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Duus KS, Tjørnhøj-Thomsen T, Krølner RF. Implementation of health-promoting retail initiatives in the Healthier Choices in Supermarkets Study-qualitative perspectives from a feasibility study. BMC Med 2024; 22:349. [PMID: 39218867 PMCID: PMC11367934 DOI: 10.1186/s12916-024-03561-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Improving food environments like supermarkets has the potential to affect customers' health positively. Scholars suggest researchers and retailers collaborate closely on implementing and testing such health-promoting interventions, but knowledge of the implementation of such interventions is limited. We explore the implementation of four health-promoting food retail initiatives selected and developed by a partnership between a research institution, a large retail group, and a non-governmental organisation. METHODS The four initiatives included downsizing of bags for pick'n' mix sweets and soda bottles at the check-out registers, shelf tags promoting healthier breakfast cereal options, and replacing a complimentary bun with a banana offered to children. The initiatives were implemented for 6 weeks (or longer if the store manager allowed it) in one store in Copenhagen, Denmark. Data were collected through observations, informal interviews with customers, and semi-structured interviews with retailers. We conducted a thematic analysis of transcripts and field notes inspired by process evaluation concepts and included quantitative summaries of selected data. RESULTS Two out of four initiatives were not implemented as intended. The implementation was delayed due to delivery issues, which also resulted in soda bottles not being downsized as intended. The maintenance of the shelf tags decreased over time. Retailers expressed different levels of acceptability towards the initiatives, with a preference for the complimentary banana for children. This was also the only initiative noticed by customers with both positive and negative responses. Barriers and facilitators of implementation fell into three themes: Health is not the number one priority, general capacity of retailers, and influence of customers and other stakeholders on store operation. CONCLUSIONS The retailers' interests, priorities, and general capacity influenced the initiative implementation. Retailers' acceptability of the initiatives was mixed despite their involvement in the pre-intervention phase. Our study also suggests that customer responses towards health-promoting initiatives, as well as cooperation with suppliers and manufacturers in the development phase, may be determining to successful implementation. Future studies should explore strategies to facilitate implementation, which can be applied prior to and during the intervention.
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Affiliation(s)
- Katrine Sidenius Duus
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Tine Tjørnhøj-Thomsen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Ruggles PR, Taillie LS, Lee CJY, Prestemon CE, Duffy EW, Rojas CFU, Hall MG. Examining the effects of brand and licensed characters on parents' perceptions of Children's breakfast cereals. Appetite 2024; 200:107557. [PMID: 38880284 PMCID: PMC11328928 DOI: 10.1016/j.appet.2024.107557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/24/2024] [Accepted: 06/12/2024] [Indexed: 06/18/2024]
Abstract
Brand and licensed characters frequently appear on children's breakfast cereal boxes and are known to affect children's product perceptions, selection, and consumption. However, less is known about their impact on parents' perceptions of foods they purchase for their child. The present study assessed the impact of brand and licensed characters featured on three children's breakfast cereal packages on parents' intentions and perceptions in an online experiment. Parents of children aged 2-12 years (n = 1013) were randomized into one of two conditions: breakfast cereals containing brand and licensed characters or breakfast cereals without any characters. Within each condition, participants viewed three breakfast cereal brands in random order per their assigned condition and reported their purchase intentions, healthfulness perceptions, and perceptions of appeal to children using 5-point Likert scales. No significant differences in purchase intentions (p = 0.91), perceived healthfulness (p = 0.52) or perceived child appeal (p = 0.59) were observed between the experimental and control groups. However, exploratory moderation analyses revealed that educational attainment moderated the impact of experimental condition on purchase intentions (p for interaction = 0.002) such that participants with a bachelor's degree in the character condition reported 0.36 points lower purchase intentions compared to the control with no difference between conditions for those with an associate's degree/trade school or high school degree or less. This study did not find an impact of brand and licensed characters on children's breakfast cereals, suggesting that their primary appeal is directly to children. Parents with higher educational attainment may be skeptical of characters on cereal brands. Additional research on the impact of brand and licensed characters on other products, in real-world settings, is needed.
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Affiliation(s)
- Phoebe R Ruggles
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Carolina Population Center, University of North Carolina at Chapel, USA
| | - Cristina J Y Lee
- Department of Pediatrics, Stanford University School of Medicine, USA
| | | | - Emily W Duffy
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA
| | - Carlos F U Rojas
- Department of Design, University of Joinville Region, Brazil; Laboratory of Information Design Systems (LabDSI), Federal University of Paraná, Brazil
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA; Carolina Population Center, University of North Carolina at Chapel, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, USA.
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Kim Y, Rangel J, Colabianchi N. Food Environments and Cardiovascular Disease: Evidence From the Health and Retirement Study. Am J Prev Med 2024; 67:201-209. [PMID: 38484903 DOI: 10.1016/j.amepre.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Residential food environments are one of the important determinants of cardiovascular health. However, past literature has been limited by short-term follow-ups, time-invariant environmental measurements at baseline, and/or not investigating both healthy and unhealthy aspects of the food environment. This study examines the effects of time-varying healthy and unhealthy food environments on incident cardiovascular disease (CVD) over 10 years, extracting data from the Health and Retirement Study (2006-2016; N=10,413). METHODS Cox proportional hazards modeling was performed with inverse probability weighting to assess the association between time-varying food environmental measures (i.e., densities of grocery stores, supercenters/club stores, full-service restaurants, and fast-food restaurants) and incident CVD over 10 years. Education level and race/ethnicity were tested as potential moderators. Analyses were conducted in 2022-2023. RESULTS Race/ethnicity had a significant interaction effect with supercenters/club stores and indicated that a 1-standard-deviation increase in the density of supercenters/club stores was associated with a 6%-8% lower risk of incident CVD in non-Hispanic Black (HR=0.78, 95% CI=0.70-0.87) and Hispanic older adults (HR=0.69, 95% CI=0.50-0.96), but not non-Hispanic White older adults. Additionally, education had a significant interaction effect with full-service restaurants, indicating that a 1-standard-deviation increase in the density of full-service restaurants was associated with a 10% lower risk of incident CVD in individuals with 13+ years of schooling, but not those with 0-12 years of schooling. CONCLUSIONS Findings suggest that public policymakers should be aware of the benefits and nuances of varying food environment components as they can contribute to positive or negative cardiovascular health.
