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Khan A, Evangelista AU, Varua ME. Evaluating the impact of marketing interventions on sugar-free and sugar-sweetened soft drink sales and sugar purchases in a fast-food restaurant setting. BMC Public Health 2023; 23:1578. [PMID: 37596602 PMCID: PMC10439673 DOI: 10.1186/s12889-023-16395-z] [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: 09/04/2022] [Accepted: 07/26/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Beverages high in added sugar, such as sugar-sweetened soft drinks, continue to be associated with various health issues. This study examines the effects of a manufacturer-initiated multicomponent intervention on the sales of sugar-free (SFD) and sugar-sweetened (SSD) soft drinks and the amount of sugar people purchase from soft drinks in a fast-food restaurant setting. METHODS A database of monthly sales data of soft drinks from January 2016 to December 2018 was obtained from three treatment and three control fast-food restaurants. A multicomponent intervention consisting of free coupons, point-of-purchase displays, a menu board, and two sugar-free replacements for sugar-sweetened soft drinks was introduced in August 2018 for five months in Western Sydney, Australia. A retrospective interrupted time series analysis was used to model the data and examine the effects of the interventions on SFD and SSD sales and their consequential impact on sugar purchases from soft drinks. The analyses were carried out for volume sales in litres and sugar in grams per millilitre of soft drinks sales. A comparison of these measures within the treatment site (pre- and post-intervention) and between sites (treatment and control) was conducted. RESULTS The interventions had a statistically significant impact on SFDs but not SSDs. On average, SFD sales in the treatment site were 56.75% higher than in the control site. Although SSD sales were lower in the treatment site, the difference with the control site was not statistically significant. The net reduction of 6.34% in the amount of sugar purchased from soft drinks between sites during the experimental period was attributed to the interventions. CONCLUSIONS The interventions significantly increased SFD sales and reduced sugar purchases in the short run. Aside from free coupons, the findings support the recommendation for fast food restaurants to nudge customers towards choosing SFDs through point-of-purchase displays and the replacement of popular SSDs with their SFD counterparts.
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Affiliation(s)
- Aila Khan
- School of Business, Hospitality, Marketing and Sport, Western Sydney University, Sydney, Australia
| | - Anna Uro Evangelista
- School of Business, Economics, Finance and Property, Western Sydney University, Sydney, Australia.
| | - Maria Estela Varua
- School of Business, Economics, Finance and Property, Western Sydney University, Sydney, Australia
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Falbe J, Marinello S, Wolf EC, Solar SE, Schermbeck RM, Pipito AA, Powell LM. Food and Beverage Environments at Store Checkouts in California: Mostly Unhealthy Products. Curr Dev Nutr 2023; 7:100075. [PMID: 37250387 PMCID: PMC10213198 DOI: 10.1016/j.cdnut.2023.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background As the only place in a store where customers must pass through, checkouts may be especially influential over purchases. Research is needed to understand the healthfulness of checkout environments. Objectives The objective of this study was to classify checkout product facings in California food stores. Methods In a cross-sectional study, 102 stores, including chains (dollar stores, drugstores, specialty food stores, supermarkets, and mass merchandisers) and independent supermarkets and grocery stores were sampled from 4 northern California cities. Observational assessments of each checkout product facing were conducted in February 2021 using the Store CheckOUt Tool. Facings were classified by category and healthfulness, defined by meeting Berkeley's Healthy Checkout Ordinance's healthy checkout standards: unsweetened beverages and specific foods containing ≤5 g added sugar and ≤200 mg sodium per serving. Log binomial regressions compared healthfulness by store and checkout characteristics. Results Of 26,758 food and beverage checkout facings, the most common categories were candy (31%), gum (18%), sugar-sweetened beverages (SSBs; 11%), salty snacks (9%), mints (7%), and sweets (6%). Water represented only 3% and fruits and vegetables 1% of these facings. Only 30% of food and beverage facings met Berkeley's healthy checkout standards, with 70% not meeting the standards. The percentage of food and beverage facings not meeting the standards was even higher (89%) among snack-sized packages (≤2 servings/package). Compared with chain supermarkets, mass merchandisers, and specialty food stores (34%-36%), dollar and independent grocery stores had a lower percentage of food and beverage facings that met the healthy checkout standards (18%-20%; P < 0.05). Compared with lane and register areas (35%), endcaps and snaking sections within checkouts had fewer food and beverage facings that met the standards (21%-23%; P < 0.001). Conclusions Most foods and beverages at checkout consisted of candy, SSBs, salty snacks, and sweets and failed to meet the healthy checkout standards.Curr Dev Nutr 2023;xx:xx.
