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Buccini G, Larrison C, Neupane S, Palapa M, Schincaglia RM, Brown S, Gubert MB. Complex intertwined association between breastfeeding practices and household food insecurity: Systematic review and meta-analysis. MATERNAL & CHILD NUTRITION 2024:e13696. [PMID: 38960401 DOI: 10.1111/mcn.13696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
Breastfeeding offers ideal food and nutrition for infants; however, structural barriers may amplify breastfeeding inequities. We aimed to identify whether household food insecurity (HFI) is associated with exclusive and continued breastfeeding (EBF and CBF) as recommended by the World Health Organization/United Nations Children's Fund (UNICEF) Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, literature searches using 'breastfeeding', 'food insecurity' and 'infant' terms were conducted in PubMed/MEDLINE, Embase, CINAHL, Global Health and LILACS from inception through November 2023, without language restrictions, yielding 1382 publications (PROSPERO:CRD42022329836). Predetermined eligibility criteria yielded the 12 included studies (nine cross-sectional and three cohorts). The risk of bias was assessed through the Effective Public Health Practice Project. Meta-analysis was performed for studies assessing EBF (n = 10), and metaregression was used to explore heterogeneity across studies. Prevalence of EBF ranged from 1.6% to 85.3%, with a lower prevalence among HFI. The pooled effect of the association between HFI and EBF presented an odds ratio (OR) of 0.61 (95% CI = 0.49-0.76) with consistent results across marginal (OR = 0.72, 95% CI = 0.55-0.94), moderate (OR = 0.59, 95% CI = 0.41-0.84) and severe HFI (OR = 0.49, 95% CI = 0.32-0.76). High heterogeneity was found only when HFI was dichotomized. The prevalence of CBF ranged from 35.4% to 78.0%, with inconsistent prevalence among HFI; a meta-analysis was not performed due to the low number of studies (n = 3). We concluded that HFI levels are associated with lower odds of EBF. Integrating service and policy-level strategies, such as screening, referrals, skilled breastfeeding counseling and access to comprehensive nutrition and social programs, could reduce structural inequities and promote adherence to the World Health Organization/UNICEF breastfeeding recommendations among food-insecure families.
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Affiliation(s)
- Gabriela Buccini
- Department of Social and Behavioural Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Cali Larrison
- Department of Social and Behavioural Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Smriti Neupane
- Department of Social and Behavioural Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Maria Palapa
- Department of Social and Behavioural Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Raquel Machado Schincaglia
- Department of Social and Behavioural Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Sara Brown
- School of Nursing, University of California, Irvine, Irvine, California, USA
| | - Muriel B Gubert
- Department of Social and Behavioural Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
- Department of Nutrition, University of Brasilia, Brasilia, Brazil
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Barrett M, Spires M, Vogel C. The Healthy Start scheme in England "is a lifeline for families but many are missing out": a rapid qualitative analysis. BMC Med 2024; 22:177. [PMID: 38715000 PMCID: PMC11077836 DOI: 10.1186/s12916-024-03380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Healthy Start (HS) is a government scheme in England, Wales and Northern Ireland that offers a financial payment card and free vitamins to families experiencing low income. Pregnant women and families with children < 4 years can use the HS card to buy fruit, vegetables, cow's milk, infant formula and pulses. HS was fully digitalised in March 2022. While digitalisation has improved the user experience for many families, in the context of the cost-of-living crisis and increasing dietary inequalities, it is important to understand why HS is not reaching more families. This study aimed to (i) assess the perceptions and experiences of HS from stakeholders across the system including those who promote, implement and are eligible for HS, and (ii) identify recommendations to improve the scheme's effectiveness and uptake. METHODS The study design was a post-implementation rapid qualitative evaluation using stakeholder interviews. Data were collected between January and June 2023 via semi-structured interviews (50% online; 50% in person) with 112 stakeholders, including parents (n = 59), non-government organisations (n = 13), retailers (n = 11) and health and community professionals (n = 29) at national and local levels. Findings were confirmed by a sub-sample of participants. RESULTS Six core themes cut across stakeholders' perceptions and experiences, and stakeholders collectively outlined seven recommendations they felt could be acted upon to maximise uptake and efficiency of HS, with actions at both national and local levels. A novel finding from this study is that raising awareness about HS alone is unlikely to result automatically or universally in higher uptake rate. Recommendations include: continuing to provide this scheme that is universally valued; the need for many families to be provided with a helping hand to successfully complete the application; reframing of the scheme as a child's right to food and development to ensure inclusivity; improved leadership, coordination and accountability at both national and local levels. CONCLUSIONS HS provides benefits for child development and family wellbeing. The study's recommendations should be actioned by national and local governments to enable all families eligible for the scheme to benefit from this nutritional safety net.
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Affiliation(s)
- Millie Barrett
- Centre for Food Policy, City, University of London, London, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
| | - Mark Spires
- Centre for Food Policy, City, University of London, London, UK
| | - Christina Vogel
- Centre for Food Policy, City, University of London, London, UK
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
- National Institute for Health and Care Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
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Iannotti L, Kleban E, Fracassi P, Oenema S, Lutter C. Evidence for Policies and Practices to Address Global Food Insecurity. Annu Rev Public Health 2024; 45:375-400. [PMID: 38166503 DOI: 10.1146/annurev-publhealth-060922-041451] [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] [Indexed: 01/04/2024]
Abstract
Food insecurity affects an estimated 691-783 million people globally and is disproportionately high in Africa and Asia. It arises from poverty, armed conflict, and climate change, among other demographic and globalization forces. This review summarizes evidence for policies and practices across five elements of the agrifood system framework and identifies gaps that inform an agenda for future research. Under availability, imbalanced agriculture policies protect primarily staple food producers, and there is limited evidence on food security impacts for smallholder and women food producers. Evidence supports the use of cash transfers and food aid for affordability and school feeding for multiple benefits. Food-based dietary guidelines can improve the nutritional quality of dietary patterns, yet they may not reflect the latest evidence or food supplies. Evidence from the newer food environment elements, promotion and sustainability, while relatively minimal, provides insight into achieving long-term impacts. To eliminate hunger, our global community should embrace integrated approaches and bring evidence-based policies and practices to scale.
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Affiliation(s)
- Lora Iannotti
- E3 Nutrition Lab, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Eliza Kleban
- E3 Nutrition Lab, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Patrizia Fracassi
- Food and Nutrition Division, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Stineke Oenema
- UN-Nutrition Secretariat, Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Chessa Lutter
- Division of Food Security and Agriculture, RTI International, Washington, DC, USA
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Dally D, Amith M, Mauldin RL, Thomas L, Dang Y, Tao C. A Semantic Approach to Describe Social and Economic Characteristics That Impact Health Outcomes (Social Determinants of Health): Ontology Development Study. Online J Public Health Inform 2024; 16:e52845. [PMID: 38477963 PMCID: PMC10973958 DOI: 10.2196/52845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Social determinants of health (SDoH) have been described by the World Health Organization as the conditions in which individuals are born, live, work, and age. These conditions can be grouped into 3 interrelated levels known as macrolevel (societal), mesolevel (community), and microlevel (individual) determinants. The scope of SDoH expands beyond the biomedical level, and there remains a need to connect other areas such as economics, public policy, and social factors. OBJECTIVE Providing a computable artifact that can link health data to concepts involving the different levels of determinants may improve our understanding of the impact SDoH have on human populations. Modeling SDoH may help to reduce existing gaps in the literature through explicit links between the determinants and biological factors. This in turn can allow researchers and clinicians to make better sense of data and discover new knowledge through the use of semantic links. METHODS An experimental ontology was developed to represent knowledge of the social and economic characteristics of SDoH. Information from 27 literature sources was analyzed to gather concepts and encoded using Web Ontology Language, version 2 (OWL2) and Protégé. Four evaluators independently reviewed the ontology axioms using natural language translation. The analyses from the evaluations and selected terminologies from the Basic Formal Ontology were used to create a revised ontology with a broad spectrum of knowledge concepts ranging from the macrolevel to the microlevel determinants. RESULTS The literature search identified several topics of discussion for each determinant level. Publications for the macrolevel determinants centered around health policy, income inequality, welfare, and the environment. Articles relating to the mesolevel determinants discussed work, work conditions, psychosocial factors, socioeconomic position, outcomes, food, poverty, housing, and crime. Finally, sources found for the microlevel determinants examined gender, ethnicity, race, and behavior. Concepts were gathered from the literature and used to produce an ontology consisting of 383 classes, 109 object properties, and 748 logical axioms. A reasoning test revealed no inconsistent axioms. CONCLUSIONS This ontology models heterogeneous social and economic concepts to represent aspects of SDoH. The scope of SDoH is expansive, and although the ontology is broad, it is still in its early stages. To our current understanding, this ontology represents the first attempt to concentrate on knowledge concepts that are currently not covered by existing ontologies. Future direction will include further expanding the ontology to link with other biomedical ontologies, including alignment for granular semantics.
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Affiliation(s)
- Daniela Dally
- The University of Texas Health Science Center at Houston School of Public Health, The Brownsville Region, Brownsville, TX, United States
| | - Muhammad Amith
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, United States
- Department of Internal Medicine, University of Texas Medical Branch, Galveton, TX, United States
| | - Rebecca L Mauldin
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Latisha Thomas
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Yifang Dang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cui Tao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, United States
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Zhu Y, Mierau JO, Riphagen IJ, Heiner-Fokkema MR, Dekker LH, Navis GJ, Bakker SJL. Types of fish consumption differ across socioeconomic strata and impact differently on plasma fish-based omega-3 fatty acids: a cross-sectional study. Eur J Nutr 2024; 63:435-443. [PMID: 37985508 PMCID: PMC10899282 DOI: 10.1007/s00394-023-03274-x] [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: 02/18/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE We investigated the associations of socioeconomic position (SEP) with total and type of fish intake in a large general population and validated whether types of fish intake were differently associated with plasma EPA and DHA in a subset of the population. METHODS From the Lifelines Cohort Study, 94,246 participants aged 44 ± 13 years old were included to test the association of two SEP indicators, i.e., education level and household income level, with dietary intakes of total, oily, lean, fried, and other types of fish. In a subset of 575 participants (mean age: 50 ± 13 years), EPA and DHA levels were measured in plasma phospholipids and triglycerides. Dietary fish intake was assessed using Food Frequency Questionnaire. Linear regressions were applied and adjusted for relevant covariates. RESULTS Compared to the high education level, lower education levels were negatively associated with total, oily, lean, and other fish intake (p < 0.001 for all), and positively associated with fried fish intake (β (SE): 0.04 (0.04), p < 0.001 for middle education; 0.07 (0.04), p < 0.001 for low education), independently of relevant covariates. Similar results were observed for income levels. In the subset population, total and oily fish intakes were positively associated with plasma EPA and DHA (p < 0.02 for all). Lean and other fish intakes were positively associated with only DHA (p < 0.008 for all), but not EPA, while fried fish was not associated with either EPA or DHA in plasma (p > 0.1 for all). CONCLUSION Lower SEP was associated with a lower total intake of fish, and of oily and lean fish, but with higher intake of fried fish. Fried fish was not associated with the fish-based EPA and DHA in plasma. Hence, SEP-related differences in fish consumption are both quantitative and qualitative.