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Affiliation(s)
- Yeonwoo Kim
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas; School of Social Work, University of Texas at Arlington, Arlington, Texas.
| | - Joseph Rangel
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
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Dhuria P, Muir S, Lawrence W, Roe E, Crozier S, Cooper C, Baird J, Vogel C. Women Consumers' Views on Legislation to Restrict Prominent Placement and Multibuy Promotions of High Fat, Sugar, and Salt Products in England: A Qualitative Perspective. Int J Health Policy Manag 2023; 12:7597. [PMID: 38618804 PMCID: PMC10590244 DOI: 10.34172/ijhpm.2023.7597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/15/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND As part of the childhood obesity strategy, the UK Government has introduced regulations to restrict the ways high fat salt and sugar (HFSS) products can be promoted in retail settings from October 2022. This study explored (i) consumers' views on the likely impact of the UK legislation restricting the placement and promotion of HFSS products on their shopping behaviours and (ii) consumers' beliefs about who is responsible for healthy eating. METHODS Using a cross-sectional study design, qualitative semi-structured telephone interviews were conducted with a purposive sample of women who shopped at a discount supermarket. Thematic analysis was employed to identify key themes. RESULTS Participants' (n = 34) had a median age of 35 years and over half were in paid employment. Five themes were identified: (1) The legislation is acceptable, but people can still (and should be able to) buy HFSS items; (2) The legislation is likely to have more impact on shoppers who do not plan their shopping; (3) Affordability of healthy food is just as, or more, important than the legislation; (4) It's up to the individual to eat healthily; and (5) Government and retailers can better support consumers to make healthy choices. CONCLUSION Most participants were optimistic about the incoming regulations and believed that it would support consumers to make healthier food choices. Many raised concerns, however, that the high price of healthy foods and continued availability of unhealthy foods within the stores could undermine the legislation's benefits. Coupling the legislation with interventions to promote and reduce the costs of healthier products would go some way to ensure its success. Raising awareness about marketing strategies that play into consumer concerns for cost and autonomy could further increase acceptance of the policy.
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Affiliation(s)
- Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Sarah Muir
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emma Roe
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
- Centre for Food Policy, City, University of London, London, UK
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Vogel C, Dijkstra C, Huitink M, Dhuria P, Poelman MP, Mackenbach JD, Crozier S, Seidell J, Baird J, Ball K. Real-life experiments in supermarkets to encourage healthy dietary-related behaviours: opportunities, challenges and lessons learned. Int J Behav Nutr Phys Act 2023; 20:73. [PMID: 37340326 DOI: 10.1186/s12966-023-01448-8] [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: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Supermarkets are the primary source of food for many people yet their full potential as a setting to encourage healthy dietary-related behaviours remains underutilised. Sharing the experiences from research groups who have worked with supermarket chains to evaluate strategies that promote healthy eating could improve the efficiency of building such relationships and enhance the design quality of future research studies. METHODS A collective case study approach was used to synthesise experiences of engaging and sustaining research collaborations with national supermarket chains to test the effectiveness of health-focused in-store interventions. The collective narrative covers studies conducted in three high-income countries: Australia, the Netherlands and the United Kingdom. RESULTS We have distilled our experiences and lessons learned into six recommendations for conducting high quality public health research with commercial supermarket chains. These include: (i) using personal contacts, knowledge of supermarket activities and engaging executive management to establish a partnership and allowing time to build trust; (ii) using scientifically robust study designs with appropriate sample size calculations; (iii) formalising data exchange arrangements and allocating adequate resource for data extraction and re-categorisation; (iv) assessing effects at individual/households level where possible; (v) designing a mixed-methods process evaluation to measure intervention fidelity, dose and unintended consequences; and (vi) ensuring scientific independence through formal contract agreements. CONCLUSIONS Our collective experiences of working in non-financial partnerships with national supermarket chains could be useful for other research groups looking to develop and implement supermarket studies in an efficient manner. Further evidence from real-life supermarket interventions is necessary to identify sustainable strategies that can improve population diet and maintain necessary commercial outcomes.
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Affiliation(s)
- Christina Vogel
- Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Marlijn Huitink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Wageningen, 6700 EW, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute, De Boelelaan 1089a, 1081HV, Amsterdam, the Netherlands
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Jacob Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Muir S, Dhuria P, Roe E, Lawrence W, Baird J, Vogel C. UK government's new placement legislation is a 'good first step': a rapid qualitative analysis of consumer, business, enforcement and health stakeholder perspectives. BMC Med 2023; 21:33. [PMID: 36703194 PMCID: PMC9878939 DOI: 10.1186/s12916-023-02726-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/03/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders. METHODS A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders. RESULTS Stakeholders perceived the legislation to be a 'good first step' towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health. CONCLUSIONS This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20-30 years.
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Affiliation(s)
- Sarah Muir
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Emma Roe
- School of Geography and Environmental Science, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton, SO16 7NP, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton, SO16 7NP, UK.,Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK
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Vogel C, Shaw S, Strömmer S, Crozier S, Jenner S, Cooper C, Baird J, Inskip H, Barker M. Inequalities in energy drink consumption among UK adolescents: a mixed-methods study. Public Health Nutr 2022; 26:1-28. [PMID: 36472075 PMCID: PMC9989712 DOI: 10.1017/s1368980022002592] [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: 05/18/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine energy drink consumption among adolescents in the United Kingdom (UK) and associations with deprivation and dietary inequalities. DESIGN Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis. SETTING UK. PARTICIPANTS Quantitative data: nationally representative sample of 2587 adolescents aged 11-18 years. Qualitative data: 20 parents, 9 teachers, and 28 adolescents from Hampshire, UK. RESULTS NDNS data showed adolescents' consumption of energy drinks was associated with poorer dietary quality (OR 0.46 per SD; 95% CI 0.37, 0.58; p<0.001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1.40; 95%CI 1.16, 1.69; p<0.001; OR 0.98 per £1000; 95%CI, 0.96, 0.99; p<0.001 respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (p=0.04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents don't know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work. CONCLUSIONS This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents' energy drink intake.
