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Trapp GSA, Pulker CE, Hurworth M, Law KK, Brinkman S, Pollard CM, Harray AJ, Sambell R, Mandzufas J, Anzman-Frasca S, Hickling S. The Nutritional Quality of Kids’ Menus from Cafés and Restaurants: An Australian Cross-Sectional Study. Nutrients 2022; 14:nu14132741. [PMID: 35807919 PMCID: PMC9269398 DOI: 10.3390/nu14132741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022] Open
Abstract
Australian families increasingly rely on eating foods from outside the home, which increases intake of energy-dense nutrient-poor foods. ‘Kids’ Menus’ are designed to appeal to families and typically lack healthy options. However, the nutritional quality of Kids’ Menus from cafes and full-service restaurants (as opposed to fast-food outlets) has not been investigated in Australia. The aim of this study was to evaluate the nutritional quality of Kids’ Menus in restaurants and cafés in metropolitan Perth, Western Australia. All 787 cafes and restaurants located within the East Metropolitan Health Service area were contacted and 33% had a separate Kids’ Menu. The validated Kids’ Menu Healthy Score (KIMEHS) was used to assess the nutritional quality of the Kids’ Menus. Almost all Kids’ Menus (99%) were rated ‘unhealthy’ using KIMEHS. The mean KIMEHS score for all restaurants and cafés was −8.5 (range −14.5 to +3.5) which was lower (i.e., more unhealthy) than the mean KIMEHS score for the top 10 most frequented chain fast-food outlets (mean −3.5, range −6.5 to +3). The findings highlight the need for additional supports to make improvements in the nutritional quality of Kids’ Menus. Local Government Public Health Plans provide an opportunity for policy interventions, using locally relevant tools to guide decision making.
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Affiliation(s)
- Gina S. A. Trapp
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, Perth, WA 6872, Australia; (M.H.); (S.B.); (A.J.H.); (J.M.)
- Correspondence: ; Tel.: +61-410-589-374
| | - Claire E. Pulker
- East Metropolitan Health Service, Kirkman House, 20 Murray Street, East Perth, Perth, WA 6004, Australia; (C.E.P.); (K.K.L.)
- School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth, WA 6845, Australia;
| | - Miriam Hurworth
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, Perth, WA 6872, Australia; (M.H.); (S.B.); (A.J.H.); (J.M.)
| | - Kristy K. Law
- East Metropolitan Health Service, Kirkman House, 20 Murray Street, East Perth, Perth, WA 6004, Australia; (C.E.P.); (K.K.L.)
| | - Sally Brinkman
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, Perth, WA 6872, Australia; (M.H.); (S.B.); (A.J.H.); (J.M.)
| | - Christina M. Pollard
- School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth, WA 6845, Australia;
| | - Amelia J. Harray
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, Perth, WA 6872, Australia; (M.H.); (S.B.); (A.J.H.); (J.M.)
- School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth, WA 6845, Australia;
| | - Ros Sambell
- Institute of Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia;
| | - Joelie Mandzufas
- Telethon Kids Institute, The University of Western Australia, P.O. Box 855, West Perth, Perth, WA 6872, Australia; (M.H.); (S.B.); (A.J.H.); (J.M.)
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia;
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 12 Capen Hall, Buffalo, NY 14260-1660, USA;
| | - Siobhan Hickling
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia;
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Fuster M, Handley MA, Alam T, Fullington LA, Elbel B, Ray K, Huang TTK. Facilitating Healthier Eating at Restaurants: A Multidisciplinary Scoping Review Comparing Strategies, Barriers, Motivators, and Outcomes by Restaurant Type and Initiator. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041479. [PMID: 33557280 PMCID: PMC7915132 DOI: 10.3390/ijerph18041479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
Restaurants are understudied yet increasingly important food environment institutions for tackling diet-related diseases. This scoping review analyzes research and gray literature (n = 171 records) to assess which healthy eating promotion strategies have been implemented in restaurants and the associated motivations, barriers, and outcomes, compared by restaurant type (corporate/chain vs. independently owned restaurants) and initiator (restaurant-initiated vs. investigator-initiated). We found that the most commonly reported strategy was the increase of generally healthy offerings and the promotion of such offerings. Changes in food availability were more common among corporate restaurants and initiated by restaurants, while environmental facilitators were more commonly initiated by investigators and associated with independently owned restaurants. Aside from those associated with revenue, motivations and barriers for healthy eating promoting strategies varied by restaurant type. While corporate restaurants were also motivated by public health criticism, independently owned restaurants were motivated by interests to improve community health. Revenue concerns were followed by food sourcing issues in corporate restaurants and lack of interest among independently owned restaurants. Among reporting sources, most outcomes were revenue positive. This study shows the need for practice-based evidence and accounting for restaurant business models to tailor interventions and policies for sustained positive changes in these establishments.