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Affiliation(s)
- Jennifer Falbe
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Samantha Marinello
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Ethan C. Wolf
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
- Public Health Nutrition Program, Community Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, United States
| | - Sarah E. Solar
- Human Development and Family Studies Program, Department of Human Ecology, University of California, Davis, CA, United States
| | - Rebecca M. Schermbeck
- Institute for Health Research and Policy, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Andrea A. Pipito
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa M. Powell
- Health Policy and Administration, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
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Yin E, Cameron AJ, Schultz S, White CM, Vanderlee L, Hammond D, Sacks G. Public Support for Nutrition-Related Actions by Food Companies in Australia: A Cross-Sectional Analysis of Findings from the 2020 International Food Policy Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4054. [PMID: 36901060 PMCID: PMC10002083 DOI: 10.3390/ijerph20054054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Unhealthy food environments contribute to unhealthy population diets. In Australia, the government currently relies on voluntary food company actions (e.g., related to front-of-pack labelling, restricting promotion of unhealthy foods, and product formulation) as part of their efforts to improve population diets, despite evidence that such voluntary approaches are less effective than mandatory policies. This study aimed to understand public perceptions of potential food industry nutrition-related actions in Australia. An online survey was completed by 4289 Australians in 2020 as part of the International Food Policy Study. The level of public support was assessed for six different nutrition-related actions related to food labelling, food promotion, and product formulation. High levels of support were observed for all six company actions, with the highest support observed for displaying the Health Star Rating on all products (80.4%) and restricting children's exposure to online promotion of unhealthy food (76.8%). Findings suggest the Australian public is strongly supportive of food companies taking action to improve nutrition and the healthiness of food environments. However, given the limitations of the voluntary action from food companies, mandatory policy action by the Australian government is likely to be needed to ensure company practices align with public expectations.
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Affiliation(s)
- Ebony Yin
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Adrian J. Cameron
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Sally Schultz
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Christine M. White
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Lana Vanderlee
- School of Nutrition, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Gary Sacks
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
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Whelan J, Love P, Aitken J, Millar L, Morley C, Melgren N, Allender S, Bell C. A mixed-methods evaluation of a health-promoting café located in a small health service in rural Victoria, Australia. Aust J Rural Health 2023; 31:61-69. [PMID: 35894288 PMCID: PMC10946910 DOI: 10.1111/ajr.12901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Residents of rural areas internationally typically experience chronic disease risk profiles worse than city dwellers. Poor diet, a key driver of chronic disease, has been associated with unhealthy food environments, and rural areas often experience limited access to healthy, fresh and affordable food. OBJECTIVE This study aimed to evaluate the first three years of a health promoting social enterprise café established in a small rural health service. DESIGN A mixed-methods evaluation study. Quantitative sales data, surveys and key informant interviews that included both quantitative and qualitative responses. FINDINGS Three years of sales data were included; 111customer surveys and five key informant interviews were conducted. Food and beverages on displayed and sold consistently met or exceeded the healthy criteria set by policy. Stakeholders supported the traffic light system, the social enterprise model and rated the likelihood of sustainability of the café as high. DISCUSSION Customers used the 'traffic light' system to inform food choices, placed value on the warmth of the staff and on the welcoming environment created through the social enterprise model. Resources remain tight although all stakeholders are committed to the sustainability of the YarriYak café. CONCLUSION The study shows the acceptability, feasibility and sustainability of a health promoting social enterprise café in a rural area.
