1
|
Murphy M, Coffey A, Pallan M, Oyebode O. Changing the food environment in secondary school canteens to promote healthy dietary choices: a qualitative study with school caterers. BMC Public Health 2024; 24:1970. [PMID: 39044155 PMCID: PMC11267781 DOI: 10.1186/s12889-024-19513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/17/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Typical adolescent diets do not meet current dietary recommendations. There is a need to address these dietary patterns to reduce the risk of obesity and other diet-related diseases. Schools provide an opportune setting to do so, as students consume a substantial proportion of their daily dietary intake whilst at school. There is a developing evidence base on the use of choice architecture (food choice cues) to promote healthy eating in school contexts. It is necessary to understand the acceptability and feasibility of implementing such interventions. We aimed to explore these factors from the perspectives of secondary school caterers. METHODS We conducted qualitative interviews with caterers from secondary schools across the West Midlands, UK and national/regional catering representatives. A semi-structured topic guide and visual aid were used to guide interviews. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12. RESULTS Twelve participants took part. Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Limits of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as they require minimal reflective motivation. Salient cues included enhancing the placement, presentation and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity. Student engagement was considered important. Some catering decision drivers conflicted with healthy food cues, and many felt that their role in healthy eating was limited due to the overwhelming influence of external food environments, adolescent resistance, and features of the secondary school canteen setting e.g. short duration of lunchtime, lack of space. However, caterers appeared motivated to implement healthy food cues and identified key opportunities for implementation, including integration into whole-school approaches to healthy eating. CONCLUSIONS Interventions using healthy food cues appeared acceptable to secondary school caterers, key potential implementers of these strategies. Future interventions could incorporate strategies relating to placement, presentation and pricing to prompt healthy selections, and actions to engage the student body and improve the dining environment. Evaluations should consider potential impacts upon food purchasing, consumption and waste to address caterers' concerns about these issues.
Collapse
Affiliation(s)
- Marie Murphy
- Institute of Applied Health Research, University Birmingham, Birmingham, UK.
| | - Alice Coffey
- Institute of Global Sustainable Development, University of Warwick, Coventry, UK
| | - Miranda Pallan
- Institute of Applied Health Research, University Birmingham, Birmingham, UK
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| |
Collapse
|
2
|
Allcott-Watson H, Chater A, Troop N, Howlett N. A systematic review of interventions targeting physical activity and/or healthy eating behaviours in adolescents: practice and training. Health Psychol Rev 2024; 18:117-140. [PMID: 36722423 DOI: 10.1080/17437199.2023.2173631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023]
Abstract
Despite the many health benefits of physical activity (PA) and healthy eating (HE) most adolescents do not meet current guidelines which poses future health risks. This review aimed to (1) identify whether adolescent PA and HE interventions show promise at promoting behaviour change and maintenance, (2) identify which behaviour change techniques (BCTs) are associated with promising interventions, and (3) explore the optimal approaches to training deliverers of adolescent PA/HE interventions. Nine databases were searched for randomised controlled, or quasi-experimental, trials targeting 10-19 year olds, with a primary aim to increase PA/HE, measured at baseline and at least six months post-intervention, in addition to papers reporting training of deliverers of adolescent PA/HE interventions. Included were seven PA studies, three HE studies and four studies targeting both, with two training papers. For PA studies, two were promising post-intervention with two promising BCTs, and five were promising for maintenance with two promising BCTs. For HE studies, three were promising at post-intervention and four at maintenance, both with four promising BCTs. There is preliminary evidence that interventions support adolescents to improve their PA and HE behaviours over a period of at least six months.
Collapse
Affiliation(s)
- Hannah Allcott-Watson
- Department of Psychology, Sport, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Angel Chater
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedfordshire, UK
- University College London Centre for Behaviour Change, London, UK
| | - Nick Troop
- Department of Psychology, Sport, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Neil Howlett
- Department of Psychology, Sport, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| |
Collapse
|
3
|
Durão S, Wilkinson M, Davids EL, Gerritsen A, Kredo T. Effects of policies or interventions that influence the school food environment on children's health and nonhealth outcomes: a systematic review. Nutr Rev 2024; 82:332-360. [PMID: 37253393 PMCID: PMC10859694 DOI: 10.1093/nutrit/nuad059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
CONTEXT Globally, 1 in 3 children under 5 years is undernourished or overweight, and 1 in 2 suffers from hidden hunger due to nutrient deficiencies. As children spend a considerable time at school, school-based policies that aim to improve children's dietary intake may help address this double burden of malnutrition. OBJECTIVE This systematic review aimed to assess the effects of implementing policies or interventions that influence the school food environment on children's health and nonhealth outcomes. DATA SOURCES, EXTRACTION, AND ANALYSIS Eleven databases were searched up to April 2020 and the World Health Organization (WHO) released a call for data due in June 2020. Records were screened against the eligibility criteria, and data extraction and risk-of-bias assessment were conducted by 1 reviewer and checked by another. The synthesis was based on effect direction, and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. CONCLUSIONS Seventy-four studies reporting 10 different comparisons were included. The body of evidence indicates that interventions addressing the school food environment may have modest beneficial effects on certain key outcomes. Nutrition standards for healthy foods and beverages at schools, interventions that change how food is presented and positioned, and fruit and vegetable provision may have a beneficial effect on the consumption of healthy foods and beverages. Regarding effects on the consumption of discretionary foods and beverages, nutrition standards may have beneficial effects. Nutrition standards for foods and beverages, changes to portion size served, and the implementation of multiple nudging strategies may have beneficial effects on energy intake. Regarding effects of purchasing or selecting healthier foods, changes to how food is presented and positioned may be beneficial. This review was commissioned and supported by the WHO (registration 2020/1001698-0). WHO reviewed and approved the protocol for the systematic review and reviewed the initial report of the completed systematic review. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no: CRD42020186265.
Collapse
Affiliation(s)
- Solange Durão
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maryke Wilkinson
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Better Health Programme South Africa, Mott MacDonald, Cape Town, South Africa
| | - Eugene L Davids
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Annette Gerritsen
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, and Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
4
|
Antunes ABS, Hassan BK, Pinto RL, Sichieri R, Cunha DB. A choice architecture intervention targeting school meals and water frequency intake: A school-based randomized trial. Appetite 2024; 193:107118. [PMID: 37977257 DOI: 10.1016/j.appet.2023.107118] [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: 04/03/2023] [Revised: 10/19/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Our aim was to evaluate the impact of choice architecture on school meals and water intake frequency. We conducted a school-based randomized trial in seven elementary municipal public schools (control = 3; intervention = 4) in Rio de Janeiro, Brazil. The interventions group received the following modifications: (1) banner of the daily school meal menu and two superheroes, (2) waterproof tablecloths, (3) posters on healthy eating habits, (4) displays with playful names, (5) new containers for fruits, and (6) colored footprints for one month. Changes in school meals and daily water frequency consumption were evaluated through intention-to-treat analyses, using generalized estimating equations models for repeated measures, considering the classes' cluster effect. Data from 974 students in the fifth and sixth elementary school grades were analyzed (control = 356; intervention = 618). At baseline, 47.1% of students were female, with a mean age of 12 years (SD = 1.4), 39.2% reported daily consumption of school meals, and 45.7% consumed water from the school drinking fountain three or more times a day. We observed an increase in the odds of daily water intake in the intervention group compared to the control (OR = 1.4 95% CI = 1.1-1.9), no changes in the school meals (OR = 1.2 95% CI = 0.9; 1.6). Low-complexity strategies based on choice architecture applied in the school environment can be promising in increasing water intake frequency among elementary students in public schools. TRIAL REGISTRATION: This study was registered on the Clinicaltrials.gov platform under the number NCT03136016. Access: https://clinicaltrials.gov/ct2/show/NCT03136016.
Collapse
Affiliation(s)
- Anna Beatriz Souza Antunes
- Department of Epidemiology, Hesio Cordeiro Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | - Rafael Lavourinha Pinto
- Department of Epidemiology, Hesio Cordeiro Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Hesio Cordeiro Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Hesio Cordeiro Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
5
|
Pierguidi L, Spinelli S, Prescott J, Monteleone E, Dinnella C. Responsiveness to warning sensations and anxiety-related psychological traits modulate individual differences in preference for vegetable foods with varied sensory properties. Food Res Int 2023; 173:113342. [PMID: 37803693 DOI: 10.1016/j.foodres.2023.113342] [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: 04/04/2023] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 10/08/2023]
Abstract
The innate aversion to warning sensations is an important barrier to the acceptance of vegetable food often characterized by bitter and sour tastes, and astringency. Large individual variations exist in preference for this food category. The present study aimed at exploring differences in demographics, anthropometrics, taste responsiveness, personality traits and attitudes in consumers differing in their preference for vegetable food with varied levels of warning sensations. A panel of Italian consumers (n = 718; 53.6% women, age 18-74 years) self-reported familiarity with, preference for and choice of vegetables with high and low levels of warning sensations. Two clusters were identified: High Warning-Vegetable Consumers (HWVC, n = 464) and Low-Warning Vegetable Consumers (LWVC, n = 254). HWVC showed higher familiarity with and preference for vegetables as a whole and higher choice of vegetables characterized by warning sensations than LWVC. HWVC were more represented by older and normal weight individuals as compared to LWVC. Differences among clusters in liking for and perception of a phenol-enriched plant-based food model specifically developed to induce different levels of bitterness, sourness and astringency were found. HWVC rated bitterness, sourness, and astringency lower and liking higher than LWVC. Scores in anxiety-related psychological traits were lower while attitudes to healthy and high-quality food choice were higher in HWVC than in LWVC. The results of the present study depicted a coherent interplay among several person-related dimensions in modulating preference for vegetable foods. Higher responsiveness to warning sensations, higher level of anxiety-related traits, lower importance assigned to food healthy/quality aspects and younger age all acted as barriers to exposure and acceptance of vegetable food and call for a multidimensional approach to promote the consumption of this food category.