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Affiliation(s)
- Melissa Fuster
- Department of Health and Nutrition Science, Brooklyn College, City University of New York, Brooklyn, New York, NY 11210, USA;
- Correspondence:
| | - Margaret A. Handley
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA 94158, USA;
| | - Tamara Alam
- Department of Health and Nutrition Science, Brooklyn College, City University of New York, Brooklyn, New York, NY 11210, USA;
| | - Lee Ann Fullington
- Library, Brooklyn College, City University of New York, Brooklyn, New York, NY 11210, USA;
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, and Wagner Graduate School of Public Service, New York University, New York, NY 10016, USA;
| | - Krishnendu Ray
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA;
| | - Terry T-K Huang
- Department of Community Health and Social Sciences and Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY 10027, USA;
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Barriers and facilitators to implementing a healthier food outlet initiative: perspectives from local governments. Public Health Nutr 2020; 24:2758-2770. [PMID: 32895071 DOI: 10.1017/s1368980020002323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Local governments have integral roles in contributing to public health. One recent focus has been on how local governments can impact community nutrition by engaging food service outlets to improve their food offer. The Healthier Catering Commitment (HCC) is an initiative where London local governments support takeaways and restaurants to meet centrally defined nutrition criteria on their food options. Using the case of HCC, the current study aims to provide (1) practical learnings of how local governments could facilitate and overcome barriers associated with implementing healthy food service initiatives in general, and (2) specific recommendations for enhancements for HCC. DESIGN Key informant, semi-structured interviews were conducted with local government staff involved in HCC, exploring barriers and facilitators to HCC implementation in food businesses. A thematic analysis approach was used, with results presented according to a logic pathway of ideal implementation in order to provide practical, focused insights. SETTING Local governments implementing HCC. PARTICIPANTS Twenty-two individuals supporting HCC implementation. RESULTS Facilitators to implementation included flexible approaches, shared resourcing and strategically engaging businesses with practical demonstrations. Barriers were limited resources, businesses fearing negative customer responses and low uptake in disadvantaged areas. Key suggestions to enhance implementation and impact included offering additional incentives, increasing HCC awareness and encouraging recruited businesses to make healthy changes beyond initiative requirements. CONCLUSIONS In order to facilitate the implementation of healthy food initiatives in food outlets, local governments would benefit from involving their environmental health team, employing community-tailored approaches and focusing on supporting businesses in disadvantaged areas.
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Reznar MM, Brennecke K, Eathorne J, Gittelsohn J. A cross-sectional description of mobile food vendors and the foods they serve: potential partners in delivering healthier food-away-from-home choices. BMC Public Health 2019; 19:744. [PMID: 31196159 PMCID: PMC6567609 DOI: 10.1186/s12889-019-7075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background Food away from home (FAFH) in the US is associated with adverse health outcomes, and food dollars spent on FAFH continues to increase. FAFH studies have typically focused on restaurants and carryout establishments, but mobile food vendors – popularly known in the US as food trucks – have become more numerous and are an understudied segment of FAFH. The objective of this study was to assess mobile food vendors, their attitudes toward health and nutrition, and the foods they serve. Methods This was a cross-sectional study of 41 mobile food vendors in Michigan, US. The survey contained questions about food and nutrition attitudes, such as barriers to putting healthy items on menus and perceived agreement with healthy food preparation practices. Participants were classified into a healthy and a less healthy attitude group based on whether they believed healthy menu items could be successful or not. In addition, participant menus were collected and analyzed according to whether menu items were healthy, moderately healthy, or unhealthy. Descriptive, univariate, and bivariate analyses were conducted. Results Two-thirds of the participants felt that healthy menu items could be successful, and yet taste and value were the most important menu item success factors, each rated as important by 100% of the participants. Low consumer demand was the biggest barrier to putting healthy items on the menu (76%) whereas lack of chef interest (29%) and need for special training (24%) were the smallest. 72% of the vendors offered at least one healthy menu item, but only 20% of all reviewed menu items were healthy overall. There was no difference in the proportion of menu items that were healthy when comparing those with healthy attitudes (23% of menu items healthy) to those less healthy attitudes (17% of menu items healthy, p = 0.349). Conclusions Mobile food vendors had positive views about putting healthy items on menus. However, a low proportion of menu items were classified as healthy. This suggests that mobile food vendors are promising potential public health partners in improving the health profile of FAFH, but that education of vendors is needed to ensure the success of healthier items. Electronic supplementary material The online version of this article (10.1186/s12889-019-7075-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa M Reznar
- Oakland University School of Health Sciences, 433 Meadow Brook Road, 3102 Human Health Building, Rochester, MI, 48309, USA.