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Affiliation(s)
- Christina Vogel
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- Centre for Food Policy, City, University of London, London, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK
| | - Sarah Shaw
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sofia Strömmer
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Crozier
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK
| | - Sarah Jenner
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Chilworth, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Lloyd DT, Skinner HG, Maguire R, Murphy SK, Motsinger-Reif AA, Hoyo C, House JS. Clomifene and Assisted Reproductive Technology in Humans Are Associated with Sex-Specific Offspring Epigenetic Alterations in Imprinted Control Regions. Int J Mol Sci 2022; 23:10450. [PMID: 36142363 PMCID: PMC9499479 DOI: 10.3390/ijms231810450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 12/04/2022] Open
Abstract
Children conceived with assisted reproductive technology (ART) have an increased risk of adverse outcomes, including congenital malformations and imprinted gene disorders. In a retrospective North Carolina-based-birth-cohort, we examined the effect of ovulation drugs and ART on CpG methylation in differentially methylated CpGs in known imprint control regions (ICRs). Nine ICRs containing 48 CpGs were assessed for methylation status by pyrosequencing in mixed leukocytes from cord blood. After restricting to non-smoking, college-educated participants who agreed to follow-up, ART-exposed (n = 27), clomifene-only-exposed (n = 22), and non-exposed (n = 516) groups were defined. Associations of clomifene and ART with ICR CpG methylation were assessed with linear regression and stratifying by offspring sex. In males, ART was associated with hypomethylation of the PEG3 ICR [β(95% CI) = -1.46 (-2.81, -0.12)] and hypermethylation of the MEG3 ICR [3.71 (0.01, 7.40)]; clomifene-only was associated with hypomethylation of the NNAT ICR [-5.25 (-10.12, -0.38)]. In female offspring, ART was associated with hypomethylation of the IGF2 ICR [-3.67 (-6.79, -0.55)]. Aberrant methylation of these ICRs has been associated with cardiovascular disease and metabolic and behavioral outcomes in children. The results suggest that the increased risk of adverse outcomes in offspring conceived through ART may be due in part to altered methylation of ICRs. Larger studies utilizing epigenome-wide interrogation are warranted.
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Affiliation(s)
- Dillon T. Lloyd
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27606, USA
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27607, USA
| | - Harlyn G. Skinner
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27606, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Rachel Maguire
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27606, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - Susan K. Murphy
- Department of Obstetrics and Gynecology, Duke University Medical Center, Duke University, Durham, NC 27701, USA
| | - Alison A. Motsinger-Reif
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA
| | - Cathrine Hoyo
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27606, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27607, USA
| | - John S. House
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27606, USA
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC 27607, USA
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Solomon-Moore E, Lambert J, Grey E, Gillison F, Townsend N, Busam B, Velemis K, Millen C, Baber F, Griffin T. Life in lockdown: a longitudinal study investigating the impact of the UK COVID-19 lockdown measures on lifestyle behaviours and mental health. BMC Public Health 2022; 22:1495. [PMID: 35932040 PMCID: PMC9354438 DOI: 10.1186/s12889-022-13888-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to the UK government enforcing lockdown restrictions to control virus transmission. Such restrictions present opportunities and barriers for physical activity and healthy eating. Emerging research suggests that in the early stages of the pandemic, physical activity levels decreased, consumption of unhealthy foods increased, while levels of mental distress increased. Our aims were to understand patterns of diet, physical activity, and mental health during the first lockdown, how these had changed twelve-months later, and the factors associated with change. METHODS An online survey was conducted with UK adults (N = 636; 78% female) during the first national lockdown (May-June 2020). The survey collected information on demographics, physical activity, diet, mental health, and how participants perceived lifestyle behaviours had changed from before the pandemic. Participants who provided contact details were invited to complete a twelve-month follow-up survey (May-June 2021), 160 adults completed the survey at both time-points. Descriptive statistics, T-tests and McNemar Chi Square statistics were used to assess patterns of diet, physical activity, and mental health at baseline and change in behaviours between baseline and follow-up. Linear regression models were conducted to explore prospective associations between demographic and psycho-social variables at baseline with change in healthy eating habit, anxiety, and wellbeing respectively. RESULTS Between baseline and follow-up, healthy eating habit strength, and the importance of and confidence in eating healthily reduced. Self-rated health (positively) and confidence in eating healthily (negatively) were associated with change in healthy eating habit. There were no differences between baseline and follow-up for depression or physical activity. Mean anxiety score reduced, and wellbeing increased, from baseline to follow-up. Living with children aged 12-17 (compared to living alone) was associated with an increase in anxiety, while perceiving mental health to have worsened during the first lockdown (compared to staying the same) was associated with reduced anxiety and an increase in mental wellbeing. CONCLUSIONS While healthy eating habits worsened in the 12 months since the onset of the pandemic, anxiety and mental wellbeing improved. However, anxiety may have increased for parents of secondary school aged children.
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Affiliation(s)
- Emma Solomon-Moore
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Jeffrey Lambert
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Elisabeth Grey
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
- Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, UK
| | - Fiona Gillison
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Nick Townsend
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Betty Busam
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
- Department of Psychology, University of Heidelberg, Grabengasse 1, 69117, Heidelberg, Germany
| | - Kyriakos Velemis
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Christopher Millen
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Fran Baber
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Tania Griffin
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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10
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Becker TB, Contreras D, Porth O. Differences in Eating and Physical Activity Behaviors, and Perceived Accessibility and Availability Barriers between Midwestern Rural and Urban Adults. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2021.1930318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tyler Brian Becker
- Department of Food Science and Human Nutrition, Michigan State University(MSU), East Lansing, Michigan, USA
- Health and Nutrition Institute, Michigan State University(MSU), East Lansing, Michigan, USA
| | - Dawn Contreras
- Health and Nutrition Institute, Michigan State University(MSU), East Lansing, Michigan, USA
| | - Olivia Porth
- Department of Food Science and Human Nutrition, Michigan State University(MSU), East Lansing, Michigan, USA
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11
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Corona G, Dubowitz T, Troxel WM, Ghosh-Dastidar M, Rockette-Wagner B, Gary-Webb TL. Neighborhood Food Environment Associated with Cardiometabolic Health among Predominately Low-income, Urban, Black Women. Ethn Dis 2021; 31:537-546. [PMID: 34720557 DOI: 10.18865/ed.31.4.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives This study sought to: 1) understand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store types with cardiometabolic health outcomes. Methods We report on cross-sectional data from 459 individuals participating in the Pittsburgh, PA Hill/Homewood Research on Neighborhoods and Health (PHRESH) study. Mean participant age was 60.7 (SD=13.9); 81.7% were female. We used logistic regression to examine associations between three factors (perceived fruit and vegetable availability, quality, and price; primary food shopping store characteristics; and frequency of shopping at stores with low or high access to healthy foods) and cardiometabolic and self-rated health. Results Adjusting for sociodemographic characteristics, participants with higher perceived fruit and vegetable accessibility (AOR:.47, 95%CI: .28-.79, P=.004) and affordability (AOR:.59, 95%CI: .36-.96, P=.034) had lower odds of high blood pressure. Shopping often (vs rarely) at stores with low access to healthy foods was associated with higher odds of high total cholesterol (AOR:3.52, 95%CI: 1.09-11.40, P=.035). Finally, primary food shopping at a discount grocery (vs full-service supermarket) was associated with lower odds of overweight/obesity (AOR:.51, 95%CI: .26-.99, P=.049). Conclusions These results suggest that both perceived accessibility and affordability of healthy foods are associated with reduced cardiometabolic risk factors in this urban, low-income predominantly Black population. Additionally, discount grocery stores may be particularly valuable by providing access and affordability of healthy foods in this population.