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Affiliation(s)
- Yinjie Zhu
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Jochen O Mierau
- Department of Economics, Econometrics & Finance, Faculty of Economics and Business, University of Groningen, University Complex, 9747 AJ, Groningen, The Netherlands
- Lifelines Cohort Study and Biobank, Groningen, The Netherlands
- Team Strategy & External Relations, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Ineke J Riphagen
- Certe Medical Diagnostics and Advice, Medical Center Leeuwarden, 8934 AD, Leeuwarden, The Netherlands
| | - M Rebecca Heiner-Fokkema
- Laboratory of Metabolic Diseases, University Medical Center Groningen, University of Groningen, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Louise H Dekker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- National Institute for Public Health and the Environment (RIVM), 3720 BA, Bilthoven, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Gupta A, Raine KD, Moynihan P, Peres MA. Australians support for policy initiatives addressing unhealthy diet: a population-based study. Health Promot Int 2023; 38:daad036. [PMID: 37216315 PMCID: PMC10558039 DOI: 10.1093/heapro/daad036] [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: 05/24/2023] Open
Abstract
To inform public health policy implementation in Australia, our study investigated the level of public support for six policy initiatives addressing unhealthy diet. The policy initiatives included taxing soft drinks and energy drinks, taxing less healthy food and beverage purchases, zoning to restrict the supply of junk foods near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugar-sweetened beverages from vending machines in schools, and public places. Data from a cross-sectional population-based study for 4040 Australians aged 15+ years, were analysed. A high overall support across all policy initiatives was observed. Nearly three-quarter of public support was observed for policy initiatives targeting children (zoning to restrict the supply of junk food near schools, prohibiting advertising and promotion of less healthy food and beverages to children under the age of 16 and restricting sugars-sweetened beverages from vending machines in schools), and half of Australians supported policy initiatives of taxing soft drinks and energy drinks and taxing less healthy food and beverage purchases. Australian women and those with tertiary level of education were more likely to support public health initiatives targeting children and all policy initiatives respectively. Interestingly, young adults expressed low level of support for all policy initiatives. The study demonstrated considerable public support for policy initiatives focussed on protecting children from unhealthy diet in Australia. Framing, designing and implementing policies targeting children is potentially a good starting point for policymakers to create a health promoting food environment.
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Affiliation(s)
- Adyya Gupta
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia
| | - Kim D Raine
- School of Public Health, University of Alberta, 3-061 Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada
| | - Paula Moynihan
- Adelaide Dental School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore
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Narayan KMV, Varghese JS, Beyh YS, Bhattacharyya S, Khandelwal S, Krishnan GS, Siegel KR, Thomas T, Kurpad AV. A Strategic Research Framework for Defeating Diabetes in India: A 21st-Century Agenda. J Indian Inst Sci 2023; 103:1-22. [PMID: 37362852 PMCID: PMC10029804 DOI: 10.1007/s41745-022-00354-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/14/2022] [Indexed: 03/24/2023]
Abstract
Indian people are at high risk for type 2 diabetes (T2DM) even at younger ages and lower body weights. Already 74 million people in India have the disease, and the proportion of those with T2DM is increasing across all strata of society. Unique aspects, related to lower insulin secretion or function, and higher hepatic fat deposition, accompanied by the rise in overweight (related to lifestyle changes) may all be responsible for this unrelenting epidemic of T2DM. Yet, research to understand the causes, pathophysiology, phenotypes, prevention, treatment, and healthcare delivery of T2DM in India seriously lags behind. There are major opportunities for scientific discovery and technological innovation, which if tapped can generate solutions for T2DM relevant to the country's context and make leading contributions to global science. We analyze the situation of T2DM in India, and present a four-pillar (etiology, precision medicine, implementation research, and health policy) strategic research framework to tackle the challenge. We offer key research questions for each pillar, and identify infrastructure needs. India offers a fertile environment for shifting the paradigm from imprecise late-stage diabetes treatment toward early-stage precision prevention and care. Investing in and leveraging academic and technological infrastructures, across the disciplines of science, engineering, and medicine, can accelerate progress toward a diabetes-free nation.
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Affiliation(s)
- K. M. Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322 USA
| | - Jithin Sam Varghese
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322 USA
| | - Yara S. Beyh
- Laney Graduate School, Nutrition and Health Sciences Doctoral Program, Emory University, Atlanta, USA
| | | | | | - Gokul S. Krishnan
- Robert Bosch Centre for Data Science and Artificial Intelligence, Indian Institute of Technology Madras, Chennai, India
| | - Karen R. Siegel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322 USA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA 30322 USA
| | - Tinku Thomas
- Department of Biostatistics, St. John’s Medical College, Bengaluru, India
| | - Anura V. Kurpad
- Department of Physiology, St. John’s Medical College, Bengaluru, India
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Headey DD, Ecker O, Comstock AR, Ruel MT. Poverty, price and preference barriers to improving diets in sub-Saharan Africa. GLOBAL FOOD SECURITY 2023; 36:100664. [PMID: 36937376 PMCID: PMC10015269 DOI: 10.1016/j.gfs.2022.100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
Suboptimal diets are the most important preventable risk factor for the global burden of non-communicable diseases. The EAT-Lancet reference diet was therefore developed as a benchmark for gauging divergence from healthy eating standards. However, no previous research has comprehensively explored how and why this divergence exists in poorer countries undergoing nutrition transitions. This study therefore analyzes dietary patterns and drivers of the demand for nutritious foods using nationally representative household surveys from Ethiopia, Kenya, Tanzania, and Uganda. We show how barriers to dietary convergence stem from combinations of poverty, high relative food prices and weak preferences for some specific healthy foods. The article concludes by discussing interventions for strengthening consumer demand for healthy diets in Africa.
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Vos M, Deforche B, Van Kerckhove A, Michels N, Geuens M, Van Lippevelde W. Intervention strategies to promote healthy and sustainable food choices among parents with lower and higher socioeconomic status. BMC Public Health 2022; 22:2378. [PMID: 36536355 PMCID: PMC9761028 DOI: 10.1186/s12889-022-14817-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A global shift towards more healthy and sustainable diets is necessary for the prevention of obesity and chronic diseases, as well as for the growing pressure on our ecosystems. Given that parents are important actors in affecting dietary behaviors of their children, developing intervention strategies targeting families and their practices is promising to reach positive behavior change among children. Also, it is important to tailor these interventions to the needs of parents with different socioeconomic statuses (SES), given that health inequalities continue to grow. This study aims to investigate perspectives of lower and higher SES parents on the usability and acceptability of various innovative intervention strategies. METHODS Fourteen focus groups and four individual interviews (n = 78, nlowerSES = 17; nhigherSES = 61) were conducted in Belgium. A semi-structured interview guide was used to facilitate the discussions. The interviews were recorded, transcribed, and analyzed via thematic content analysis using NVivo. RESULTS To encourage healthy and sustainable food choices, interventions via online food shopping platforms and nudging strategies in grocery stores were mostly cited by higher SES parents, but these were less applicable for lower SES parents as they buy less online and mainly consider the price of products. Mobile applications that provide inspiration for healthy and sustainable recipes and easily accessible shopping lists received moderate support among lower and higher SES parents. Furthermore, both lower and higher SES parents showed interest in meal boxes delivered at home, but lower SES parents have not yet tried such meal boxes because of their higher prices. Still, both groups of SES parents mentioned many advantages of these meal boxes, such as the convenience and time-saving component, as well as the cooking inspiration aspect. CONCLUSION Our study reveals the preferences of lower and higher SES parents for practical intervention strategies, providing insight in what features these strategies should have to be acceptable and useful. Hence, the findings can inform the development of a tailored family-based intervention strategy to improve parental food choices in favor of increased health and sustainability.
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Affiliation(s)
- Marjolijn Vos
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Movement and Nutrition for Health and Performance Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Ixelles, Belgium
| | - Anneleen Van Kerckhove
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Nathalie Michels
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maggie Geuens
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Wendy Van Lippevelde
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Adams LE, Sommer EC, Truesdale KP, Barkin SL, Heerman WJ. Validation of a new scoring approach of a child dietary questionnaire for use in early childhood among low-income, Latino populations. BMC Nutr 2022; 8:125. [PMID: 36316788 PMCID: PMC9620651 DOI: 10.1186/s40795-022-00618-4] [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: 08/27/2021] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Measuring diet quality in early childhood requires time-intensive and costly measurements (e.g., 24-hour diet recall) that are especially burdensome for low-income, minority populations. This study aimed to validate a new method for calculating overall diet quality among low-income, Latino preschoolers. METHODS This study was an observational study using data from a randomized controlled trial. Participants included parents of Latino preschoolers who reported child diet quality at baseline, 4-month, 7-month, 12-month, and 13-month follow-up. At each timepoint parents responded to a 28-item child dietary questionnaire (CDQ), based on the National Health and Nutrition Examination Survey (NHANES) dietary module, which generated the number of times/day that a child ate each of 28 foods in the past month. These 28 items were then used to create a total standardized child diet quality index (possible range 0-100), using a percent of maximum method. Parents were asked to complete three 24-hour diet recalls at the 13-month follow-up, from which the 2015 Healthy Eating Index (HEI) was derived. Construct validity was evaluated by Spearman's rank correlations between the new child diet quality index and the 2015 HEI at the 13-month follow-up. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) for sequential pairs of time points. RESULTS Among 71 eligible parent-child pairs, mean child age was 4.2 (SD = 0.8) years, 50.7% of children were female, and mean child body mass index (BMI) was 17.8 (SD = 2.0) kg/m2. Mean Child Diet Quality Index was 45.2 (SD = 3.2) and mean HEI was 68.4 (SD = 10.5). Child Diet Quality Index and HEI total scores were significantly correlated (r = 0.37; p = 0.001). Test-retest ICCs were statistically significant between all sequential pairs of time points. CONCLUSION The new approach for calculating a measure of overall diet quality from the previously-validated 28-item dietary questionnaire demonstrated modest construct validity. When time and resources are limited, this new measure of overall diet quality may be an appropriate choice among low-income, Latino preschoolers. TRIAL REGISTRATION This reports presents observational data collected as a part of a clinical trial, which was registered on clinicaltrials.gov prior to participant enrollment (NCT03141151).