| | - Katherine Brennecke
- Oakland University School of Health Sciences, 433 Meadow Brook Road, 3102 Human Health Building, Rochester, MI, 48309, USA
| | - Jamie Eathorne
- Oakland University School of Health Sciences, 433 Meadow Brook Road, 3102 Human Health Building, Rochester, MI, 48309, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W2041, Baltimore, MD, 21205, USA
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Boelsen‐Robinson T, Blake MR, Backholer K, Hettiarachchi J, Palermo C, Peeters A. Implementing healthy food policies in health services: A qualitative study. Nutr Diet 2018; 76:336-343. [DOI: 10.1111/1747-0080.12471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tara Boelsen‐Robinson
- Department of Medicine, Nursing and Health Sciences, School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
| | - Miranda R. Blake
- Department of Medicine, Nursing and Health Sciences, School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
| | - Kathryn Backholer
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
| | - Janitha Hettiarachchi
- Department of Clinical Diabetes and Epidemiology, Baker Institute Melbourne Victoria Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, School of Clinical ScienceMonash University Melbourne Victoria Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
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Ma GX, Shive SE, Zhang G, Aquilante J, Tan Y, Pharis M, Bettigole C, Lawman H, Wagner A, Zhu L, Zeng Q, Wang MQ. Evaluation of a Healthy Chinese Take-Out Sodium-Reduction Initiative in Philadelphia Low-Income Communities and Neighborhoods. Public Health Rep 2018; 133:472-480. [PMID: 29846132 DOI: 10.1177/0033354918773747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Sodium reduction in restaurant foods is important because 77% of sodium in the United States is consumed by eating prepared and restaurant foods. We evaluated a sodium-reduction intervention, Healthy Chinese Take-Out Initiative, among Chinese take-out restaurants in low-income neighborhoods in Philadelphia, Pennsylvania. Our objectives were to (1) analyze changes in the sodium content of food samples and (2) collect data on changes in chefs' and owners' knowledge about the health risks of sodium overconsumption, perceptions of the need for sodium reduction, self-efficacy for lowering sodium use, and perceptions of training needs for sodium-reduction strategies. METHODS The initiative trained chefs from 206 Chinese take-out restaurants on strategies to reduce sodium in prepared dishes. We analyzed changes in the sodium content of the 3 most frequently ordered dishes-shrimp and broccoli, chicken lo mein, and General Tso's chicken-from baseline (July-September 2012) to 36 months after baseline (July-September 2015) among 40 restaurants. We conducted a survey to examine the changes in chefs' and owners' knowledge, perceptions, and self-efficacy of sodium reduction. We used multilevel analysis and repeated-measures analysis of variance to examine effects of the intervention on various outcomes. RESULTS We found significant reductions in the sodium content of all 3 dishes 36 months after a low-sodium cooking training intervention (coefficients range, -1.06 to -1.69, P < .001 for all). Mean knowledge (range, 9.2-11.1), perceptions (range, 4.6-6.0), and self-efficacy (range, 4.2-5.9) ( P < .001 for all) of sodium reduction improved significantly from baseline (August 2012) to posttraining (also August 2012), but perceptions of the need for sodium reduction and self-efficacy for lowering sodium use returned to baseline levels 36 months later (August 2015). CONCLUSIONS The intervention was a useful population health approach that led to engaging restaurants in sodium-reduction practices. Local public health agencies and professionals could partner with independent restaurants to introduce environmental changes that can affect population health on a broad scale, particularly for vulnerable populations.
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Affiliation(s)
- Grace X Ma
- 1 Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,2 Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Steven E Shive
- 1 Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.,3 Department of Health Studies, East Stroudsburg University, East Stroudsburg, PA, USA
| | - Guo Zhang
- 1 Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | | | - Yin Tan
- 1 Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Meagan Pharis
- 4 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Cheryl Bettigole
- 4 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Hannah Lawman
- 4 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Amanda Wagner
- 4 Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Lin Zhu
- 1 Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Qiaoling Zeng
- 5 Asian Community Health Coalition, Philadelphia, PA, USA
| | - Min Qi Wang
- 6 Department of Public and Community Health, University of Maryland, College Park, MD, USA
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Hillier-Brown FC, Summerbell CD, Moore HJ, Routen A, Lake AA, Adams J, White M, Araujo-Soares V, Abraham C, Adamson AJ, Brown TJ. The impact of interventions to promote healthier ready-to-eat meals (to eat in, to take away or to be delivered) sold by specific food outlets open to the general public: a systematic review. Obes Rev 2017; 18:227-246. [PMID: 27899007 PMCID: PMC5244662 DOI: 10.1111/obr.12479] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Ready-to-eat meals sold by food outlets that are accessible to the general public are an important target for public health intervention. We conducted a systematic review to assess the impact of such interventions. METHODS Studies of any design and duration that included any consumer-level or food-outlet-level before-and-after data were included. RESULTS Thirty studies describing 34 interventions were categorized by type and coded against the Nuffield intervention ladder: restrict choice = trans fat law (n = 1), changing pre-packed children's meal content (n = 1) and food outlet award schemes (n = 2); guide choice = price increases for unhealthier choices (n = 1), incentive (contingent reward) (n = 1) and price decreases for healthier choices (n = 2); enable choice = signposting (highlighting healthier/unhealthier options) (n = 10) and telemarketing (offering support for the provision of healthier options to businesses via telephone) (n = 2); and provide information = calorie labelling law (n = 12), voluntary nutrient labelling (n = 1) and personalized receipts (n = 1). Most interventions were aimed at adults in US fast food chains and assessed customer-level outcomes. More 'intrusive' interventions that restricted or guided choice generally showed a positive impact on food-outlet-level and customer-level outcomes. However, interventions that simply provided information or enabled choice had a negligible impact. CONCLUSION Interventions to promote healthier ready-to-eat meals sold by food outlets should restrict choice or guide choice through incentives/disincentives. Public health policies and practice that simply involve providing information are unlikely to be effective.
