterdam, the Netherlands.
| | - N L W J Wezenbeek
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081, HV, Amsterdam, the Netherlands
| | - E L Vyth
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081, HV, Amsterdam, the Netherlands
| | - L Veldhuis
- Netherlands Nutrition Centre, PO Box 85700, 2508, CK, The Hague, the Netherlands
| | - M P Poelman
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Heidelberglaan 2, 3584, CS, Utrecht, the Netherlands
| | - D Wolvers
- Netherlands Nutrition Centre, PO Box 85700, 2508, CK, The Hague, the Netherlands
| | - J C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081, HV, Amsterdam, the Netherlands
| | - C M Renders
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081, HV, Amsterdam, the Netherlands
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Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES. J Racial Ethn Health Disparities 2018; 6:220-229. [PMID: 30027480 DOI: 10.1007/s40615-018-0517-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.
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Zenk SN, Tarlov E, Wing C, Matthews SA, Jones K, Tong H, Powell LM. Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009-14. Health Aff (Millwood) 2018; 36:1433-1442. [PMID: 28784736 DOI: 10.1377/hlthaff.2017.0122] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In recent years, various levels of government in the United States have adopted or discussed subsidies, tax breaks, zoning laws, and other public policies that promote geographic access to healthy food. However, there is little evidence from large-scale longitudinal or quasi-experimental research to suggest that the local mix of food outlets actually affects body mass index (BMI). We used a longitudinal design to examine whether the proximity of food outlets, by type, was associated with BMI changes between 2009 and 2014 among 1.7 million veterans in 382 metropolitan areas. We found no evidence that either absolute or relative geographic accessibility of supermarkets, fast-food restaurants, or mass merchandisers was associated with changes in an individual's BMI over time. While policies that alter only geographic access to food outlets may promote equitable access to healthy food and improve nutrition, our findings suggest they will do little to combat obesity in adults.
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Affiliation(s)
- Shannon N Zenk
- Shannon N. Zenk is a professor in the Department of Health Systems Science, University of Illinois at Chicago
| | - Elizabeth Tarlov
- Elizabeth Tarlov is a research health scientist at the Edward Hines Jr. Veterans Affairs Hospital, in Hines, Illinois and an assistant professor in the Department of Health Systems Science, University of Illinois at Chicago
| | - Coady Wing
- Coady Wing is an assistant professor in the School of Public and Environmental Affairs, Indiana University, in Bloomington
| | - Stephen A Matthews
- Stephen A. Matthews is a professor in the Department of Sociology, Anthropology, and Demography at Pennsylvania State University, in State College
| | - Kelly Jones
- Kelly Jones is a PhD student in the Department of Health Systems Science, University of Illinois at Chicago
| | - Hao Tong
- Hao Tong is a data manager/analyst at the Edward Hines Jr. VA Hospital
| | - Lisa M Powell
- Lisa M. Powell is a professor in the Health Policy and Administration Division, University of Illinois at Chicago
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Gorski Findling MT, Wolfson JA, Rimm EB, Bleich SN. Differences in the Neighborhood Retail Food Environment and Obesity Among US Children and Adolescents by SNAP Participation. Obesity (Silver Spring) 2018; 26:1063-1071. [PMID: 29797558 PMCID: PMC5975976 DOI: 10.1002/oby.22184] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The goal of this study was to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. METHODS Data were obtained from the National Household Food Acquisition and Purchase Survey (2012-2013; n = 3,748 children aged 2 to 18 years). Logistic regression was used to examine associations between neighborhood retail food access (≤1 mile from home), food purchases (including sugary beverages), and overweight/obesity, stratified by SNAP status (1,720 participants, 453 eligible nonparticipants, 1,575 SNAP ineligible). Store types included supermarkets/grocery, combination grocery/other (independent drug, dollar, and general stores), convenience, fast food, and non-fast food restaurants. RESULTS Odds of childhood overweight/obesity (OR [95% CI]) were higher with greater access to combination grocery/other stores overall (1.10 [1.03-1.17]) and for children in SNAP (1.14 [1.05-1.24]). Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores (1.11 [1.04-1.18]). The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages (SNAP: 8.3%, eligible non-SNAP: 7.7%, SNAP ineligible: 5.5%). CONCLUSIONS Greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
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Affiliation(s)
| | - Julia A. Wolfson
- Departments of Health Management and Policy and Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Eric B. Rimm