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Affiliation(s)
- Laura E. Adams
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave, 37232-9225 Nashville, TN USA
| | - Evan C. Sommer
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave, 37232-9225 Nashville, TN USA
| | - Kimberly P. Truesdale
- grid.410711.20000 0001 1034 1720Department of Nutrition, University of North Carolina, McGavran-Greenberg Hall, 2209, 27599 Chapel Hill, NC USA
| | - Shari L. Barkin
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave, 37232-9225 Nashville, TN USA
| | - William J. Heerman
- grid.412807.80000 0004 1936 9916Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave, 37232-9225 Nashville, TN USA
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11
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Sociodemographic and Biological Factors of Health Disparities of Mothers and Their Very Low Birth-Weight Infants. Adv Neonatal Care 2022; 22:E169-E181. [PMID: 35588063 PMCID: PMC9422772 DOI: 10.1097/anc.0000000000000997] [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: 02/04/2023]
Abstract
BACKGROUND Black mothers and their very low birth-weight infants in the United States have increased risk of adverse neonatal and maternal health outcomes compared with White mothers and infants. Disparities in adverse birth outcomes associated with sociodemographic factors are difficult to quantify and modify, limiting their usefulness in assessing intervention effects. PURPOSE To test hypotheses that (1) the biological factors of maternal testosterone and cortisol are associated with sociodemographic factors and (2) both factors are associated with neonatal health and maternal mental health and healthy behaviors between birth and 40 weeks' gestational age. METHODS We used a descriptive, longitudinal design. Eighty-eight mothers and very low birth-weight neonates were recruited from a tertiary medical center in the United States. Data on sociodemographic factors and neonatal health were collected from medical records. Maternal mental health and healthy behaviors were collected with questionnaires. Maternal salivary testosterone and cortisol levels were measured using enzyme immunoassays. Data were analyzed primarily using general linear and mixed models. RESULTS High testosterone and/or low cortisol levels were associated with younger age, less education, enrollment in a federal assistance program, being unmarried, being Black, poorer neonatal health, and delayed physical growth. Low cortisol level was related to higher levels of depressive symptoms. Black mothers had fewer healthy behaviors than White mothers. IMPLICATIONS FOR PRACTICE AND RESEARCH Findings confirm that biological factors are associated with sociodemographic factors, and both are associated with neonatal health and maternal mental health and healthy behaviors. We propose using sociodemographic and biological factors concurrently to identify risk and develop and evaluate ante- and postpartum interventions.Video abstract available athttps://journals.na.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=59.
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12
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Investigating the association between the socioeconomic environment of the service area and fast food visitation: A context-based crystal growth approach. Health Place 2022; 76:102855. [PMID: 35834903 DOI: 10.1016/j.healthplace.2022.102855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 01/21/2023]
Abstract
Fast food consumption is one of the major causes of rising obesity rates. Fast food consumers are mostly residents located in the service area-the fast food outlet's surrounding area. Conventional buffer approaches may exhibit bias in measuring service areas by ignoring the local community's detailed spatial configuration and transportation preferences. This study uses fast food outlets and their visits provided by a mobile phone-based dataset named SafeGraph and applies a novel context-based crystal growth algorithm (CG) to delineate improved service areas of fast food outlets in Chicago. We also explore how socioeconomic variables in service areas by CG and buffer-based approaches are related to visits to fast food outlets. Results show that compared to conventional buffers, CG produces improved service areas as it excludes inaccessible barriers and adjusts the accessible areas by transportation preferences. Further, the model using service areas of public transport users by CG yields the best performance. Additionally, the rate of single-mother households and the number of other fast food outlets nearby are positively related to fast food visits in all models. Findings acknowledge the advantages of CG and help make policy interventions to reduce fast food consumption.
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13
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Greenwald HP, Tao E, Tilley G. Farmers' Market Incentives for Low-Income Families: Who Uses, How Much, and Why. Am J Prev Med 2022; 62:864-871. [PMID: 35597565 DOI: 10.1016/j.amepre.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Focusing on participation and utilization, this research helps to assess the potential impact and contributions of farmers' market incentive programs, often seen as means for improving nutrition and preventing disease among low-income families. METHODS Evaluating the largest farmers' market incentive program in the U.S. (California Market Match), this study used (1) 3 administrative databases (n=1,469, 6,799, and 30,506), (2) a participant survey (n=2,723), and (3) longitudinal interviews (n=163) with active and former participants. Quantitative data were analyzed with contingency tables and multiple regression. Qualitative data were coded into analytically significant themes. Data were collected in 2015-2018 and analyzed in 2018-2021. RESULTS Participation was typically low and varied across localities (3.7%-19.8% of eligible families in a sample of ZIP codes). According to administrative records, market visits by participants in 2 California regions averaged 2.18 and 3.12 per season. However, 77.1% of participants in the shopper survey indicated that they were repeat customers, and 51.0% indicated that they were regular utilizers. Deterrents to utilization included perceptions of inconvenience and high prices but not availability of produce in the community or travel time to markets. Utilization was most frequent among Asian shoppers and residents of Southern California outside Los Angeles County. CONCLUSIONS Farmers' market incentive programs such as Market Match appear likely to benefit population health through a core of committed shoppers. Improvement in participation and utilization may be attained through a better understanding of the communities that the markets are intended to serve.
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Affiliation(s)
- Howard P Greenwald
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California.
| | - Ernie Tao
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Gabrielle Tilley
- The Los Angeles Trust for Children's Health, Los Angeles, California
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14
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Carbonneau E, Dumas A, Brodeur-Doucet A, Fontaine-Bisson B. A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes. Nutrients 2022; 14:nu14061151. [PMID: 35334807 PMCID: PMC8951613 DOI: 10.3390/nu14061151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 02/04/2023] Open
Abstract
This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m2. This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.
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Affiliation(s)
- Elise Carbonneau
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Centre NUTRISS—Nutrition, Santé et Société, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec, QC G1V 0A6, Canada
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
- Correspondence:
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
| | | | - Bénédicte Fontaine-Bisson
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- Institut du Savoir Montfort, Montfort Hospital, Ottawa, ON K1K 0T2, Canada
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15
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Løvhaug AL, Granheim SI, Djojosoeparto SK, Harrington JM, Kamphuis CBM, Poelman MP, Roos G, Sawyer A, Stronks K, Torheim LE, Twohig C, Vandevijvere S, van Lenthe FJ, Terragni L. The potential of food environment policies to reduce socioeconomic inequalities in diets and to improve healthy diets among lower socioeconomic groups: an umbrella review. BMC Public Health 2022; 22:433. [PMID: 35246074 PMCID: PMC8895543 DOI: 10.1186/s12889-022-12827-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/14/2022] [Indexed: 12/19/2022] Open
Abstract
Socioeconomic inequalities in diets need to be tackled to improve population diets and prevent obesity and diet-related non-communicable diseases. The potential of food environment policies to reduce such inequalities has to date however not been appraised. The objective of this umbrella review was to assess the impact of food environment policies on socioeconomic inequalities in diets and to identify knowledge gaps in the existing literature, using the Healthy Food Environment Policy Index as a conceptual framework. The policies considered in the umbrella review are within six domains: 1) food composition 2) food labelling 3) food promotion 4) food provision 5) food retail 6) food pricing. A systematic search for systematic literature reviews on the effect of food environment policies on dietary-related outcomes across socioeconomic groups and published in English between 2004 and 2019 was conducted. Sixteen systematic literature reviews encompassing 159 primary studies were included, covering food composition (n = 2), food labelling (n = 3), food provision (n = 2), food prices (n = 13) and food in retail (n = 4). Quality assessment using the “Assessing the Methodological Quality of Systematic Reviews” quality rating scale showed that review quality was mainly low or critically low. Results suggest that food taxation may reduce socioeconomic inequalities in diets. For all other policy areas, the evidence base was poor. Current research largely fails to provide good quality evidence on impacts of food environment policies on socioeconomic inequalities in diets. Research to fill this knowledge gap is urgently needed.
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Affiliation(s)
- Anne Lene Løvhaug
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.
| | - Sabrina Ionata Granheim
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Sanne K Djojosoeparto
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands
| | - Janas M Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, Netherlands
| | - Gun Roos
- Consumption Research Norway (SIFO), OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Alexia Sawyer
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Liv Elin Torheim
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Cliona Twohig
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | | | - Frank J van Lenthe
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, Netherlands.,Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura Terragni
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
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16
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South E, Rodgers M, Wright K, Whitehead M, Sowden A. Reducing lifestyle risk behaviours in disadvantaged groups in high-income countries: A scoping review of systematic reviews. Prev Med 2022; 154:106916. [PMID: 34922995 PMCID: PMC8803546 DOI: 10.1016/j.ypmed.2021.106916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/06/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022]
Abstract
High prevalence of risk behaviours may exacerbate existing poor health in disadvantaged groups. We aimed to identify and bring together systematic reviews with a focus on reducing risk behaviours in disadvantaged groups and highlight where evidence is lacking. We searched MEDLINE and Embase up to October 2020, with supplementary searching in Epistemonikos and Health Systems Evidence. We included systematic reviews that reported behavioural outcomes and targeted smoking, excessive alcohol use, unhealthy diet, or physical inactivity in groups with the following characteristics: low income or low socio-economic status (SES), unemployed people, homeless people, care leavers, prisoners, refugees or asylum seeker, Gypsies, Travellers, or Roma, people with learning disabilities and people living in disadvantaged areas. Reviews that included primary studies from any high-income country were eligible. Reviews were mapped based on the disadvantaged group(s) and behaviour(s) targeted. Ninety-two reviews were included, with the majority (n = 63) focusing on people with low income or low SES. We identified gaps in the evidence for care leavers; Gypsies, Travellers, and Roma and limited evidence for refugees and unemployed people. Few reviews targeted alcohol use. There was limited evidence on barriers and facilitators to behaviour change. This suggests there is insufficient evidence to inform policy and practice and new reviews or primary studies may be required.
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Affiliation(s)
- Emily South
- Centre for Reviews and Dissemination, University of York, York, United Kingdom.
| | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Margaret Whitehead
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Amanda Sowden
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
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17
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Green MA, Hobbs M, Ding D, Widener M, Murray J, Reece L, Singleton A. The Association between Fast Food Outlets and Overweight in Adolescents Is Confounded by Neighbourhood Deprivation: A Longitudinal Analysis of the Millennium Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413212. [PMID: 34948820 PMCID: PMC8703340 DOI: 10.3390/ijerph182413212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
The aim of our study is to utilise longitudinal data to explore if the association between the retail fast food environment and overweight in adolescents is confounded by neighbourhood deprivation. Data from the Millennium Cohort Study for England were obtained for waves 5 (ages 11/12; 2011/12; n = 13,469) and 6 (ages 14/15; 2014/15; n = 11,884). Our outcome variable was overweight/obesity defined using age and sex-specific International Obesity Task Force cut points. Individuals were linked, based on their residential location, to data on the density of fast food outlets and neighbourhood deprivation. Structural Equation Models were used to model associations and test for observed confounding. A small positive association was initially detected between fast food outlets and overweight (e.g., at age 11/12, Odds Ratio (OR) = 1.0006, 95% Confidence Intervals (CI) = 1.0002–1.0009). Following adjusting for the confounding role of neighbourhood deprivation, this association was non-significant. Individuals who resided in the most deprived neighbourhoods had higher odds of overweight than individuals in the least deprived neighbourhoods (e.g., at age 11/12 OR = 1.95, 95% CIs = 1.64–2.32). Neighbourhood deprivation was also positively associated to the density of fast food outlets (at age 11/12 Incidence Rate Ratio = 3.03, 95% CIs = 2.80–3.28).