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Affiliation(s)
- F C Hillier-Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - C D Summerbell
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - H J Moore
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - A Routen
- School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A A Lake
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Centre for Public Policy & Health, School of Medicine, Pharmacy & Health, Durham University, Stockton-on-Tees, UK
| | - J Adams
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M White
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - V Araujo-Soares
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK
| | - C Abraham
- Psychology Applied to Heath, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - A J Adamson
- Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK.,Institute of Health & Society, Newcastle University, Newcastle Upon Tyne, UK.,Human Nutrition Research Centre, Newcastle University, Newcastle Upon Tyne, UK
| | - T J Brown
- Obesity Related Behaviours Research Group, School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK.,Fuse - UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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8
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Food ordering for children in restaurants: multiple sources of influence on decision making. Public Health Nutr 2016; 19:2404-9. [PMID: 27334904 DOI: 10.1017/s1368980016001403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Restaurants are playing an increasingly important role in children's dietary intake. Interventions to promote healthy ordering in restaurants have primarily targeted adults. Much remains unknown about how to influence ordering for and by children. Using an ecological lens, the present study sought to identify sources of influence on ordering behaviour for and by children in restaurants. DESIGN A mixed-methods study was conducted using unobtrusive observations of dining parties with children and post-order interviews. Observational data included: child's gender, person ordering for the child and server interactions with the dining party. Interview data included: child's age, restaurant visit frequency, timing of child's decision making, and factors influencing decision making. SETTING Ten independent, table-service restaurants in San Diego, CA, USA participated. SUBJECTS Complete observational and interview data were obtained from 102 dining parties with 150 children (aged 3-14 years). RESULTS Taste preferences, family influences and menus impacted ordering. However, most children knew what they intended to order before arriving at the restaurant, especially if they dined there at least monthly. Furthermore, about one-third of children shared their meals with others and all shared meals were ordered from adult (v. children's) menus. Parents placed most orders, although parental involvement in ordering was less frequent with older children. Servers interacted frequently with children but generally did not recommend menu items or prompt use of the children's menu. CONCLUSIONS Interventions to promote healthy ordering should consider the multiple sources of influence that are operating when ordering for and by children in restaurants.
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Ortega AN, Albert SL, Chan-Golston AM, Langellier BA, Glik DC, Belin TR, Garcia RE, Brookmeyer R, Sharif MZ, Prelip ML. Substantial improvements not seen in health behaviors following corner store conversions in two Latino food swamps. BMC Public Health 2016; 16:389. [PMID: 27169514 PMCID: PMC4864998 DOI: 10.1186/s12889-016-3074-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/04/2016] [Indexed: 11/23/2022] Open
Abstract
Background The effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors. Methods Household data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention. Results Improvements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables. Conclusions Results suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3074-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander N Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Nesbitt Hall, Room 335, Philadelphia, PA, 19104, USA.
| | - Stephanie L Albert
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Alec M Chan-Golston
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Nesbitt Hall, Room 335, Philadelphia, PA, 19104, USA
| | - Deborah C Glik
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Thomas R Belin
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Rosa Elena Garcia
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Ron Brookmeyer
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Mienah Z Sharif
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Michael L Prelip
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, 90095, USA
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10
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Escaron AL, Martinez-Donate AP, Riggall AJ, Meinen A, Hall B, Nieto FJ, Nitzke S. Developing and Implementing "Waupaca Eating Smart": A Restaurant and Supermarket Intervention to Promote Healthy Eating Through Changes in the Food Environment. Health Promot Pract 2015; 17:265-77. [PMID: 26546508 DOI: 10.1177/1524839915612742] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Restaurants and food stores are suitable settings for healthy eating interventions. A community-academic partnership developed and implemented "Waupaca Eating Smart" (WES), a healthy eating program in restaurants and supermarkets of a rural, Midwest community. Previous interventions targeted either restaurants or small food stores nearly all in urban areas. Intervention design and implementation is rarely documented, making replication difficult for interested researchers and communities. In this article, we report the activities we undertook to develop and implement WES. METHODS Working with a local nutrition and activity coalition, we used evidence-based strategies guided by the social ecological model and social marketing principles to inform the content of WES. Formative assessment included a review of the literature, statewide key informant interviews and focus groups with restaurant and food store operators and patrons, a local community survey, and interviews with prospective WES businesses. WES was implemented in seven restaurants and two supermarkets and evaluated for feasibility and acceptance using surveys and direct observation of WES implementation. FINDINGS Prior to this intervention, only one of seven restaurants had three or more meals that met WES nutrition criteria. By the end of the program, 38 meals were labeled and promoted to restaurant customers, and the team had staffed four side salad taste tests for supermarket customers. Four and 10 months after intervention launch, the majority of the program's strategies were observed in participating outlets, suggesting that these program's strategies are feasible and can be sustained. Operators reported strong satisfaction overall. CONCLUSIONS A combined restaurant- and supermarket-based healthy eating intervention is feasible and positively valued in rural communities. Further research is needed to better understand how to foster sustainability of these interventions and their impact on customer food choices.