Collapse
Affiliation(s)
- L Pierguidi
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Italy.
| | - S Spinelli
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Italy
| | - J Prescott
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Italy; TasteMatters Research & Consulting, Sydney, Australia
| | - E Monteleone
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Italy
| | - C Dinnella
- Department of Agriculture, Food, Environment and Forestry (DAGRI), University of Florence, Italy
| |
Collapse
|
6
|
Prowse R, Lawlor N, Powell R, Neumann EM. Creating healthy food environments in recreation and sport settings using choice architecture: a scoping review. Health Promot Int 2023; 38:daad098. [PMID: 37705493 PMCID: PMC10500220 DOI: 10.1093/heapro/daad098] [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] [Indexed: 09/15/2023] Open
Abstract
Recreation and sport settings (RSS) are ideal for health promotion, however, they often promote unhealthy eating. Choice architecture, a strategy to nudge consumers towards healthier options, has not been comprehensively reviewed in RSS and indicators for setting-based multi-level, multi-component healthy eating interventions in RSS are lacking. This scoping review aimed to generate healthy food environment indicators for RSS by reviewing peer-reviewed and grey literature evidence mapped onto an adapted choice architecture framework. One hundred thirty-two documents were included in a systematic search after screening. Data were extracted and coded, first, according to Canada's dietary guideline key messages, and were, second, mapped onto a choice architecture framework with eight nudging strategies (profile, portion, pricing, promotion, picks, priming, place and proximity) plus two multi-level factors (policy and people). We collated data to identify overarching guiding principles. We identified numerous indicators related to foods, water, sugary beverages, food marketing and sponsorship. There were four cross-cutting guiding principles: (i) healthy food and beverages are available, (ii) the pricing and placement of food and beverages favours healthy options, (iii) promotional messages related to food and beverages supports healthy eating and (iv) RSS are committed to supporting healthy eating and healthy food environments. The findings can be used to design nested, multipronged healthy food environment interventions. Future research is needed to test and systematically review the effectiveness of healthy eating interventions to identify the most promising indicators for setting-based health promotion in RSS.
Collapse
Affiliation(s)
- Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's NL A1B 3V6, Canada
| | - Natasha Lawlor
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's NL A1B 3V6, Canada
| | - Rachael Powell
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's NL A1B 3V6, Canada
| | - Eva-Marie Neumann
- Library Services Division, Health Canada, Jeanne Mance Building, 200 Eglantine Driveway, Tunney’s Pasture, Ottawa, ON K1A 0K9, Canada
| |
Collapse
|
7
|
Schulte EA, Winkler G, Brombach C, Buyken AE. Choice architecture interventions promoting sustained healthier food choice and consumption by students in a secondary school setting: a systematic review of intervention studies. Public Health Nutr 2023; 26:1896-1906. [PMID: 37293811 PMCID: PMC10478061 DOI: 10.1017/s1368980023001118] [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: 06/13/2022] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To systematically review the impact of choice architecture interventions (CAI) on the food choice of healthy adolescents in a secondary school setting. Factors potentially contributing to the effectiveness of CAI types and numbers implemented and its long-term success were examined. DESIGN PUBMED and Web of Science were systematically searched in October 2021. Publications were included following predefined inclusion criteria and grouped according to the number and duration of implemented interventions. Intervention impact was determined by a systematic description of the reported quantitative changes in food choice and/or consumption. Intervention types were compared with regard to food selection and sustained effects either during or following the intervention. SETTING CAI on food choice of healthy adolescents in secondary schools. PARTICIPANTS Not applicable. RESULTS Fourteen studies were included; four randomised controlled trials and five each of controlled or uncontrolled pre-post design, respectively. Four studies implemented a single CAI type, with ten implementing > 1. Three studies investigated CAI effects over the course of a school year either by continuous or repeated data collection, while ten studies' schools were visited on selected days during an intervention. Twelve studies reported desired changes in overall food selection, yet effects were not always significant and appeared less conclusive for longer-term studies. CONCLUSIONS This review found promising evidence that CAI can be effective in encouraging favourable food choices in healthy adolescents in a secondary school setting. However, further studies designed to evaluate complex interventions are needed.
Collapse
Affiliation(s)
- Eva Andrea Schulte
- Public Health Nutrition, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn33098, Germany
| | - Gertrud Winkler
- Department of Life Sciences, University of Applied Sciences Albstadt-Sigmaringen, Sigmaringen, Germany
| | - Christine Brombach
- Forschungsgruppe für Lebensmittel-Sensorik, Life Sciences and Facility Management, Züricher Hochschule für Angewandte Wissenschaften, Zürich, Schweiz
| | - Anette E Buyken
- Public Health Nutrition, Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn33098, Germany
| |
Collapse
|
8
|
Pearce AL, Brick TR. Validation of computational models to characterize cumulative intake curves from video-coded meals. Front Nutr 2023; 10:1088053. [PMID: 37588051 PMCID: PMC10425552 DOI: 10.3389/fnut.2023.1088053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Observational coding of eating behaviors (e.g., bites, eating rate) captures behavioral characteristics but is limited in its ability to capture dynamic patterns (e.g., temporal changes) across a meal. While the Universal Eating Monitor captures dynamic patterns of eating through cumulative intake curves, it is not commonly used in children due to strict behavioral protocols. Therefore, the objective of this study was to test the ability of computational models to characterize cumulative intake curves from video-coded meals without the use of continuous meal weight measurement. Methods Cumulative intake curves were estimated using Kisslieff's Quadratic model and Thomas's logistic ordinary differential equation (LODE) model. To test if cumulative intake curves could be characterized from video-coded meals, three different types of data were simulated: (1) Constant Bite: simplified cumulative intake data; (2) Variable Bite: continuously measured meal weight data; and (3) Bite Measurement Error: video-coded meals that require the use of average bite size rather than measured bite size. Results Performance did not differ by condition, which was assessed by examining model parameter recovery, goodness of fit, and prediction error. Therefore, the additional error incurred by using average bite size as one would with video-coded meals did not impact the ability to accurately estimate cumulative intake curves. While the Quadratic and LODE models were comparable in their ability to characterize cumulative intake curves, the LODE model parameters were more distinct than the Quadradic model. Greater distinctness suggests the LODE model may be more sensitive to individual differences in cumulative intake curves. Discussion Characterizing cumulative intake curves from video-coded meals expands our ability to capture dynamic patterns of eating behaviors in populations that are less amenable to strict protocols such as children and individuals with disordered eating. This will improve our ability to identify patterns of eating behavior associated with overconsumption and provide new opportunities for treatment.
Collapse
Affiliation(s)
- Alaina L Pearce
- Social Science Research Institute, Pennsylvania State University, University Park, PA, United States
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States
| | - Timothy R Brick
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, United States
- Institute for Computational and Data Sciences, Pennsylvania State University, University Park, PA, United States
| |
Collapse
|
9
|
Kawa C, Ianiro-Dahm PM, Nijhuis JFH, Gijselaers WH. Effects of a Nudging Cue Targeting Food Choice in a University Cafeteria: A Field Study. Healthcare (Basel) 2023; 11:healthcare11091307. [PMID: 37174849 PMCID: PMC10178432 DOI: 10.3390/healthcare11091307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/29/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Many students approaching adulthood often choose high-calorie food products. Concurrently, health interventions applied during this life phase can potentially lead to a healthier lifestyle. Nudge health interventions in experimental cafeteria settings have been found to improve eating behavior effectively, yet research in real-world settings is lacking. Accepting nudges as health interventions impacts nudge effectiveness. The present study applies a pretest-posttest design for a period of three consecutive weeks (no nudge, nudge, no nudge), testing the effectiveness of the so-called Giacometti cue on the number of calories purchased in a real-world cafeteria. Students were exposed to the nudge during the intervention week when entering the cafeteria and when choosing their meals. After purchasing a meal, their choice was recorded, and they completed a questionnaire. The Giacometti cue immediately reduced the number of calories purchased (comparing weeks one and two). After nudge removal, an effect was identified, increasing the number of calories purchased (comparing weeks two and three). Contrary to expectations, higher nudge acceptance resulted in more calories purchased. Neither awareness of the nudge's presence when buying food nor the interaction between acceptance and awareness played a role. We explore potential explanations for the Giacometti cue's effects.
Collapse
Affiliation(s)
- Christine Kawa
- Department of Management Sciences, University of Applied Sciences Bonn-Rhein-Sieg, 53359 Rheinbach, Germany
| | - Patrizia M Ianiro-Dahm
- Department of Management Sciences, University of Applied Sciences Bonn-Rhein-Sieg, 53359 Rheinbach, Germany
| | - Jan F H Nijhuis
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, 6211 LM Maastricht, The Netherlands
| | - Wim H Gijselaers
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, 6211 LM Maastricht, The Netherlands
| |
Collapse
|
10
|
Improving adolescents' dietary behaviours in the school-setting: challenges and opportunities. Proc Nutr Soc 2023:1-14. [PMID: 36916515 DOI: 10.1017/s0029665123002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Adolescence is a critical time of physical, psychological and social development, and thus, optimal nutritional intakes are required during this life stage. Despite this, adolescence is recognised as a period of nutritional vulnerability, with many reportedly failing to meet current dietary guidelines. The school-setting presents a favourable environment to intervene and promote positive dietary behaviours and is also inclusive regardless of socio-economic status. However, a lack of consensus exists on how best to utilise schools to facilitate improvements in dietary behaviours among this age group. Whilst previous research has focused on identifying the factors motivating dietary choices within the school-setting, less is known on the optimum strategies to enhance these dietary choices which could positively contribute to the design of future interventions. It is reported that adolescents have good nutritional knowledge, although this does not appear to be a central consideration when making their dietary choices. Alternative factors at the individual (taste, visual appeal, familiarity, food quality, price, portion size, value for money, time/ convenience), social (peer influence), physical (product placement) and macro environment (food availability) levels have been frequently cited as important influences on adolescents' dietary choices in school. Although school-based interventions have shown potential in achieving positive dietary change among adolescents, more research is needed to determine the most effective methods in improving dietary behaviours in schools. This review summarises the key factors which influence adolescents' school-based dietary choices and the effectiveness of previously conducted interventions, identifying promising components for consideration when developing future dietary interventions within the school-setting.