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, School of Medicine, Global Obesity CentreDeakin UniversityGeelongAustralia
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongAustralia
| | - John Aitken
- LaTrobe Rural Health SchoolLa Trobe UniversityBendigoAustralia
| | - Lynne Millar
- Telethon Kids InstituteNedlandsWestern AustraliaAustralia
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | | | - Ngareta Melgren
- Rural Northwest Health ServiceWarracknabealVictoriaAustralia
| | - Steven Allender
- Institute of Health Transformation, School of Health and Social Development, Global Obesity CentreDeakin UniversityGeelongVictoriaAustralia
| | - Colin Bell
- Institute for Health Transformation, School of Medicine, Global Obesity CentreDeakin UniversityGeelongAustralia
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Fildes A, Lally P, Morris MA, Dalton A, Croker H. Impact on purchasing behaviour of implementing ‘junk free checkouts’: A pre‐post study. NUTR BULL 2022; 47:333-345. [DOI: 10.1111/nbu.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Phillippa Lally
- Research Department of Behavioural Science and Health University College London London UK
| | - Michelle A. Morris
- Leeds Institute for Data Analytics & School of Medicine University of Leeds Leeds UK
| | - Alexandra Dalton
- Leeds Institute for Data Analytics & School of Medicine University of Leeds Leeds UK
| | - Helen Croker
- UCL Great Ormond Street Institute of Child Health, UCL Population, Policy and Practice Research and Teaching Department London UK
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Needham C, Strugnell C, Allender S, Orellana L. Beyond food swamps and food deserts: exploring urban Australian food retail environment typologies. Public Health Nutr 2022; 25:1-13. [PMID: 35022093 PMCID: PMC9991784 DOI: 10.1017/s136898002200009x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE 'Food deserts' and 'food swamps' are food retail environment typologies associated with unhealthy diet and obesity. The current study aimed to identify more complex food retail environment typologies and examine temporal trends. DESIGN Measures of food retail environment accessibility and relative healthy food availability were defined for small areas (SA2s) of Melbourne, Australia, from a census of food outlets operating in 2008, 2012, 2014 and 2016. SA2s were classified into typologies using a two-stage approach: (1) SA2s were sorted into twenty clusters according to accessibility and availability and (2) clusters were grouped using evidence-based thresholds. SETTING The current study was set in Melbourne, the capital city of the state of Victoria, Australia. SUBJECTS Food retail environments in 301 small areas (Statistical Area 2) located in Melbourne in 2008, 2012, 2014 and 2016. RESULTS Six typologies were identified based on access (low, moderate and high) and healthy food availability including one where zero food outlets were present. Over the study period, SA2s experienced an overall increase in accessibility and healthiness. Distribution of typologies varied by geographic location and area-level socio-economic position. CONCLUSION Multiple typologies with contrasting access and healthiness measures exist within Melbourne and these continue to change over time, and the majority of SA2s were dominated by the presence of unhealthy relative to healthy outlets, with SA2s experiencing growth and disadvantage having the lowest access and to a greater proportion of unhealthy outlets.
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Affiliation(s)
- Cindy Needham
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong3220, Australia
| | - Claudia Strugnell
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong3220, Australia
| | - Steven Allender
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong3220, Australia
| | - Liliana Orellana
- Deakin University, Biostatistics Unit, Faculty of Health, Geelong, Australia
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Zavala GA, Tenorio-Palos Y, Campos-Ponce M, Elton-Puente JE, López-González CA, Doak CM, Rosado JL, García OP. Proximity and High Density of Convenience Stores Was Associated With Obesity in Children of a Rural Community of Mexico: Using a Geographic Information System Approach. Food Nutr Bull 2021; 42:490-501. [PMID: 34427148 DOI: 10.1177/03795721211033146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Food environment (FE) has been linked to obesity in urban areas, but there is limited information in rural areas, particularly in developing countries, where prevalence of obesity is high. OBJECTIVE To determine the association between FE and childhood obesity using Geographic Information Systems (GIS). METHODS A total of 218 (8-10 years) children participated in a cross-sectional study. Weight, height, and body fat were measured. Geolocation of convenience stores (CS) and participants' households was collected, and the amount of processed food (PF) in the stores was measured. The proximity to the nearest CS and the number of CS within a 250-m buffer from each participant's household was calculated using GIS. Linear regression models between obesity measurements and FE were performed. RESULTS The combined prevalence of overweight and obesity was 32%. A total of 91% of the children had access to a CS within 250 m. On average, 48% of the shelf-space of the CS were occupied with PF. A positive association between the density of CS with body fat % (β = .145; 95% CI, 0.048-0.241, P = .004), abdominal fat % (β = .206; 95% CI, 0.048-0.241, P = .003), and body mass index (BMI)-for-age z-score (BMIz; β = .028; 95% CI, 0.005-0.062, P = .005) was found. Living closer to CS was associated with increases in body fat % (β = -0.009; 95% CI, -0.017 to -0.001, P = 0.025), abdominal fat % (β = -0.012; 95% CI, -0.023 to -0.001, P = 0.033), and BMIz (β = -0.002, 95% CI, -0.004 to -0.001, P = 0.003). CONCLUSION In a rural community in Mexico, a high density and low proximity to CS is associated with obesity in school-aged children.