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts and Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Sara N. Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Camden A, Levy J, Bassil K, Vanderlinden L, Barnett OW, Minaker LM, Mulligan K, Campbell M. A Census of Midsize to Large Supermarkets in Toronto: A Cross-Sectional Analysis of the Consumer Nutrition Environment. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:573-581. [PMID: 29496398 DOI: 10.1016/j.jneb.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Assess the consumer nutrition environment in midsize to large supermarkets by supermarket type and area-level socioeconomic variables. DESIGN Cross-sectional census of 257 supermarkets using the Toronto Nutrition Environment Measures Survey in Stores. SETTING Toronto, Canada. VARIABLES MEASURED Availability; price and linear shelf space of fruits and vegetables vs energy-dense snack foods by supermarket type; after-tax, low-income measure; and neighborhood improvement area. ANALYSIS Multivariate linear regression. RESULTS There was a high availability of fruits (7.7 of 8) and vegetables (9.5 of 11). There was similar linear shelf space for fruits and vegetables vs energy-dense snack foods (ratio, 1.1 m). Adjusted fruit prices were lowest in quintiles 1 (β = -$1.30; P = .008), 2 (β = -$1.41; P = .005), and 3 (β = -$1.89; P < .001) vs quintile 5 (lowest percentage of people living with low income) and in ethnic (β = -$3.47; P < .001) and discount stores (β = -$5.64; P < .001) vs conventional. Adjusted vegetable prices were lowest in quintiles 2 (β = -$1.87; P = .04), 3 (β = -$1.78; P = .03), and 4 (β = -$2.65; P = .001) vs quintile 5 and in ethnic (β = -$7.10; P < .001) and discount (β = -$5.49; P < .001) stores. They were highest in other (β = + $3.08; P = .003) vs conventional stores. Adjusted soda and chips prices were lower in discount (β = -$1.16; P < .001) and higher in other stores (β = + $0.67; P < .001) vs conventional. CONCLUSIONS AND IMPLICATIONS Findings do not indicate inequities in shelf space, availability, or price across diverse neighborhoods. Practitioners can use findings to help consumers navigate supermarkets to make healthy choices.
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Affiliation(s)
- Andi Camden
- Healthy Public Policy, Toronto Public Health, Toronto, Ontario, Canada
| | - Jennifer Levy
- Healthy Public Policy, Toronto Public Health, Toronto, Ontario, Canada
| | - Kate Bassil
- Healthy Public Policy, Toronto Public Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Loren Vanderlinden
- Healthy Public Policy, Toronto Public Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Leia M Minaker
- School of Planning, and Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | - Kate Mulligan
- Healthy Public Policy, Toronto Public Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Monica Campbell
- Healthy Public Policy, Toronto Public Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Jalbert-Arsenault É, Robitaille É, Paquette MC. Development, reliability and use of a food environment assessment tool in supermarkets of four neighbourhoods in Montréal, Canada. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2018; 37:293-302. [PMID: 28902478 DOI: 10.24095/hpcdp.37.9.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The food environment is a promising arena in which to influence people's dietary habits. This study aimed to develop a comprehensive food environment assessment tool for businesses and characterize the food environment of a low-tomedium income area of Montréal, Canada. METHODS We developed a tool, Mesure de l'environnement alimentaire du consommateur dans les supermarchés (MEAC-S), and tested it for reliability. We used the MEAC-S to assess the consumer food environment of 17 supermarkets in four neighbourhoods of Montréal. We measured the shelf length, variety, price, display counts and in-store positions of fruits and vegetables (FV) and ultra-processed food products (UPFPs). We also assessed fresh FV for quality. Store size was estimated using the total measured shelf length for all food categories. We conducted Spearman correlations between these indicators of the food environment. RESULTS Reliability analyses revealed satisfactory results for most indicators. Characterization of the food environment revealed high variability in shelf length, variety and price of FV between supermarkets and suggested a disproportionate promotion of UPFPs. Display counts of UPFPs outside their normal display location ranged from 7 to 26, and they occupied 8 to 33 strategic in-store positions, whereas the number of display counts of fresh FV outside their normal display location exceeded 1 in only 2 of the 17 stores surveyed, and they occupied a maximum of 2 strategic in-store positions per supermarket. Price of UPFPs was inversely associated with their prominence (p < .005) and promotion (p < .003). Store size was associated with display counts and strategic in-store positioning of UPFPs (p < .001), but not FV, and was inversely associated with the price of soft drinks (p < .003). CONCLUSION This study illustrates the variability of the food environment between supermarkets and underscores the importance of measuring in-store characteristics to adequately picture the consumer food environment.
