Point-of-purchase nutrition information influences food-purchasing behaviors of college students: a pilot study

The impact of fast-food energy posting on college students' food purchases

BACKGROUND

The Patient Protection US Affordable Care Act (ACA) energy posting mandate requires restaurant chains to disclose information on the energy content of their food items. Assessments of the effect of menu energy labeling on dietary choices have reported inconsistent findings.

OBJECTIVES

This study examined the impact of menu energy labeling on food items purchased by college students after the mandate was enacted nationally.

METHODS

Student food sales data from purchases made at 3 fast-food restaurants during the 2017/2018 and 2018/2019 academic years at a university campus were used for the analysis. The total sample included 1662 students on the university meal plan; these students generated 145,295 food transactions at the restaurants over the study period. We utilized a difference-in-differences (DiD) empirical strategy, comparing changes in transaction-level energy purchases at 2 fast-food restaurants B and C (FFRB and FFRC - treatment groups) that posted energy information in the summer of 2018 with another fast-food restaurant A (FFRA - control group) that began posting energy information before the study period.

RESULTS

We observed increases in the mean energy content per transaction after implementing the menu-labeling policy. The DiD estimates found an increase of 20.6 in the mean calories of energy purchased per transaction at the treatment restaurants relative to the control restaurant. In the subgroup analyses, the DiD estimates indicated calories of energy increased: 18.7 for female students, 20.5 for male students, 23.5 for non-Hispanic Black students, 30.2 for students eligible for federal financial aid, and 19.9 for students not eligible for federal financial aid.

CONCLUSIONS

The results suggest that the ACA energy menu-labeling policy led to an increase in the energy content per transaction by students at a public university. This paper highlights the need for more research to better understand the determinants of food choice among college students.

Assessing food availability and healthier options in an urban Chinese university: a case study using the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S)

Young adults (18-24 years) in universities are frequently exposed to an environment that promotes unhealthy eating behaviors. Using a validated tool, the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S), we assess the food availability and healthier options in a large, urban Chinese university. We employed C-NEMS-S for scoring criteria and weighting. A total of 52 on-campus canteen outlets were audited in an urban university located in Shijiazhuang City, China. General food outlets (n 43) and self-served food outlets (n 7) were further categorized into eight subtypes. Beverage outlets (n 2) were discussed separately from food outlets. C-NEMS-S scores were significantly different across food outlet types (P = 0.0024), especially between noodle and rice outlets (P = 0.0415). Food availability scores for starchy tubers (P < 0.001), dry beans (P < 0.001), vegetables (P = 0.0225), and fruits (P < 0.001) were significantly different across food outlet subtypes. Healthier options were scarce and only appeared in "grains" (n 2) and "meat and poultry" (n 2) categories. Further research on improving the accustomed audit tool and assessing university student diet quality is warranted.

Point of Decision Design to Address Adolescent Overweight and Obesity

OBJECTIVES

This study aims to utilize the point of decision design framework to understand how, where, and why adolescents and families make decisions about diet and physical activity and to explore how modifications to the environment can help to promote healthier choices and reduce obesity.

BACKGROUND

Child and adolescent obesity is a critical public health problem. As environmental factors are a primary contributor, understanding the role of design in our surrounding environment highlights an important area of interdisciplinary study. Design strategies have been used successfully to increase stair use and reduce sedentary behavior and can be used to further promote healthier diet and activity choices among adolescents and families.

METHODS

We leveraged the human-centered design-thinking process through (1) qualitative interviews and survey instruments, (2) persona and prompt development, and (3) a design workshop with multidisciplinary stakeholders.

RESULTS

Five personas were developed from the qualitative data and used in a design-thinking workshop. During the workshop, participants generated 12 influential factors and nine points of decision which were used to generate 33 solutions spanning the design continuum (from information and policy design to the design of urban, architectural, and interior environments) aimed at improving nutrition and physical activity among adolescents. Additionally, a tool kit was prototyped, which includes interview guides, a persona framework, and a workshop facilitation guide.

CONCLUSIONS

Our novel process led to the generation of design solutions that can be implemented to expand and improve upon existing interventions for childhood obesity and create environments that encourage positive health outcomes.

College students' attitude toward menu labeling differs by sex, BMI, weight management status, and athletic type

Objective Determine students' attitude toward menu labeling before and after menu labeling implementation at university dining facility. Participants: College students aged 18 years and older eating at campus dining facility. Methods: Survey on attitude toward menu labeling, weight management status, and athletic classification (NCAA, recreational, or non-athlete) was completed 30 days pre- and post-menu labeling implementation. Results: Females showed stronger positive attitude toward menu labeling. Students trying to lose or gain weight had stronger positive attitudes toward menu labeling than students maintaining weight, as did overweight students compared to normal weight students. NCAA athletes had lower attitude mean scores toward menu labeling than other athletic classifications. Conclusion: Attitude toward menu labeling varies by students' gender, body mass index (BMI), and weight management focus, with NCAA athletes having the least positive attitude. Focus future research on effective ways to inform students on menu labeling in university dining facilities in order to nutritionally engage young adults.

Nutrition-Related Mobile Application for Daily Dietary Self-Monitoring

Nutrition apps for mobile devices such as smartphones are becoming more widely available. They can help ease the arduous chore of documenting intake for nutritional assessment and self-monitoring. This allows people to control food intake, support their participation in physical activities, and promote a healthy lifestyle. However, there remains a lack of research regarding systematic analysis mapping studies in this area. The objective of this study is to identify dietary self-monitoring implementation strategies on a mobile application. This study analyzed 205 journals from the Scopus database using the descriptive-analytic method. The records used in this exploration study were those released between 2007 and 2021 that were collected based on the keywords “dietary self-monitoring,” or “nutrition application,” or “nutrition apps,” and “calorie application.” Data analysis was conducted using the VOSviewer and NVivo software analytical tools. The results show that research studies on dietary self-monitoring increased in 2017. Results also indicated that the country that contributed the most to this topic was China. The study on mobile applications for dietary self-monitoring revealed seven clusters of dominant themes: attitude to improved dietary behaviors, parameters for disease diagnosis, noncommunicable diseases, methods, nutrition algorithms, mobile health applications, and body mass index. This study also analyzed research trends by year. The current research trends are about dietary self-monitoring using a mobile application that can upgrade people's lifestyles, enable real-time meal recording and the convenience of automatically calculating the calorie content of foods consumed, and potentially improve the delivery of health behavior modification interventions to large groups of people. The researchers summarized the recent advances in dietary self-monitoring research to shed light on their research frontier, trends, and hot topics through bibliometric analysis and network visualization. These findings may provide valuable guidance for future research and perspectives in this rapidly developing field.