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Affiliation(s)
- Gabrielle Corona
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Tamara Dubowitz
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA
| | - Wendy M Troxel
- RAND Corporation, Behavior and Policy Sciences, Pittsburgh, PA
| | | | - Bonny Rockette-Wagner
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
| | - Tiffany L Gary-Webb
- University of Pittsburgh Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA
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Harmer G, Jebb SA, Ntani G, Vogel C, Piernas C. Capturing the Healthfulness of the In-store Environments of United Kingdom Supermarket Stores Over 5 Months (January-May 2019). Am J Prev Med 2021; 61:e171-e179. [PMID: 34158196 DOI: 10.1016/j.amepre.2021.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Numerous environmental factors within supermarkets can influence the healthfulness of food purchases. This research aims to identify the changes in store healthfulness scores and assess the variations by store type and neighborhood deprivation using an adapted Consumer Nutrition Environment tool. METHODS Between January and May 2019, a total of 104 supermarkets in London were surveyed on 1-3 occasions. The adapted Consumer Nutrition Environment tool included data on 9 variables (variety, price, quality, promotions, shelf placement, store placement, nutrition information, healthier alternatives, and single fruit sale) for 11 healthy and 5 less healthy food items. An algorithm was used to create a composite score of in-store healthfulness and to assess inter-rater reliability. Longitudinal changes in overall store healthfulness and individual variables were investigated using multivariable hierarchical mixed models. Descriptive statistics were used to describe the differences by store type and neighborhood deprivation in each month. All analyses were conducted between January and July 2020. RESULTS The adapted Consumer Nutrition Environment tool showed acceptable inter-rater reliability. Large stores exhibited healthier environments than small stores (p<0.001), with a similar pattern for each of the 9 individual variables. Within large stores, the overall healthfulness score did not change over the study period. Promotions on more healthful items increased in February (p=0.04), and the availability of healthier alternatives for less healthy foods decreased in March (p=0.01). Within small stores, there was a trend toward increasing healthfulness (p<0.001), primarily owing to more promotions on healthy items (p<0.001). There was no difference in overall healthfulness by neighborhood deprivation. CONCLUSIONS The adapted Consumer Nutrition Environment tool is sensitive to longitudinal changes in environmental variables that contribute to store healthfulness. A wider application of this tool could be used to map in-store environments to identify targets for interventions to encourage healthier food purchasing.
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Affiliation(s)
- Georgina Harmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Georgia Ntani
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
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13
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Vogel C, Crozier S, Penn-Newman D, Ball K, Moon G, Lord J, Cooper C, Baird J. Altering product placement to create a healthier layout in supermarkets: Outcomes on store sales, customer purchasing, and diet in a prospective matched controlled cluster study. PLoS Med 2021; 18:e1003729. [PMID: 34491999 PMCID: PMC8423266 DOI: 10.1371/journal.pmed.1003729] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous product placement trials in supermarkets are limited in scope and outcome data collected. This study assessed the effects on store-level sales, household-level purchasing, and dietary behaviours of a healthier supermarket layout. METHODS AND FINDINGS This is a prospective matched controlled cluster trial with 2 intervention components: (i) new fresh fruit and vegetable sections near store entrances (replacing smaller displays at the back) and frozen vegetables repositioned to the entrance aisle, plus (ii) the removal of confectionery from checkouts and aisle ends opposite. In this pilot study, the intervention was implemented for 6 months in 3 discount supermarkets in England. Three control stores were matched on store sales and customer profiles and neighbourhood deprivation. Women customers aged 18 to 45 years, with loyalty cards, were assigned to the intervention (n = 62) or control group (n = 88) of their primary store. The trial registration number is NCT03518151. Interrupted time series analysis showed that increases in store-level sales of fruits and vegetables were greater in intervention stores than predicted at 3 (1.71 standard deviations (SDs) (95% CI 0.45, 2.96), P = 0.01) and 6 months follow-up (2.42 SDs (0.22, 4.62), P = 0.03), equivalent to approximately 6,170 and approximately 9,820 extra portions per store, per week, respectively. The proportion of purchasing fruits and vegetables per week rose among intervention participants at 3 and 6 months compared to control participants (0.2% versus -3.0%, P = 0.22; 1.7% versus -3.5%, P = 0.05, respectively). Store sales of confectionery were lower in intervention stores than predicted at 3 (-1.05 SDs (-1.98, -0.12), P = 0.03) and 6 months (-1.37 SDs (-2.95, 0.22), P = 0.09), equivalent to approximately 1,359 and approximately 1,575 fewer portions per store, per week, respectively; no differences were observed for confectionery purchasing. Changes in dietary variables were predominantly in the expected direction for health benefit. Intervention implementation was not within control of the research team, and stores could not be randomised. It is a pilot study, and, therefore, not powered to detect an effect. CONCLUSIONS Healthier supermarket layouts can improve the nutrition profile of store sales and likely improve household purchasing and dietary quality. Placing fruits and vegetables near store entrances should be considered alongside policies to limit prominent placement of unhealthy foods. TRIAL REGISTRATION ClinicalTrials.gov NCT03518151 (pre-results).
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Daniel Penn-Newman
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
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Pradeilles R, Irache A, Wanjohi MN, Holdsworth M, Laar A, Zotor F, Tandoh A, Klomegah S, Graham F, Muthuri SK, Kimani-Murage EW, Coleman N, Green MA, Osei-Kwasi HA, Bohr M, Rousham EK, Asiki G, Akparibo R, Mensah K, Aryeetey R, Bricas N, Griffiths P. Urban physical food environments drive dietary behaviours in Ghana and Kenya: A photovoice study. Health Place 2021; 71:102647. [PMID: 34375838 PMCID: PMC8520917 DOI: 10.1016/j.healthplace.2021.102647] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/20/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
We identified factors in the physical food environment that influence dietary behaviours among low-income dwellers in three African cities (Nairobi, Accra, Ho). We used Photovoice with 142 males/females (≥13 years). In the neighbourhood environment, poor hygiene, environmental sanitation, food contamination and adulteration were key concerns. Economic access was perceived as a major barrier to accessing nutritionally safe and healthy foods. Home gardening supplemented household nutritional needs, particularly in Nairobi. Policies to enhance food safety in neighbourhood environments are required. Home gardening, food pricing policies and social protection schemes could reduce financial barriers to safe and healthy diets.