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Affiliation(s)
| | - Éric Robitaille
- Université de Montréal, Montréal, Quebec, Canada.,Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Marie-Claude Paquette
- Université de Montréal, Montréal, Quebec, Canada.,Institut national de santé publique du Québec, Montréal, Quebec, Canada
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Understanding Out-of-Home Food Environment, Family Restaurant Choices, and Childhood Obesity with an Agent-Based Huff Model. SUSTAINABILITY 2018. [DOI: 10.3390/su10051575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kaczynski AT, Jake-Schoffman DE, Peters NA, Dunn CG, Wilcox S, Forthofer M. Development and Testing of the Church Environment Audit Tool. Am J Health Behav 2018; 42:17-26. [PMID: 29663977 PMCID: PMC6202683 DOI: 10.5993/ajhb.42.3.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES In this paper, we describe development and reliability testing of a novel tool to evaluate the physical environment of faith-based settings pertaining to opportunities for physical activity (PA) and healthy eating (HE). METHODS Tool development was a multistage process including a review of similar tools, stakeholder review, expert feedback, and pilot testing. Final tool sections included indoor opportunities for PA, outdoor opportunities for PA, food preparation equipment, kitchen type, food for purchase, beverages for purchase, and media. Two independent audits were completed at 54 churches. Interrater reliability (IRR) was determined with Kappa and percent agreement. RESULTS Of 218 items, 102 were assessed for IRR and 116 could not be assessed because they were not present at enough churches. Percent agreement for all 102 items was over 80%. For 42 items, the sample was too homogeneous to assess Kappa. Forty-six of the remaining items had Kappas greater than 0.60 (25 items 0.80-1.00; 21 items 0.60-0.79), indicating substantial to almost perfect agreement. CONCLUSIONS The tool proved reliable and efficient for assessing church environments and identifying potential intervention points. Future work can focus on applications within faith-based partnerships to understand how church environments influence diverse health outcomes.
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Affiliation(s)
- Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Danielle E Jake-Schoffman
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nathan A Peters
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Caroline G Dunn
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Melinda Forthofer
- Department of Public Health Sciences, University of North Carolina-Charlotte, Charlotte, NC, USA
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Saelens BE, Arteaga SS, Berrigan D, Ballard RM, Gorin AA, Powell-Wiley TM, Pratt C, Reedy J, Zenk SN. Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Environmental Domain. Obesity (Silver Spring) 2018; 26 Suppl 2:S35-S44. [PMID: 29575779 PMCID: PMC5875459 DOI: 10.1002/oby.22159] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/31/2018] [Accepted: 02/12/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is growing interest in how environment is related to adults' weight and activity and eating behaviors. However, little is known about whether environmental factors are related to the individual variability seen in adults' intentional weight loss or maintenance outcomes. OBJECTIVES The environmental domain subgroup of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project sought to identify a parsimonious set of objective and perceived neighborhood and social environment constructs and corresponding measures to include in the assessment of response to adult weight-loss treatment. SIGNIFICANCE Starting with the home address, the environmental domain subgroup recommended for inclusion in future weight-loss or maintenance studies constructs and measures related to walkability, perceived land use mix, food outlet accessibility (perceived and objective), perceived food availability, socioeconomics, and crime-related safety (perceived and objective) to characterize the home neighborhood environment. The subgroup also recommended constructs and measures related to social norms (perceived and objective) and perceived support to characterize an individual's social environment. The 12 neighborhood and social environment constructs and corresponding measures provide a succinct and comprehensive set to allow for more systematic examination of the impact of environment on adults' weight loss and maintenance.
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Affiliation(s)
- Brian E Saelens
- Department of Pediatrics, University of Washington, Seattle Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - S Sonia Arteaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David Berrigan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel M Ballard
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Tiffany M Powell-Wiley
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jill Reedy
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shannon N Zenk
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
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Zenk SN, Tarlov E, Wing CM, Matthews SA, Tong H, Jones KK, Powell L. Long-Term Weight Loss Effects of a Behavioral Weight Management Program: Does the Community Food Environment Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E211. [PMID: 29373556 PMCID: PMC5858280 DOI: 10.3390/ijerph15020211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 12/18/2022]
Abstract
This study examined whether community food environments altered the longer-term effects of a nationwide behavioral weight management program on body mass index (BMI). The sample was comprised of 98,871 male weight management program participants and 15,385 female participants, as well as 461,302 and 37,192 inverse propensity-score weighted matched male and female controls. We measured the community food environment by counting the number of supermarkets, convenience stores, and fast food restaurants within a 1-mile radius around each person's home address. We used difference-in-difference regression models with person and calendar time fixed effects to estimate MOVE! effects over time in sub-populations defined by community food environment attributes. Among men, after an initial decrease in BMI at 6 months, the effect of the program decreased over time, with BMI increasing incrementally at 12 months (0.098 kg/m², p < 0.001), 18 months (0.069 kg/m², p < 0.001), and 24 months (0.067 kg/m², p < 0.001). Among women, the initial effects of the program decreased over time as well. Women had an incremental BMI change of 0.099 kg/m² at 12 months (p < 0.05) with non-significant incremental changes at 18 months and 24 months. We found little evidence that these longer-term effects of the weight management program differed depending on the community food environment. Physiological adaptations may overwhelm environmental influences on adherence to behavioral regimens in affecting longer-term weight loss outcomes.