Collapse
|
11
|
Godden E, Thornton L, Avramova Y, Dens N. High hopes for front-of-pack (FOP) nutrition labels? A conjoint analysis on the trade-offs between a FOP label, nutrition claims, brand and price for different consumer segments. Appetite 2023; 180:106356. [PMID: 36309232 DOI: 10.1016/j.appet.2022.106356] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 12/15/2022]
Abstract
An increasing number of studies investigate the effect of front-of-pack (FOP) nutrition labels on consumer choice without considering differences in consumer preferences for product attributes. This study used a choice-based conjoint analysis to test consumers' preferences for four product attributes (5 levels of a FOP nutrition label, absence/presence of a nutrition claim, brand (unfamiliar, private label or premium) and 5 levels of price) when they coexist (n = 1156). As the consumer preferences showed distinct patterns (multimodality), consumers were subsequently clustered based on how a FOP nutrition label (Nutri-Score) influenced their food choices. Three consumer segments were identified, each valuing the Nutri-Score label differently. The label effectively seems to nudge one segment toward healthier choices (n = 456), while in contrast, another segment is unexpectedly steered toward unhealthier food choices by the label (n = 343). The third segment is only consistently nudged by the FOP label's extremes (n = 357). The segments also differ in their preferences for other product attributes (brand and price), health involvement, and self-reported understanding and use of the Nutri-Score, but not in the measured socio-demographic variables (age, sex, education, social class), dieting or smoking habits. In summary, consumers vary in their food label preferences, and studies that pool consumers may fail to capture these nuances, leading to biased results. This study shows that FOP labels do not steer all consumers toward healthier choices and may even have adverse effects for some. This suggests combining different policies and marketing strategies to reach all consumer segments.
Collapse
Affiliation(s)
- Elke Godden
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| | - Lukar Thornton
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| | - Yana Avramova
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| | - Nathalie Dens
- Faculty of Business and Economics, Department of Marketing, University of Antwerp, Belgium, Prinsstraat 13, 2000, Antwerp, Belgium.
| |
Collapse
|
12
|
Mingay E, Hart M, Yoong S, Palazzi K, D’Arcy E, Pursey KM, Hure A. The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student's Food Behaviours, Health and Dining Experience: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:3640. [PMID: 36079897 PMCID: PMC9460342 DOI: 10.3390/nu14173640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).
Collapse
Affiliation(s)
- Edwina Mingay
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Melissa Hart
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter New England Mental Health Service, Calvary Mater Hospital, Newcastle, NSW 2298, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW 2287, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Ellie D’Arcy
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Kirrilly M. Pursey
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| |
Collapse
|
13
|
Capper TE, Brennan SF, Woodside JV, McKinley MC. What makes interventions aimed at improving dietary behaviours successful in the secondary school environment? A systematic review of systematic reviews. Public Health Nutr 2022; 25:2448-2464. [PMID: 35357283 PMCID: PMC9991643 DOI: 10.1017/s1368980022000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To systematically review evidence from systematic reviews of interventions to improve dietary behaviours and reduce food wastage in secondary school pupils. DESIGN CINAHL, Cochrane Reviews, EMBASE, MEDLINE, PsychINFO and Web of Science were searched for systematic reviews of school-based dietary interventions from 2000 to 2020 published in a peer-reviewed journal in English. Articles were reviewed independently by two authors. AMSTAR-2 was used for quality assessment. SETTING Secondary school dietary interventions. PARTICIPANTS Adolescents (aged 11-18). RESULTS In total, thirteen systematic reviews of dietary interventions in secondary schools met the inclusion criteria. A number of key characteristics of interventions that contributed to improvements in food choices in secondary school pupils were identified. These included the combination of education and environmental restructuring, incorporation of computer-based feedback, media or messaging, peer and/or parent involvement, an increase in the availability of healthy foods and the use of behavioural theory as a basis to the intervention. Intervention components that contributed specifically to a reduction in sugar-sweetened beverage intake or an increase in fruit and vegetable consumption, which are particularly relevant to adolescents, could not be determined. Similarly, evidence for interventions that improve nutritional knowledge and attitudes was limited. CONCLUSIONS This systematic review of systematic reviews has identified a number of components of dietary interventions that can be explored to improve dietary behaviours in secondary school environments and, if demonstrated to be effective, be considered for inclusion in policies and strategies to improve the school food environment and promote dietary change.
Collapse
Affiliation(s)
- TE Capper
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences, Grosvenor Road, BelfastBT12 6BJ, UK
| | - SF Brennan
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences, Grosvenor Road, BelfastBT12 6BJ, UK
| | - JV Woodside
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences, Grosvenor Road, BelfastBT12 6BJ, UK
| | - MC McKinley
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences, Grosvenor Road, BelfastBT12 6BJ, UK
- Corresponding author: Email
| |
Collapse
|
14
|
Weimer K, Ahlström R, Esteves F. The Effect of Nudging in Promoting the Consumption of Organic Fruits and Vegetables. Front Psychol 2022; 13:720606. [PMID: 35465494 PMCID: PMC9021786 DOI: 10.3389/fpsyg.2022.720606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
A field study collecting behavioral data was conducted to investigate effects of behavioral interventions, commonly known as nudges, in promoting the consumption of organic fruits and vegetables. Consumption, both organically and conventionally produced fruits and vegetables, was measured in a grocery store during 4 days (1 day every other week) where consumers were exposed to informational messages in combination with either emotional images or social norm messages. Measurements of daily consumption without exposure to nudges were carried out during four other days (1 day every other week, alternated with the nudging days). The results showed no effect of the nudging strategy; instead, it pointed to the importance of the price as a determinant of buying decisions. Buying ecological alternatives was associated with lower price differences between the ecological and non-ecological alternatives. We conclude that combined nudges and collected psychological data from participants may contribute to more successful nudging interventions. Some political measures in balancing the price difference between organically and conventionally produced products might also be interesting strategies in order to promote the consumption of organic fruits and vegetables.
Collapse
Affiliation(s)
- Kerstin Weimer
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Richard Ahlström
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Francisco Esteves
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| |
Collapse
|
15
|
Kawa C, Gijselaers WH, Nijhuis JFH, Ianiro-Dahm PM. Are You "Nudgeable"? Factors Affecting the Acceptance of Healthy Eating Nudges in a Cafeteria Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074107. [PMID: 35409789 PMCID: PMC8998962 DOI: 10.3390/ijerph19074107] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 12/10/2022]
Abstract
Research has identified nudging as a promising and effective tool to improve healthy eating behavior in a cafeteria setting. However, it remains unclear who is and who is not “nudgeable” (susceptible to nudges). An important influencing factor at the individual level is nudge acceptance. While some progress has been made in determining influences on the acceptance of healthy eating nudges, research on how personal characteristics (such as the perception of social norms) affect nudge acceptance remains scarce. We conducted a survey on 1032 university students to assess the acceptance of nine different types of healthy eating nudges in a cafeteria setting with four influential factors (social norms, health-promoting collaboration, responsibility to promote healthy eating, and procrastination). These factors are likely to play a role within a university and a cafeteria setting. The present study showed that key influential factors of nudge acceptance were the perceived responsibility to promote healthy eating and health-promoting collaboration. We also identified three different student clusters with respect to nudge acceptance, demonstrating that not all nudges were accepted equally. In particular, default, salience, and priming nudges were at least moderately accepted regardless of the degree of nudgeability. Our findings provide useful policy implications for nudge development by university, cafeteria, and public health officials. Recommendations are formulated for strengthening the theoretical background of nudge acceptance and the susceptibility to nudges.
Collapse
Affiliation(s)
- Christine Kawa
- Department of Management Sciences, University of Applied Sciences Bonn-Rhein-Sieg, 53359 Rheinbach, Germany;
- Correspondence:
| | - Wim H. Gijselaers
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, 6211 LM Maastricht, The Netherlands; (W.H.G.); (J.F.H.N.)
| | - Jan F. H. Nijhuis
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, 6211 LM Maastricht, The Netherlands; (W.H.G.); (J.F.H.N.)
| | - Patrizia M. Ianiro-Dahm
- Department of Management Sciences, University of Applied Sciences Bonn-Rhein-Sieg, 53359 Rheinbach, Germany;
| |
Collapse
|
16
|
Kawa C, Gijselaers WH, Nijhuis JF, Ianiro-Dahm PM. Effects of a thin body shape nudge and other determinants of adolescents’ healthy and unhealthy food consumption in a school setting. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2021.104388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Bel-Serrat S, Greene E, Mullee A, Murrin CM. Theoretical and practical approaches for dietary behavior change in urban socioeconomically disadvantaged adolescents: a systematic review. Nutr Rev 2022; 80:1531-1557. [PMID: 35041005 PMCID: PMC9086747 DOI: 10.1093/nutrit/nuab120] [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] [Indexed: 11/14/2022] Open
Abstract
CONTEXT There is limited evidence on strategies used to promote dietary behavior changes in socioeconomically disadvantaged urban adolescents and on their effectiveness. OBJECTIVE A synthesis of nutrition interventions used in this group of adolescents is provided in this systematic review. DATA SOURCES Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, and ERIC) were searched until November 2020 to identify relevant studies. DATA EXTRACTION Forty-six manuscripts (n = 38 intervention studies) met the inclusion criteria. Quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool. A qualitative synthesis summarizing data on study characteristics was conducted. DATA ANALYSIS Studies were classified by intervention type as those focusing on hedonic determinants of dietary intake (n = 1), environmental changes to promote a specific dietary intake (n = 3), cognitive determinants (n = 29), and multicomponent strategies (n = 13). The social cognitive theory was the most applied theoretical framework, either alone or combined with other frameworks. Most of the intervention studies targeted multiple dietary outcomes, and success was not always reported for each. CONCLUSIONS Despite the heterogeneity of the studies and lack of combination of dietary outcomes into dietary scores or patterns to evaluate changes on the individuals' whole diets, long-term, theory-driven interventions targeting a single dietary factor seem promising in obtaining sustainable dietary behavior changes. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020188219.