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Affiliation(s)
- Anne L Escaron
- AltaMed Health Services Corporation, Los Angeles, CA, USA
| | - Ana P Martinez-Donate
- University of Wisconsin-Madison, Madison, WI, USA Drexel University, Philadelphia, PA, USA
| | | | - Amy Meinen
- University of Wisconsin-Madison, Madison, WI, USA Wisconsin Obesity Prevention Network in Madison, WI, USA
| | | | | | - Susan Nitzke
- University of Wisconsin-Madison, Madison, WI, USA
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11
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Valdivia Espino JN, Guerrero N, Rhoads N, Simon NJ, Escaron AL, Meinen A, Nieto FJ, Martinez-Donate AP. Community-based restaurant interventions to promote healthy eating: a systematic review. Prev Chronic Dis 2015; 12:E78. [PMID: 25996986 PMCID: PMC4454412 DOI: 10.5888/pcd12.140455] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Eating in restaurants is associated with high caloric intake. This review summarizes and evaluates the evidence supporting community-based restaurant interventions. METHODS We searched all years of PubMed and Web of Knowledge through January 2014 for original articles describing or evaluating community-based restaurant interventions to promote healthy eating. We extracted summary information and classified the interventions into 9 categories according to the strategies implemented. A scoring system was adapted to evaluate the evidence, assigning 0 to 3 points to each intervention for study design, public awareness, and effectiveness. The average values were summed and then multiplied by 1 to 3 points, according to the volume of research available for each category. These summary scores were used to determine the level of evidence (insufficient, sufficient, or strong) supporting the effectiveness of each category. RESULTS This review included 27 interventions described in 25 studies published since 1979. Most interventions took place in exclusively urban areas of the United States, either in the West or the South. The most common intervention categories were the use of point-of-purchase information with promotion and communication (n = 6), and point-of-purchase information with increased availability of healthy choices (n = 6). Only the latter category had sufficient evidence. The remaining 8 categories had insufficient evidence because of interventions showing no, minimal, or mixed findings; limited reporting of awareness and effectiveness; low volume of research; or weak study designs. No intervention reported an average negative impact on outcomes. CONCLUSION Evidence about effective community-based strategies to promote healthy eating in restaurants is limited, especially for interventions in rural areas. To expand the evidence base, more studies should be conducted using robust study designs, standardized evaluation methods, and measures of sales, behavior, and health outcomes.
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Affiliation(s)
| | | | | | | | | | - Amy Meinen
- University of Wisconsin-Madison and Wisconsin Obesity Prevention Network, Madison, Wisconsin
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Martínez-Donate AP, Riggall AJ, Meinen AM, Malecki K, Escaron AL, Hall B, Menzies A, Garske G, Nieto FJ, Nitzke S. Evaluation of a pilot healthy eating intervention in restaurants and food stores of a rural community: a randomized community trial. BMC Public Health 2015; 15:136. [PMID: 25885704 PMCID: PMC4331304 DOI: 10.1186/s12889-015-1469-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/27/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Research suggests that the food environment influences individual eating practices. To date, little is known about effective interventions to improve the food environment of restaurants and food stores and promote healthy eating in rural communities. We tested "Waupaca Eating Smart " (WES), a pilot intervention to improve the food environment and promote healthy eating in restaurants and supermarkets of a rural community. WES focused on labeling, promoting, and increasing the availability of healthy foods. METHODS We conducted a randomized community trial, with two Midwestern U.S. communities randomly assigned to serve as intervention or control site. We collected process and outcome data using baseline and posttest owner and customer surveys and direct observation methods. The RE-AIM framework was used to guide the evaluation and organize the results. RESULTS Seven of nine restaurants and two of three food stores invited to participate in WES adopted the intervention. On a 0-4 scale, the average level of satisfaction with WES was 3.14 (SD=0.69) for restaurant managers and 3 (SD=0.0) for store managers. On average, 6.3 (SD=1.1) out of 10 possible intervention activities were implemented in restaurants and 9.0 (SD=0.0) out of 12 possible activities were implemented in food stores. One month after the end of the pilot implementation period, 5.4 (SD=1.6) and 7.5 (SD=0.7) activities were still in place at restaurants and food stores, respectively. The intervention reached 60% of customers in participating food outlets. Restaurant food environment scores improved from 13.4 to 24.1 (p < 0.01) in the intervention community and did not change significantly in the control community. Food environment scores decreased slightly in both communities. No or minimal changes in customer behaviors were observed after a 10-month implementation period. CONCLUSION The intervention achieved high levels of reach, adoption, implementation, and maintenance, suggesting the feasibility and acceptability of restaurant-and food store-based interventions in rural communities. Pilot outcome data indicated very modest levels of effectiveness, but additional research adequately powered to test the impact of this intervention on food environment scores and customer behaviors needs to be conducted in order to identify its potential to promote healthy eating in rural community settings.
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Affiliation(s)
- Ana P Martínez-Donate
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.
| | - Ann Josie Riggall
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.
| | - Amy M Meinen
- Obesity Prevention Network, University of Wisconsin, Madison, WI, USA.
| | - Kristen Malecki
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.
| | | | - Bev Hall
- Waupaca County NuAct Coalition, Waupaca, WI, USA.
| | - Anne Menzies
- Waupaca County NuAct Coalition, Waupaca, WI, USA.
| | - Gary Garske
- Portage County Activity and Nutrition Coalition, Stevens Point, WI, USA.
| | - F Javier Nieto
- Department of Population Health Sciences, University of Wisconsin, Madison, WI, USA.
| | - Susan Nitzke
- Department of Nutritional Sciences, University of Wisconsin, Madison, WI, USA.