Health Literacy and Its Associations with Understanding and Perception of Front-of-Package Nutrition Labels among Higher Education Students

(1) Background: Nutrition labels on the front of food packages have increasingly become the focus of research. However, too few studies have placed special emphasis on nutritionally at-risk subpopulations, such as young adults or those with low literacy/numeracy skills. The present study aimed to assess both the perception and objective understanding of three front-of-package labeling (FOPL) formats currently in use on the Belgian market, i.e., the Nutri-Score, Reference Intakes, and Multiple Traffic Lights, among students of varying health literacy (HL) levels. (2) Methods: A web-based survey was carried out among 2295 students of tertiary education in the province of Liège, Belgium. The questionnaire included questions related to general characteristics, objective understanding, and perception in response to the assigned FOPL format and level of HL. (3) Results: With respect to objective understanding, the Nutri-Score outperformed all other labels across all HL levels, and it was similarly understood in students of varying HL levels. Several students' characteristics appeared to be associated with each cluster of perception, with the Nutri-Score cluster having the highest percentages of disadvantaged students, i.e., those with inadequate HL, from non-university institutions, with low self-estimated nutrition knowledge, and with low self-estimated diet quality. (4) Conclusion: Overall, the findings supported the Nutri-Score as particularly effective in guiding students in their food choices. Of particular importance is the fact that the summarized and graded color-coded nutritional label would be a useful strategy for those disadvantaged by limited HL.

Impact of Pricing and Product Information on Consumer Buying Behavior With Customer Satisfaction in a Mediating Role

The relationship between product pricing and product packaging plays an important role in the buying behavior of consumers, whereas customer satisfaction plays a mediating role. To test these hypotheses, research was conducted on university students in China. Questionnaire-based convenience sampling was conducted on 500 students for data collection using online and offline sources. A total of 367 (73%) students responded, and 17 questionnaires were rejected due to missing information. SPSS and AMOS software were used for the data analysis. Product pricing and product information were independent variables in this study, whereas consumer buying behavior was a dependent variable. Customer satisfaction is mediated by one dependent and two independent variables. Confirmatory factor analysis, path analysis, and discriminant validity in structural equation modeling revealed that product pricing and packaging had a statistically significant relationship with the buyer decision process. The introduction of satisfaction as a mediating variable led to the observation of full mediation in the case of product pricing and partial mediation in product packaging. Given the results of this research, product managers should adopt pricing tactics along with product packaging to influence the buying intentions of consumers.

College Students' Perception of Snacks Sold in Vending Machines in the US: A Mixed-Methods Study

Introduction: Food in vending machines in US colleges contain limited nutritious foods available for purchase, which could affect the food choices made by students leading to poor diet quality. Interventions to improve college foodscapes usually follow a top-down approach and fail to affect dietary behavioral changes ultimately. This research aims to uncover what students want and ways to achieve change.

Methods: The mixed-methods approach included peer-led qualitative focus group discussions and a brief quantitative questionnaire on satisfaction from foods available in vending machines. A convenience sample of 20 students (15 females) was recruited from a Hispanic serving institution for this study.

Results: Vending machines were perceived as convenient, plentiful, and unhealthy. Students expressed dissatisfaction with both the variety and nutritional quality of snacks in vending machines. Suggestions for improvement included more fresh items (fruits and vegetables) and refrigerated items with higher protein content (low-fat yogurt, hummus, and peanut butter). To implement these improvements, participants discussed the cost and feasibility of perishable items. Increasing awareness and partnering strategies were proposed to mediate potential cost and buy-in obstacles as was elevating the appeal of healthy vending machines with technological enhancements that draw customers in and educate.

Conclusion and Implication for Practice: This group of college students was eager for positive changes in foods sold in vending machines and understand the major difficulties. The suggested changes may help this and other colleges develop policies to regulate the foods in vending machines to promote overall health and help prevent chronic diseases in the future.

A systematic review of supermarket automated electronic sales data for population dietary surveillance

Context

Most dietary assessment methods are limited by self-report biases, how long they take for participants to complete, and cost of time for dietitians to extract content. Electronically recorded, supermarket-obtained transactions are an objective measure of food purchases, with reduced bias and improved timeliness and scale.

Objective

The use, breadth, context, and utility of electronic purchase records for dietary research is assessed and discussed in this systematic review.

Data sources

Four electronic databases (MEDLINE, EMBASE, PsycINFO, Global Health) were searched. Included studies used electronically recorded supermarket transactions to investigate the diet of healthy, free-living adults.

Data extraction

Searches identified 3422 articles, of which 145 full texts were retrieved and 72 met inclusion criteria. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Data analysis

Purchase records were used in observational studies, policy evaluations, and experimental designs. Nutrition outcomes included dietary patterns, nutrients, and food category sales. Transactions were linked to nutrient data from retailers, commercial data sources, and national food composition databases.

Conclusion

Electronic sales data have the potential to transform dietary assessment and worldwide understanding of dietary behavior. Validation studies are warranted to understand limits to agreement and extrapolation to individual-level diets.

Systematic Review Registration

PROSPERO registration no. CRD42018103470

Point-of-sale nutrition information interventions in food retail stores to promote healthier food purchase and intake: A systematic review

Providing simple information that identifies healthier/less healthy products at the point-of-sale has been increasingly recognized as a potential strategy for improving population diet. This review evaluated the effect on healthiness of food purchasing/intake of interventions that identify specific products as healthier/less healthy at the point-of-sale in food retail settings. Five databases were searched for peer-reviewed randomized controlled or quasi-experimental trials published 2000-2020. Effects on primary outcomes of the 26 eligible studies (322 stores and 19,002 participants) were positive (n = 14), promising (effective under certain conditions; n = 3), mixed (different effect across treatment arms/outcomes; n = 4), null (n = 3), negative (n = 1), or unclear (n = 1). Shelf-label studies (three studies of two rating systems across all products) were positive. Technology-delivered (mobile applications/podcast/kiosk) interventions were positive (n = 3/5) or promising/mixed (n = 2/5). In-store displays (n = 16) had mixed effectiveness. Interventions provided information on targeted healthier products only (n = 17), unhealthy products only (n = 1), both healthy and unhealthy (n = 2), and across all products (n = 5). No patterns were found between behavior change technique used and effectiveness. Study quality was mixed. These findings indicate that point-of-sale interventions identifying healthy/unhealthy options can lead to healthier customer purchasing behavior, particularly those delivered using shelf-labels or technology. Further research on discouraging unhealthy foods is needed.