Collapse
Affiliation(s)
- Silvia Bel-Serrat
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Ellen Greene
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Amy Mullee
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| | - Celine M Murrin
- S. Bel-Serrat, E. Greene, and C.M. Murrin are with the National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland. A. Mullee is with the Department of Health and Nutritional Sciences, Institute of Technology Sligo, Sligo, Ireland
| |
Collapse
|
18
|
Forsyth A, Nicholson M, Skiadopoulos A, Trakman G, Devlin B, Belski R, Randle E, O'Halloran P, Cameron M, Staley K. Interventions to reduce sugar-sweetened beverage consumption using a nudge approach in Victorian community sports settings. Aust N Z J Public Health 2021; 45:592-598. [PMID: 34762340 DOI: 10.1111/1753-6405.13182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of interventions using a nudge approach to reduce sugar-sweetened beverage purchases in community sports settings. METHODS A total of 155 community sporting organisations participating in VicHealth funded programs were invited to nominate a nudge based on a traffic light approach to drinks classification. These included limit red drinks, red drinks off display, water the cheapest option, and meal deals. Sales data was collected for a predetermined period prior to and following the introduction of the nudge. Nudges were classified initially on whether they were implemented to VicHealth standards. Appropriately implemented nudges were classified as successful if they achieved a relative decrease in sales from drinks classified as red. RESULTS In all, 148 organisations trialled 195 nudges; 15 (7.7%) were successful and 20 (10.3%) were appropriately implemented but unsuccessful. Limit red drinks was the most frequently attempted nudge (30.8%). Red drinks off display had the greatest rate of success (20.0%). CONCLUSIONS Red drinks off display was the simplest and most successful nudge. Implications for public health: Guidelines limiting the display of sugar-sweetened beverages may be an effective means of altering consumer behaviour.
Collapse
Affiliation(s)
- Adrienne Forsyth
- Department of Dietetics, Nutrition and Sport, La Trobe University, Victoria.,Centre for Sport and Social Impact, La Trobe University, Victoria
| | | | - Anne Skiadopoulos
- Centre for Sport and Social Impact, La Trobe University, Victoria.,RMIT University, Victoria
| | - Gina Trakman
- Department of Dietetics, Nutrition and Sport, La Trobe University, Victoria.,Centre for Sport and Social Impact, La Trobe University, Victoria
| | - Brooke Devlin
- Department of Dietetics, Nutrition and Sport, La Trobe University, Victoria.,Centre for Sport and Social Impact, La Trobe University, Victoria
| | - Regina Belski
- Centre for Sport and Social Impact, La Trobe University, Victoria.,School of Health Sciences, Swinburne University of Technology, Victoria
| | - Erica Randle
- Centre for Sport and Social Impact, La Trobe University, Victoria
| | - Paul O'Halloran
- Centre for Sport and Social Impact, La Trobe University, Victoria.,Department of Public Health, La Trobe University, Victoria
| | | | - Kiera Staley
- Centre for Sport and Social Impact, La Trobe University, Victoria
| |
Collapse
|
19
|
Vande Velde F, Overgaard HJ, Bastien S. Nudge strategies for behavior-based prevention and control of neglected tropical diseases: A scoping review and ethical assessment. PLoS Negl Trop Dis 2021; 15:e0009239. [PMID: 34723983 PMCID: PMC8584752 DOI: 10.1371/journal.pntd.0009239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/11/2021] [Accepted: 10/13/2021] [Indexed: 12/19/2022] Open
Abstract
Background Nudging, a strategy that uses subtle stimuli to direct people’s behavior, has recently been included as an effective and low-cost behavior change strategy in low- and middle- income countries (LMIC), targeting behavior-based prevention and control of neglected tropical diseases (NTDs). The present scoping review aims to provide a timely overview of how nudge interventions have been applied within this field. In addition, the review proposes a framework for the ethical consideration of nudges for NTD prevention and control, or more broadly global health promotion. Methods A comprehensive search was performed in several databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Additionally, studies were included through a handpicked search on websites of governmental nudge units and global health or development organizations. Results This scoping review identified 33 relevant studies, with only two studies targeting NTDs in particular, resulting in a total of 67 nudge strategies. Most nudges targeted handwashing behavior and were focused on general health practices rather than targeting a specific disease. The most common nudge strategies were those targeting decision assistance, such as facilitating commitment and reminder actions. The majority of nudges were of moderate to high ethical standards, with the highest standards being those that had the most immediate and significant health benefits, and those implemented by agents in a trust relationship with the target audience. Conclusion Three key recommendations should inform research investigating nudge strategies in global health promotion in general. Firstly, future efforts should investigate the different opportunities that nudges present for targeting NTDs in particular, rather than relying solely on integrated health promotion approaches. Secondly, to apply robust study designs including rigorous process and impact evaluation which allow for a better understanding of ‘what works’ and ‘how it works’. Finally, to consider the ethical implications of implementing nudge strategies, specifically in LMIC. Behavior is at the core of neglected tropical disease (NTD) prevention and control, certainly within low-, and middle- income countries (LMIC) where resources are often limited. Therefore, strategies to promote behavior change should be included and investigated in future efforts. Nudging, a low-cost strategy that subtly directs people towards positive behavioral choices, has recently gained attention in global health promotion. Nudge strategies have been applied to a wide range of health-promoting behaviors such as handwashing. To understand which strategies were used, where and how these were applied, and whether these were ethically informed and implemented, we undertook a comprehensive review of the available sources. This resulted in 33 included studies, with a total of 67 nudge strategies for behavior-based prevention and control of NTDs in LMIC. Only two studies targeted NTDs in particular, the other 31 included studies were focused on more general health promoting behaviors, with the majority targeting handwashing with soap. The most common nudge strategies were those targeting decision assistance, such as fostering commitment and reminder actions. In general, the ethical assessment presented favorable results. We identified the need for robust study designs to better understand how nudges can be implemented in the future.
Collapse
Affiliation(s)
- Fiona Vande Velde
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
- * E-mail:
| | - Hans J. Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Ås, Norway
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Sheri Bastien
- Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- The Centre for Evidence-Based Public Health: A JBI Affiliated Group, Department of Public Health Science, NMBU, Ås, Norway
| |
Collapse
|
20
|
Murphy M, Mensah D, Mylona E, Oyebode O. Acceptability and feasibility of strategies to promote healthy dietary choices in UK secondary school canteens: a qualitative study. BMC Res Notes 2021; 14:365. [PMID: 34544486 PMCID: PMC8454098 DOI: 10.1186/s13104-021-05778-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the acceptability and feasibility of choice architecture strategies for dietary change in UK secondary school canteens from the perspectives of pupils, school staff and catering providers through qualitative focus groups and interviews. Results Three focus groups with adolescents (n = 15; mean age 13.7 years; standard deviation 1.9) and eight interviews with school staff and caterers recruited from one school and catering provider in Coventry UK were undertaken. The most acceptable choice architecture strategies for intervening to drive healthy dietary choices are those that make use of proximity and positioning, on the basis that convenience was one of the main drivers for food/drink selections. Acknowledging adolescents’ desire for autonomy and for food to be familiar and predictable was considered important in enhancing acceptability. Challenges to the feasibility of nudge strategies included concerns about behavioural issues, increased food waste, and a decline in uptake of canteen purchases. The design of food choice architecture interventions for secondary school settings should consider the specific characteristics of this age group and setting to ensure successful implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05778-3.
Collapse
Affiliation(s)
- Marie Murphy
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. .,Murray Learning Centre, Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Daniel Mensah
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Elena Mylona
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Oyinlola Oyebode
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| |
Collapse
|
21
|
Mecheva MDV, Rieger M, Sparrow R, Prafiantini E, Agustina R. Snacks, nudges and asymmetric peer influence: Evidence from food choice experiments with children in Indonesia. JOURNAL OF HEALTH ECONOMICS 2021; 79:102508. [PMID: 34333202 DOI: 10.1016/j.jhealeco.2021.102508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Many children in low- and middle-income countries are growing up during a rapid nutrition transition. Experimental evidence on food choice in developing countries is scarce, while it is unclear to what extent evidence from high-income countries can be generalized. Children participated in a snack choice experiment. We expose some children to emoji labels encouraging healthy snacks, while others observe healthy or unhealthy snacking by peers. While emoji labels moderately promote healthy snacking, the adverse effect of observing a peer eating the unhealthy snack is very large. The effect associated with observing a healthy peer is insignificant. Additionally, cross-randomized blocks of children watched a nutrition video to study the interaction of information provision and nudging. The video independently improves healthy choices but does not aid the emoji nudge and cannot counter the strong negative peer effect. We compare our findings to studies conducted in developed countries and discuss policy implications.
Collapse
Affiliation(s)
| | - Matthias Rieger
- The International Institute of Social Studies of Erasmus University Rotterdam, the Netherlands.
| | - Robert Sparrow
- The International Institute of Social Studies of Erasmus University Rotterdam, the Netherlands; Development Economics Group, Wageningen University, the Netherlands
| | - Erfi Prafiantini
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia
| |
Collapse
|
22
|
|
23
|
Kelly C, Callaghan M, Gabhainn SN. 'It's Hard to Make Good Choices and It Costs More': Adolescents' Perception of the External School Food Environment. Nutrients 2021; 13:nu13041043. [PMID: 33804848 PMCID: PMC8063803 DOI: 10.3390/nu13041043] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/04/2022] Open
Abstract
Research on the impact of school and community food environments on adolescent food choice is heavily reliant on objective rather than subjective measures of food outlets around schools and homes. Gaining the perspective of adolescents and how they perceive and use food environments is needed. The aim of this study was to explore adolescent’s perception and use of the food environment surrounding their schools. Purposive sampling was used to recruit schools. Mapping exercises and discussion groups were facilitated with 95 adolescents from six schools. Thematic analysis showed that adolescents are not loyal to particular shops but are attracted to outlets with price discounts, those with ‘deli’ counters and sweets. Cost, convenience and choice are key factors influencing preference for food outlets and foods. Quality, variety and health were important factors for adolescents but these features, especially affordable healthy food, were hard to find. Social factors such as spending time with friends is also an important feature of food environments that deserves further attention. Adolescents’ perceptions of their food environment provide insights into features that can be manipulated to enable healthy choices.