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Affiliation(s)
- Shannon N Zenk
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Elizabeth Tarlov
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
- Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA.
| | - Coady M Wing
- School of Public and Environmental Affairs, Indiana University, Bloomington, IN 47405, USA.
| | - Stephen A Matthews
- Department of Sociology & Criminology and Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA.
- Department of Anthropology, Pennsylvania State University, University Park, PA 16802, USA.
| | - Hao Tong
- Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA.
| | - Kelly K Jones
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Lisa Powell
- School of Public Health, University of Illinois at Chicago, IL 60612, USA.
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47
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Towards healthier supermarkets: a national study of in-store food availability, prominence and promotions in New Zealand. Eur J Clin Nutr 2018; 72:971-978. [DOI: 10.1038/s41430-017-0078-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/29/2017] [Accepted: 12/07/2017] [Indexed: 11/09/2022]
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48
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Barrientos-Gutierrez T, Moore KAB, Auchincloss AH, Mujahid MS, August C, Sanchez BN, Diez Roux AV. Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol 2017; 186:1237-1245. [PMID: 29206987 DOI: 10.1093/aje/kwx186] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 01/26/2017] [Indexed: 11/13/2022] Open
Abstract
Longitudinal associations between neighborhood characteristics and body mass index (BMI; weight (kg)/height (m)2) were assessed from 2000 to 2011 among 5,919 participants in the Multi-Ethnic Study of Atherosclerosis. The perceived availability of healthy food and walking environment were assessed via surveys, and 1-mile (1.6-km) densities of supermarkets, fruit-and-vegetable stores, and recreational facilities were obtained through a commercial database. Econometric fixed-effects models were used to estimate the association between within-person changes in neighborhood characteristics and within-person change in BMI. In fully adjusted models, a 1-standard-deviation increase in the healthy food environment index was associated with a 0.16-kg/m2 decrease in BMI (95% confidence interval (CI): -0.27, -0.06) among participants with obesity at baseline. A 1-standard-deviation increase in the physical activity environment index was associated with 0.13-kg/m2 (95% CI: -0.24, -0.02) and 0.14-kg/m2 (95% CI: -0.27, -0.01) decreases in BMI for participants who were overweight and obese at baseline, respectively. Paradoxically, increases in the physical activity index were associated with BMI increases in persons who were normal-weight at baseline. This study provides preliminary longitudinal evidence that favorable changes in neighborhood physical environments are related to BMI reductions in obese persons, who comprise a substantial proportion of the US population.
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Affiliation(s)
| | - Kari A B Moore
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Carmella August
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brisa N Sanchez
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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49
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James A, Birch L, Fletcher P, Pearson S, Boyce C, Ness AR, Hamilton-Shield JP, Lithander FE. Are food and drink retailers within NHS venues adhering to NICE Quality standard 94 guidance on childhood obesity? A cross-sectional study of two large secondary care NHS hospitals in England. BMJ Open 2017; 7:e018214. [PMID: 29150472 PMCID: PMC5701976 DOI: 10.1136/bmjopen-2017-018214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess whether the food and drink retail outlets in two major National Health Service (NHS) district general hospitals in England adhere to quality statements 1-3 of the UK National Institute for Health and Care Excellence (NICE) quality standard 94. DESIGN Cross-sectional, descriptive study to assess the food and drink options available in vending machines, restaurants, cafes and shops in two secondary care hospitals. MAIN OUTCOME MEASURES Adherence to quality statement 1 whereby the food and drink items available in the vending machines were classified as either healthy or less healthy using the Nutrient Profiling Model (NPM). Compliance with quality statements 2 and 3 was assessed through the measurement of how clearly the shops, cafes and restaurants displayed nutrition information on menus, and the availability and prominent display of healthy food and drink options in retail outlets, respectively. RESULTS Adherence to quality statement 1 was poor. Of the 18 vending machines assessed, only 7 (39%) served both a healthy food and a healthy drink option. Neither hospital was compliant with quality statement 2 wherein nutritional information was not available on menus of food providers in either hospital. There was inconsistent compliance with quality standard 3 whereby healthy food and drink options were prominently displayed in the two main hospital restaurants, but all shops and cafes prioritised the display of unhealthy items. CONCLUSIONS Neither hospital was consistently compliant with quality statements 1-3 of the NICE quality standard 94. Improving the availability of healthy foods and drinks while reducing the display and accessibility to less healthy options in NHS venues may improve family awareness of healthy alternatives. Making it easier for parents to direct their children to healthier choices is an ostensibly central component of our healthcare system.