[Towards healthy pathways: Effect of nutrition labels on eating behaviours in a university canteen]

Objetivo

Evaluar la efectividad de incluir información nutricional y de propiedades de los alimentos en un comedor universitario de Salamanca (España), para promover las conductas alimentarias saludables.

Diseño

Estudio experimental y correlacional transversal.

Emplazamiento

Comedor universitario de Salamanca (España).

Participantes

En el experimento se recogió información de la elección de 1.122 menús por parte de estudiantes universitarios. El cuestionario fue respondido por 48 estudiantes universitarios que participaron en el experimento.

Medidores principales

Metodología mixta (experimento de campo y cuestionario en línea). La variable independiente fue la inclusión o no de información nutricional de los menús. Con el cuestionario se evaluó la actitud de los estudiantes sobre este tipo de herramientas.

Resultados

El experimento muestra una mejora en la dieta de los estudiantes universitarios con la inclusión de elementos informativos que apelan a la elección más saludable, aumentando su consumo de fruta, verduras, legumbres, pescado y carne blanca.

Los encuestados mostraron un alto grado de receptividad de estas herramientas para la promoción de la salud. A pesar de esto, su autopercepción de mejoría de la dieta era más optimista que lo cuantificado en el experimento. Los estudiantes universitarios muestran un grado de aprobación muy alto frente a otras herramientas de promoción de alimentación saludable, especialmente aquellas de carácter educativo e informativo. Se comprobó que una preocupación mayor por la dieta estaba asociada con un mayor apoyo de estas herramientas.

Conclusión

Existe una mejora en la alimentación de los estudiantes universitarios y una actitud positiva frente a herramientas de promoción de la salud, especialmente por parte de quienes tienen una autopercepción más saludable. Es necesario emplear nuevas herramientas basadas en las ciencias conductuales en la promoción de la salud, por parte de la industria privada y las entidades públicas.

Influence of cooking skills and nutritional training on dietary choices of incoming chiropractic students

OBJECTIVE

We aimed to identify chiropractic students' cooking skills, perceptions of healthy eating, and influence of prior nutrition training on dietary intake.

METHODS

Two cohorts of incoming graduate students were surveyed to assess nutritional training prior to matriculation, perceptions of healthy eating behaviors, cooking skills, current dietary intake, and barriers to healthy eating. Using independent t tests, correlations, and descriptive statistics, data from the cohorts were assessed.

RESULTS

The response rate was 88.7% (n = 178). Nutritional training significantly increased perception of nutritional knowledge and confidence in giving nutrition advice. Completion of at least 1 college nutrition course was associated with nearly double students' weekly fatty fish intake. Males were more likely to eat animal protein, and females preferred desserts. Modeling a healthy diet for future patients was rated as being important, yet most students consumed diets consistent with the typical American diet. The leading barriers to healthy eating included lack of time and money.

CONCLUSION

Similar to students in other healthcare professions, incoming chiropractic students wish to model healthy behaviors but fail to apply their knowledge and attitudes to their own dietary intakes due to common barriers.

The Influence of Health Messages in Nudging Consumption of Whole Grain Pasta

Health messages may be an important predictor in the selection of healthier food choices among young adults. The primary objective of our study is to test the impact of labeling whole grain pasta with a health message descriptor displayed at the point-of-purchase (POP) on consumer choice in a campus dining setting. The study was conducted in a large US college dining venue during lunch service; data were collected during a nine-week period, for a total of 18 days of observation. Each day, an information treatment (i.e., no-message condition; vitamin message; fiber message) was alternated assigned to whole grain penne. Over the study period, the selection of four pasta options (white penne, whole grain penne, spinach fettuccine, and tortellini) were recorded and compiled for analysis. Logistic regression and pairwise comparison analyses were performed to estimate the impact of health messages on diners’ decisions to choose whole grain penne among the four pasta types. Our results indicate that only the message about vitamin benefits had a significant effect on this choice, with a 7.4% higher probability of selecting this pasta than the no-message condition and 6.0% higher than the fiber message condition. These findings suggest that psychological health claims (e.g., reduction of fatigue) of whole grains seem more attractive than physiological health claims (e.g., maintaining a healthy weight) for university students. In line with the 2015–2020 Dietary Guidelines for Americans, our results suggest that small changes made at the POP have the potential to contribute to significant improvements in diet (e.g., achieving recommended levels of dietary fiber). These findings have important implications for food service practitioners in delivering information with the greatest impact on healthy food choices.

A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies

PURPOSE OF REVIEW

Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks.

RECENT FINDINGS

Of 86 articles (1974-2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the "4Ps" of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.

Front-of-Pack Labeling and the Nutritional Quality of Students' Food Purchases: A 3-Arm Randomized Controlled Trial

Objectives. To assess the effects of the Nutri-Score label (relative to the Reference Intakes label or no label) on the nutritional quality of students' food purchases. Methods. A 3-arm randomized controlled trial was conducted in France in 2017; 2907 participants were randomized into 1 of the 3 study arms (Nutri-Score, Reference Intakes, no label) and invited to purchase groceries from an experimental Web-based supermarket. The main outcome was the overall nutritional quality of purchases, measured according to a modified version of the Food Standards Agency Nutrient Profiling System (FSAm-NPS/HCSP) score. Results. The mean (±SD) FSAm-NPS/HCSP score was lower in the Nutri-Score group (2.02 ±3.56) than in the Reference Intakes group (2.69 ±3.44), reflecting higher nutritional quality; however, there was no significant difference between the Nutri-Score and no-label (2.45 ±3.28) groups or between the Reference Intakes and no-label groups. Shopping cart content was lower in calories and saturated fatty acids and higher in fruits and vegetables in the Nutri-Score arm than in the other arms. Conclusions. The Nutri-Score label appeared to improve the nutritional composition of students' food purchases relative to the Reference Intakes label or no label.