Collapse
|
24
|
Chambers T, Segal A, Sassi F. Interventions using behavioural insights to influence children's diet-related outcomes: A systematic review. Obes Rev 2021; 22:e13152. [PMID: 33462932 DOI: 10.1111/obr.13152] [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: 06/30/2020] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
The global prevalence of children with overweight and obesity continues to rise. Obesity in childhood has dire long-term consequences on health, social and economic outcomes. Promising interventions using behavioural insights to address obesity in childhood have emerged. This systematic review examines the effectiveness and health equity implications of interventions using behavioural insights to improve children's diet-related outcomes. The search strategy included searches on six electronic databases, reference lists of previous systematic reviews and backward searching of all included studies. One-hundred and eight papers describing 137 interventions were included. Interventions using behavioural insights were effective at modifying children's diet-related outcomes in 74% of all included interventions. The most promising approaches involved using incentives, changing defaults and modifying the physical environment. Information provision alone was the least effective approach. Health equity implications were rarely analysed or discussed. There was limited evidence of the sustainability of interventions-both in relation to their overall effectiveness and cost-effectiveness. The limited evidence on health equity, long-term effectiveness and the cost-effectiveness of these interventions limit what can be inferred for policymakers. This review synthesises the use of behavioural insights to improve children's diet-related outcomes, which can be used to inform future interventions.
Collapse
Affiliation(s)
- Timothy Chambers
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, UK.,Health Environment & Infection Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Alexa Segal
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, UK
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial College Business School, London, UK
| |
Collapse
|
25
|
Le marketing social et les nudges, les outils efficaces du changement de comportement. CAHIERS DE NUTRITION ET DE DIÉTÉTIQUE 2021. [PMCID: PMC7657936 DOI: 10.1016/j.cnd.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
De nombreux problèmes sociétaux et de santé requièrent des changements de comportement des populations. L’information et l’injonction ne suffisent pas à obtenir de tels changements de manière durable. Le marketing social et les nudges proposent des méthodes alternatives et complémentaires pour changer les comportements en se fondant sur une réflexion et des méthodes rigoureuses issues des sciences sociales.
Collapse
|
26
|
A nudge in the right direction: the role of food choice architecture in changing populations' diets. Proc Nutr Soc 2021; 80:195-206. [PMID: 33446288 DOI: 10.1017/s0029665120007983] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Populations' diets typically fall short of recommendations. The implication of this on ill health and quality of life is well established, as are the subsequent health care costs. An area of growing interest within public health nutrition is food choice architecture; how a food choice is framed and its influence on subsequent food selection. In particular, there is an appeal to manipulating the choice architecture in order to nudge individuals' food choice. This review outlines the current understanding of food choice architecture, theoretical background to nudging and the evidence on the effectiveness of nudge strategies, as well as their design and implementation. Interventions emphasising the role of nudge strategies have investigated changes to the accessibility, availability and presentation of food and the use of prompts. Empirical studies have been conducted in laboratories, online and in real-world food settings, and with different populations. Evidence on the effectiveness of nudge strategies in shifting food choice is encouraging. Underpinning mechanisms, not yet fully explicated, are proposed to relate to salience, social norms and the principle of least effort. Emerging evidence points to areas for development including the effectiveness of choice architecture interventions with different and diverse populations, and the combined effect of multiple nudges. This, alongside further examination of theoretical mechanisms and guidance to engage and inspire across the breadth of food provision, is critical. In this way, the potential of choice architecture to effect meaningful change in populations' diets will be realised.
Collapse
|
27
|
Bauer JM, Bietz S, Rauber J, Reisch LA. Nudging healthier food choices in a cafeteria setting: A sequential multi-intervention field study. Appetite 2021; 160:105106. [PMID: 33422678 DOI: 10.1016/j.appet.2021.105106] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/05/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
Creating more health-fostering environments is high on the agenda of public and private actors. The behavioral approach to nudge people towards healthier food choices is gaining popularity despite limited understanding about where, and for whom, which specific nudges work. This study contributes by reporting on three different nudging interventions in the same setting and presents effects on different sub-populations. We find overall small effects that are heterogeneous, ranging from robustly more to even less healthy choices. We discuss the importance of transparency and reactance to health interventions and the potential interplay of interventions with habitual behavior among different sub-populations.
Collapse
Affiliation(s)
- Jan M Bauer
- Copenhagen Business School, Department of Management, Society and Communication, Dalgas Have 15, 2000, Frederiksberg, Denmark.
| | - Sabine Bietz
- Zeppelin University, Center for Consumer, Markets and Politics, Am Seemooser Horn 20, 88045, Friedrichshafen, Germany.
| | - Julius Rauber
- ConPolicy GmbH - Institute for Consumer Policy, Friedrichstraße 224, 10969, Berlin, Germany.
| | - Lucia A Reisch
- Copenhagen Business School, Department of Management, Society and Communication, Dalgas Have 15, 2000, Frederiksberg, Denmark; Zeppelin University, Center for Consumer, Markets and Politics, Am Seemooser Horn 20, 88045, Friedrichshafen, Germany.
| |
Collapse
|
28
|
Nudges, Norms, or Just Contagion? A Theory on Influences on the Practice of (Non-)Sustainable Behavior. SUSTAINABILITY 2020. [DOI: 10.3390/su122410418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
‘Nudging’ symbolizes the widespread idea that if people are only provided with the ‘right’ options and contextual arrangements, they will start consuming sustainably. Opposite to this individual-centered, top-down approach stand observations highlighting the ‘contagiousness’ of thoughts, emotions, and behaviors of reference groups or persons present in a decision-context. Tying in these two lines, this paper argues that nudging may sound promising and easily applicable, yet the social dynamics occurring around it can easily distort or nullify its effects. This argument stems from empirical evidence gained in an exploratory observation study conducted in a Swedish cafeteria (N = 1073), which included a ‘nudging’ treatment. In the study, people in groups almost unanimously all chose the same options. After rearranging the choice architecture to make a potentially sustainable choice easier, people stuck to this mimicking behavior—while turning to choose more the non-intended option than before. A critical reflection of extant literature leads to the conclusion that the tendency to mimic each other (unconsciously) is so strong that attempts to nudge people towards certain choices appear overwhelmed. Actions become ‘contagious’; so, if only some people stick to their (consumption) habits, it may be hard to induce more sustainable behaviors through softly changing choice architectures.
Collapse
|
29
|
Forberger S, Wichmann F, Comito CNN. Using nudges to promote physical activity and to reduce sedentary behaviour in the workplace: a scoping review protocol. BMJ Open 2020; 10:e038205. [PMID: 33444182 PMCID: PMC7678358 DOI: 10.1136/bmjopen-2020-038205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Physical inactivity and sedentary behaviour are associated with numerous health problems and increasing risks of premature morbidity and mortality. Workplace health promotion with a focus on increasing physical activity (PA) and reducing sedentary behaviour is of growing interest. The concept of choice architecture with the use of nudges is a promising approach to influence decision making regarding health behaviours. It can help to understand why people often fail to act in their best interest, to follow well-informed preferences or to achieve their set goals. Nudges, the way the choice is presented, can help to overcome these challenges by using the same habits, biases or boundaries to alter our decision-making in favour of the more preferred behaviour. Aims of the scoping review will be to analyse (a) to what extent the concept of choice architecture is used in workplace health promotion to promote PA and/or to reduce sedentary behaviour and (b) which instruments (nudges) are used to archive that. METHODS AND ANALYSES Medline, PsychInfo, Web of Science and CINHAL will be searched from 2009 until June 2020. Applying a two-level screening process, title and abstracts will be screened according to a set of predetermined inclusion and exclusion criteria. Included articles will be screened a second time to determine the extent to which choice architecture has been used. Analyses for publication year, location, setting and target group will be provided. Interventions will be analysed presenting the instruments used, number of studies per instrument, combinations of instruments and alteration of the environment. Outcome measures and results will be reported as they occur. ETHICS AND DISSEMINATION Due to the nature of the scoping review, ethical concerns are minimal. No patient data will be included. Results are published in peer-review journals.
Collapse
Affiliation(s)
- Sarah Forberger
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Frauke Wichmann
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | |
Collapse
|
30
|
Flodgren GM, Helleve A, Lobstein T, Rutter H, Klepp KI. Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews. Obes Rev 2020; 21:e13102. [PMID: 32677208 DOI: 10.1111/obr.13102] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022]
Abstract
The aim of this overview of systematic reviews was to summarize evidence from up-to-date reviews of the effectiveness of interventions aimed at preventing overweight and obesity in adolescents aged 10 to 19 years. We searched nine databases for systematic reviews published between January 2008 and November 2019. We used A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 to assess the quality of reviews, excluding those of critically low quality, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to grade the certainty of included evidence. We included 13 reviews. Three reviews focused on dietary behaviour, six on physical activity, and four on both types of behaviours. Individual-oriented and school-based interventions dominated. Results across reviews showed little or no effect on body mass index, or physical activity levels of adolescents, whereas results from a couple of reviews suggest possibly beneficial effects of public health interventions on dietary behaviours (i.e., consumption of sugar-sweetened beverages). The certainty of evidence was low to very low for all outcomes. Overall, the evidence base for the effect of primary interventions to prevent overweight and obesity in adolescents is weak. In particular, there is a lack of reviews assessing the impact of environmental interventions targeting adolescents, and reviews addressing social inequality are virtually absent from this body of literature.