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Barac R, Stein S, Bruce B, Barwick M. Scoping review of toolkits as a knowledge translation strategy in health. BMC Med Inform Decis Mak 2014; 14:121. [PMID: 25539950 PMCID: PMC4308831 DOI: 10.1186/s12911-014-0121-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 12/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Significant resources are invested in the production of research knowledge with the ultimate objective of integrating research evidence into practice. Toolkits are becoming increasingly popular as a knowledge translation (KT) strategy for disseminating health information, to build awareness, inform, and change public and healthcare provider behavior. Toolkits communicate messages aimed at improving health and changing practice to diverse audiences, including healthcare practitioners, patients, community and health organizations, and policy makers. This scoping review explores the use of toolkits in health and healthcare. METHODS Using Arksey and O'Malley's scoping review framework, health-based toolkits were identified through a search of electronic databases and grey literature for relevant articles and toolkits published between 2004 and 2011. Two reviewers independently extracted data on toolkit topic, format, target audience, content, evidence underlying toolkit content, and evaluation of the toolkit as a KT strategy. RESULTS Among the 253 sources identified, 139 met initial inclusion criteria and 83 toolkits were included in the final sample. Fewer than half of the sources fully described the toolkit content and about 70% made some mention of the evidence underlying the content. Of 83 toolkits, only 31 (37%) had been evaluated at any level (27 toolkits were evaluated overall relative to their purpose or KT goal, and 4 toolkits evaluated the effectiveness of certain elements contained within them). CONCLUSIONS Toolkits used to disseminate health knowledge or support practice change often do not specify the evidence base from which they draw, and their effectiveness as a knowledge translation strategy is rarely assessed. To truly inform health and healthcare, toolkits should include comprehensive descriptions of their content, be explicit regarding content that is evidence-based, and include an evaluation of the their effectiveness as a KT strategy, addressing both clinical and implementation outcomes.
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Affiliation(s)
| | | | | | - Melanie Barwick
- Hospital for Sick Children, Toronto, Canada. .,University of Toronto, Toronto, Canada.
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Crixell SH, Friedman B, Fisher DT, Biediger-Friedman L. Improving children's menus in community restaurants: best food for families, infants, and toddlers (Best Food FITS) intervention, South Central Texas, 2010-2014. Prev Chronic Dis 2014; 11:E223. [PMID: 25539127 PMCID: PMC4279868 DOI: 10.5888/pcd11.140361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Approximately 32% of US children are overweight or obese. Restaurant and fast food meals contribute 18% of daily calories for children and adolescents aged 2 to 18 years. Changing children’s menus may improve their diets. This case study describes Best Food for Families, Infants, and Toddlers (Best Food FITS), a community-based intervention designed to address childhood obesity. The objective of this study was to improve San Marcos children’s access to healthy diets through partnerships with local restaurants, removing sugar-sweetened beverages, decreasing the number of energy-dense entrées, and increasing fruit and vegetable offerings on restaurant menus. Community Context San Marcos, Texas, the fastest growing US city, has more restaurants and fewer grocery stores than other Texas cities. San Marcos’s population is diverse; 37.8% of residents and 70.3% of children are Hispanic. Overweight and obesity rates among school children exceed 50%; 40.3% of children live below the poverty level. Methods This project received funding from the Texas Department of State Health Services Nutrition, Physical Activity, and Obesity Prevention Program to develop Best Food FITS. The case study consisted of developing a brand, engaging community stakeholders, reviewing existing children’s menus in local restaurants, administering owner–manager surveys, collaborating with restaurants to improve menus, and assessing the process and outcomes of the intervention. Outcome Best Food FITS regularly participated in citywide health events and funded the construction of a teaching kitchen in a new community building where regular nutrition classes are held. Sixteen independent restaurants and 1 chain restaurant implemented new menus. Interpretation Improving menus in restaurants can be a simple step toward changing children’s food habits. The approach taken in this case study can be adapted to other communities. Minimal funding would be needed to facilitate development of promotional items to support brand recognition.
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Affiliation(s)
- Sylvia Hurd Crixell
- Professor, School of Family and Consumer Sciences, Nutrition and Foods, Texas State University, 601 University Drive, San Marcos, Texas 78666.
| | - Bj Friedman
- School of Family and Consumer Sciences, Texas State University, San Marcos, Texas
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Lee-Kwan SH, Bleich SN, Kim H, Colantuoni E, Gittelsohn J. Environmental Intervention in Carryout Restaurants Increases Sales of Healthy Menu Items in a Low-Income Urban Setting. Am J Health Promot 2014; 29:357-64. [PMID: 24968184 DOI: 10.4278/ajhp.130805-quan-408] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate how a pilot environmental intervention changed food sales patterns in carryout restaurants. DESIGN Quasi-experimental. SETTING Low-income neighborhoods of Baltimore, Maryland. SUBJECTS Seven carryouts (three intervention, four comparison). INTERVENTION Phase 1, menu board revision and healthy menu labeling; phase 2, increase of healthy sides and beverages; and phase 3, promotion of cheaper and healthier combination meals. MEASURES Weekly handwritten menu orders collected to assess changes in the proportion of units sold and revenue of healthy items (entrée, sides and beverages, and combined). ANALYSIS Logistic and Poisson regression models with generalized estimating equations. RESULTS In the intervention group, odds for healthy entrée units and odds for healthy side and beverage units sold significantly increased in phases 2 and 3; odds for healthy entrée revenue significantly increased in phase 1 (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08-1.26), phase 2 (OR 1.32, 95% CI 1.25-1.41), and phase 3 (OR 1.39, 95% CI 1.14-1.70); and odds for healthy side and beverage revenues increased significantly in phase 2 (OR 1.62, 95% CI 1.33-1.97) and phase 3 (OR 2.73, 95% CI 2.15-3.47) compared to baseline. Total revenue in the intervention group was significantly higher in all phases than in the comparison group (p < .05). CONCLUSION Environmental intervention changes such as menu revision, menu labeling, improved healthy food selection, and competitive pricing can increase availability and sales of healthy items in carryouts.