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Affiliation(s)
- Gerardo Antonio Zavala
- Facultad de Ciencias Naturales, School of Natural Sciences, 27772Universidad Autónoma de Querétaro, Querétaro, Mexico.,Faculty of Health Sciences, 8748University of York, York, United Kingdom
| | - Yessica Tenorio-Palos
- Facultad de Ciencias Naturales, School of Natural Sciences, 27772Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - Maiza Campos-Ponce
- Faculty of Health Sciences, 8748University of York, York, United Kingdom
| | - Juana Elizabeth Elton-Puente
- Facultad de Ciencias Naturales, School of Natural Sciences, 27772Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - Carlos Alberto López-González
- Facultad de Ciencias Naturales, School of Natural Sciences, 27772Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Jorge L Rosado
- Facultad de Ciencias Naturales, School of Natural Sciences, 27772Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - Olga P García
- Facultad de Ciencias Naturales, School of Natural Sciences, 27772Universidad Autónoma de Querétaro, Querétaro, Mexico
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Understanding regional food environments: A qualitative exploration of food purchasing behaviour. Health Place 2021; 71:102652. [PMID: 34392056 DOI: 10.1016/j.healthplace.2021.102652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 11/23/2022]
Abstract
The characteristics of regional food environments differ from those of urban food environments, however, the importance of these characteristics in shaping food purchasing behaviours is unclear. Using a qualitative descriptive approach, how regional adults use and perceive their food environment and the factors that determine their food purchasing behaviour were explored. Semi-structured in-depth interviews were undertaken with thirteen regional-dwelling Australian adults. Findings suggest regional residents consider a range of factors beyond proximity to home, in deciding where to purchase food. Knowing how people use their food environment will inform contextually-appropriate policy recommendations and interventions to improve regional food environments and healthy purchasing behaviours.
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Consumer Food Environment Healthiness Score: Development, Validation, and Testing between Different Types of Food Retailers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073690. [PMID: 33916263 PMCID: PMC8037126 DOI: 10.3390/ijerph18073690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/13/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
The aim of this study was to develop and validate a scoring system, based on AUDITNOVA, to assess the healthiness of the consumer food environment, considering food availability, price, advertising, and placement strategies. Audited data of 650 food retailers were used to develop, validate, and test the consumer food environment healthiness score. To compose the score, the reference was the Dietary Guidelines for the Brazilian Population. The total and subscores were standardized for a scale from 0 to 100. Construct validity was assessed using the Kruskal–Wallis Dunn tests. Cronbach’s alpha coefficients were calculated to determine the consistency of the scores. The median score was 33.7 (p25 = 26.9; p75 = 42.1). The public and private specialized indoor fresh food markets showed the highest medians; otherwise, bakeries and food retailers with the predominant sale of ultra-processed foods showed the lowest. The score was able to satisfactorily classify the extreme food retailer groups by the predominant sale of fresh or minimally processed foods and the predominant sale of ultra-processed foods. The results of Cronbach’s alpha showed excellent internal consistency (α = 0.91). The score helped to provide an overall assessment of consumer food environment healthiness and was able to classify food retailer groups as healthy and unhealthy according to the degree of processing of the available foods.