Collapse
Affiliation(s)
- Gerd M Flodgren
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Tim Lobstein
- World Obesity Federation, London, UK.,Boden Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
31
|
Szakály Z, Soós M, Balsa-Budai N, Kovács S, Kontor E. The Effect of an Evaluative Label on Consumer Perception of Cheeses in Hungary. Foods 2020; 9:foods9050563. [PMID: 32370266 PMCID: PMC7278936 DOI: 10.3390/foods9050563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 11/16/2022] Open
Abstract
Traditional strategies (such as education, economic incentives or prohibitions) targeted at altering dietary habits only influence health-conscious consumers. Less health-conscious consumers are less capable of self-regulatory behavior, therefore they are more likely to be influenced through perception. The present study aimed to examine how external cues such as labeling affect the consumer's perception of foods. The paper includes a case study based on an experiment. In the experiment the same cheese was tested with four different types of labeling (labeled "conventional", "low salt", "low fat" and "low salt and low fat"). It was found that the health halo effect worked in the case of cheese testing. In spite of all the samples being identical, the healthy samples were associated with considerably less sensory pleasure. The use of labels by the producers resulted in exactly the opposite effect to that intended. The experiment confirmed the efficiency of the application of this type of behavior-oriented nudge.
Collapse
Affiliation(s)
- Zoltán Szakály
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Böszörményi Str. 138, 4032 Debrecen, Hungary; (Z.S.); (M.S.); (N.B.-B.)
| | - Mihály Soós
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Böszörményi Str. 138, 4032 Debrecen, Hungary; (Z.S.); (M.S.); (N.B.-B.)
| | - Nikolett Balsa-Budai
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Böszörményi Str. 138, 4032 Debrecen, Hungary; (Z.S.); (M.S.); (N.B.-B.)
| | - Sándor Kovács
- Institute of Sectorial Economics and Methodology, Faculty of Economics and Business, University of Debrecen, Böszörményi Str. 138, 4032 Debrecen, Hungary;
| | - Enikő Kontor
- Institute of Marketing and Commerce, Faculty of Economics and Business, University of Debrecen, Böszörményi Str. 138, 4032 Debrecen, Hungary; (Z.S.); (M.S.); (N.B.-B.)
- Correspondence:
| |
Collapse
|
32
|
When a Combination of Nudges Decreases Sustainable Food Choices Out-Of-Home-The Example of Food Decoys and Descriptive Name Labels. Foods 2020; 9:foods9050557. [PMID: 32370148 PMCID: PMC7278719 DOI: 10.3390/foods9050557] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/24/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022] Open
Abstract
This paper reports results from three consecutive studies focusing on the comparison of the effectiveness of different nudges and their combinations to increase sustainable food choices out of the home. The nudges compared are the use of descriptive name labels (DNLs) for the most sustainable dish of a choice set (menu) and the decoy effect (DE), created by adding a less attractive decoy dish to a more attractive target dish with the goal of increasing the choice frequency of the target dish. In the literature, both nudges have been found to influence consumers’ choices. In the first study, six category names of sustainability indicators were deduced from a focus group. These were tested with 100 students to identify the most attractive DNLs. Study II, a randomized choice study (n = 420), tested the DE, the DNLs and a combination of the DNLs and the DE used on four different dishes in a university canteen. In study III, 820 guests of a business canteen voted during four weeks for the special meals of the following week (identical to the four choice sets displayed in study II). Results indicate that the combination of DNLs and the DE is not recommended for fostering sustainable food choices. Pure DNLs were more efficient in increasing the choice frequency of the more sustainable meal, whereas the decoy effect resulted in decreased choice frequencies. Regional and sustainable DNLs were favoured by consumers.
Collapse
|
33
|
Hermans RC, Smit K, van den Broek N, Evenhuis IJ, Veldhuis L. Adolescents' Food Purchasing Patterns in The School Food Environment: Examining the Role of Perceived Relationship Support and Maternal Monitoring. Nutrients 2020; 12:nu12030733. [PMID: 32168757 PMCID: PMC7146524 DOI: 10.3390/nu12030733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
The school food environment plays a role in adolescents’ dietary behaviors. In this study, adolescents’ food purchasing patterns in and around school and its potential relationship with perceived maternal relationship support and maternal monitoring were examined. Data were collected in The Netherlands in 2017. A total of 726 adolescents (45.8% boys; Mage = 13.78 ± 0.49) and 713 mothers (Mage = 45.05 ± 4.45) participated. Adolescents’ frequency of bringing and purchasing foods was assessed via a Food Frequency Questionnaire (FFQ). Relationship support and monitoring were measured via self-report questionnaires. Structural Equation Modelling (SEM) was conducted to examine associations between adolescents’ food purchasing patterns, relationship support, and monitoring. Results indicated that adolescents brought food and drinks mostly from home, and infrequently purchased these products in and around school. Yet, differences exist between subgroups of adolescents. Relationship support was positively associated with bringing fruit, vegetables and salad and negatively associated with purchasing sweet snacks. No associations were found for monitoring. These findings indicate that family-home determinants of healthy and unhealthy eating are important factors to consider when examining the impact of the school food environment on adolescents’ food purchasing patterns. This has implications for policy makers who aim to develop and implement measures to improve adolescents’ eating in and around school.
Collapse
Affiliation(s)
- Roel C.J. Hermans
- The Netherlands Nutrition Centre, 2594 AC The Hague, The Netherlands; (I.J.E.); (L.V.)
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6299 AH Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-43-388-2415
| | - Koen Smit
- Behavioural Science Institute, Radboud University, 6500 HE Nijmegen, The Netherlands; (K.S.); (N.v.d.B.)
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, 3500 AS Utrecht, The Netherlands
| | - Nina van den Broek
- Behavioural Science Institute, Radboud University, 6500 HE Nijmegen, The Netherlands; (K.S.); (N.v.d.B.)
| | - Irma J. Evenhuis
- The Netherlands Nutrition Centre, 2594 AC The Hague, The Netherlands; (I.J.E.); (L.V.)
| | - Lydian Veldhuis
- The Netherlands Nutrition Centre, 2594 AC The Hague, The Netherlands; (I.J.E.); (L.V.)
| |
Collapse
|
34
|
Marcano-Olivier MI, Horne PJ, Viktor S, Erjavec M. Using Nudges to Promote Healthy Food Choices in the School Dining Room: A Systematic Review of Previous Investigations. THE JOURNAL OF SCHOOL HEALTH 2020; 90:143-157. [PMID: 31852016 DOI: 10.1111/josh.12861] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There is a growing interest in low-cost interventions that modify obesogenic environments and encourage positive behavior change. We conducted a systematic review of studies that used behavioral nudges to promote a healthy school cafeteria environment. METHODS A literature search was conducted using 5 databases; of 381 papers noted, we included 25 and assessed them using the Quality Assessment Tool for Quantitative Studies. RESULTS Most studies used relatively small, convenience samples and data collection methods that could not be described as robust, necessitating cautious interpretation of their results. A range of behavioral nudges were employed. Seventeen studies reported positive effects on children's selection and 11 studies reported improvements in their consumption of target foods, effected by changing the order of serving; increasing the convenience, attractiveness, and normativeness of selecting healthy options; increasing the variety available; and attractive target food labeling. CONCLUSIONS Overall, this review identified the requirement for well-designed and well-controlled investigations into the effects of changing the choice architecture in school cafeterias, assessing short-, medium-, and long-term changes in individual children's consumption, utilizing validated measures, and conducted across a variety of settings, including dining rooms of schools outside the United States.
Collapse
Affiliation(s)
- Mariel I Marcano-Olivier
- Birmingham City University, School of Business, Law, and Social Sciences, Curzon Building, 4 Cardigan Street, Birmingham, B4 7BD
| | - Pauline J Horne
- The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), LL57 2AS, UK
| | - Simon Viktor
- Wheldon, Deiniol Road, Bangor (Gwynedd), LL57 2UW, UK
| | - Mihela Erjavec
- The Centre for Activity and Eating Research, Bangor University, School of Psychology, Brigantia, Penrallt Road, Bangor (Gwynedd), LL57 2AS, UK
| |
Collapse
|
35
|
Pinto RL, de Souza BDSN, Antunes ABS, De Cnop ML, Sichieri R, Cunha DB. Papass clinical trial protocol: a multi-component school-based intervention study to increase acceptance and adherence to school feeding. BMC Public Health 2019; 19:1644. [PMID: 31805902 PMCID: PMC6896593 DOI: 10.1186/s12889-019-7988-2] [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: 11/12/2019] [Accepted: 11/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background One of the largest school feeding programs in the world is the National School Feeding Program of Brazil. However, results from the 2012 National School Health Survey indicated that only 22.8% of 9th grade students in Brazilian public school system consumed school meals. The literature presents few studies aiming to promote healthy food consumption in the school environment from interventions, which found inconclusive results. Thus, this study aims to present a protocol to evaluate the effectiveness of multi-component school-level interventions to increase adherence and acceptance to school feeding. Methods School-based multi-component clinical trial with students from 4th-9h grade from 3 municipal schools of Sumidouro, Rio de Janeiro, Brazil, in 2019. The study design will be parallel, with 3 arms: Control group (without intervention); Intervention group 1 (changes in school environment) and Intervention group 2 (changes in menu and school environment). Interventions in the environment will be based on the principles of choices architecture and, the modification in the dishes that make up the menus offered to the students, on the factors that contribute to poor adherence and acceptance to school feeding, identified by focus groups. Adherence to school feeding will be assessed through a specific question in the questionnaire directed to the frequency of consuming school meals in the week, applied by researchers in three moments. Acceptance will be assessed from the acceptability test application with dishes served to students during the year. Statistical analyses will be performed using generalized linear models, which will be used to assess the impact of the intervention, and will include 3 main variables: intervention, time and the intervention x time interaction. Discussion This study will investigate if the impact of the implementation of interventions in the environment and in the dishes served to students may increase adherence and acceptance to school feeding. Positive results could show the effect of implementing interventions throughout Sumidouro’s public school system, as well as throughout the country, aiming to improve the consumption of school meals. Trial registration Brazilian Registry of Clinical Trials, RBR-7mf794. Date of registration: December 27, 2018.