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Affiliation(s)
- Alice James
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Laura Birch
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Peter Fletcher
- Department of General and Old Age Medicine, Cheltenham General Hospital, Gloucestershire, UK
| | - Sally Pearson
- Department of Clinical Strategy, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Catherine Boyce
- Department of Clinical Strategy, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - Andy R Ness
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Julian P Hamilton-Shield
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Fiona E Lithander
- NIHR Bristol Biomedical Research Centre (Nutrition Theme), University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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50
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Cade JE, Warthon-Medina M, Albar S, Alwan NA, Ness A, Roe M, Wark PA, Greathead K, Burley VJ, Finglas P, Johnson L, Page P, Roberts K, Steer T, Hooson J, Greenwood DC, Robinson S. DIET@NET: Best Practice Guidelines for dietary assessment in health research. BMC Med 2017; 15:202. [PMID: 29137630 PMCID: PMC5686956 DOI: 10.1186/s12916-017-0962-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/19/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Dietary assessment is complex, and strategies to select the most appropriate dietary assessment tool (DAT) in epidemiological research are needed. The DIETary Assessment Tool NETwork (DIET@NET) aimed to establish expert consensus on Best Practice Guidelines (BPGs) for dietary assessment using self-report. METHODS The BPGs were developed using the Delphi technique. Two Delphi rounds were conducted. A total of 131 experts were invited, and of these 65 accepted, with 48 completing Delphi round I and 51 completing Delphi round II. In all, a total of 57 experts from North America, Europe, Asia and Australia commented on the 47 suggested guidelines. RESULTS Forty-three guidelines were generated, grouped into the following four stages: Stage I. Define what is to be measured in terms of dietary intake (what? who? and when?); Stage II. Investigate different types of DATs; Stage III. Evaluate existing tools to select the most appropriate DAT by evaluating published validation studies; Stage IV. Think through the implementation of the chosen DAT and consider sources of potential biases. CONCLUSIONS The Delphi technique consolidated expert views on best practice in assessing dietary intake. The BPGs provide a valuable guide for health researchers to choose the most appropriate dietary assessment method for their studies. These guidelines will be accessible through the Nutritools website, www.nutritools.org .
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Affiliation(s)
- Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK.
| | - Marisol Warthon-Medina
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Salwa Albar
- Department of Food Science and Nutrition, King Abdulaziz University, PO Box 42807, 21551, Jeddah, Saudi Arabia
| | - Nisreen A Alwan
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - Andrew Ness
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, BS8 1TH, UK
| | - Mark Roe
- Quadram Institute Bioscience, Norwich, NR4 7UA, UK
| | - Petra A Wark
- Centre for Innovative Research Across the Life Course (CIRAL), Faculty of Health and Life Sciences, Coventry University, Coventry, CV1 5FB, UK.,Global eHealth Unit, Department of Primary Care and Public Health, Imperial College London, London, SW7 2AZ, UK
| | - Katharine Greathead
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Victoria J Burley
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Paul Finglas
- Quadram Institute Bioscience, Norwich, NR4 7UA, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TH, UK
| | - Polly Page
- MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK
| | - Katharine Roberts
- Public Health Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, S10 2TN, UK.,Public Health England, London, SE1 8UG, UK
| | - Toni Steer
- MRC Elsie Widdowson Laboratory, Cambridge, CB1 9NL, UK
| | - Jozef Hooson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, LS2 9JT, UK
| | - Darren C Greenwood
- Faculty of Medicine and Health, Division of Biostatistics, University of Leeds, Leeds, LS2 9JT, UK
| | - Sian Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
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