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Affiliation(s)
- Mark A. Green
- Geographic Data Science Lab, Department of Geography & Planning, University of Liverpool, Liverpool L69 7ZT, UK; (J.M.); (A.S.)
- Correspondence:
| | - Matthew Hobbs
- GeoHealth Laboratory, University of Canterbury, Christchurch 8140, New Zealand;
- School of Health Sciences, University of Canterbury, Christchurch 8140, New Zealand
| | - Ding Ding
- School of Public Health, University of Sydney, Sydney 2006, Australia; (D.D.); (L.R.)
| | - Michael Widener
- Department of Geography & Planning, University of Toronto, Toronto, ON M5S 3G3, Canada;
| | - John Murray
- Geographic Data Science Lab, Department of Geography & Planning, University of Liverpool, Liverpool L69 7ZT, UK; (J.M.); (A.S.)
| | - Lindsey Reece
- School of Public Health, University of Sydney, Sydney 2006, Australia; (D.D.); (L.R.)
| | - Alex Singleton
- Geographic Data Science Lab, Department of Geography & Planning, University of Liverpool, Liverpool L69 7ZT, UK; (J.M.); (A.S.)
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18
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Dalma A, Petralias A, Tsiampalis T, Nikolakopoulos S, Veloudaki A, Kastorini CM, Papadimitriou E, Zota D, Linos A. Effectiveness of a school food aid programme in improving household food insecurity; a cluster randomized trial. Eur J Public Health 2021; 30:171-178. [PMID: 31127302 DOI: 10.1093/eurpub/ckz091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aim of this cluster randomized trial was to examine the impact of a school feeding programme combining healthy meals provision and educational activities to reduce food insecurity. METHODS Schools participating in the DIATROFI Program in Greece during the 2014-2015 school year were randomly allocated between a multicomponent intervention (MI: each student received a daily healthy meal along with educational actions; 28 schools) and an educational intervention (EI; 23 schools). A linear-mixed model was used to examine intervention effect on change from baseline in the food insecurity score, as measured via the Food Security Survey Module (FSSM). The analysis was based on 1442 pre-post intervention questionnaire pairs in the MI group and 986 in the EI group. RESULTS The reduction in food insecurity score in the MI group was statistically significantly greater compared to the EI group, by 9.8% or -0.31 [95% confidence interval (CI) -0.61 to -0.01] FSSM units after adjusting for potential confounders. MI intervention was significantly more effective compared to EI, among students in food insecure households (mean -0.44, 95% CI -0.84 to -0.04), students in households facing hunger (mean -1.04, 95% CI -1.91 to -0.17) and overweight/obese students (mean -0.36, 95% CI -0.72 to -0.01). CONCLUSION For interventions aiming to address childhood food insecurity, public health focus should be oriented towards school-based programmes combining food assistance with activities that promote healthy nutrition.
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Affiliation(s)
- Archontoula Dalma
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanassios Petralias
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece.,Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Thomas Tsiampalis
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece
| | - Stavros Nikolakopoulos
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece.,Department of Statistics, Athens University of Economics and Business, Athens, Greece
| | - Afroditi Veloudaki
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Papadimitriou
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece
| | - Dina Zota
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athena Linos
- Institute of Preventive Medicine, Environmental & Occupational Health, Prolepsis, Maroussi, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Moledina A, Magwood O, Agbata E, Hung J, Saad A, Thavorn K, Pottie K. A comprehensive review of prioritised interventions to improve the health and wellbeing of persons with lived experience of homelessness. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1154. [PMID: 37131928 PMCID: PMC8356292 DOI: 10.1002/cl2.1154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Homelessness has emerged as a public health priority, with growing numbers of vulnerable populations despite advances in social welfare. In February 2020, the United Nations passed a historic resolution, identifying the need to adopt social-protection systems and ensure access to safe and affordable housing for all. The establishment of housing stability is a critical outcome that intersects with other social inequities. Prior research has shown that in comparison to the general population, people experiencing homelessness have higher rates of infectious diseases, chronic illnesses, and mental-health disorders, along with disproportionately poorer outcomes. Hence, there is an urgent need to identify effective interventions to improve the lives of people living with homelessness. Objectives The objective of this systematic review is to identify, appraise, and synthesise the best available evidence on the benefits and cost-effectiveness of interventions to improve the health and social outcomes of people experiencing homelessness. Search Methods In consultation with an information scientist, we searched nine bibliographic databases, including Medline, EMBASE, and Cochrane CENTRAL, from database inception to February 10, 2020 using keywords and MeSH terms. We conducted a focused grey literature search and consulted experts for additional studies. Selection Criteria Teams of two reviewers independently screened studies against our inclusion criteria. We included randomised control trials (RCTs) and quasi-experimental studies conducted among populations experiencing homelessness in high-income countries. Eligible interventions included permanent supportive housing (PSH), income assistance, standard case management (SCM), peer support, mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI) and injectable antipsychotics, and substance-use interventions, including supervised consumption facilities (SCFs), managed alcohol programmes and opioid agonist therapy. Outcomes of interest were housing stability, mental health, quality of life, substance use, hospitalisations, employment and income. Data Collection and Analysis Teams of two reviewers extracted data in duplicate and independently. We assessed risk of bias using the Cochrane Risk of Bias tool. We performed our statistical analyses using RevMan 5.3. For dichotomous data, we used odds ratios and risk ratios with 95% confidence intervals. For continuous data, we used the mean difference (MD) with a 95% CI if the outcomes were measured in the same way between trials. We used the standardised mean difference with a 95% CI to combine trials that measured the same outcome but used different methods of measurement. Whenever possible, we pooled effect estimates using a random-effects model. Main Results The search resulted in 15,889 citations. We included 86 studies (128 citations) that examined the effectiveness and/or cost-effectiveness of interventions for people with lived experience of homelessness. Studies were conducted in the United States (73), Canada (8), United Kingdom (2), the Netherlands (2) and Australia (1). The studies were of low to moderate certainty, with several concerns regarding the risk of bias. PSH was found to have significant benefits on housing stability as compared to usual care. These benefits impacted both high- and moderate-needs populations with significant cimorbid mental illness and substance-use disorders. PSH may also reduce emergency department visits and days spent hospitalised. Most studies found no significant benefit of PSH on mental-health or substance-use outcomes. The effect on quality of life was also mixed and unclear. In one study, PSH resulted in lower odds of obtaining employment. The effect on income showed no significant differences. Income assistance appeared to have some benefits in improving housing stability, particularly in the form of rental subsidies. Although short-term improvement in depression and perceived stress levels were reported, no evidence of the long-term effect on mental health measures was found. No consistent impact on the outcomes of quality of life, substance use, hospitalisations, employment status, or earned income could be detected when compared with usual services. SCM interventions may have a small beneficial effect on housing stability, though results were mixed. Results for peer support interventions were also mixed, though no benefit was noted in housing stability specifically. Mental health interventions (ICM, ACT, CTI) appeared to reduce the number of days homeless and had varied effects on psychiatric symptoms, quality of life, and substance use over time. Cost analyses of PSH interventions reported mixed results. Seven studies showed that PSH interventions were associated with increased cost to payers and that the cost of the interventions were only partially offset by savings in medical- and social-services costs. Six studies revealed that PSH interventions saved the payers money. Two studies focused on the cost-effectiveness of income-assistance interventions. For each additional day housed, clients who received income assistance incurred additional costs of US$45 (95% CI, -$19, -$108) from the societal perspective. In addition, the benefits gained from temporary financial assistance were found to outweigh the costs, with a net savings of US$20,548. The economic implications of case management interventions (SCM, ICM, ACT, CTI) was highly uncertain. SCM clients were found to incur higher costs than those receiving the usual care. For ICM, all included studies suggested that the intervention may be cost-offset or cost-effective. Regarding ACT, included studies consistently revealed that ACT saved payers money and improved health outcomes than usual care. Despite having comparable costs (US$52,574 vs. US$51,749), CTI led to greater nonhomeless nights (508 vs. 450 nights) compared to usual services. Authors' Conclusions PSH interventions improved housing stability for people living with homelessness. High-intensity case management and income-assistance interventions may also benefit housing stability. The majority of included interventions inconsistently detected benefits for mental health, quality of life, substance use, employment and income. These results have important implications for public health, social policy, and community programme implementation. The COVID-19 pandemic has highlighted the urgent need to tackle systemic inequality and address social determinants of health. Our review provides timely evidence on PSH, income assistance, and mental health interventions as a means of improving housing stability. PSH has major cost and policy implications and this approach could play a key role in ending homelessness. Evidence-based reviews like this one can guide practice and outcome research and contribute to advancing international networks committed to solving homelessness.
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Affiliation(s)
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyere Research InstituteOttawaCanada
| | - Eric Agbata
- Bruyere Research Institute, School of EpidemiologyPublic Health and Preventive MedicineOttawaCanada
| | - Jui‐Hsia Hung
- Faculty of Medicine, School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Ammar Saad
- Department of Epidemiology, C.T. Lamont Primary Care Research Centre, Bruyere Research InstituteUniversity of OttawaOttawaCanada
| | - Kednapa Thavorn
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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20
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Browne J, Lock M, Walker T, Egan M, Backholer K. Effects of food policy actions on Indigenous Peoples' nutrition-related outcomes: a systematic review. BMJ Glob Health 2020; 5:e002442. [PMID: 32816952 PMCID: PMC7437701 DOI: 10.1136/bmjgh-2020-002442] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Indigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap. METHODS Eight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework. RESULTS We identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples' diets, health or well-being. CONCLUSION Both targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.