The Effect of Randomly Providing Nutri-Score Information on Actual Purchases in Colombia

Recently, front-of-package (FOP) food labeling systems have captured the attention of researchers and policy makers. Several Latin American governments are currently considering employing different FOP labeling systems. However, there is much need for more research-based evidence in these countries. In this paper, we study whether food-purchasing decisions and the nutritional qualities of those purchases are influenced by randomly informing some customers and not others about an FOP label known as Nutri-Score. We also separate the information effect from the effect of being aware of the system. We combined a randomized field intervention in a university cafeteria in Bogotá, Colombia with data from an after-purchase survey and receipts. We found that randomly providing information on Nutri-Score increased total expenditure by $0.18. Additional spending on healthier items was 21% or $0.26 higher, with no change for less healthy items. Expenditure estimates were higher among customers who were aware of the system’s existence. Customers in the study were also 10% more likely to buy a healthier item than control customers were, and the concentration of protein in their purchases was greater. Information on the Nutri-Score system increased the store’s sales. This potential financial incentive may facilitate the implementation of Nutri-Score.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores

Background: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students’ dietary intentions/behaviors, and body mass index (BMI). Methods: Through multilevel structural equation modeling, a comparison was made of students’ healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. Results: Controlling for gender, HMI was negatively associated with SSBs (β = −0.859) and %kcal/fat (β = −1.057) and positively with whole-grains (β = 0.186) and fruits/vegetables intake (β = 0.267); %Kcal/fat was positively (β = 0.098) and fruits/vegetables intake (β = −0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (β = 0.214, β = 0.129) and directly/negatively to BMI (β = −2.657, β = −1.124). Conclusions: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

Point-of-Purchase Labels and Reward Cards Improve Sales of Healthy Foods in University Dining Halls

Purpose: To compare sales of Food Resources and Education for Student Health (FRESH) Approved versus non-FRESH Approved menu cycle items pre- and postimplementation of the FRESH program.

Methods: Sales data from 2011–2015 of FRESH Approved versus non-FRESH Approved menu items were analyzed. Fruit and milk items sold, net sales, and the cost of free fruit and milk redeemed through the FRESH Reward Card (FRC) program, were also analyzed.

Results: FRESH Approved items sold more often than non-FRESH Approved items in the latter 2 years (P = 0.01). Prices of FRESH Approved menu items were significantly lower than non-FRESH Approved items for all years (e.g., $1.52 ± $0.94 vs $2.21 ± $1.02 per serving in 2014–2015; P < 0.001). Across all FRESH implementation years, FRESH Approved menu items were found more often on the 6-week menu (P < 0.05). The number of fruit items sold increased from a baseline of 143 052 to 170 954, and net sales increased from $135 450 to $154 248 after 3 years of the FRC implementation.

Conclusions: FRESH Approved items were less expensive, available more often, and had higher sales. The FRC increased net fruit sales despite the cost of free fruit. Highlighting and reducing the cost of healthy foods are promising practices to improve campus food environments.

Information-based cues at point of choice to change selection and consumption of food, alcohol and tobacco products: a systematic review

BACKGROUND

Reducing harmful consumption of food, alcohol, and tobacco products would prevent many cancers, diabetes and cardiovascular disease. Placing information-based cues in the environments in which we select and consume these products has the potential to contribute to changing these behaviours.

METHODS

In this review, information-based cues are defined as those which comprise any combination of words, symbols, numbers or pictures that convey information about a product or its use. We specifically exclude cues which are located on the products themselves. We conducted a systematic review of randomised, cluster- randomised, and non-randomised controlled trials to assess the impact of such cues on selection and consumption. Thirteen studies met the inclusion criteria, of which 12 targeted food (most commonly fruit and vegetables), one targeted alcohol sales, and none targeted tobacco products.

RESULTS

Ten studies reported statistically significant effects on some or all of the targeted products, although studies were insufficiently homogenous to justify meta-analysis. Existing evidence suggests information-based cues can influence selection and consumption of food and alcohol products, although significant uncertainty remains.

CONCLUSIONS

The current evidence base is limited both in quality and quantity, with relatively few, heterogeneous studies at unclear or high risk of bias. Additional, more rigorously conducted studies are warranted to better estimate the potential for these interventions to change selection and consumption of food, alcohol and tobacco products.

TRIAL REGISTRATION

PROSPERO. 2016; CRD42016051884 .

Testing a Beverage and Fruit/Vegetable Education Intervention in a University Dining Hall

OBJECTIVE

To test the effect of a nutrition intervention that included education and 2 labeling components on students' food choices.

DESIGN

Repeat cross-sectional study taking place on 6 dinner occasions before and 6 afterward.

SETTING

The study was conducted during dinner meals in a buffet-style dining hall in a university campus residence, where students paid a set price and consumed all they cared to eat.

PARTICIPANTS

University students (n = 368 to 510) visited the cafeteria on each of the data collection dates.

INTERVENTION

Fruit and vegetable consumption were encouraged; sugar-sweetened beverage consumption was discouraged using physical activity calorie equivalent labeling.

MAIN OUTCOME MEASURES

Beverage choices and vegetable/fruit bar visits.

ANALYSIS

Logistic regression was used to compare the proportion of student who selected each beverage, fruit, or vegetable before and after the intervention, while controlling for menu and gender as covariates.

RESULTS

There was a significant decrease in the proportion of students selecting a sugar-sweetened beverage before vs after the intervention (49% vs 41%, respectively; P = .004) and an increase in students choosing water (43% vs 54%, respectively; P < .001). There was a significant increase in students who took fruit after the intervention (36%; P < .001) vs before (30%). The number of students visiting the vegetable bar significantly increased from 60% to 72% (P < .001).

CONCLUSIONS

This intervention may be a way to encourage healthy dietary choices in campus dining halls.

A Cross-Sectional Study of the Relationship between Nutrition Label Use and Food Selection, Servings, and Consumption in a University Dining Setting

BACKGROUND

Nutrition labels at the point of purchase are recommended to improve food choice, yet food choice does not always translate into food consumption. It is important to understand the relationship between label use, food selection, servings, and consumption. Previous research, which has relied on self-reported intake or inferred label use or intake based on sales data, has not adequately answered this question.

OBJECTIVE

To combine survey and meal photographic data to compare food selection, servings, and consumption between label users and nonusers.

DESIGN

Diners were surveyed in two cross-sectional waves during the fall 2014 semester. Food selections were recorded, and pre- and postmeal photographs were taken of diners' plate. Photographs were coded to identify the selection, servings, and consumption of MyPlate food categories.

PARTICIPANTS/SETTING

Convenience sample of 1,069 diners (39% women, 53% freshman) in two university dining halls. Students had to be older than age 18 years and just beginning their meal to participate.

MAIN OUTCOME MEASURES

Selection, servings, and consumption of MyPlate food categories for label users and nonusers.

STATISTICAL ANALYSES PERFORMED

Differences in food selection were tested via χ² tests, and differences in adjusted least squares means for servings and consumption were tested via t tests.

RESULTS

A greater proportion of nutrition label users selected fruits, vegetables, and beans and fewer selected potatoes compared with nonusers. In addition, fewer label users selected fried foods and foods with added sugars (all P values <0.05). Label users served themselves and consumed more vegetables and fewer potatoes and refined grains compared with nonusers (all P values <0.05).

CONCLUSIONS

Our results suggest label users behave differently compared with nonusers. Based on the meals observed, these differences appear more qualitative in nature (selecting different foods) than quantitative (selecting more or less food).