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Elorriaga N, Moyano DL, López MV, Cavallo AS, Gutierrez L, Panaggio CB, Irazola V. Urban Retail Food Environments: Relative Availability and Prominence of Exhibition of Healthy vs. Unhealthy Foods at Supermarkets in Buenos Aires, Argentina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030944. [PMID: 33499044 PMCID: PMC7908167 DOI: 10.3390/ijerph18030944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 01/06/2023]
Abstract
There is growing evidence that the food environment can influence diets. The present study aimed to assess the relative availability and prominence of healthy foods (HF) versus unhealthy products (UP) in supermarkets in Buenos Aires, Argentina and to explore differences by retail characteristics and neighborhood income level. We conducted store audits in 32 randomly selected food retails. Food availability (presence/absence, ratio of cumulative linear shelf length for HF vs. UP) and prominence inside the store (location visibility) were measured based on the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) protocol. On average, for every 1 m of shelf length for UP, there was about 25 cm of shelf length for HF (HF/UP ratio: 0.255, SD 0.130). UP were more frequently available in high-prominence store areas (31/32 retails) than HF (9/32 retails). Shelf length ratio differed across commercial chains (p = 0.0268), but not by store size or type. Retails in the lower-income neighborhoods had a lower HF/UP ratio than those in the higher-income neighborhoods (p = 0.0329). Availability of the selected HF was overcome largely by the UP, particularly in high prominence areas, and in neighborhoods with lower income level, which may pose an opportunity for public health interventions.
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Affiliation(s)
- Natalia Elorriaga
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- National Scientific and Technical Research Council (CONICET), Center for Research on Epidemiology and Public Health (CIESP-IECS), Ciudad Autónoma de Buenos Aires C1414CPV, Argentina
- Escuela de Nutrición, Universidad de Buenos Aires (UBA), Ciudad Autónoma de Buenos Aires C1121ABG, Argentina
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
- Correspondence: ; Tel.: +54-011-4777-8767
| | - Daniela L. Moyano
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
| | - María V. López
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
| | - Ana S. Cavallo
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
| | - Camila B. Panaggio
- Departamento de Salud, Universidad Nacional de La Matanza (UNLaM), San Justo B1754JEC, Argentina;
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Department of Research on Chronic Diseases, Ciudad Autónoma de Buenos Aires C1414CPV, Argentina; (D.L.M.); (M.V.L.); (A.S.C.); (L.G.); (V.I.)
- National Scientific and Technical Research Council (CONICET), Center for Research on Epidemiology and Public Health (CIESP-IECS), Ciudad Autónoma de Buenos Aires C1414CPV, Argentina
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Hawkes C, Fox E, Downs SM, Fanzo J, Neve K. Child-centered food systems: Reorienting food systems towards healthy diets for children. GLOBAL FOOD SECURITY 2020. [DOI: 10.1016/j.gfs.2020.100414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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12
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Brimblecombe J, McMahon E, Ferguson M, De Silva K, Peeters A, Miles E, Wycherley T, Minaker L, Greenacre L, Gunther A, Chappell E, Chatfield MD, Mah CL. Effect of restricted retail merchandising of discretionary food and beverages on population diet: a pragmatic randomised controlled trial. Lancet Planet Health 2020; 4:e463-e473. [PMID: 33038320 DOI: 10.1016/s2542-5196(20)30202-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contributing most to free sugar sales, on food and beverage sales. METHODS In this community-level pragmatic, partially randomised, parallel group trial, stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a co-designed strategy restricted merchandising of unhealthy food, or to a control group of usual retail practice. The trial was done in partnership with an organisation operating 25 stores in remote Australia. The primary analysis was based on difference in weekly sales with the strategy compared with no strategy in free sugar from all foods and beverages (g/total MJ; primary outcome), targeted food or beverages (weight and free sugars; g/total MJ), and gross profit (AU$) using mixed models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001588280. FINDINGS Between June 13 and Aug 15, 2018, 20 stores were recruited; ten stores were randomly assigned to the intervention group and ten stores to the control group. The trial was done between Sept 2 and Dec 2, 2018. The Healthy Stores 2020 strategy resulted in a reduction in sales of free sugar of 2·8% (95% CI -4·9 to -0·7). Targeted beverages were reduced by 8·4% (-12·3 to -4·3) and associated free sugar by 6·8% (-10·9 to -2·6), sugar-sweetened soft drinks by 13·2% (-18·5 to -7·6), and associated free sugar by 13·4% (-18·7 to -7·7). Reductions in sales of free sugar from confectionery of 7·5% (-14·3 to -0·2) and in weight sold (-4·6%, -11·1 to 2·3) resulted; however, the reduction in weight was not statistically significant. No differences in sales of table sugar and sweet biscuits were observed. Gross profit was not impacted adversely; a small increase resulted (5·3%, 0·3 to 10·5). INTERPRETATION Restricted merchandising of unhealthy foods and beverages, while allowing for complementary merchandising of healthier foods and beverages in a real-world store setting and co-designed with retailers, can achieve both public health and business relevant gains. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia; Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia.