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Affiliation(s)
- Jennifer Browne
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mark Lock
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Troy Walker
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
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21
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Aktary ML, Caron-Roy S, Sajobi T, O'Hara H, Leblanc P, Dunn S, McCormack GR, Timmins D, Ball K, Downs S, Minaker LM, Nykiforuk CI, Godley J, Milaney K, Lashewicz B, Fournier B, Elliott C, Raine KD, Prowse RJ, Olstad DL. Impact of a farmers' market nutrition coupon programme on diet quality and psychosocial well-being among low-income adults: protocol for a randomised controlled trial and a longitudinal qualitative investigation. BMJ Open 2020; 10:e035143. [PMID: 32371514 PMCID: PMC7228519 DOI: 10.1136/bmjopen-2019-035143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/19/2020] [Accepted: 04/02/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Low-income populations have poorer diet quality and lower psychosocial well-being than their higher-income counterparts. These inequities increase the burden of chronic disease in low-income populations. Farmers' market subsidies may improve diet quality and psychosocial well-being among low-income populations. In Canada, the British Columbia (BC) Farmers' Market Nutrition Coupon Programme (FMNCP) aims to improve dietary patterns and health among low-income participants by providing coupons to purchase healthy foods from farmers' markets. This study will assess the impact of the BC FMNCP on the diet quality and psychosocial well-being of low-income adults and explore mechanisms of programme impacts. METHODS AND ANALYSIS In a parallel group randomised controlled trial, low-income adults will be randomised to an FMNCP intervention (n=132) or a no-intervention control group (n=132). The FMNCP group will receive 16 coupon sheets valued at CAD$21/sheet over 10-15 weeks to purchase fruits, vegetables, dairy, meat/poultry/fish, eggs, nuts and herbs at farmers' markets and will be invited to participate in nutrition skill-building activities. Overall diet quality (primary outcome), diet quality subscores, mental well-being, sense of community, food insecurity and malnutrition risk (secondary outcomes) will be assessed at baseline, immediately post-intervention and 16 weeks post-intervention. Dietary intake will be assessed using the Automated Self-Administered 24-hour Dietary Recall. Diet quality will be calculated using the Healthy Eating Index-2015. Repeated measures mixed-effect regression will assess differences in outcomes between groups from baseline to 16 weeks post-intervention. Furthermore, 25-30 participants will partake in semi-structured interviews during and 5 weeks after programme completion to explore participants' experiences with and perceived outcomes from the programme. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary Conjoint Health Research Ethics Board, Rutgers University Ethics and Compliance, and University of Waterloo Office of Research Ethics. Findings will be disseminated through policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03952338.
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Affiliation(s)
- Michelle L Aktary
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Tolulope Sajobi
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Heather O'Hara
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Peter Leblanc
- British Columbia Association of Farmers' Markets, Vancouver, British Columbia, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gavin R McCormack
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
- School of Architecture, Planning and Landscape, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Timmins
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kylie Ball
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Shauna Downs
- School of Public Health, Rutgers University, Newark, New Jersey, USA
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Jenny Godley
- Department of Sociology, University of Calgary, Calgary, Alberta, Canada
| | - Katrina Milaney
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Lashewicz
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Bonnie Fournier
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
| | - Charlene Elliott
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Communication Media and Film, University of Calgary, Calgary, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Rachel Jl Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dana Lee Olstad
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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22
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Spires M, Berggreen-Clausen A, Kasujja FX, Delobelle P, Puoane T, Sanders D, Daivadanam M. Snapshots of Urban and Rural Food Environments: EPOCH-Based Mapping in a High-, Middle-, and Low-Income Country from a Non-Communicable Disease Perspective. Nutrients 2020; 12:E484. [PMID: 32075027 PMCID: PMC7071357 DOI: 10.3390/nu12020484] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 02/05/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022] Open
Abstract
A changing food environment is implicated as a primary contributor to the increasing levels of non-communicable diseases (NCDs). This study aimed to generate snapshots of selected external food environments to inform intervention strategies for NCD prevention in three countries: Uganda (low income), South Africa (middle income) and Sweden (high income), with one matched pair of urban-rural sites per country. Fifty formal and informal food retail outlets were assessed, and descriptive and comparative statistical analyses were performed. We found that formal food retail outlets in these countries had both positive and negative traits, as they were the main source of basic food items but also made unhealthy food items readily available. The Ugandan setting had predominantly informal outlets, while the Swedish setting had primarily formal outlets and South Africa had both, which fits broadly into the traditional (Uganda), mixed (South Africa) and modern (Sweden) conceptualized food systems. The promotion of unhealthy food products was high in all settings. Uganda had the highest in-community advertising, followed by South Africa and Sweden with the lowest, perhaps related to differences in regulation and implementation. The findings speak to the need to address contextual differences in NCD-related health interventions by incorporating strategies that address the food environment, and for a critical look at regulations that tackle key environment-related factors of food on a larger scale.
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Affiliation(s)
- Mark Spires
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
- Centre for Food Policy, City, University of London, London EC1R 1UW, UK
| | | | - Francis Xavier Kasujja
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda;
| | - Peter Delobelle
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
- Chronic Disease Initiative for Africa, University of Cape Town, Cape Town 7925, South Africa
- Department of Public Health, Vrije Universiteit Brussel, 1090 Brussels, Belgium
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
| | - David Sanders
- School of Public Health, University of the Western Cape, Bellville 7535, South Africa; (M.S.); (P.D.); (T.P.)
| | - Meena Daivadanam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, 75122 Uppsala, Sweden;
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden
- International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, 75237 Uppsala, Sweden
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23
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Piaskoski A, Reilly K, Gilliland J. A Conceptual Model of Rural Household Food Insecurity: A Qualitative Systematic Review and Content Analysis. FAMILY & COMMUNITY HEALTH 2020; 43:296-312. [PMID: 32773496 PMCID: PMC7447178 DOI: 10.1097/fch.0000000000000273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This systematic review explores experiences of household food insecurity in rural areas of developed countries. A search of 5 databases resulted in 32 peer-reviewed articles for inclusion. Data were analyzed using directed content analysis to broaden the understanding of rural household food insecurity. Elements of food security (ie, availability, accessibility, acceptability, adequacy, and agency) were exemplified across the literature. In addition, 4 key themes were found: exercising human capital, realizing social capital, coping with compounding stressors, and navigating complex systems. This review demonstrates the need for interventions that improve social connectedness, individual coping skills, and system navigation.
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Affiliation(s)
| | | | - Jason Gilliland
- Correspondence: Jason Gilliland, PhD, Human Environments Analysis Laboratory, Western University, London, Ontario, Canada ()
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24
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Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Jayatunga W, Kelly G, Black M, Gopfert A, Roderick P, Barr B, Bambra C. Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health 2019; 19:1678. [PMID: 31842835 PMCID: PMC6915896 DOI: 10.1186/s12889-019-7895-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. METHODS Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. RESULTS The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. CONCLUSIONS The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. TRIAL REGISTRATION Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.
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Affiliation(s)
- Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Peter Baker
- Global Health and Development Group, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
| | - Sharif A. Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Taavi Tillmann
- Centre for Global Non-Communicable Diseases, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Darryl Quantz
- NW School of Public Health, Health Education England North West, First Floor Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL UK
| | - Frances Hillier-Brown
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN UK
| | - Wikum Jayatunga
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Gill Kelly
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Michelle Black
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Anya Gopfert
- Junior Doctor and National Medical Director’s Fellow, London, UK
| | - Peter Roderick
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Ben Barr
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Clare Bambra
- Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
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Berube LT, Messito MJ, Woolf K, Deierlein A, Gross R. Correlates of Prenatal Diet Quality in Low-Income Hispanic Women. J Acad Nutr Diet 2019; 119:1284-1295. [PMID: 30956126 PMCID: PMC6663603 DOI: 10.1016/j.jand.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. OBJECTIVE The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. DESIGN This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. PARTICIPANTS The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). MAIN OUTCOME MEASURES Prenatal diet quality was measured by the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. RESULTS Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. CONCLUSIONS Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.
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Affiliation(s)
- Lauren Thomas Berube
- New York University Steinhardt, Department of Nutrition and Food Studies, 411 Lafayette St, 5 Floor, New York, NY 10003, 212-998-5580,
| | - Mary Jo Messito
- New York University School of Medicine, Department of Pediatrics, 462 First Avenue, New York, NY 10016, 212-263-6424,
| | - Kathleen Woolf
- New York University Steinhardt, Department of Nutrition and Food Studies, 411 Lafayette Street, 5 Floor, New York, NY 10003, 212-992-7898,
| | - Andrea Deierlein
- New York University College of Global Public Health, Department of Public Health Nutrition, 715-719 Broadway, 12 Floor, New York, NY 10003,
| | - Rachel Gross
- New York University School of Medicine, Department of Pediatrics, 462 First Avenue, New York, NY 10016, 212-263-8974,
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26
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Milani C, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. An Umbrella Review and Narrative Synthesis of the Effectiveness of Interventions Aimed at Decreasing Food Prices to Increase Food Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2346. [PMID: 31269776 PMCID: PMC6650924 DOI: 10.3390/ijerph16132346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND sustainability of population diet is a public health concern: the high price of healthy food is one of the main causes of diet-related health problems. The aim of this study is to synthesize the evidence produced by systematic reviews that evaluated the effectiveness of decreasing healthy food prices to improve accessibility in order to positively modify the dietary pattern. METHODS We carried out a review of systematic reviews that examined the effects of the interventions, by exploring the online databases PubMed, Embase, Web of Science, Cochrane Library and hand-searching the reference lists. RESULTS after screening by titles and abstracts, we selected 11 systematic reviews that met the inclusion criteria, plus one that was hand-searched. The review generally presented a good quality. Studies concluded that measures aimed at modifying the prices of targeted healthy food were effective in improving population diet by modifying what people buy. CONCLUSIONS the complexity of the outcome-population diet-as well as the poor transferability of data across populations and geographical areas makes it obligatory to provide clear and universal conclusions. Nonetheless, this should not stop policymakers from adapting them and resorting to food fiscal interventions to improve people's diet and health.
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Affiliation(s)
- Chiara Milani
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, 50134 Florence, Italy.
| | - Alberto Baldasseroni
- Department of Prevention, Local Health Unit Toscana Centro, 50135 Florence, Italy
| | - Claudia Dellisanti
- Department of Prevention, Local Health Unit Toscana Centro, 50135 Florence, Italy
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27
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McCartney G, Hearty W, Arnot J, Popham F, Cumbers A, McMaster R. Impact of Political Economy on Population Health: A Systematic Review of Reviews. Am J Public Health 2019; 109:e1-e12. [PMID: 31067117 PMCID: PMC6507992 DOI: 10.2105/ajph.2019.305001] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Abstract
Background. Although there is a large literature examining the relationship between a wide range of political economy exposures and health outcomes, the extent to which the different aspects of political economy influence health, and through which mechanisms and in what contexts, is only partially understood. The areas in which there are few high-quality studies are also unclear. Objectives. To systematically review the literature describing the impact of political economy on population health. Search Methods. We undertook a systematic review of reviews, searching MEDLINE, Embase, International Bibliography of the Social Sciences, ProQuest Public Health, Sociological Abstracts, Applied Social Sciences Index and Abstracts, EconLit, SocINDEX, Web of Science, and the gray literature via Google Scholar. Selection Criteria. We included studies that were a review of the literature. Relevant exposures were differences or changes in policy, law, or rules; economic conditions; institutions or social structures; or politics, power, or conflict. Relevant outcomes were any overall measure of population health such as self-assessed health, mortality, life expectancy, survival, morbidity, well-being, illness, ill health, and life span. Two authors independently reviewed all citations for relevance. Data Collection and Analysis. We undertook critical appraisal of all included reviews by using modified Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria and then synthesized narratively giving greater weight to the higher-quality reviews. Main Results. From 4912 citations, we included 58 reviews. Both the quality of the reviews and the underlying studies within the reviews were variable. Social democratic welfare states, higher public spending, fair trade policies, extensions to compulsory education provision, microfinance initiatives in low-income countries, health and safety policy, improved access to health care, and high-quality affordable housing have positive impacts on population health. Neoliberal restructuring seems to be associated with increased health inequalities and higher income inequality with lower self-rated health and higher mortality. Authors' Conclusions. Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health, and there is a need for higher-quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts. Public Health Implications. Policymakers should be aware that social democratic welfare state types, countries that spend more on public services, and countries with lower income inequalities have better self-rated health and lower mortality. Research funders and researchers should be aware that there remain substantial gaps in the available evidence base. One such area concerns the interrelationship between governance, polities, power, macroeconomic policy, public policy, and population health, including how these aspects of political economy generate social class processes and forms of discrimination that have a differential impact across social groups. This includes the influence of patterns of ownership (of land and capital) and tax policies. For some areas, there are many lower-quality reviews, which leave uncertainties in the relationship between political economy and population health, and a high-quality review is needed. There are also areas in which the available reviews have identified primary research gaps such as the impact of changes to housing policy, availability, and tenure.