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Affiliation(s)
- Rebecca Pradeilles
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom.
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Michelle Holdsworth
- IRD (French National Research Institute for Sustainable Development), NUTRIPASS Unit, Université de Montpellier-IRD, Montpellier, France
| | - Amos Laar
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Francis Zotor
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Akua Tandoh
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Fiona Graham
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | | | - Nathaniel Coleman
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana; Department of Obstetrics and Gynaecology, University of Ghana Medical School, College of Health Sciences, Accra, Ghana
| | - Mark A Green
- Department of Geography and Planning, University of Liverpool, UK
| | | | - Marco Bohr
- School of Art & Design, Nottingham Trent University, UK
| | - Emily K Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Robert Akparibo
- Public Health Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - Kobby Mensah
- Department of Marketing and Entrepreneurship, University of Ghana Business School, Accra, Ghana
| | - Richmond Aryeetey
- University of Ghana, Department of Population, Family & Reproductive Health, School of Public Health, Accra, Ghana
| | - Nicolas Bricas
- UMR MOISA, CIRAD- Agricultural Research & International Cooperation Organization, Montpellier, France
| | - Paula Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, United Kingdom
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Dhuria P, Lawrence W, Crozier S, Cooper C, Baird J, Vogel C. Women's perceptions of factors influencing their food shopping choices and how supermarkets can support them to make healthier choices. BMC Public Health 2021; 21:1070. [PMID: 34090410 PMCID: PMC8178895 DOI: 10.1186/s12889-021-11112-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To examine women's perceptions of factors that influence their food shopping choices, particularly in relation to store layout, and their views on ways that supermarkets could support healthier choices. DESIGN This qualitative cross-sectional study used semi-structured telephone interviews to ask participants the reasons for their choice of supermarket and factors in-store that prompted their food selections. The actions supermarkets, governments and customers could take to encourage healthier food choices were explored with women. Thematic analysis was conducted to identify key themes. SETTING Six supermarkets across England. PARTICIPANTS Twenty women customers aged 18-45 years. RESULTS Participants had a median age of 39.5 years (IQR: 35.1, 42.3), a median weekly grocery spend of £70 (IQR: 50, 88), and 44% had left school aged 16 years. Women reported that achieving value for money, feeling hungry, tired, or stressed, and meeting family members' food preferences influenced their food shopping choices. The physical environment was important, including product quality and variety, plus ease of accessing the store or products in-store. Many participants described how they made unintended food selections as a result of prominent placement of unhealthy products in supermarkets, even if they adopted more conscious approaches to food shopping (i.e. written or mental lists). Participants described healthy eating as a personal responsibility, but some stated that governments and supermarkets could be more supportive. CONCLUSIONS This study highlighted that in-store environments can undermine intentions to purchase and consume healthy foods. Creating healthier supermarket environments could reduce the burden of personal responsibility for healthy eating, by making healthier choices easier. Future research could explore the interplay of personal, societal and commercial responsibility for food choices and health status.
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Affiliation(s)
- Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
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Development and testing of the Sustainable Nutrition Environment Measures Survey for retail stores in Ontario. Public Health Nutr 2021; 24:1962-1971. [PMID: 33517938 DOI: 10.1017/s1368980021000446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop and test a tool to assess the price and availability of low-carbon footprint and nutritionally balanced dietary patterns in retail food environments in Ontario, Canada. DESIGN Availability and price of selected food from discount and regular grocery stores (n 23) in urban/rural areas of northern/southern Ontario were assessed with the Sustainable Nutrition Environment Measures Survey in 2017. SETTING Ontario, Canada. RESULTS Inter-rater reliability was high for price (intra-class correlation coefficients = 0·819) and for availability (Cohen's κ = 0·993). The tool showed 78 % of the selected food items were available in all stores. Overall, price differences were small between urban and rural locations, and northern and southern Ontario. The greatest price difference was between discount and regular stores. CONCLUSIONS The tool showed excellent inter-rater agreement. Researchers and public health dietitians can use this tool for research, practice and policy to link consumer-level health outcomes to the retail environment.
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Shaw SC, Ntani G, Baird J, Vogel CA. A systematic review of the influences of food store product placement on dietary-related outcomes. Nutr Rev 2020; 78:1030-1045. [PMID: 32483615 PMCID: PMC7666915 DOI: 10.1093/nutrit/nuaa024] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
CONTEXT Product placement strategies have been used to influence customers' food purchases in food stores for some time; however, assessment of the evidence that these techniques can limit unhealthy, and promote healthy, food choices has not been completed. OBJECTIVE This systematic review aimed to determine how product placement strategies, availability, and positioning, in physical retail food stores located in high-income countries, influence dietary-related behaviors. DATA SOURCES From a search of 9 databases, 38 articles, 17 observational studies, and 22 intervention studies met the study inclusion criteria. DATA EXTRACTION Two reviewers independently extracted data relating to study design, study population, exposures, outcomes, and key results. Each study was also assessed for risk of bias in relation to the research question. DATA ANALYSIS Meta-analysis was not possible owing to heterogeneous study designs and outcomes. As recommended by Cochrane, results were synthesized in effect direction plots using a vote-counting technique which recorded the direction of effect and significance level according to the expected relationship for health improvement. CONCLUSIONS The majority of studies showed that greater availability and more prominent positioning of healthy foods, or reduced availability and less prominent positioning of unhealthy foods, related to better dietary-related behaviors. A large number of results, however, were nonsignificant, which likely reflects the methodological difficulties inherent in this research field. Adequately powered intervention studies that test both the independent and additive effects of availability and positioning strategies are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. 42016048826.