Collapse
Affiliation(s)
- Rafael Lavourinha Pinto
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua São Francisco Xavier, 524, 7° andar, bloco E, sala E 7017B, Maracanã, CEP 20550-900, Rio de Janeiro, Brazil.
| | - Bárbara da Silva Nalin de Souza
- Department of Collective Health, Collective Health Institute, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Anna Beatriz Souza Antunes
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua São Francisco Xavier, 524, 7° andar, bloco E, sala E 7017B, Maracanã, CEP 20550-900, Rio de Janeiro, Brazil
| | - Mara Lima De Cnop
- Gastronomy course, Institute of Nutrition Josué de Castro., Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosely Sichieri
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua São Francisco Xavier, 524, 7° andar, bloco E, sala E 7017B, Maracanã, CEP 20550-900, Rio de Janeiro, Brazil
| | - Diana Barbosa Cunha
- Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rua São Francisco Xavier, 524, 7° andar, bloco E, sala E 7017B, Maracanã, CEP 20550-900, Rio de Janeiro, Brazil
| |
Collapse
|
36
|
vanDellen MR, Rajbhandari-Thapa J, Sevilla J. Does serving vegetables in partitioned portions promote vegetable consumption? Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.103750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
|
38
|
Möllenkamp M, Zeppernick M, Schreyögg J. The effectiveness of nudges in improving the self-management of patients with chronic diseases: A systematic literature review. Health Policy 2019; 123:1199-1209. [PMID: 31676042 DOI: 10.1016/j.healthpol.2019.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 09/06/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022]
Abstract
In this systematic literature review, we identify evidence on the effectiveness of nudges in improving the self-management of adults with chronic diseases and derive policy recommendations. We included empirical studies of any design published up to April 12th, 2018. We synthesized the results of the studies narratively by comparing statistical significance and direction of different nudge types' effects on primary study outcomes. Lastly, we categorized the nudges according to their degree of manipulation and transparency. We identified 26 studies, where 13 were of high or moderate quality. The most commonly tested nudges were reminders, planning prompts, small financial incentives, and feedback. Overall, 8 of 9 studies with a high or moderate quality ranking, focused on self-management outcomes, i.e., physical activity, attendance, self-monitoring, and medication adherence, found that nudges had significant positive effects. However, only 1 of 4 studies of high or moderate quality, analyzing disease control outcomes (e.g., glycemic control), found that nudges had a significant positive effect for one intervention arm. In summary, this review demonstrates that nudges can improve chronic disease self-management, but there is hardly any evidence to date that these interventions lead to improved disease control. Reminders, feedback, and planning prompts appear to improve chronic disease self-management most consistently and are among the least controversial types of nudges. Accordingly, they can generally be recommended to policymakers.
Collapse
Affiliation(s)
- Meilin Möllenkamp
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany.
| | - Maike Zeppernick
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany
| |
Collapse
|
39
|
Forberger S, Reisch L, Kampfmann T, Zeeb H. Nudging to move: a scoping review of the use of choice architecture interventions to promote physical activity in the general population. Int J Behav Nutr Phys Act 2019; 16:77. [PMID: 31481090 PMCID: PMC6724306 DOI: 10.1186/s12966-019-0844-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Nudges are used to alter lifestyles and thus curb the rise of non-communicable diseases. Physical activity is a core prevention strategy to reduce the burden of non-communicable diseases. This paper aims to (1) give an overview of the scope of interventions using choice architecture techniques to promote physical activity at the population levels and (2) identify research gaps by analysing the different approaches in terms of class and type of intervention used. Methods A systematic electronic database search was combined with snowball citation sampling of a starter set of publications to search for studies published through October 2018 reporting interventions to promote physical activity at the population level using choice architecture techniques. The methodology of the Joanna Briggs Institute for Scoping Reviews was applied. Results In all, 35 publications were included. Most of the interventions used point-of-choice prompts tested at railway stations, shopping malls and airports (N = 27). Eight studies were online studies. While all studies were aimed at the general population, details, if reported at all, were vague and basic. All studies focused on individual-level lifestyle behaviour. None of the studies attempted to alter population-based lifestyle behaviour. Online and “real-world” approaches were rarely combined. Neither, interventions targeting meso- and macro-level structures nor combinations of individual-level and specific meso- or macro-level interventions were found. Conclusion Nudging is in principle an effective approach to promote physical activity within the general population. However, there are large gaps in research. Available opportunities have not yet been exhausted. Further research is needed that is explicitly based on behavioural insights and covering the full range of nudging approaches, particularly focussing on theoretical developments, practical feasibility tests and scale-up activities. Electronic supplementary material The online version of this article (10.1186/s12966-019-0844-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- S Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - L Reisch
- Leibniz-Chair, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Copenhagen Business School, MSC, Dalgas Have 15, 2000, Frederiksberg, Denmark
| | - T Kampfmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| |
Collapse
|
40
|
Examining the Efficacy of a 'Feasible' Nudge Intervention to Increase the Purchase of Vegetables by First Year University Students (17-19 Years of Age) in British Columbia: A Pilot Study. Nutrients 2019; 11:nu11081786. [PMID: 31382395 PMCID: PMC6722732 DOI: 10.3390/nu11081786] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/16/2022] Open
Abstract
In the transition from high school to university, vegetable consumption tends to deteriorate, potentially influencing immediate and longer-term health outcomes. Nudges, manipulation of the environment to influence choice, have emerged as important to behavior change goals. This quasi-experimental pilot study examined the impact of a contextually feasible evidence-informed nudge intervention on food purchasing behavior of older adolescents (1st year students) in a university residence cafeteria in British Columbia, Canada. A co-design process with students and staff identified a student relevant and operationally feasible nudge intervention; a placement nudge, fresh vegetables at the hot food table, combined with a sensory and cognitive nudge, signage encouraging vegetable purchase). Using a 12-week single-case A-B-A-B design, observations of the proportion of vegetables purchased were used to assess intervention efficacy. Data analysis included visual trend inspection, central tendency measures, data overlap, variability and latency. Visual trend inspection showed a positive trend when nudges were in place, which was more apparent with female purchases and during the first intervention (B) phase. However, further analysis showed lack of baseline stability, high variability across phases and overlapping data, limiting efficacy conclusions. Menu choices, staff encouragement, term timing and student finances are other potential influences. Further 'real world' nudge research is needed.
Collapse
|
41
|
Improving the quality of foods available in a rural kibbutz cafeteria in Israel to align with a freshly prepared Mediterranean-style diet through a community culinary coaching programme. Public Health Nutr 2019; 22:3229-3237. [PMID: 31327325 DOI: 10.1017/s1368980019001721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the impact of a community culinary coaching programme (CCCP) on cafeteria food alignment with a freshly prepared Mediterranean-style diet, and diners' consumption habits and satisfaction. DESIGN A non-randomized, controlled, community-based participatory research programme. CCCP included eight 90 min coaching sessions with a community steering committee, 22 h of kitchen staff training, 12 h of pre-school staff training and 30 h of education for diners; control communities received no intervention. Outcomes, measured before and 12 months after programme initiation, included cafeteria food alignment with a freshly prepared Mediterranean-style diet through a food items list derived from the cafeteria food purchasing software, and adult diners' consumption habits and satisfaction through questionnaires. SETTING Communal cafeterias of rural kibbutzim. PARTICIPANTS Intervention: kibbutz with 493 adults and 214 children. Control: Two kibbutzim with a total of 487 adults and 206 children. RESULTS Intervention cafeteria food improved significantly in all Mediterranean index categories except nuts (legumes, wholegrain products, fish, MUFA/SFA P < 0·0001; fruits, vegetables P < 0·001; processed meats P = 0·004), and in the proportion of ultra-processed and unprocessed or minimally processed foods categories of the NOVA classification (-22 %, P < 0·001 and +7 %, P < 0·001, respectively), compared with the control community. The intervention group's satisfaction was significantly improved in twenty-five (83 %) out of the thirty satisfaction items, compared with twelve (40 %) in the control group. No changes were identified in diners' consumption habits in either intervention or control communities. CONCLUSIONS CCCP might be useful in improving alignment of cafeteria food with a freshly prepared Mediterranean-style diet.
Collapse
|
42
|
Zhou X, Perez-Cueto FJ, Dos Santos Q, Bredie WL, Molla-Bauza MB, Rodrigues VM, Buch-Andersen T, Appleton KM, Hemingway A, Giboreau A, Saulais L, Monteleone E, Dinnella C, Hartwell H. Promotion of novel plant-based dishes among older consumers using the ‘dish of the day’ as a nudging strategy in 4 EU countries. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
43
|
Broers VJV, Van den Broucke S, Taverne C, Luminet O. Default-name and tasting nudges increase salsify soup choice without increasing overall soup choice. Appetite 2019; 138:204-214. [PMID: 30928516 DOI: 10.1016/j.appet.2019.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/04/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
Nudging is a popular behavior change technique but the conditions for its effectiveness have not been researched extensively. The current study aimed to test whether the effectiveness of nudging is limited to certain characteristics of the nudged product by focusing on a specific product (salsify soup) within a broader category (soups). Two parallel studies were conducted in two sandwich restaurants in a university setting at which a default-name nudge ("suggestion of the chef") and a tasting nudge were implemented aimed at increasing the choice for salsify soup using a non-randomized study design during 10 and 12 measurement days. The beta-regression model showed that the default-name nudge increased the proportion of customers that choose the salsify soup during intervention days compared to non-intervention days, p < .001, OR: 1.70. The tasting nudge also increased the proportion of customers that choose the salsify soup from baseline to intervention, p < .001, OR: 6.17 and from baseline to post-intervention, p < .01, OR: 1.87, and decreased from intervention to post-intervention, p < .001, OR: 0.30. Both nudges did not increase the choice for the overall category of soups. The results show that certain types of nudges are able to increase specific products of a category without increasing overall choice of a category in contrast to previous findings.