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Affiliation(s)
- Gerry McCartney
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Wendy Hearty
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Julie Arnot
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Frank Popham
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Andrew Cumbers
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
| | - Robert McMaster
- Gerry McCartney, Wendy Hearty, and Julie Arnot are with Public Health Science, NHS Health Scotland, Glasgow, Scotland. Frank Popham is with Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow. Gerry McCartney, Andrew Cumbers, and Robert McMaster are with Adam Smith Business School, University of Glasgow
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28
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Hudak KM, Racine EF. The Supplemental Nutrition Assistance Program and Child Weight Status: A Review. Am J Prev Med 2019; 56:882-893. [PMID: 31003806 DOI: 10.1016/j.amepre.2019.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 01/31/2023]
Abstract
CONTEXT The Supplemental Nutrition Assistance Program (SNAP) is a food assistance program that helps Americans afford a healthy diet. However, its influence on children's weight status is unclear. This review examined the evidence of the relationship between SNAP participation and child weight. EVIDENCE ACQUISITION The following databases were searched: PubMed, EconLit, Web of Science, and the U.S. Department of Agriculture Economic Research Service. The last search was performed in October 2018. This systematic review gives a narrative synthesis of included studies. EVIDENCE SYNTHESIS Twenty-three studies that examined the weight outcomes of children aged 2-18 years and SNAP participation were included. Eleven studies found no significant relationship between SNAP and child weight outcomes. Nine found that SNAP participation was associated with increased weight outcomes in certain subpopulations, and four found that SNAP was linked to a predicted decrease in weight outcomes in some subpopulations. However, many of these studies did not address a key methodologic challenge: self-selection. Of those that did, five found that SNAP participation was associated with an increased risk of being overweight and elevated weight in certain subpopulations. CONCLUSIONS SNAP participation may help boys maintain a healthy body weight but can be a contributing factor in being overweight or obese in girls who are long-term participants, or who are already overweight. Food security and participation in multiple food assistance programs may be important modifiers. These findings are relevant to policymakers who are considering reducing SNAP funding or restructuring the program. Further research that utilizes strong designs is needed.
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Affiliation(s)
- Katelin M Hudak
- Department of Public Policy, University of North Carolina-Charlotte, Charlotte, North Carolina.
| | - Elizabeth F Racine
- Department of Public Health Sciences, University of North Carolina-Charlotte, Charlotte, North Carolina
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29
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Sandín Vázquez M, Rivera J, Conde P, Gutiérrez M, Díez J, Gittelsohn J, Franco M. Social Norms Influencing the Local Food Environment as Perceived by Residents and Food Traders: The Heart Healthy Hoods Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E502. [PMID: 30754690 PMCID: PMC6388162 DOI: 10.3390/ijerph16030502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/21/2022]
Abstract
Exploring subjective elements of the food environment remains key to understand why and how residents purchase food. Our aim was to explore and describe the social norms relating to the local food environment and food purchasing behaviors, as perceived by residents and food traders in Madrid, Spain. This qualitative study took place in a middle socioeconomic status neighborhood of Madrid between January 2015 and May 2016. We conducted 35 semi-structured interviews. We used stratified purposive sampling to recruit residents, neighborhood workers (N = 20) and food traders (N = 15) representing different levels of involvement with food purchasing behaviors. We analyzed these data using an interpretative phenomenological analysis approach. Participants highlighted social aspects of the food environment in relation to food purchasing behaviors. First, interpersonal and relational food environment elements were emphasized, including trust and tradition. Participants also identified generational demographic trends in relation to changes in the way residents purchased food: the new pace of life and the lack of time to buy fresh food and to cook at home. All these elements were influenced by the economic crisis. Food environment interventions aiming to improve food purchasing behaviors and residents' diets should consider intermediate social aspects of the food environment like trust and tradition and the fast pace of life of younger generations.
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Affiliation(s)
- María Sandín Vázquez
- Surgery and Medical and Social Sciences Department, School of Medicine, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
| | - Jesús Rivera
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Sociology and Communication Department, Social Sciences Faculty, Salamanca University, 37008 Salamanca, Spain.
| | - Paloma Conde
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
| | - Marta Gutiérrez
- Sociology and Communication Department, Social Sciences Faculty, Salamanca University, 37008 Salamanca, Spain.
| | - Julia Díez
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
| | - Joel Gittelsohn
- Center for Human Nutrition and Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Manuel Franco
- Surgery and Medical and Social Sciences Department, School of Medicine, University of Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, 28871 Madrid, Spain.
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Shahidi FV, Ramraj C, Sod-Erdene O, Hildebrand V, Siddiqi A. The impact of social assistance programs on population health: a systematic review of research in high-income countries. BMC Public Health 2019; 19:2. [PMID: 30606263 PMCID: PMC6318923 DOI: 10.1186/s12889-018-6337-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023] Open
Abstract
Background Socioeconomic disadvantage is a fundamental cause of morbidity and mortality. One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. We conducted a systematic review of research examining the health impact of social assistance programs in high-income countries. Methods We systematically searched Embase, Medline, ProQuest, Scopus, and Web of Science from inception to December 2017 for peer-reviewed studies published in English-language journals. We identified empirical patterns through a qualitative synthesis of the evidence. We also evaluated the empirical rigour of the selected literature. Results Seventeen studies met our inclusion criteria. Thirteen descriptive studies rated as weak (n = 7), moderate (n = 4), and strong (n = 2) found that social assistance is associated with adverse health outcomes and that social assistance recipients exhibit worse health outcomes relative to non-recipients. Four experimental and quasi-experimental studies, all rated as strong (n = 4), found that efforts to limit the receipt of social assistance or reduce its generosity (also known as welfare reform) were associated with adverse health trends. Conclusions Evidence from the existing literature suggests that social assistance programs in high-income countries are failing to maintain the health of socioeconomically disadvantaged populations. These findings may in part reflect the influence of residual confounding due to unobserved characteristics that distinguish recipients from non-recipients. They may also indicate that the scope and generosity of existing programs are insufficient to offset the negative health consequences of severe socioeconomic disadvantage. Electronic supplementary material The online version of this article (10.1186/s12889-018-6337-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Faraz V Shahidi
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
| | - Chantel Ramraj
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Odmaa Sod-Erdene
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Vincent Hildebrand
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Department of Economics, Glendon College, York University, 2275 Bayview Abe, North York, ON, M4N 3M6, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.,Gillings School of Public Health, University of North Carolina, 135 Dauer Dr, Chapel Hill, North Carolina, 27599, USA
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Labonté MÈ, Poon T, Gladanac B, Ahmed M, Franco-Arellano B, Rayner M, L'Abbé MR. Nutrient Profile Models with Applications in Government-Led Nutrition Policies Aimed at Health Promotion and Noncommunicable Disease Prevention: A Systematic Review. Adv Nutr 2018; 9:741-788. [PMID: 30462178 PMCID: PMC6247226 DOI: 10.1093/advances/nmy045] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nutrient profile (NP) models, tools used to rate or evaluate the nutritional quality of foods, are increasingly used by government bodies worldwide to underpin nutrition-related policies. An up-to-date and accessible list of existing NP models is currently unavailable to support their adoption or adaptation in different jurisdictions. This study used a systematic approach to develop a global resource that summarizes key characteristics of NP models with applications in government-led nutrition policies. NP models were identified from an unpublished WHO catalog of NP models last updated in 2012 and from searches conducted in different databases of the peer-reviewed (n = 3; e.g., PubMed) and gray literature (n = 15). Included models had to meet the following inclusion criteria (selected) as of 22 December 2016: 1) developed or endorsed by governmental or intergovernmental organizations, 2) allow for the evaluation of individual food items, and 3) have publicly available nutritional criteria. A total of 387 potential NP models were identified, including n = 361 from the full-text assessment of >600 publications and n = 26 exclusively from the catalog. Seventy-eight models were included. Most (73%) were introduced within the past 10 y, and 44% represent adaptations of ≥1 previously built model. Models were primarily built for school food standards or guidelines (n = 27), food labeling (e.g., front-of-pack; n = 12), and restriction of the marketing of food products to children (n = 10). All models consider nutrients to limit, with sodium, saturated fatty acids, and total sugars being included most frequently; and 86% also consider ≥1 nutrient to encourage (e.g., fiber). No information on validity testing could be identified for 58% of the models. Given the proliferation of NP models worldwide, this new resource will be highly valuable for assisting health professionals and policymakers in the selection of an appropriate model when the establishment of nutrition-related policies requires the use of nutrient profiling.
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Affiliation(s)
- Marie-Ève Labonté
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Theresa Poon
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Branka Gladanac
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beatriz Franco-Arellano
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mike Rayner
- Center on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mary R L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health 2018; 18:869. [PMID: 30005611 PMCID: PMC6044092 DOI: 10.1186/s12889-018-5677-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Socio-economic inequalities are associated with unequal exposure to social, economic and environmental risk factors, which in turn contribute to health inequalities. Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects on health inequalities. METHODS Systematic review methodology was used to identify systematic reviews from high-income countries that describe the health equity effects of upstream public health interventions. Twenty databases were searched from their start date until May 2017. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR). RESULTS Twenty-nine systematic reviews were identified reporting 150 unique relevant primary studies. The reviews summarised evidence of all types of primary and secondary prevention policies (fiscal, regulation, education, preventative treatment and screening) across seven public health domains (tobacco, alcohol, food and nutrition, reproductive health services, the control of infectious diseases, the environment and workplace regulations). There were no systematic reviews of interventions targeting mental health. Results were mixed across the public health domains; some policy interventions were shown to reduce health inequalities (e.g. food subsidy programmes, immunisations), others have no effect and some interventions appear to increase inequalities (e.g. 20 mph and low emission zones). The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted. CONCLUSIONS The review does tentatively suggest interventions that policy makers might use to reduce health inequalities, although whether the programmes are transferable between high-income countries remains unclear. TRIAL REGISTRATION PROSPERO registration number: CRD42016025283.