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Affiliation(s)
- Sarah C Shaw
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Georgia Ntani
- UK Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christina A Vogel
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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The interplay between fast-food outlet exposure, household food insecurity and diet quality in disadvantaged districts. Public Health Nutr 2020; 25:105-113. [PMID: 33106199 PMCID: PMC8825968 DOI: 10.1017/s1368980020004280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The current study aimed to explore the interplay between food insecurity, fast-food outlet exposure and dietary quality in disadvantaged neighbourhoods. DESIGN In this cross-sectional study, main associations between fast-food outlet density and proximity, food insecurity status and dietary quality were assessed using Generalized Estimating Equation analyses. We assessed potential moderation by fast-food outlet exposure in the association between food insecurity status and dietary quality by testing for effect modification between food insecurity status and fast-food outlet density and proximity. SETTING A deprived urban area in the Netherlands. PARTICIPANTS We included 226 adult participants with at least one child below the age of 18 years living at home. RESULTS Fast-food outlet exposure was not associated with experiencing food insecurity (fast-food outlet density: b = -0·026, 95 % CI = -0·076; 0·024; fast-food outlet proximity: b = -0·003, 95 % CI = -0·033; 0·026). Experiencing food insecurity was associated with lower dietary quality (b = -0·48 per unit increase, 95 % CI = -0·94; -0·012). This association was moderated by fast-food outlet proximity (Pinteraction = 0·008), and stratified results revealed that the adverse effect of food insecurity on dietary quality was more pronounced for those with the nearest fast-food outlet located closer to the home. CONCLUSIONS Food insecurity but not fast-food outlet density is associated with dietary quality. However, the association between food insecurity and dietary quality may be modified by the food environment. These findings could inform policymakers to promote a healthier food environment including less fast-food outlets, with particular emphasis on areas with high percentages of food insecure households.
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NASRALLAH D, EZ-ELARAB H, SULTAN E, ALLAM M. Predictive factors for nutritional behavior among pregnant women attending antenatal care clinic in 6 th of October City. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E186-E193. [PMID: 32803004 PMCID: PMC7419123 DOI: 10.15167/2421-4248/jpmh2020.61.2.1302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/06/2020] [Indexed: 11/29/2022]
Abstract
Background Good maternal nutrition during pregnancy is important to ensure health for both the mother and the foetus. This study aimed to assess nutritional knowledge and behavior among a group of Egyptian pregnant women in addition to identify the factors influencing both their nutritional knowledge and behavior. Methods This comparative cross sectional study included 300 pregnant women attending the antenatal care clinics in 6th of October University private hospital and El-Hussary primary health care (PHC) unit. The data was collected through a modified nutritional survey that was translated from Spanish to Arabic and revised by language experts for clarity. Results Almost all of the women attending the private hospital were university educated while about half of the women attending the PHC unit were graduated from technical education. In general, the level of knowledge about food requirements of both groups was satisfactory good; however, neither of them fulfilled the WHO recommendations of food intake during pregnancy or the optimum number of meals per day. The mean of random blood glucose was higher among the women attending the PHC unit; the BMI, mid arm circumference and subcutaneous fat were higher among the same group as well. In regard to fulfilling the WHO recommended servings per day, only starch and fat items were fulfilled by both groups, whereas the other three items (vegetables, fruits and dairy products) were merely included in the diets of both groups. Conclusions Healthy behavior among pregnant women in both group were influenced by their educational level, occupation as well as their pre-gestational BMI. Those were the only three significant predictive factors, where women with higher education showed an active lifestyle. In addition, women starting with normal BMI before pregnancy had better healthy behaviours including the choice of healthy diets.
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Affiliation(s)
- D.A. NASRALLAH
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - H.S. EZ-ELARAB
- Department of Community Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt and at Fakeeh College for Medical Sciences, Jeddah, KSA
| | | | - M.F. ALLAM
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Correspondence: Mohamed Farouk Allam, Department of Family Medicine, Faculty of Medicine, Ain Shams University, 11566 Abbasia, Cairo, Egypt - Tel.: +(202) 24346888/ +(2) 011 43559946 - Fax: +(202) 24346888 - E-mail:
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Factors influencing dietary behaviours in urban food environments in Africa: a systematic mapping review. Public Health Nutr 2020; 23:2584-2601. [PMID: 32450938 PMCID: PMC7116038 DOI: 10.1017/s1368980019005305] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To identify factors influencing dietary behaviours in urban food environments in Africa and identify areas for future research. Design: We systematically reviewed published/grey literature (protocol CRD4201706893). Findings were compiled into a map using a socio-ecological model on four environmental levels: individual, social, physical and macro. Setting: Urban food environments in Africa. Participants: Studies involving adolescents and adults (11–70 years, male/female). Results: Thirty-nine studies were included (six adolescent, fifteen adolescent/adult combined and eighteen adult). Quantitative methods were most common (twenty-eight quantitative, nine qualitative and two mixed methods). Studies were from fifteen African countries. Seventy-seven factors influencing dietary behaviours were identified, with two-thirds at the individual level (45/77). Factors in the social (11/77), physical (12/77) and macro (9/77) environments were investigated less. Individual-level factors that specifically emerged for adolescents included self-esteem, body satisfaction, dieting, spoken language, school attendance, gender, body composition, pubertal development, BMI and fat mass. Studies involving adolescents investigated social environment-level factors more, for example, sharing food with friends. The physical food environment was more commonly explored in adults, for example, convenience/availability of food. Macro-level factors associated with dietary behaviours were food/drink advertising, religion and food prices. Factors associated with dietary behaviour were broadly similar for men and women. Conclusions: The dominance of studies exploring individual-level factors suggests a need for research to explore how social, physical and macro-level environments drive dietary behaviours of adolescents and adults in urban Africa. More studies are needed for adolescents and men, and studies widening the geographical scope to encompass all African countries.
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Preconception nutrition: building advocacy and social movements to stimulate action. J Dev Orig Health Dis 2020; 12:141-146. [PMID: 32419689 DOI: 10.1017/s2040174420000197] [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: 11/06/2022]
Abstract
Action to improve preconception nutrition is a collective, societal responsibility. We believe that the Developmental Origins of Health and Disease (DOHaD) society is ideally placed to facilitate the development of a global agenda for preconception nutrition which recognises the societal importance of nutrition for young women and men, and supports them in optimising their nutritional status for the benefit of the next generation. In this paper, we outline four key actions that can be taken by the members of DOHaD's international society located across 67 countries, and nine regional societies, to demonstrate this leadership role. The recommended actions to place preconception nutrition at the top of national and regional agendas include (i) continuing to build the scientific evidence, (ii) monitoring of progress made by governments and commercial companies, (iii) developing advocacy coalitions that unite individuals and organisations around common policy options and (iv) working with partners to develop an emotive and empowering preconception nutrition awareness campaign. Collectively, these actions hold the potential to develop into a preconception nutrition social movement to invoke high-level government support and across-sector policy action, while raising public demand for action and engaging corporate actors.