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Chen Q, Goto K, Wolff C, Zhao Y. Relationships Between Children’s Exposure to Ethnic Produce and Their Dietary Behaviors. J Immigr Minor Health 2014; 17:383-8. [DOI: 10.1007/s10903-014-0036-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gase L, Dunning L, Kuo T, Simon P, Fielding JE. Restaurant owners' perspectives on a voluntary program to recognize restaurants for offering reduced-size portions, Los Angeles County, 2012. Prev Chronic Dis 2014; 11:E44. [PMID: 24650622 PMCID: PMC3965323 DOI: 10.5888/pcd11.130310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Reducing the portion size of food and beverages served at restaurants has emerged as a strategy for addressing the obesity epidemic; however, barriers and facilitators to achieving this goal are not well characterized. Methods In fall 2012, the Los Angeles County Department of Public Health conducted semistructured interviews with restaurant owners to better understand contextual factors that may impede or facilitate participation in a voluntary program to recognize restaurants for offering reduced-size portions. Results Interviews were completed with 18 restaurant owners (representing nearly 350 restaurants). Analyses of qualitative data revealed 6 themes related to portion size: 1) perceived customer demand is central to menu planning; 2) multiple portion sizes are already being offered for at least some food items; 3) numerous logistical barriers exist for offering reduced-size portions; 4) restaurant owners have concerns about potential revenue losses from offering reduced-size portions; 5) healthful eating is the responsibility of the customer; and 6) a few owners want to be socially responsible industry leaders. Conclusion A program to recognize restaurants for offering reduced-size portions may be a feasible approach in Los Angeles County. These findings may have applications for jurisdictions interested in engaging restaurants as partners in reducing the obesity epidemic.
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Affiliation(s)
- Lauren Gase
- Health and Policy Assessment, Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, 3530 Wilshire Blvd, 8th Floor, Los Angeles, CA 90010. E-mail:
| | - Lauren Dunning
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Tony Kuo
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Paul Simon
- Los Angeles County Department of Public Health, Los Angeles, California
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Gittelsohn J, Lee-Kwan SH, Batorsky B. Community-based interventions in prepared-food sources: a systematic review. Prev Chronic Dis 2013; 10:E180. [PMID: 24176084 PMCID: PMC3816610 DOI: 10.5888/pcd10.130073] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction Food purchased from prepared-food sources has become a major part of the American diet and is linked to increased rates of chronic disease. Many interventions targeting prepared-food sources have been initiated with the goal of promoting healthful options. The objective of this study was to provide a systematic review of interventions in prepared-food sources in community settings. Methods We used PubMed and Google Scholar and identified 13 interventions that met these criteria: 1) focused on prepared-food sources in public community settings, 2) used an impact evaluation, 3) had written documentation, and 4) took place after 1990. We conducted interviews with intervention staff to obtain additional information. Reviewers extracted and reported data in table format to ensure comparability. Results Interventions mostly targeted an urban population, predominantly white, in a range of income levels. The most common framework used was social marketing theory. Most interventions used a nonexperimental design. All made use of signage and menu labeling to promote healthful food options. Several promoted more healthful cooking methods; only one introduced new healthful menu options. Levels of feasibility and sustainability were high; sales results showed increased purchasing of healthful options. Measures among consumers were limited but in many cases showed improved awareness and frequency of purchase of promoted foods. Conclusion Interventions in prepared-food sources show initial promising results at the store level. Future studies should focus on improved study designs, expanding intervention strategies beyond signage and assessing impact among consumers.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Ste W2041A, Baltimore, MD 21205. E-mail:
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Lee-Kwan SH, Goedkoop S, Yong R, Batorsky B, Hoffman V, Jeffries J, Hamouda M, Gittelsohn J. Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results. BMC Public Health 2013; 13:638. [PMID: 23837722 PMCID: PMC3716976 DOI: 10.1186/1471-2458-13-638] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation. METHODS To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment. RESULTS On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility. CONCLUSIONS The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.
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Affiliation(s)
- Seung Hee Lee-Kwan
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonja Goedkoop
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel Yong
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin Batorsky
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Hoffman
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jayne Jeffries
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohamed Hamouda
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Hanni KD, Ahn DA, Winkleby MA. Signal Detection Analysis of Factors Associated With Diabetes Among Semirural Mexican American Adults. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2013. [DOI: 10.1177/0739986312471824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Signal detection analysis was used to evaluate a combination of sociodemographic, acculturation, mental health, health care, and chronic disease risk factors potentially associated with diabetes in a sample of 4,505 semirural Mexican American adults. Overall, 8.9% of adults had been diagnosed with diabetes. The analysis resulted in 12 mutually exclusive groups, with diabetes prevalence ranging from 1.8% to 44.1%. Three groups were at the highest risk (34.5%-44.1% diabetic) and accounted for almost half of those with diabetes. Each of these groups was distinguished by their middle to older ages and presence of one or more chronic conditions (high blood pressure, high cholesterol, obesity, and/or poor mental health) in addition to diabetes. The differing composition of the groups identified by the signal detection analysis has important implications for the design and implementation of public health interventions and health care treatment programs for Mexican Americans with diabetes.