Store owners as potential agents of change: energy drinks in the interior of Alaska

Childhood obesity disproportionately impacts disadvantaged communities, including Alaska Native children. In part, lack of access to fresh fruits and vegetables and over consumption of sugar sweetened beverages including energy drinks contribute to excessive weight gain in Alaska Native youth. This commentary reports the possibility of storeowners and workers partnering with community members to limit sales of nutrient-poor energy drinks through point-of-sale counselling in rural communities in the interior of Alaska. This model of intervention may be useful to implement in areas where there are limited health workers or others that can serve as health educators. This study reports preliminary evidence from rural Alaska and from other Arctic communities that store workers may effectively improve community health status by limiting or promoting specific products. Storeowners or workers may be helpful partners in the fight against childhood obesity as they are present at the point of sale of high-risk beverages to Alaska Native youth.

What is the effectiveness of obesity related interventions at retail grocery stores and supermarkets? -a systematic review

Background

The Prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review’s key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them.

Methods

Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD).

Results

The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods.

Conclusion

Given the diverse study settings and despite the challenges of methodological quality for some papers, we find efficacy of in-store healthy food interventions in terms of increased purchase of healthy foods. Researchers need to take risk of bias and methodological quality into account when designing future studies that should guide policy makers. Interventions which combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy foods.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3985-x) contains supplementary material, which is available to authorized users.

Design and Feasibility of a Text Messaging Intervention to Prevent Indoor Tanning Among Young Adult Women: A Pilot Study

Background

Although skin cancer is largely preventable, it affects nearly 1 of 5 US adults. There is a need for research on how to optimally design persuasive public health indoor tanning prevention messages.

Objective

The objective of our study was to examine whether framed messages on indoor tanning behavioral intentions delivered through short message service (SMS) text messaging would produce (1) positive responses to the messages, including message receptivity and emotional response; (2) indoor tanning efficacy beliefs, including response efficacy and self-efficacy; and (3) indoor tanning risk beliefs.

Methods

We conducted a pilot study of indoor tanning prevention messages delivered via mobile phone text messaging in a sample of 21 young adult women who indoor tan. Participants completed baseline measures, were randomly assigned to receive gain-, loss-, or balanced-framed text messages, and completed postexposure outcome measures on indoor tanning cognitions and behaviors. Participants received daily mobile phone indoor tanning prevention text messages for 1 week and completed the same postexposure measures as at baseline.

Results

Over the 1-week period there were trends or significant changes after receipt of the text messages, including increased perceived susceptibility (P<.001), response efficacy beliefs (P<.001), and message receptivity (P=.03). Ordinary least squares stepwise linear regression models showed an effect of text message exposure on self-efficacy to quit indoor tanning (t₆=–2.475, P<.02). Ordinary least squares linear regression including all measured scales showed a marginal effect of SMS texts on self-efficacy (t₂₀=1.905, P=.08). Participants endorsed highly favorable views toward the text messaging protocol.

Conclusions

This study supports this use of mobile text messaging as an indoor tanning prevention strategy. Given the nature of skin cancer risk perceptions, the addition of multimedia messaging service is another area of potential innovation for disseminating indoor tanning prevention messages.

Impact of the front-of-pack 5-colour nutrition label (5-CNL) on the nutritional quality of purchases: an experimental study

Background

Front-of-pack (FOP) nutrition labelling has received growing attention from public health authorities, as a tool to promote healthier diets in the population. Recently, the French Health law introduced the principle of implementing a FOP nutrition labelling system. A scientific proposal has put forward the 5-Colour Nutrition Label (5-CNL), a five-category colour-coded summary system supported by research suggesting that it is well perceived and understood in the population. Our objective was to investigate the impact of the 5-CNL on the nutritional quality of purchases in experimental supermarkets.

Methods

Participants (n = 901) were recruited using quota sampling between September and December 2015 and evenly distributed in three experimental conditions: 1) control situation; 2) Application of the 5-CNL on all food products in three specific sections: breakfast cereals, sweet biscuits and appetizers; 3) introduction of the 5-CNL accompanied by consumer information on use and understanding of the label. Main outcome was the nutritional quality of the shopping cart in the three sections combined, measured using the United Kingdom Food Standards Agency nutrient profiling system (FSA score).

Results

Significantly higher mean nutritional quality of the purchased items per section were observed for the sweet biscuits category in the intervention combining the label + communication (overall FSA score 21.01 vs. 20.23, P = 0.02). No significant effects were observed for the general mean over the three sections combined or other food categories. The results observed on purchase may be related to the high level of recall, self-reported and objective understanding of the label that were observed in the intervention groups as they are pre-requisites for use of a label in purchasing situations.

Conclusion

These results suggest that the 5-CNL FOP nutrition label may have a limited impact on purchases, leading to healthier food choices in some food categories such as sweet biscuits.

Trial registration

The trial was registered on Clinicaltrials.gov under the number NCT02546505.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0416-4) contains supplementary material, which is available to authorized users.

Impact of Different Front-of-Pack Nutrition Labels on Consumer Purchasing Intentions: A Randomized Controlled Trial

INTRODUCTION

Despite growing evidence supporting the utility of front-of-pack nutrition labels in enabling consumer evaluation of food product healthiness, research on food choices is scarce. This study aims at comparing the impact of front-of-pack nutrition labels on consumers' purchasing intentions.

DESIGN

Five-arm, open-label RCT.

SETTING/PARTICIPANTS

The study setting was a virtual web-based supermarket, with participants from the French NutriNet-Santé study. The eligibility requirement was grocery shopping involvement.

INTERVENTION

The intervention was to simulate one shopping situation with front-of-pack nutrition labels affixed on food products (December 2014 to March 2015). Participants were randomly assigned to one of five exposure conditions using a central computer system: Guideline Daily Amounts, Multiple Traffic Lights, Five-Color Nutrition Label, Green Tick, or control (no front-of-pack exposure). Given the nature of the intervention, masking of participants was not performed.

MAIN OUTCOME MEASURES

The primary outcome was the overall nutritional quality of the contents of the shopping cart, estimated using the United Kingdom Food Standards Agency nutrient profiling system. Secondary outcomes included energy and nutrient content of the shopping cart. Impact of the front-of-pack labels was also evaluated across sociodemographic subgroups based on age, educational level, income, and nutrition knowledge.

RESULTS

A total of 11,981 participants were included in the analyses (April 2015). The Five-Color Nutrition Label significantly led to the highest overall nutritional quality of the shopping cart, as reflected by lower Food Standards Agency scores (M=8.72; SD=2.75), followed by Multiple Traffic Lights (M=8.97; SD=2.68) and Green Tick (M=8.99; SD=2.71), compared with the control (M=9.34; SD=2.57) (p<0.0001). The Five-Color Nutrition Label was the only front-of-pack format that led to a lower content in lipids, saturated fatty acids, and sodium of the shopping cart (all p<0.05). The impact of the different front-of-pack labels was similar across sociodemographic subgroups.