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Vogel C, Crozier S, Dhuria P, Shand C, Lawrence W, Cade J, Moon G, Lord J, Ball K, Cooper C, Baird J. Protocol of a natural experiment to evaluate a supermarket intervention to improve food purchasing and dietary behaviours of women (WRAPPED study) in England: a prospective matched controlled cluster design. BMJ Open 2020; 10:e036758. [PMID: 32047023 PMCID: PMC7044911 DOI: 10.1136/bmjopen-2020-036758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Poor diet is a leading risk factor for non-communicable diseases and costs the National Health Service £5.8 billion annually. Product placement strategies used extensively in food outlets, like supermarkets, can influence customers' preferences. Policy-makers, including the UK Government, are considering legislation to ensure placement strategies promote healthier food purchasing and dietary habits. High-quality scientific evidence is needed to inform future policy action. This study will assess whether healthier placement strategies in supermarkets improve household purchasing patterns and the diets of more than one household member. METHODS AND ANALYSES This natural experiment, with a prospective matched controlled cluster design, is set in discount supermarkets across England. The primary objective is to investigate whether enhanced placement of fresh fruit and vegetables improves household-level purchasing of these products after 6 months. Secondary objectives will examine: (1) differences in intervention effects on purchasing by level of educational attainment, (2) intervention effects on the dietary quality of women and their young children, (3) intervention effects on store-level sales of fruit and vegetables and (4) cost-effectiveness of the intervention from individual, retailer and societal perspectives. Up to 810 intervention and 810 control participants will be recruited from 18 intervention and 18 matched control stores. Eligible participants will be women aged 18-45 years, who hold a loyalty card and shop in a study store. Each control store will be matched to an intervention store on: (1) sales profile, (2) neighbourhood deprivation and (3) customer profile. A detailed process evaluation will assess intervention implementation, mechanisms of impact and, social and environmental contexts. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Southampton, Faculty of Medicine Ethics Committee (ID 20986.A5). Primary, secondary and process evaluation results will be submitted for publication in peer-reviewed scientific journals and shared with policy-makers. TRIAL REGISTRATION NUMBER NCT03573973; Pre-results.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Calum Shand
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janet Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham Moon
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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A Systematic Review on Socioeconomic Differences in the Association between the Food Environment and Dietary Behaviors. Nutrients 2019; 11:nu11092215. [PMID: 31540267 PMCID: PMC6769523 DOI: 10.3390/nu11092215] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/25/2022] Open
Abstract
Little is known about socioeconomic differences in the association between the food environment and dietary behavior. We systematically reviewed four databases for original studies conducted in adolescents and adults. Food environments were defined as all objective and perceived aspects of the physical and economic food environment outside the home. The 43 included studies were diverse in the measures used to define the food environment, socioeconomic position (SEP) and dietary behavior, as well as in their results. Based on studies investigating the economic (n = 6) and school food environment (n = 4), somewhat consistent evidence suggests that low SEP individuals are more responsive to changes in food prices and benefit more from healthy options in the school food environment. Evidence for different effects of availability of foods and objectively measured access, proximity and quality of food stores on dietary behavior across SEP groups was inconsistent. In conclusion, there was no clear evidence for socioeconomic differences in the association between food environments and dietary behavior, although a limited number of studies focusing on economic and school food environments generally observed stronger associations in low SEP populations. (Prospero registration: CRD42017073587)
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Alves MDA, Pinho MGM, Corrêa EN, das Neves J, de Assis Guedes de Vasconcelos F. Parental Perceived Travel Time to and Reported Use of Food Retailers in Association with School Children's Dietary Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E824. [PMID: 30866407 PMCID: PMC6427110 DOI: 10.3390/ijerph16050824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/21/2019] [Accepted: 03/01/2019] [Indexed: 11/16/2022]
Abstract
Considering the association between the neighborhood food environment and individual eating behaviors, this study aimed to assess the association between parents' reported use of food facilities by their children, and parental perceived travel time to food facilities, with their children's dietary patterns. Parents reported the use of supermarkets, full-service and fast-food restaurants, and perceived travel time to these food retailers. To assess school children's food consumption, a previous day dietary recall was applied. Factor analysis was conducted to identify dietary patterns. To test the association between reported use and perceived travel time to food retailers and school children's dietary patterns, we performed multilevel linear regression analyses. Parents' reported use of supermarkets was associated with children's higher score in the "Morning/Evening Meal" pattern. The use of full-service and fast-food restaurants was associated with children's higher score in the "Fast Food" pattern. Higher parental perceived travel time to full-service and fast-food restaurants was associated with children's lower score in the "Fast Food" pattern. Although the use of full-service and fast-food restaurants was associated with a less healthy dietary pattern, the perception of living further away from these food retailers may pose a barrier for the use of these facilities.
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Affiliation(s)
- Mariane de Almeida Alves
- Department of Nutrition, Centre of Health Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina 88040-900, Brazil.
| | - Maria Gabriela M Pinho
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, F wing, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands.
| | - Elizabeth Nappi Corrêa
- Department of Nutrition, Centre of Health Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina 88040-900, Brazil.
| | - Janaina das Neves
- Department of Nutrition, Centre of Health Sciences, Federal University of Santa Catarina, Trindade, Florianópolis, Santa Catarina 88040-900, Brazil.