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Affiliation(s)
- K. D. Hanni
- Monterey County Health Department, Salinas, CA, USA
| | - D. A. Ahn
- Stanford Prevention Research Center, Stanford, CA, USA
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Yong R, Lee SH, Freishtat H, Bleich S, Gittelsohn J. Availability of Healthy Foods in Prepared Food Sources in Urban Public Markets. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2012. [DOI: 10.1080/19320248.2012.735219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Johnson DB, Payne EC, McNeese MA, Allen D. Menu-labeling policy in King County, Washington. Am J Prev Med 2012; 43:S130-5. [PMID: 22898162 DOI: 10.1016/j.amepre.2012.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Food eaten away from home now accounts for about one third of total calories consumed in the U.S. Policy change could lead to sustainable improvements in restaurant and other nutrition environments. Broadly described, policy development is one of the three core functions of public health, and there is a need to more fully understand and evaluate this function. Policy process research has developed frameworks and models that can be used to understand the policy development process. PURPOSE To describe policy processes associated with the passage of restaurant menu-labeling regulations in order to inform nutrition policy development in other settings. METHODS Document reviews and interviews with 12 key players in the policy process were conducted and analyzed between June 2009 and October 2010. RESULTS Policy process actors primarily belonged to two advocacy coalitions: a public health coalition and an industry coalition. Within the coalitions there were shared values and beliefs about the appropriate role of governmental regulation in protecting the health of the population and the need for environmental change. The process was adversarial at times, but "policy learning" built the trust needed for collaboration to negotiate agreements. Expert technical assistance moved the process forward. CONCLUSIONS Elements that contributed to the success of a menu-labeling policy initiative in a large, urban health department have been identified. The King County case study can inform the work of others who seek to build healthier nutrition environments through policy change.
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Affiliation(s)
- Donna B Johnson
- Nutritional Sciences, University of Washington, Seattle, WA 98195, USA.
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Nichols P, Ussery-Hall A, Griffin-Blake S, Easton A. The evolution of the steps program, 2003-2010: transforming the federal public health practice of chronic disease prevention. Prev Chronic Dis 2012; 9:E50. [PMID: 22300870 PMCID: PMC3340214 DOI: 10.5888/pcd9.110220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The Steps program, formerly known as Steps to a HealthierUS, was the first Centers for Disease Control and Prevention (CDC) program to support a community-based, integrated approach to chronic disease prevention. Steps interventions addressed both diseases and risk factors, focusing on the 3 leading causes of preventable deaths in the United States--tobacco use, poor nutrition, and physical inactivity--and the associated chronic conditions of asthma, diabetes, and obesity. When Steps shifted from interventions focused on individual health-risk behaviors to the implementation of policy, systems, and environmental changes, the program became an integral part of changing the way CDC addressed chronic disease prevention. In this article, we describe the shift in intervention strategies that occurred among Steps communities, the model that was developed as Steps evolved, common interventions implemented before and after the shift in approach, challenges experienced by Steps communities, and CDC programs that were modeled after Steps.
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Affiliation(s)
- Phyllis Nichols
- Centers for Disease Control and Prevention, 4770 Buford Hwy, MS K-93, Atlanta, GA 30341, USA.
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Lee SH, Rowan MT, Powell LM, Newman S, Klassen AC, Frick KD, Anderson J, Gittelsohn J. Characteristics of prepared food sources in low-income neighborhoods of Baltimore City. Ecol Food Nutr 2011; 49:409-30. [PMID: 21359162 DOI: 10.1080/03670244.2010.524102] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The food environment is associated with obesity risk and diet-related chronic diseases. Despite extensive research conducted on retail food stores, little is known about prepared food sources(PFSs). We conducted an observational assessment of all PFSs(N = 92) in low-income neighborhoods in Baltimore. The most common PFSs were carry-outs, which had the lowest availability of healthy food choices. Only a small proportion of these carry-outs offered healthy sides, whole wheat bread, or entrée salads (21.4%, 7.1%, and 33.9%, respectively). These findings suggest that carry-out-specific interventions are necessary to increase healthy food availability in low-income urban neighborhoods.
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Affiliation(s)
- Seung Hee Lee
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205-2179, USA
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Chen R, Carrillo M, Kapp J, Cheadle A, Angulo A, Chrisman N, Rubio R. Partnering with REACH to create a "diabetes-friendly" restaurant: a restaurant owner's experience. Prog Community Health Partnersh 2011; 5:307-12. [PMID: 22080779 PMCID: PMC3746078 DOI: 10.1353/cpr.2011.0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe a Latino restaurateur's perspectives and partnership with Seattle-King County REACH to improve the healthfulness of his restaurant as a step toward tackling diabetes in his community. We interviewed the owner and reviewed other documentation to capture his perspectives and identify key elements in this restaurant intervention. The impact of diabetes in the owner's family and Latino community motivated him to make changes at his restaurant. If changes were successful, he hoped this would motivate other Latino restaurateurs to make similar changes. At his request, REACH gathered consumer feedback, provided diabetes education and nutritional guidance, and worked with him to develop simple, economically feasible, healthier items. Positive consumer response and media coverage motivated the owner to explore additional changes at his restaurant and encourage other restaurateurs to make healthful changes. This intervention illustrates the potential for local businesses to collaborate with community partners, like REACH, to promote healthy food environments.
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Affiliation(s)
- Roxana Chen
- Public Health-Seattle & King Country, University of Washington, School of Public Health, USA
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