CONCLUSIONS

The Five-Color Nutrition Label based on a color-coded and graded scale indicating overall nutritional quality is effective in promoting overall healthier food choices in all population subgroups.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02385838.

Identification of Healthy Eating and Active Lifestyle Issues through Photo Elicitation

PURPOSE

Effective workplace wellness programs, featuring supports for healthy eating and active lifestyle behaviours, have been found to reduce health risks and the associated economic burdens for individuals, organizations, and their communities. As part of a larger study, the purpose of this research was to engage volunteer participants from a university community to identify healthy eating and active lifestyle barriers and supports.

METHODS

An ethics-approved, action-research design with photo elicitation technique was used to engage employees and students. Data were analyzed using qualitative analysis software.

RESULTS

Participants identified barriers and both current and future supports for healthy eating and active lifestyle on campus. These were coded under the sub-themes of food environment, food and nutrition quality, physical environment, physical activity, fitness centre, and awareness/communication.

CONCLUSION

Photo elicitation was determined to be an effective technique to engage participants. Despite many supports, members of the university community still found it difficult to follow healthy eating and active lifestyle behaviours; however, a number of practical future supports were identified. This study also provided valuable insight into the role that dietitians can play in the development of successful wellness programs.

Assessment of a University Campus Food Environment, California, 2015

Introduction

University campuses offer an opportunity to study the extent to which modifying the food environment influences eating, but in-depth characterizations of campus food environments are needed to identify potential targets for intervention. The objective of this project was to describe the availability, accessibility, and quality of healthful food choices in dining venues and food stores at or near a public, 4-year university in California.

Methods

Trained assessors used the Nutrition Environment Measures Survey for campus dining (NEMS-CD) to evaluate all 18 campus dining venues, and NEMS for stores (NEMS-S) to evaluate 2 on-campus and 37 off-campus food stores. We calculated prevalence of healthful and unhealthful constructs (eg, availability of selected food items, presence of signage encouraging healthful eating, pricing options that encourage healthful eating), based on the NEMS and compared scores across different types of venues.

Results

NEMS-CD scores ranged from 4 to 47 (mean [SD], 26.0 [14.4]) out of a possible maximum score of 97; 12% of entrées and 36% of main dish salads served in these venues were classified as healthful. NEMS-S score for the 2 on-campus food stores (24 for both) was intermediate between off-campus convenience stores (mean [SD], 12.0 [5.3]) and grocery/supermarket stores (mean [SD], 31.1 [10.0]), with a possible maximum score of 54.

Conclusion

Standardized environmental evaluation provides insights into both positive and negative aspects of campus community food venues. Environmental assessment identifies potential targets for modification and baseline data for designing and implementing action-oriented research aimed at improving the campus food environment’s support of healthful food choices for college students.

Students' perspectives on promoting healthful food choices from campus vending machines: a qualitative interview study

Background

Increasing the healthfulness of campus food environments is an important step in promoting healthful food choices among college students. This study explored university students’ suggestions on promoting healthful food choices from campus vending machines. It also examined factors influencing students’ food choices from vending machines.

Methods

Peer-led semi-structured individual interviews were conducted with 43 undergraduate students (33 females and 10 males) recruited from students enrolled in an introductory nutrition course in a large national university in the United Arab Emirates. Interviews were audiotaped, transcribed, and coded to generate themes using N-Vivo software.

Results

Accessibility, peer influence, and busy schedules were the main factors influencing students’ food choices from campus vending machines. Participants expressed the need to improve the nutritional quality of the food items sold in the campus vending machines. Recommendations for students’ nutrition educational activities included placing nutrition tips on or beside the vending machines and using active learning methods, such as competitions on nutrition knowledge.

Conclusions

The results of this study have useful applications in improving the campus food environment and nutrition education opportunities at the university to assist students in making healthful food choices.

Dose-response effects of the text4baby mobile health program: randomized controlled trial

BACKGROUND

Mobile health (mHealth) is growing rapidly, but more studies are needed on how to optimize programs, including optimal timing of messaging, dose of exposure, and value of interactive features. This study evaluates final outcomes of text4baby (a text message service for pregnant and postpartum women) from a randomized trial performed in a population of pregnant female soldiers and family members.

OBJECTIVE

The study aims were to evaluate (1) treatment effects and (2) dose-response effects of text4baby on behavioral outcomes compared to control (no text4baby) condition.

METHODS

The study was a randomized trial of text4baby at Madigan Army Medical Center. Female military health beneficiaries who met inclusion criteria were eligible for the study. Participants provided consent, completed a baseline questionnaire, and then were randomized to enroll in text4baby or not. They were followed up at 3 time points thereafter through delivery of their baby. Generalized estimating equation models were used to evaluate outcomes. We examined treatment effects and the effects of higher doses of text4baby messages on outcomes.

RESULTS

We report descriptive statistics including dosage of text messages delivered. The main finding was a significant effect of high exposure to text4baby on self-reported alcohol consumption postpartum (OR 0.212, 95% CI 0.046-0.973, P=.046), as measured by the question "Since you found out about your pregnancy, have you consumed alcoholic beverages?" The text4baby participants also reported lower quantities of alcohol consumed postpartum.

CONCLUSIONS

Studies of text4baby have helped to build the mHealth evidence base. The effects of text4baby offer lessons for future scalable mHealth programs and suggest the need to study dose-response effects of these interventions.

The influence of menu labeling on calories selected or consumed: a systematic review and meta-analysis

Recent menu labeling initiatives in North America involve posting the calorie content of standard menu items, sometimes with other nutrients of public health concern, with or without contextual information (such as the recommended daily caloric intake for an average adult) or interpretive information (such as traffic light symbols). It is not clear whether this is an effective method to convey nutrition information to consumers wanting to make more-informed food choices. Of particular concern are those consumers who may be limited in their food and health literacy skills to make informed food choices to meet their dietary needs or goals. The purpose of this systematic review was to determine whether the provision of menu-based nutrition information affects the selection and consumption of calories in restaurants and other foodservice establishments. A secondary objective was to determine whether the format of the nutrition information (informative vs contextual or interpretive) influences calorie selection or consumption. Several bibliographic databases were searched for experimental or quasiexperimental studies that tested the effect of providing nutrition information in a restaurant or other foodservice setting on calories selected or consumed. Studies that recruited generally healthy, noninstitutionalized adolescents or adults were included. When two or more studies reported similar outcomes and sufficient data were available, meta-analysis was performed. Menu labeling with calories alone did not have the intended effect of decreasing calories selected or consumed (-31 kcal [P=0.35] and -13 kcal [P=0.61], respectively). The addition of contextual or interpretive nutrition information on menus appeared to assist consumers in the selection and consumption of fewer calories (-67 kcal [P=0.008] and -81 kcal [P=0.007], respectively). Sex influenced the effect of menu labeling on selection and consumption of calories, with women using the information to select and consume fewer calories. The findings of this review support the inclusion of contextual or interpretive nutrition information with calories on restaurant menus to help consumers select and consume fewer calories when eating outside the home. Further exploration is needed to determine the optimal approach for providing this menu-based nutrition information, particularly for those consumers who may be limited in their food and health literacy skills.