| | - Emma McMahon
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Edward Miles
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Thomas Wycherley
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Leia Minaker
- School of Planning, University of Waterloo, Waterloo, ON, Canada
| | - Luke Greenacre
- Business School, Monash University, Melbourne, VIC, Australia
| | - Anthony Gunther
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Emma Chappell
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Catherine L Mah
- Faculty of Health, Dalhousie University, Halifax, NS, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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13
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Energy-dense, nutrient-poor food and beverage sales in Australia: where and when products are sold, and how sales are changing over time. Public Health Nutr 2020; 24:193-202. [PMID: 32782045 DOI: 10.1017/s1368980020002347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To quantify sales trends for key energy-dense, nutrient-poor (EDNP) foods and beverages over 5 years in Australia. DESIGN The Euromonitor Global Market Information Database and linear regression models were used to estimate average annual change in sales per capita of thirteen EDNP food categories and two EDNP beverage categories (defined using Australian Dietary Guidelines) over 5 years (2012-2017 for foods and 2011-2016 for beverages). The average annual change in sales was divided by the observed sales in 2012 (foods) or 2011 (beverages) to estimate the average percentage-change in sales per capita per annum. SETTING All major retail outlets in Australia. PARTICIPANTS Euromonitor Global Market Information Database sales data. RESULTS Between 2012 and 2017, sales per capita per annum of frozen pizza (6 %), pastries (5 %), potato chips (crisps) (5 %), tortilla chips (3 %), chocolate confectionery (2 %), frozen processed potatoes (2 %), ice cream (2 %) and sugar confectionery (0·2 %) increased. There were no changes in sales of sweet biscuits, chocolate spreads and cakes, and sales of savoury biscuits and processed meat decreased (-2 and -1 %, respectively). Between 2011 and 2016, sales per capita per annum of sports and energy drinks increased (4 %), sales of regular (sugar-sweetened) cola (-6 %) and all non-cola soft drinks (-1 %) decreased and sales of diet cola did not change. CONCLUSIONS Sales of EDNP foods and beverages generally increased or remained stable relative to population growth. Our results demonstrate the need for public health policies to reduce sales of EDNP foods and beverages.
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Azzopardi DJ, Lacy KE, Woods JL. Energy Density of New Food Products Targeted to Children. Nutrients 2020; 12:E2242. [PMID: 32727115 PMCID: PMC7468825 DOI: 10.3390/nu12082242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/21/2022] Open
Abstract
High dietary energy density (ED) is linked to childhood obesity and poor diet quality. The Australian Health Star Rating (HSR) system aims to assist consumers in making healthful food choices. This cross-sectional study used 2014-2018 data from the Mintel Global New Products Database to describe the ED of new food products targeted to children (5-12 years) released after the introduction of HSR and examine relationships between ED and HSR. Products were categorised by ED (low < 630 kJ/100 g, medium 630-950 kJ/100 g, high > 950 kJ/100 g) and HSR (no, HSR < 2.5 low, HSR ≥ 2.5 high). Non-parametric statistics were used to examine ED and HSR. A total of 548 products targeted children: 21% low, 5% medium, 74% high ED. One hundred products displayed an HSR: 24% low, 76% high; 53 products with both high HSR and ED. The EDs of products differed by HSR (p < 0.05), but both group's medians (HSR < 2.5: 1850 kJ/100 g, HSR ≥ 2.5: 1507 kJ/100 g) were high. A high proportion of new products had a high ED, and the HSR of these foods did not consistently discriminate between ED levels, particularly for high ED foods. Policies to promote lower ED foods and better alignment between ED and HSR may improve childhood obesity and diet quality.