Collapse
Affiliation(s)
- V J V Broers
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium.
| | - S Van den Broucke
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium
| | - C Taverne
- Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Belgium
| | - O Luminet
- Psychological Sciences Research Institute, Université catholique de Louvain, Belgium; Fund for Scientific Research (FRS-FNRS), Belgium
| |
Collapse
|
44
|
dos Santos Q, Perez-Cueto FJA, Rodrigues VM, Appleton K, Giboreau A, Saulais L, Monteleone E, Dinnella C, Brugarolas M, Hartwell H. Impact of a nudging intervention and factors associated with vegetable dish choice among European adolescents. Eur J Nutr 2019; 59:231-247. [DOI: 10.1007/s00394-019-01903-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/17/2019] [Indexed: 12/17/2022]
|
45
|
Olfert MD, Hagedorn RL, Clegg EN, Ackerman S, Brown C. Choice Architecture in Appalachian High Schools: Evaluating and Improving Cafeteria Environments. Nutrients 2019; 11:E147. [PMID: 30641956 PMCID: PMC6356853 DOI: 10.3390/nu11010147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/29/2018] [Accepted: 01/05/2019] [Indexed: 11/16/2022] Open
Abstract
School meals are a primary source of nutrition for many adolescents. Determining factors that influence the selection of various foods can provide insight on strategies to improve students' cafeteria choices. This evaluation and observation was conducted at three Appalachian high schools to assess the cafeteria environment. The study developed and implemented an assessment tool created using principles of choice architecture and behavioral economics building on the work of the Cornell Center for Behavioral Economics in Child Nutrition Programs (BEN Center). The assessment tool scored eight components of the lunchroom-the exterior, hot serving area, cold serving area, salad bar, beverage area, payment station, dining area and grab-n-go, where a higher score equals healthier components offered. High school (HS) #1 earned 73/128 points (57%), HS #2 earned 69/128 (54%), and HS #3 earned 53/102 (52%). HS #3 did not have a grab-n-go option and the final score was out of 102. Video observation was used to collect data on lunchroom activity during mealtimes. Each school received reports that highlight the results and suggest improvements to raise their score. The scoring tool represents a novel way to assess the health of school lunches, provide insights on how to improve the healthfulness of students' lunch choice, and improve overall nutrition status.
Collapse
Affiliation(s)
- Melissa D Olfert
- Department of Human Nutrition and Food, Division of Animal and Nutritional Sciences, Natural Resources and Design, Davis College of Agriculture, West Virginia University, Morgantown, WV 26506-6108, USA.
| | - Rebecca L Hagedorn
- Department of Human Nutrition and Food, Division of Animal and Nutritional Sciences, Natural Resources and Design, Davis College of Agriculture, West Virginia University, Morgantown, WV 26506-6108, USA.
| | - Emily N Clegg
- Department of Human Nutrition and Food, Division of Animal and Nutritional Sciences, Natural Resources and Design, Davis College of Agriculture, West Virginia University, Morgantown, WV 26506-6108, USA.
| | - Shannon Ackerman
- Department of Human Nutrition and Food, Division of Animal and Nutritional Sciences, Natural Resources and Design, Davis College of Agriculture, West Virginia University, Morgantown, WV 26506-6108, USA.
| | - Cheryl Brown
- Division of Resource Economics and Management, Natural Resources and Design, Davis College of Agriculture, West Virginia University, Morgantown, WV 26506-6108, USA.
| |
Collapse
|
46
|
Investigating the conditions for the effectiveness of nudging: Cue-to-action nudging increases familiar vegetable choice. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
47
|
Duckworth AL, Milkman KL, Laibson D. Beyond Willpower: Strategies for Reducing Failures of Self-Control. Psychol Sci Public Interest 2018; 19:102-129. [PMID: 30760176 DOI: 10.1177/1529100618821893] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Almost everyone struggles to act in their individual and collective best interests, particularly when doing so requires forgoing a more immediately enjoyable alternative. Other than exhorting decision makers to "do the right thing," what can policymakers do to reduce overeating, undersaving, procrastination, and other self-defeating behaviors that feel good now but generate larger delayed costs? In this review, we synthesize contemporary research on approaches to reducing failures of self-control. We distinguish between self-deployed and other-deployed strategies and, in addition, between situational and cognitive intervention targets. Collectively, the evidence from both psychological science and economics recommends psychologically informed policies for reducing failures of self-control.
Collapse
Affiliation(s)
| | - Katherine L Milkman
- 2 Operations, Information and Decisions Department, The Wharton School of the University of Pennsylvania
| | | |
Collapse
|
48
|
Quinn EL, Johnson DB, Podrabsky M, Saelens BE, Bignell W, Krieger J. Effects of a Behavioral Economics Intervention on Food Choice and Food Consumption in Middle-School and High-School Cafeterias. Prev Chronic Dis 2018; 15:E91. [PMID: 29981258 PMCID: PMC6040595 DOI: 10.5888/pcd15.170377] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Changing food choice architecture in school cafeterias through behavioral economics may increase student selection and consumption of healthy foods. However, most research assesses the effects of short-term interventions. We evaluated a year-long choice architecture intervention implemented by school food service staff. Methods Food service staff from 6 secondary schools in one school district received training and support to implement behavioral economics strategies in their cafeterias to promote student selection of fruit, vegetables, and low-fat white milk. We compared student selection and consumption of these foods in the intervention schools to 5 comparison schools in the same district on the basis of visual assessment of plate waste. We applied a difference-in-differences approach to estimate intervention effect. Results Data for 902 students were assessed at baseline, and data for 1,407 were assessed at follow-up. In fully adjusted analyses for all students, there were significantly greater absolute increases in the proportions of intervention school students selecting any fruit, including (0.09) and excluding (0.16) juice, and students selected more fruit items including (0.21) and excluding (0.17) juice. The absolute increase in proportion of intervention students consuming fruit excluding juice (0.14) was significantly greater. However, in some analyses, fewer intervention students who selected fruits or vegetables ate them, or they ate fewer of them. There were no intervention effects for vegetables or low-fat white milk. Conclusion Our results indicate that behavioral economics–based choice architecture can promote student selection of healthy foods, but they raise questions about whether it increases their consumption.
Collapse
Affiliation(s)
- Emilee L Quinn
- Center for Public Health Nutrition, Department of Health Services, University of Washington, Box 353410, Seattle, WA 98195.
| | - Donna B Johnson
- Center for Public Health Nutrition, Department of Health Services, and Nutritional Sciences Program, University of Washington, Seattle, Washington
| | - Mary Podrabsky
- Center for Public Health Nutrition, Department of Health Services, and Nutritional Sciences Program, University of Washington, Seattle, Washington
| | - Brian E Saelens
- Seattle Children's Research Institute and Department of Pediatrics in the School of Medicine, University of Washington, Seattle, Washington
| | - Wesley Bignell
- Department of Sociology, University of Washington, Seattle, Washington
| | - James Krieger
- Healthy Food America Seattle, Washington; Departments of Medicine and Health Services, University of Washington, Seattle, Washington
| |
Collapse
|
49
|
Broers VJV, De Breucker C, Van den Broucke S, Luminet O. A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice. Eur J Public Health 2018; 27:912-920. [PMID: 28655176 DOI: 10.1093/eurpub/ckx085] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review and meta-analysis was conducted to test the effects of nudging to encourage people to select more fruit and vegetables. Methods A systematic literature search was performed on PubMed, Medline, PsycInfo, Cochrane library, Scopus and Google Scholar. After quality assessment, 20 articles (23 studies) were retained for narrative synthesis. Twelve articles (14 studies) contained enough information to calculate effect-sizes for meta-analysis using Comprehensive Meta-analysis software. Results The meta-analysis shows that nudging interventions that aim to increase fruit and/or vegetable choice/sales/servings have a moderately significant effect (d = 0.30), with the largest effect for altering placement (d = 0.39) and combined nudges (d = 0.28). Conclusion The results of this review provide an indication of the effectiveness of nudging on fruit and vegetable choice in terms of actual effect-sizes, while also highlighting the problems that must be addressed before more definitive conclusions can be drawn.
Collapse
Affiliation(s)
- Valérie J V Broers
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Céline De Breucker
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Olivier Luminet
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Fonds de la Recherche Scientifique (FNRS)
| |
Collapse
|
50
|
Oostindjer M, Aschemann-Witzel J, Wang Q, Skuland SE, Egelandsdal B, Amdam GV, Schjøll A, Pachucki MC, Rozin P, Stein J, Lengard Almli V, Van Kleef E. Are school meals a viable and sustainable tool to improve the healthiness and sustainability of children´s diet and food consumption? A cross-national comparative perspective. Crit Rev Food Sci Nutr 2018; 57:3942-3958. [PMID: 27712088 DOI: 10.1080/10408398.2016.1197180] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is little agreement among governments, institutions, scientists and food activists as to how to best tackle the challenging issues of health and sustainability in the food sector. This essay discusses the potential of school meals as a platform to promote healthy and sustainable food behavior. School meal programs are of particular interest for improving public diet because they reach children at a population scale across socio-economic classes and for over a decade of their lives, and because food habits of children are more malleable than those of adults. Current research on the history and health implications of school meal programs is reviewed in a cross-national comparative framework, and arguments explored that speak for the need of a new developmental phase of school meals as an integrative learning platform for healthy and sustainable food behavior. Nutritional, social, practical, educational, economical, political, and cultural perspectives and challenges linked to the implementation of healthy and sustainable school meals are discussed. Finally, the need for long-term interventions and evaluations is highlighted and new research directions are proposed.
Collapse
Affiliation(s)
- Marije Oostindjer
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway
| | - Jessica Aschemann-Witzel
- b MAPP Centre - Research on Value Creation in the Food Sector , Aarhus University , Aarhus C , Denmark
| | - Qing Wang
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway
| | - Silje Elisabeth Skuland
- c Consumption Research Norway , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Bjørg Egelandsdal
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway
| | - Gro V Amdam
- a Faculty of Chemistry, Biotechnology and Food Sciences , Norwegian University of Life Sciences , Ås , Norway.,d School of Life Science , Arizona State University , Tempe , Arizona , USA
| | - Alexander Schjøll
- c Consumption Research Norway , Oslo and Akershus University College of Applied Sciences , Oslo , Norway
| | - Mark C Pachucki
- e Department of Sociology, Computational Social Science Institute , University of Massachusetts Amherst , Amherst , Massachusetts , USA
| | - Paul Rozin
- f Department of Psychology , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | - Jarrett Stein
- g Netter Center for Community Partnerships , University of Pennsylvania , Philadelphia , Pennsylvania , USA
| | | | - Ellen Van Kleef
- i Marketing and Consumer Behavior Group , Wageningen University , Hollandseweg , The Netherlands
| |
Collapse
|