Systematic review of dietary interventions with college students: directions for future research and practice

OBJECTIVE

To clarify directions for research and practice, research literature evaluating nutrition and dietary interventions in college and university settings was reviewed.

DESIGN

Systematic search of database literature.

SETTING

Postsecondary education.

PARTICIPANTS

Fourteen research articles evaluating randomized controlled trials or quasi-experimental interventions targeting dietary outcomes.

MAIN OUTCOME MEASURES

Diet/nutrition intake, knowledge, motivation, self-efficacy, barriers, intentions, social support, self-regulation, outcome expectations, and sales.

ANALYSIS

Systematic search of 936 articles and review of 14 articles meeting search criteria.

RESULTS

Some in-person interventions (n = 6) show promise in improving students' dietary behaviors, although changes were minimal. The inclusion of self-regulation components, including self-monitoring and goal setting, may maximize outcomes. Dietary outcomes from online interventions (n = 5) were less promising overall, although they may be more effective with a subset of college students early in their readiness to change their eating habits. Environmental approaches (n = 3) may increase the sale of healthy food by serving as visual cues-to-action.

CONCLUSIONS AND IMPLICATIONS

A number of intervention approaches show promise for improving college students' dietary habits. However, much of this research has methodological limitations, rendering it difficult to draw conclusions across studies and hindering dissemination efforts.

Campus food and beverage purchases are associated with indicators of diet quality in college students living off campus

PURPOSE

To examine the association between college students' dietary patterns and frequency of purchasing food/beverages from campus area venues, purchasing fast food, and bringing food from home.

DESIGN

Cross-sectional Student Health and Wellness Study.

SETTING

One community college and one public university in the Twin Cities, Minnesota.

SUBJECTS

Diverse college students living off campus (n = 1059; 59% nonwhite; mean [SD] age, 22 [5] years).

MEASURES

Participants self-reported sociodemographic characteristics and frequency of purchasing food/beverages around campus, purchasing fast food, and bringing food from home. Campus area purchases included à la carte facilities, vending machines, beverages, and nearby restaurants/stores. Dietary outcomes included breakfast and evening meal consumption (d/wk) and summary variables of fruit and vegetable, dairy, calcium, fiber, added sugar, and fat intake calculated from food frequency screeners.

ANALYSIS

The associations between each purchasing behavior and dietary outcomes were examined using t-tests and linear regression.

RESULTS

Approximately 45% of students purchased food/beverages from at least one campus area venue ≥3 times per week. Frequent food/beverage purchasing around campus was associated with less frequent breakfast consumption and higher fat and added sugar intake, similar to fast-food purchasing. Bringing food from home was associated with healthier dietary patterns.

CONCLUSION

Increasing the healthfulness of campus food environments and promoting healthy food and beverage purchasing around campuses may be an important target for nutrition promotion among college students.

Effects of front-of-package and shelf nutrition labeling systems on consumers

As standards are considered for nutrition front-of-package (FOP) and shelf-labeling systems in the United States, it is important to know what types of systems are most effective in conveying scientifically accurate and useful information to consumers. A systematic literature review identified 38 empirical studies on consumer response to FOP nutrition labeling and shelf labeling. Studies indicate that consumers can more easily interpret and select healthier products with nutrient-specific FOP nutrition labels that incorporate text and symbolic color to indicate nutrient levels rather than nutrient-specific labels that only emphasize numeric information, such as Guideline Daily Amounts expressed as percentages and/or grams. Summary systems may influence consumers to purchase healthier products. However, more research is needed to assess the influence of nutrient-specific labels on consumers' purchases. This review identified few studies that compared consumers' ability to select healthier products using nutrient-specific systems that incorporate text and color codes with multiple-level summary icons. More research is needed to determine the effects of FOP nutrition labeling on consumers' actual shopping behaviors and dietary intakes.

Planning and Development of the Better Bites Program

The Better Bites program, a hospital cafeteria nutrition intervention strategy, was developed by combining evidence-based practices with hospital-specific formative research, including key informant interviews, the Nutrition Environment Measures Study in Restaurants, hospital employee surveys, and nutrition services staff surveys. The primary program components are pricing manipulation and marketing to promote delicious, affordable, and healthy foods to hospital employees and other cafeteria patrons. The pricing manipulation component includes decreasing the price of the healthy items and increasing the price of the unhealthy items using a 35% price differential. Point-of-purchase marketing highlights taste, cost, and health benefits of the healthy items. The program aims to increase purchases of healthy foods and decrease purchases of unhealthy foods, while maintaining revenue neutrality. This article addresses the formative research, planning, and development that informed the Better Bites program.

Factors across home, work, and school domains influence nutrition and physical activity behaviors of nontraditional college students

Nontraditional college students (older, part-time, and/or working) have less healthful nutrition and physical activity behaviors compared to traditional students, yet few health promotion efforts focus on nontraditional students. The purpose of this study was to use qualitative methods to explore factors affecting nutrition and physical activity behaviors of nontraditional students. Fourteen semi-structured individual interviews were conducted with nontraditional undergraduate students attending a large university. The sample had a median age of 25 (range, 21-64), 57% were men, 43% were racial/ethnic minorities, and 57% were employed (mean 22 hours/week). Data were coded using a systematic team-based approach. Consistent themes (mentioned by 4+ students) were identified and categorized into three domains: home, work, and school. Home (themes: neighborhood characteristics, family, partners), work (theme: work environment), and school (themes: cafeteria, vending machines) factors consistently influenced positive nutrition behaviors. Similarly, home (themes: neighborhood including safety, friends from home, partner,), work (theme: work environment), and school (themes: not having a car, campus structure, campus gym, friends at school) factors consistently influenced positive physical activity. Financial resources and perceptions of autonomy had influence across domains. Results indicate consistent influences on nutrition and physical activity behaviors across home, work, and school domains for nontraditional college students. Study findings suggest possible, and sometimes unconventional, intervention strategies to promote healthful eating and physical activity. For example, when cafeteria meal plans are not offered and financial constraints limit eating at the cafeteria, encouraging healthful choices from vending machines could be preferable to not eating at all.