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Vogel C, Abbott G, Ntani G, Barker M, Cooper C, Moon G, Ball K, Baird J. Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model. Int J Behav Nutr Phys Act 2019; 16:12. [PMID: 30700323 PMCID: PMC6354411 DOI: 10.1186/s12966-019-0772-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To improve population diet environmental strategies have been hailed the panacea because they require little agency or investment of personal resources; this contrasts with conventional strategies that rely on individuals to engage high levels of agency and make deliberate choices. There is an immediate need to improve understanding of the synergy between the psychological and environmental determinants of diet in order to optimise allocation of precious public health resources. This study examined the synergistic and relative association between a number of food environment and psychological factors and the dietary behaviours of a population sample of women with young children. METHODS Women in Hampshire were recruited from children's centres and asked about their demographic characteristics, psychological resources, dietary behaviours (food frequency questionnaire) and perceptions of healthy food access and affordability. Three local food environment factors were objectively assessed: i) spatial access to food outlets using activity spaces; ii) healthfulness of the supermarket where women did their main food shop, (based on nine in-store factors including price, placement and promotion on seven healthy and five less healthy foods); iii) nutrition environment of children's centres visited frequently by the women, assessed via staff-administered questionnaire. A theoretical model linking environmental factors to dietary behaviours, both directly and indirectly through three factors representing individual agency (psychological resources, perceived food affordability, perceived food accessibility), was tested using Structural Equation Modelling. RESULTS Complete data were available for 753 women. The environment of women's main supermarket was indirectly related to their dietary behaviours through psychological resources and perceived food affordability. Shopping at supermarkets classified as having a healthier in-store environment was associated with having greater psychological resources associated with healthy eating (standardised regression weight β = 0.14SD, p = 0.03) and fewer food affordability concerns (β = - 0.14SD, p = 0.01), which in turn related to healthier dietary behaviours (β = 0.55SD, < 0.001 and β = - 0.15, p = 0.01 respectively). The three food environment factors were not directly associated with dietary behaviour (p > 0.3). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]). CONCLUSIONS This pathway analysis identified three focal points for intervention and suggests that high-agency interventions targeting individual psychological resources when combined with low-agency supermarket environment interventions may confer greater benefits on dietary behaviours than either intervention alone.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
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Jilcott Pitts SB, Wu Q, McGuirt JT, Sharpe PA, Rafferty AP. Impact on Dietary Choices After Discount Supermarket Opens in Low-Income Community. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:729-735. [PMID: 29656023 DOI: 10.1016/j.jneb.2018.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/21/2018] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To examine (1) the association of a new supermarket opening with dietary intake and perceptions of healthy food availability, and (2) associations of distance to the primary food store and mean prices of fruits, vegetables, and sugary beverages with levels of consumption of these foods and body mass index in a low-income, southeastern community. METHODS The researchers used cross-sectional, self-administered questionnaire data and supermarket audit data collected in the supermarket community and comparison community before (2015) and after (2016) the supermarket opening. A difference-in-difference analysis employed propensity scores to compare pretest and posttest differences between communities. RESULTS There were no significant differences between communities on dietary behaviors. There was a significant cross-sectional, inverse association between distance to the primary food store and fruit and vegetable consumption among all respondents in 2016. CONCLUSIONS AND IMPLICATIONS The results suggest that adding a new discount supermarket is not necessarily associated with improvements in residents' fruit, vegetable, or sugary beverage consumption, or in their perceptions of the availability of healthy food in the neighborhood. However, distance to the store may be important.
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Affiliation(s)
| | - Qiang Wu
- Department of Biostatistics, East Carolina University, Greenville NC
| | - Jared T McGuirt
- Department of Nutrition, University of North Carolina-Greensboro, Greensboro, NC
| | - Patricia A Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ann P Rafferty
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC
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Barker M, Dombrowski SU, Colbourn T, Fall CHD, Kriznik NM, Lawrence WT, Norris SA, Ngaiza G, Patel D, Skordis-Worrall J, Sniehotta FF, Steegers-Theunissen R, Vogel C, Woods-Townsend K, Stephenson J. Intervention strategies to improve nutrition and health behaviours before conception. Lancet 2018; 391:1853-1864. [PMID: 29673875 PMCID: PMC6075694 DOI: 10.1016/s0140-6736(18)30313-1] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022]
Abstract
The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.
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Affiliation(s)
- Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Stephan U Dombrowski
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | - Tim Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Natasha M Kriznik
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Wendy T Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gloria Ngaiza
- UCL Institute for Global Health, University College London, London, UK
| | - Dilisha Patel
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University and Fuse, the UK Clinical Research Collaboration Centre of Excellence for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Régine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK; Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Judith Stephenson
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
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Vogel C, Lewis D, Ntani G, Cummins S, Cooper C, Moon G, Baird J. The relationship between dietary quality and the local food environment differs according to level of educational attainment: A cross-sectional study. PLoS One 2017; 12:e0183700. [PMID: 28841678 PMCID: PMC5571951 DOI: 10.1371/journal.pone.0183700] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 08/09/2017] [Indexed: 11/20/2022] Open
Abstract
There is evidence that food outlet access differs according to level of neighbourhood deprivation but little is known about how individual circumstances affect associations between food outlet access and diet. This study explored the relationship between dietary quality and a measure of overall food environment, representing the balance between healthy and unhealthy food outlet access in individualised activity spaces. Furthermore, this study is the first to assess effect modification of level of educational attainment on this relationship. A total of 839 mothers with young children from Hampshire, United Kingdom (UK) completed a cross-sectional survey including a 20-item food frequency questionnaire to measure diet and questions about demographic characteristics and frequently visited locations including home, children’s centre, general practitioner, work, main food shop and physical activity location. Dietary information was used to calculate a standardised dietary quality score for each mother. Individualised activity spaces were produced by creating a 1000m buffer around frequently visited locations using ArcGIS. Cross-sectional observational food outlet data were overlaid onto activity spaces to derive an overall food environment score for each mother. These scores represented the balance between healthy and unhealthy food outlets using weightings to characterise the proportion of healthy or unhealthy foods sold in each outlet type. Food outlet access was dominated by the presence of unhealthy food outlets; only 1% of mothers were exposed to a healthy overall food environment in their daily activities. Level of educational attainment moderated the relationship between overall food environment and diet (mid vs low, p = 0.06; high vs low, p = 0.04). Adjusted stratified linear regression analyses showed poorer food environments were associated with better dietary quality among mothers with degrees (β = -0.02; 95%CI: -0.03, -0.001) and a tendency toward poorer dietary quality among mothers with low educational attainment, however this relationship was not statistically significant (β = 0.01; 95%CI: -0.01, 0.02). This study showed that unhealthy food outlets, like takeaways and convenience stores, dominated mothers’ food outlet access, and provides some empirical evidence to support the concept that individual characteristics, particularly educational attainment, are protective against exposure to unhealthy food environments. Improvements to the imbalance of healthy and unhealthy food outlets through planning restrictions could be important to reduce dietary inequalities.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, United Kingdom
- * E-mail:
| | - Daniel Lewis
- Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London, United Kingdom
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, United Kingdom
| | - Steven Cummins
- Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London, United Kingdom
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Graham Moon
- Geography and Environment, University of Southampton, Southampton, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, United Kingdom
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Cameron AJ, Charlton E, Ngan WW, Sacks G. A Systematic Review of the Effectiveness of Supermarket-Based Interventions Involving Product, Promotion, or Place on the Healthiness of Consumer Purchases. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0172-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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