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Affiliation(s)
- Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Frances Hillier-Brown
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Applied Social Sciences, Durham University, 32 Old Elvet, Durham, DH1 3HN UK
| | - Adam Todd
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU UK
| | - Courtney McNamara
- Department of Sociology and Political Science, Norwegian University of Science and Technology, Building 9, Level 5, 7491 Dragvoll, Trondheim, Norway
| | - Tim Huijts
- Research Centre for Education and the Labour Market, Maastricht University, Tongersestraat 53, 6211 LM Maastricht, The Netherlands
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
- Fuse – UKCRC Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
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Scantlebury RJ, Moody A, Oyebode O, Mindell JS. Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014. J Epidemiol Community Health 2018. [DOI: 10.1136/jech-2017-209954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHealthy Start (HS) is a UK government programme, introduced in 2006, providing vouchers to pregnant women or families with children aged <4 who are in receipt of certain benefits. Vouchers can be exchanged for fruit and vegetables (F&V), milk or infant formula. We sought to identify any association between HS and F&V intake.MethodsWe analysed repeated cross-sectional data from the Health Survey for England. Study participants were classified into one of four groups: one HS-eligible group and three control groups, meeting only the income or demographic or no eligibility criterion. Outcome measures were mean F&V intake and the proportions of participants consuming ≥3 and ≥1 portion/day. Outcomes were compared across the four groups over four time periods: 2001–2003, 2004–2006, 2007–2009 and 2010–2014. Regression analyses examined whether F&V intake among HS-eligible participants had a significantly different rate of change from those in the control groups.ResultsThe change in mean F&V consumption over time was similar in HS-eligible adults and children to that of the control groups. Likewise, the change in odds of consuming ≥3 or ≥1 portion of F&V/day over time was similar among HS-eligible participants and control groups.ConclusionThis study found that during the period 2001–2003 to 2010–2014, F&V consumption among adults and children in households deemed eligible for HS changed similarly to that of other adults and children. Potential explanations include that vouchers may have been spent on milk or infant formula, or that vouchers helped protect F&V consumption in low-income households.
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Household Food Insecurity Is Not Associated with Overall Diet Quality Among Pregnant Women in NHANES 1999-2008. Matern Child Health J 2017; 20:2348-2356. [PMID: 27406151 DOI: 10.1007/s10995-016-2058-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Analyze the association between household food security status and diet quality during pregnancy. METHODS Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes ≤300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ethnicity, education, and household income. RESULTS Among women with household incomes ≤300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample. CONCLUSIONS FOR PRACTICE In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.
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Taillie LS, Grummon AH, Fleischhacker S, Grigsby-Toussaint DS, Leone L, Caspi CE. Best practices for using natural experiments to evaluate retail food and beverage policies and interventions. Nutr Rev 2017; 75:971-989. [PMID: 29190370 PMCID: PMC6280926 DOI: 10.1093/nutrit/nux051] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Policy and programmatic change in the food retail setting, including excise taxes on beverages with added-caloric sweeteners, new supermarkets in food deserts, and voluntary corporate pledges, often require the use of natural experimental evaluation for impact evaluation when randomized controlled trials are not possible. Although natural experimental studies in the food retail setting provide important opportunities to test how nonrandomized interventions affect behavioral and health outcomes, researchers face several key challenges to maintaining strong internal and external validity when conducting these studies. Broadly, these challenges include 1) study design and analysis; 2) selection of participants, selection of measures, and obtainment of data; and 3) real-world considerations. This article addresses these challenges and different approaches to meeting them. Case studies are used to illustrate these approaches and to highlight advantages and disadvantages of each approach. If the trade-offs required to address these challenges are carefully considered, thoughtful natural experimental evaluations can minimize bias and provide critical information about the impacts of food retail interventions to a variety of stakeholders, including the affected population, policymakers, and food retailers.
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Affiliation(s)
- Lindsey Smith Taillie
- Carolina Population Center, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anna H Grummon
- Carolina Population Center, Gillings School of Global Public Health, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sheila Fleischhacker
- Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Diana S Grigsby-Toussaint
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois, Champaign, IL, USA
| | - Lucia Leone
- School of Public Health and Health Professions, Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Caitlin Eicher Caspi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Evans-Agnew RA, Mayer KA, Miller LLL. Opportunities in the integration of primary care and public health nursing: Two case exemplars on physical activity and nutrition. Nurs Forum 2017; 53:40-45. [PMID: 28776723 DOI: 10.1111/nuf.12218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The integration of primary care and public health nursing may provide new opportunities for transforming nursing practice that addresses population health. Effective programs emphasize multilevel approaches that include both downstream (education) and upstream (policy change) actions. The purpose of this article is to identify downstream and upstream nursing actions that integrate public health and primary care practice through two case exemplars concerning disparities in physical activity and nutrition. METHODS Describe two research case exemplars: (1) a secondary analysis of school physical activity policy for female adolescents in 36 public middle schools and (2) a focus group study of African American adults in a community kitchen program. RESULTS In exemplar 1, school policies lacked population-based standards and presented structural disadvantages to African American girls who were already obese. In exemplar 2, participants found the community kitchen program to be more effective than the federally funded nutrition program. DISCUSSION Integrating primary care and public health nursing could improve the tailoring of physical activity and nutrition programs to local populations by following core principles of community engagement, infrastructural sustainability, aligned leadership, and data sharing for population health improvement.
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Affiliation(s)
- Robin A Evans-Agnew
- University of Washington Tacoma, Nursing and Healthcare Leadership Program, Tacoma, WA
| | - Kala A Mayer
- School of Nursing, University of Portland, Portland, OR
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Olstad DL, Ancilotto R, Teychenne M, Minaker LM, Taber DR, Raine KD, Nykiforuk CIJ, Ball K. Can targeted policies reduce obesity and improve obesity-related behaviours in socioeconomically disadvantaged populations? A systematic review. Obes Rev 2017; 18:791-807. [PMID: 28434185 DOI: 10.1111/obr.12546] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 12/19/2022]
Abstract
This review synthesized evidence from controlled studies pertaining to the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged children and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines were followed. Eligible studies were published from 2004 to August 2015 and examined the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged populations. Twenty articles (18 studies) were included. Eight studies examined organizational policies within multi-component interventions in schools. Common elements of successful policy-containing interventions included nutritional standards, enhancements to physical education, additional physical activity opportunities, school self-assessments, and nutrition and physical activity education. Of the 10 studies of government policies, policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children, but no impact amongst adults. Policies involving changes to built environments yielded nearly uniformly null findings in children and adults. Overall, the largest quantity of high-quality evidence of effectiveness was for comprehensive interventions that included school policies, and government policies targeting disadvantaged children in schools. None of the government policies targeting disadvantaged adults proved effective. Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage. Gaps in knowledge remain surrounding effective policies in adults, adolescents and very young children.
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Affiliation(s)
- D L Olstad
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - R Ancilotto
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - M Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - L M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada
| | - D R Taber
- Healthy Food America, Seattle, Washington, USA
| | - K D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - C I J Nykiforuk
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - K Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Martin JC, Moran LJ, Teede HJ, Ranasinha S, Lombard CB, Harrison CL. Exploring Diet Quality between Urban and Rural Dwelling Women of Reproductive Age. Nutrients 2017; 9:E586. [PMID: 28594351 PMCID: PMC5490565 DOI: 10.3390/nu9060586] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022] Open
Abstract
Health disparities, including weight gain and obesity exist between urban and rural dwelling women. The primary aim was to compare diet quality in urban and rural women of reproductive age, and secondary analyses of the difference in macronutrient and micronutrient intake in urban and rural women, and the predictors of diet quality. Diet quality was assessed in urban (n = 149) and rural (n = 394) women by a modified version of the Dietary Guideline Index (DGI) energy, macronutrient and micronutrient intake from a food frequency questionnaire (FFQ) and predictors of diet quality. Diet quality did not significantly differ between urban and rural women (mean ± standard deviation (SD), 84.8 ± 15.9 vs. 83.9 ± 16.5, p = 0.264). Rural women reported a significantly higher intake of protein, fat, saturated fat, monounsaturated fat, cholesterol and iron and a higher score in the meat and meat alternatives component of the diet quality tool in comparison to urban women. In all women, a higher diet quality was associated with higher annual household income (>$Australian dollar (AUD) 80,000 vs. <$AUD80,000 p = 0.013) and working status (working fulltime/part-time vs. unemployed p = 0.043). Total diet quality did not differ in urban and rural women; however, a higher macronutrient consumption pattern was potentially related to a higher lean meat intake in rural women. Women who are unemployed and on a lower income are an important target group for future dietary interventions aiming to improve diet quality.
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Affiliation(s)
- Julie C Martin
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia.
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia.
- Endocrinology and Diabetes Units, Monash Health, Melbourne 3004, Australia.
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia.
| | - Catherine B Lombard
- Department of Nutrition and Dietetics, School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia.
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne 3004, Australia.
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Kino S, Bernabé E, Sabbah W. Socioeconomic inequality in clusters of health-related behaviours in Europe: latent class analysis of a cross-sectional European survey. BMC Public Health 2017; 17:497. [PMID: 28535751 PMCID: PMC5442654 DOI: 10.1186/s12889-017-4440-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Modifiable health-related behaviours tend to cluster among most vulnerable sectors of the population, particularly those at the bottom of the social hierarchy. This study aimed to identify the clusters of health-related behaviours in 27 European countries and to examine the socioeconomic inequalities in these clusters. Methods Data were from Eurobarometer 72.3–2009, a cross-sectional survey of 27 European countries. The analyses were conducted in 2016. The main sections of the survey included questions pertaining to sociodemographic factors, health-related behaviours, and use of services. In this study, those aged 18 years and older were included. We selected five health-related behaviours, namely smoking, excessive alcohol consumption, frequent fresh fruit consumption, physical activity and dental check-ups. Socioeconomic position was indicated by education, subjective social status and difficulty in paying bills. Latent class analysis was conducted to explore the clusters of these five behaviours. Multinomial logistic regression model was used to examine the relationships between the clusters and socioeconomic positions adjusting for age, gender, marital status and urbanisation. Results The eligible total population was 23,842. Latent class analysis identified three clusters; healthy, moderate and risky clusters in this European population. Individuals with the lowest socioeconomic position were more likely to have risky and moderate clusters than healthy cluster compared to those with the highest socioeconomic position. Conclusions There were clear socioeconomic gradients in clusters of health-related behaviours. The findings highlight the importance of adopting interventions that address multiple health risk behaviours and policies that tackle the social determinants of health-related behaviours.