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Affiliation(s)
- Danielle J. Azzopardi
- Deakin University, School of Exercise and Nutrition Sciences, Geelong, VIC 3220, Australia;
| | - Kathleen E. Lacy
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC 3220, Australia;
| | - Julie L. Woods
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC 3220, Australia;
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15
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McMahon EJ, Jaenke R, Brimblecombe J. A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study. JMIR Mhealth Uhealth 2020; 8:e16971. [PMID: 32706683 PMCID: PMC7407248 DOI: 10.2196/16971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/20/2020] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. OBJECTIVE This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. METHODS The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. RESULTS The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8%) or good (n=81/196, 41.3%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). CONCLUSIONS These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments.
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Affiliation(s)
- Emma Joy McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Rachael Jaenke
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Food Retail Environments in Greater Melbourne 2008-2016: Longitudinal Analysis of Intra-City Variation in Density and Healthiness of Food Outlets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041321. [PMID: 32092853 PMCID: PMC7068484 DOI: 10.3390/ijerph17041321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 11/16/2022]
Abstract
Obesity prevalence is inequitably distributed across geographic areas. Food environments may contribute to health disparities, yet little is known about how food environments are evolving over time and how this may influence dietary intake and weight. This study aimed to analyse intra-city variation in density and healthiness of food outlets between 2008 and 2016 in Melbourne, Australia. Food outlet data were classified by location, type and healthiness. Local government areas (LGAs) were classified into four groups representing distance from the central business district. Residential population estimates for each LGA were used to calculate the density of food outlets per 10,000 residents. Linear mixed models were fitted to estimate the mean density and ratio of ‘healthy’ to ‘unhealthy’ food outlets and food outlet ‘types’ by LGA group over time. The number of food outlets increased at a faster rate than the residential population, driven by an increasing density of both ‘unhealthy’ and ‘healthy’ outlets. Across all years, ratios of ‘unhealthy’ to ‘healthy’ outlets were highest in LGAs located in designated Growth Areas. Melbourne’s metropolitan food environment is saturated by ‘unhealthy’ and ‘less healthy’ food outlets, relative to ‘healthy’ ones. Melbourne’s urban growth areas had the least healthy food environments.
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17
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Needham C, Sacks G, Orellana L, Robinson E, Allender S, Strugnell C. A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socioeconomic position and associations with diet and obesity. Obes Rev 2020; 21:e12941. [PMID: 31802612 DOI: 10.1111/obr.12941] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 02/04/2023]
Abstract
There is strong support across multiple sectors for the implementation of policies to create healthier food environments as part of comprehensive strategies to address obesity and improve population diets. The existing evidence base describing food retail environments and their relationship with health outcomes is limited in several respects. This systematic review examines the current evidence regarding food retail environments in Australia, including associations with diet and people with obesity, and socioeconomic and geographic disparities. Three databases were searched and independently screened. Studies were included if they were undertaken in Australia and objectively measured the food retail environment. Sixty papers were included. The broad range of methodological approaches used across studies limited the ability to synthesize the evidence and draw conclusions. Results indicated that there is some evidence that disparities exist in food retail environments across measures of socioeconomic position and geographic area in parts of Australia. Overall, there were inconsistent findings regarding the association between the healthiness of food retail environments and diet or people with obesity. Findings support previous calls for standardized tools and measures for monitoring the healthiness of food retail environments. This is imperative to inform evidence-based policy and evaluation in this critical component of recommended obesity prevention strategies.