Discrepancy between the Atwater factor predicted and empirically measured energy values of almonds in human diets

BACKGROUND

The energy content of foods is primarily determined by the Atwater factors, which may not be accurate for certain food groups. Nuts are a food group for which substantial evidence suggests that the Atwater factors may be poorly predictive.

OBJECTIVE

A study was conducted to determine the energy value of almonds in the human diet and to compare the measured energy value with the value calculated from the Atwater factors.

DESIGN

Eighteen healthy adults consumed a controlled diet or an almond-containing diet for 18 d. Three treatments were administered to subjects in a crossover design, and diets contained 1 of 3 almond doses: 0, 42, or 84 g/d. During the final 9 d of the treatment period, volunteers collected all urine and feces, and samples of diets, feces, and urine were analyzed for macronutrient and energy contents. The metabolizable energy content of the almonds was determined.

RESULTS

The energy content of almonds in the human diet was found to be 4.6 ± 0.8 kcal/g, which is equivalent to 129 kcal/28-g serving. This is significantly less than the energy density of 6.0-6.1 kcal/g as determined by the Atwater factors, which is equivalent to an energy content of 168-170 kcal/serving. The Atwater factors, when applied to almonds, resulted in a 32% overestimation of their measured energy content.

CONCLUSION

This study provides evidence for the inaccuracies of the Atwater factors for certain applications and provides a rigorous method for determining empirically the energy value of individual foods within the context of a mixed diet. This trial was registered at clinicaltrials.gov as NCT01007188.

Interventions for weight gain prevention during the transition to young adulthood: a review of the literature

PURPOSE

To review studies examining weight gain prevention interventions among young adults.

METHODS

A snowball strategy was used to identify relevant studies, beginning with systematic PubMed, MEDLINE, PsychINFO, Education Resources Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) searches.

INCLUDED STUDIES

(a) were published from 1985 to 2011; (b) were completed in the United States or Canada; (c) focused on weight gain prevention among young adults aged 18-35 years, assessing weight, body mass index, body composition, diet, or physical activity as an outcome; and (d) comprised pre- and postintervention assessments.

RESULTS

Thirty-seven interventions were identified. Ten interventions assessed weight, body mass index, or body composition; 27 addressed other relevant outcomes (e.g., diet, physical activity). Of the studies examining weight or body composition, six evaluated university courses or seminar-based interventions. Overall, many studies focused on individual-level intervention delivery and changes in weight-related knowledge and/or skills, although some incorporated relatively unique aspects (e.g., focusing on eating disorders and obesity simultaneously, using online technology, providing personalized feedback on weight change). Most showed promising results as small-scale pilot studies but lacked data from fully powered randomized trials.

CONCLUSIONS

There is an urgent need to develop effective young adult-focused weight gain prevention strategies. This review identified promising areas for future work, although much additional research is needed.

Is field of study or location associated with college students' snacking patterns?

Objective. To compare on- and off-campus snacking patterns among college students pursuing degrees in health-related fields (HRFs) and nonhealth-related fields (NHRFs). Materials and Methods. Snack frequency questionnaire, scales measuring barriers, self-efficacy, and stage of change for healthy snacking, and a snack knowledge test (SKT). Participants. 513 students, 46% HRFs, and 54% NHRFs. The students' mean ± SD BMI was 24.1 ± 4.3 kg/m(2) (range 14.6 to 43.8), and 32.2% were overweight/obese. Results. Softdrinks (on-campus), lowfat milk (off-campus), and sports drinks were popular among HRFs and NHRFs. Cost and availability were barriers to healthy snacking, students felt least confident to choose healthy snacks when emotionally upset, and 75% (65%) of HRFs (NHRFs) self-classified in the action stage of change for healthy snacking. The HRFs scored higher on the SKT. Conclusions. Neither location nor field of study strongly influenced snacking patterns, which featured few high-fiber foods.

Posting point-of-purchase nutrition information in university canteens does not influence meal choice and nutrient intake

BACKGROUND

Growing concern over the relation between out-of-home eating and overweight has triggered the use of point-of-purchase (POP) nutrition information when eating out of the home. In canteens that offer various unhealthy choices, the posting of POP nutrition information has the potential to improve meal choices and dietary intakes.

OBJECTIVE

The objective of this study was to increase the proportion of consumed meals that comply with recommendations for energy, saturated fat, sodium, and vegetable content by 5%.

DESIGN

A one-group pretest-posttest design was used. A total of 224 customers of 2 university canteens completed a questionnaire used for consumer profiling and 3-d food records to assess their meal choices and nutrient intakes. The 12 best meal combinations received star ratings and descriptors for nutrients or food groups that did not comply.

RESULTS

Reported meal choices in canteens and nutrient intakes did not improve after the intervention (P > 0.05). The nutritional profile of the meal choice, obtained from a qualitative and quantitative nutritional assessment of meals, mirrored the nutritional profile of all meals offered (P > 0.05) and not that of the recommended meals offered (P < 0.001). Meal choices were not compensated for later in the day (P > 0.05). The healthiest choices were made by participants with greater objective nutrition knowledge, stronger health and weight-control motives, and a greater openness to change meal choices at baseline (P < 0.05).

CONCLUSIONS

The posting of nutrition information in university canteens did not effectively change meal choices and nutrient intakes. Despite the intervention, meal choices were largely determined by meals offered. Therefore, nutrition-information interventions in canteens may be more effective with a healthier meal supply. This trial was registered at clinicaltrials.gov as NCT01249508.

Obesity and Food Choices Among Faculty and Staff at a Large Urban University

OBJECTIVE

in order to address increasing health care costs associated with obesity, this study sought to determine prevalence of overweight and obesity and examine eating behaviors, food choices, health beliefs, and attitudes of university employees.

PARTICIPANTS AND METHODS

an online survey was distributed to > 3,800 faculty and staff at a large public metropolitan university in Winter 2008.

RESULTS

almost half (48%) of 806 respondents were classified as overweight or obese. Compared to those with normal weights, overweight and obese respondents consumed fewer fruits and vegetables (p < .05), were less confident in making healthful food choices (p < .001), and were more influenced by food choices available in on-campus dining facilities (p < .05).

CONCLUSIONS

obesity among university employees warrants attention. Because these employees have less self-efficacy and consume less healthful diets than their normal weight colleagues, universities need to improve on-campus access to healthful foods.