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Affiliation(s)
- Shiho Kino
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Bessemer Road, Denmark Hill, London, SE5 9RS, UK.
| | - Eduardo Bernabé
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Bessemer Road, Denmark Hill, London, SE5 9RS, UK
| | - Wael Sabbah
- Division of Population and Patient Health, King's College London Dental Institute at Guy's, King's College and St Thomas' Hospitals, Bessemer Road, Denmark Hill, London, SE5 9RS, UK
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Simmet A, Depa J, Tinnemann P, Stroebele-Benschop N. The Dietary Quality of Food Pantry Users: A Systematic Review of Existing Literature. J Acad Nutr Diet 2017; 117:563-576. [DOI: 10.1016/j.jand.2016.08.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 08/18/2016] [Indexed: 10/20/2022]
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Ruckert A, Labonté R. Health inequities in the age of austerity: The need for social protection policies. Soc Sci Med 2017; 187:306-311. [PMID: 28359581 DOI: 10.1016/j.socscimed.2017.03.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
This commentary assesses the impacts of the global austerity drive on health inequities in the aftermath of the global financial crisis of 2008. In doing so, it first locates the origins of austerity within the 40 year history of neoliberal economic orthodoxy. It then describes the global diffusion of austerity since 2008, and its key policy tenets. It next describes the already visible impacts of austerity-driven welfare reform on trends in health equity, and documents how austerity has exacerbated health inequities in countries with weak social protection policies. We finally identify the components of an alternative policy response to the financial crisis than that of austerity, with specific reference to the need for shifts in national and global taxation policies and public social protection policies and spending. We conclude with a call for a reorientation of public policy towards making human health an overarching global policy goal, and how this aligns with the multilaterally agreed upon Sustainable Development Goals.
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Affiliation(s)
- Arne Ruckert
- University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, 850 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada.
| | - Ronald Labonté
- University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, 850 Peter Morand Crescent, Ottawa, ON K1G 5Z3, Canada.
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Davison KM, Gondara L, Kaplan BJ. Food Insecurity, Poor Diet Quality, and Suboptimal Intakes of Folate and Iron Are Independently Associated with Perceived Mental Health in Canadian Adults. Nutrients 2017; 9:E274. [PMID: 28335418 PMCID: PMC5372937 DOI: 10.3390/nu9030274] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/04/2017] [Accepted: 03/10/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND To address nutrition-related population mental health data gaps, we examined relationships among food insecurity, diet quality, and perceived mental health. METHODS Stratified and logistic regression analyses of respondents aged 19-70 years from the Canadian Community Health Survey, Cycle 2.2 were conducted (n = 15,546). Measures included the Household Food Security Survey Module, diet quality (i.e., comparisons to the Dietary Reference Intakes, Healthy Eating Index), perceived mental health (poor versus good), sociodemographics, and smoking. RESULTS In this sample, 6.9% were food insecure and 4.5% reported poor mental health. Stratified analysis of food security and mental health status by age/gender found associations for poor diet quality, protein, fat, fibre, and several micronutrients (p-values < 0.05); those who were food insecure tended to have higher suboptimal intakes (p-values < 0.05). After adjustment for covariates, associations in relation to mental health emerged for food insecurity (OR = 1.60, 95% CI 1.45-1.71), poor diet quality (1.61, 95% CI 1.34-1.81), and suboptimal intakes of folate (OR = 1.58, 95% CI 1.17-1.90) and iron (OR = 1.45, 95% CI 1.23-1.88). CONCLUSIONS Population approaches that improve food security and intakes of high quality diets may protect people from poor mental health.
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Affiliation(s)
- Karen M Davison
- School of Nursing, University of British Columbia and Health Science Program, Department of Biology, Kwantlen Polytechnic University, Surrey, BC V3W 2M8, Canada.
| | - Lovedeep Gondara
- Department of Computer Science, University of Illinois Springfield and Department of Computer Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Bonnie J Kaplan
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
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Levin SM, Barnard ND, Saltalamacchia RE. A Proposal for Improvements in the Supplemental Nutrition Assistance Program. Am J Prev Med 2017; 52:S186-S192. [PMID: 28109421 DOI: 10.1016/j.amepre.2016.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/06/2016] [Accepted: 07/20/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Susan M Levin
- Physicians Committee for Responsible Medicine, Washington, District of Columbia.
| | - Neal D Barnard
- Physicians Committee for Responsible Medicine, Washington, District of Columbia; Department of Medicine, George Washington University, Washington, District of Columbia
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Brimblecombe J, Ferguson M, Chatfield MD, Liberato SC, Gunther A, Ball K, Moodie M, Miles E, Magnus A, Mhurchu CN, Leach AJ, Bailie R. Effect of a price discount and consumer education strategy on food and beverage purchases in remote Indigenous Australia: a stepped-wedge randomised controlled trial. LANCET PUBLIC HEALTH 2017; 2:e82-e95. [PMID: 29253401 DOI: 10.1016/s2468-2667(16)30043-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/01/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evidence is mounting that price discounts can be effective in improving diet. This study examined the effectiveness of a 20% price discount on food and drink purchases with and without consumer education in remote Indigenous Australia. METHODS A 20% discount on fruit, vegetables, water, and artificially sweetened soft drinks was applied for 24 weeks in 20 communities in remote Indigenous Australia where the community store was managed by the Arnhem Land Progress Aboriginal Corporation (ALPA) or Outback Stores (OBS) in a stepped-wedge randomised trial. Communities were randomly allocated to a fixed framework of five sets of four stratified by store association; ten stores (two in each set) were randomly assigned to receive consumer education. A store from each of the ALPA and OBS store groups (contained in separate opaque envelopes) was selected, and stores in turn continued to be consecutively allocated to the fixed store set framework, starting with the first store slot in the first store set, until all stores had been allocated. The effect of the discount on the weight of fruit and vegetables purchased (the primary endpoint) was assessed using weekly store sales data and mixed models per protocol. We did sensitivity analyses by repeating the analyses with the outliers included and repeating the analyses for the primary outcome measure removing each store one at a time. This trial was registered with Australian New Zealand Clinical Trials Registry, number ACTRN12613000694718. FINDINGS Weekly store sales data on all food and drink products sold in 20 stores were collected from July 1, 2012, to Dec 28, 2014. Price discount alone was associated with a 12·7% (95% CI 4·1-22·1) increase in purchases in grams of fruit and vegetables combined (primary outcome), and a 19·8% (6·2-35·1) increase post discount (after vs before); an effect of 12 g and 18 g per capita per day. Sensitivity analyses did not modify the results for the primary outcome measure. INTERPRETATION A 20% discount can only increase fruit and vegetable purchases to help protect against obesity and diet related disease to a certain extent. Large discounts might have a greater impact than small discounts. Creative merchandising approaches to consumer education could also be considered alongside fiscal interventions to achieve marked improvements in diet. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Royal Darwin Hospital Campus, Tiwi, NT, Australia.
| | - Megan Ferguson
- Wellbeing and Preventable Chronic Diseases Division, Royal Darwin Hospital Campus, Tiwi, NT, Australia; Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, SA Australia
| | - Mark D Chatfield
- Wellbeing and Preventable Chronic Diseases Division, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Selma C Liberato
- Wellbeing and Preventable Chronic Diseases Division, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Anthony Gunther
- Wellbeing and Preventable Chronic Diseases Division, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia, Geelong, VIC, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Australia, Geelong, VIC, Australia
| | - Edward Miles
- Indigenous Community Volunteers, 1/67 Townshend Street, Phillip, ACT, Australia
| | - Anne Magnus
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Australia, Geelong, VIC, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Amanda Jane Leach
- Child Health Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, NT, Australia
| | - Ross Bailie
- University Centre for Rural Health North Coast, University of Sydney, Lismore, NSW, Australia
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Bruening M, McClain D, Moramarco M, Reifsnider E. The Role of SNAP in Home Food Availability and Dietary Intake among WIC Participants Facing Unstable Housing. Public Health Nurs 2017; 34:219-228. [PMID: 28084013 DOI: 10.1111/phn.12311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little nutrition research has been conducted among families with unstable housing. The objective of this study was to examine the role of food stamps (i.e., Supplemental Nutrition Assistance Program; SNAP) in home food availability and dietary intake among WIC families who experienced unstable housing. DESIGN AND SAMPLE Cross-sectional study among vulnerable families. Low-income, multiethnic families with children participating in WIC (n = 54). MEASURES Dietary intake was assessed with 24-hr recalls. Home food availability was assessed with an adapted home food inventory for low-income, multiethnic families. Validation results from adapted home food inventory for these families are also reported. RESULTS SNAP households had more foods than non-SNAP households; few significant associations were observed between food availability and child dietary intake. CONCLUSIONS With few exceptions, the home food environment was not related to children's dietary intake among these vulnerable families. More research is needed on food access for families facing unstable housing.
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Affiliation(s)
- Meg Bruening
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, Arizona
| | - Darya McClain
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Michael Moramarco
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Elizabeth Reifsnider
- College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
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The effects of policy actions to improve population dietary patterns and prevent diet-related non-communicable diseases: scoping review. Eur J Clin Nutr 2016; 71:694-711. [PMID: 27901036 PMCID: PMC5470099 DOI: 10.1038/ejcn.2016.234] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/13/2022]
Abstract
Poor diet generates a bigger non-communicable disease (NCD) burden than tobacco, alcohol and physical inactivity combined. We reviewed the potential effectiveness of policy actions to improve healthy food consumption and thus prevent NCDs. This scoping review focused on systematic and non-systematic reviews and categorised data using a seven-part framework: price, promotion, provision, composition, labelling, supply chain, trade/investment and multi-component interventions. We screened 1805 candidate publications and included 58 systematic and non-systematic reviews. Multi-component and price interventions appeared consistently powerful in improving healthy eating. Reformulation to reduce industrial trans fat intake also seemed very effective. Evidence on food supply chain, trade and investment studies was limited and merits further research. Food labelling and restrictions on provision or marketing of unhealthy foods were generally less effective with uncertain sustainability. Increasingly strong evidence is highlighting potentially powerful policies to improve diet and thus prevent NCDs, notably multi-component interventions, taxes, subsidies, elimination and perhaps trade agreements. The implications for policy makers are becoming clearer.
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Peeters A, Blake MRC. Socioeconomic Inequalities in Diet Quality: from Identifying the Problem to Implementing Solutions. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0167-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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48
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Spatial Modelling of the Relationship Between Socio-Economic Disadvantage and Child Health in Namibia. SPATIAL DEMOGRAPHY 2016. [DOI: 10.1007/s40980-016-0022-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Friel S, Hattersley L, Ford L, O'Rourke K. Addressing inequities in healthy eating: Table 1:. Health Promot Int 2015; 30 Suppl 2:ii77-88. [DOI: 10.1093/heapro/dav073] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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50
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Moore TG, McDonald M, Carlon L, O'Rourke K. Early childhood development and the social determinants of health inequities. Health Promot Int 2015; 30 Suppl 2:ii102-15. [DOI: 10.1093/heapro/dav031] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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