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Affiliation(s)
- Cindy Needham
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Whelan J, Millar L, Bell C, Russell C, Grainger F, Allender S, Love P. You Can't Find Healthy Food in the Bush: Poor Accessibility, Availability and Adequacy of Food in Rural Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2316. [PMID: 30347893 PMCID: PMC6210532 DOI: 10.3390/ijerph15102316] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 01/14/2023]
Abstract
In high-income countries, obesity disproportionately affects those from disadvantaged and rural areas. Poor diet is a modifiable risk factor for obesity and the food environment a primary driver of poor diet. In rural and disadvantaged communities, it is harder to access affordable and nutritious food, affecting both food insecurity and the health of rural residents. This paper aims to describe the food environment in a rural Australian community (approx. 7000 km² in size) to inform the development of community-relevant food supply interventions. We conducted a census audit of the food environment (ground truthing) of a local government area (LGA). We used the Nutrition Environment Measurement tools (NEMS-S and NEMS-R) to identify availability of a range of food and non-alcoholic beverages, the relative price of a healthy compared to a less healthy option of a similar food type (e.g., bread), the quality of fresh produce and any in-store nutrition promotion. Thirty-eight food retail outlets operated at the time of our study and all were included, 11 food stores (NEMS-S) and 27 food service outlets (NEMS-R). The mean NEMS-S score for all food stores was 21/54 points (39%) and mean NEMS-R score for all food service outlets was 3/23 points (13%); indicative of limited healthier options at relatively higher prices. It is difficult to buy healthy food beyond the supermarkets and one (of seven) cafés across the LGA. Residents demonstrate strong loyalty to local food outlets, providing scope to work with this existing infrastructure to positively impact poor diet and improve food security.
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Affiliation(s)
- Jill Whelan
- School of Medicine, Global Obesity Centre, Deakin University, Geelong 3220, Australia.
| | - Lynne Millar
- Australian Health Policy Collaboration, Victoria University, Melbourne 3000, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans 3021, Australia.
| | - Colin Bell
- School of Medicine, Global Obesity Centre, Deakin University, Geelong 3220, Australia.
| | - Cherie Russell
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Felicity Grainger
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
| | - Steven Allender
- School of Health and Social Development, Global Obesity Centre, Deakin University, Geelong 3220, Australia.
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3220, Australia.
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong 3220, Australia.
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Pulker CE, Thornton LE, Trapp GSA. What is known about consumer nutrition environments in Australia? A scoping review of the literature. Obes Sci Pract 2018; 4:318-337. [PMID: 30151227 PMCID: PMC6105710 DOI: 10.1002/osp4.275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research. METHODS A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included. RESULTS Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66). CONCLUSIONS This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.
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Affiliation(s)
- C. E. Pulker
- School of Public HealthCurtin UniversityPerthWAAustralia
- Telethon Kids InstituteThe University of Western AustraliaPerthWAAustralia
| | - L. E. Thornton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityMelbourneVICAustralia
| | - G. S. A. Trapp
- Telethon Kids InstituteThe University of Western AustraliaPerthWAAustralia
- School of Population and Global HealthThe University of Western AustraliaCrawleyWAAustralia
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20
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Local Food Environments, Suburban Development, and BMI: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071392. [PMID: 30004462 PMCID: PMC6068516 DOI: 10.3390/ijerph15071392] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 11/28/2022]
Abstract
More than half the world’s population now live in urban settlements. Worldwide, cities are expanding at their fringe to accommodate population growth. Low-density residential development, urban sprawl, and car dependency are common, contributing to physical inactivity and obesity. However, urban design and planning can modify urban form and enhance health by improving access to healthy food, public transport, and services. This study used a sequential mixed methods approach to investigate associations between food outlet access and body mass index (BMI) across urban-growth and established areas of Melbourne, Australia, and identify factors that influence local food environments. Population survey data for 3141 adults were analyzed to examine associations, and 27 interviews with government, non-government, and private sector stakeholders were conducted to contextualize results. Fast food density was positively associated with BMI in established areas and negatively associated in urban-growth areas. Interrelated challenges of car dependency, poor public transport, and low-density development hampered healthy food access. This study showed how patterns of suburban development influence local food environments and health outcomes in an urbanized city context and provides insights for other rapidly growing cities. More nuanced understandings of the differential effect of food environments within cities have potential to guide intra-city planning for improving health and reducing inequities.
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