1
|
Gerritsen S, Rosin M, Te Morenga L, Jiang Y, Kidd B, Shen S, Umali E, Mackay S, Ni Mhurchu C. Awareness, support, and opinions of healthy food and drink policies: a survey of staff and visitors in New Zealand healthcare organisations. BMC Public Health 2024; 24:2179. [PMID: 39135033 PMCID: PMC11318292 DOI: 10.1186/s12889-024-19693-2] [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] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/05/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND In 2016, a voluntary National Healthy Food and Drink Policy (hereafter, "the Policy") was released to encourage public hospitals in New Zealand to provide food and drink options in line with national dietary guidelines. Five years later, eight (of 20) organisations had adopted it, with several preferring to retain or update their own institutional-level version. This study assessed staff and visitors' awareness and support for and against the Policy, and collected feedback on perceived food environment changes since implementation of the Policy. METHODS Cross-sectional electronic and paper-based survey conducted from June 2021 to August 2022. Descriptive statistics were used to present quantitative findings. Free-text responses were analysed following a general inductive approach. Qualitative and quantitative findings were compared by level of implementation of the Policy, and by ethnicity and financial security of participants. RESULTS Data were collected from 2,526 staff and 261 visitors in 19 healthcare organisations. 80% of staff and 56% of visitors were aware of the Policy. Both staff and visitors generally supported the Policy, irrespective of whether they were aware of it or not, with most agreeing that "Hospitals should be good role models." Among staff who opposed the Policy, the most common reason for doing so was freedom of choice. The Policy had a greater impact, positive and negative, on Māori and Pacific staff, due to more frequent purchasing onsite. Most staff noticed differences in the food and drinks available since Policy implementation. There was positive feedback about the variety of options available in some hospitals, but overall 40% of free text comments mentioned limited choice. 74% of staff reported that food and drinks were more expensive. Low-income staff/visitors and shift workers were particularly impacted by reduced choice and higher prices for healthy options. CONCLUSIONS The Policy led to notable changes in the healthiness of foods and drinks available in NZ hospitals but this was accompanied by a perception of reduced value and choice. While generally well supported, the findings indicate opportunities to improve implementation of food and drink policies (e.g. providing more healthy food choices, better engagement with staff, and keeping prices of healthy options low) and confirm that the Policy could be expanded to other public workplaces.
Collapse
Affiliation(s)
- Sarah Gerritsen
- School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, Auckland, New Zealand.
| | - Magda Rosin
- School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, Auckland, New Zealand
| | - Lisa Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Yannan Jiang
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Bruce Kidd
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Stephanie Shen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Te Whatu Ora - Te Toka Tumai Auckland, Auckland, New Zealand
| | - Elaine Umali
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, Auckland, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- George Institute for Global Health, Sydney, Australia
| |
Collapse
|
2
|
Verra SE, Poelman MP, de Wit J, Kamphuis CBM. An unequal health policy landscape? Examining socioeconomic differences in acceptability and preferences for policies that aim to reduce socioeconomic inequalities in health. J Epidemiol Community Health 2024:jech-2024-222449. [PMID: 39048293 DOI: 10.1136/jech-2024-222449] [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: 05/06/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND This study explores socioeconomic differences in acceptability and preferences for policies that aim to reduce socioeconomic health inequalities. The investigated policies range from structural policies, requiring no individual agency, to agentic policies, which depend on the individual agency for behaviour change. METHODS An online, cross-sectional survey was conducted among 1182 participants, stratified by education and representative of Dutch adults (aged 25-65) for age and gender. Across 31 policies, including structural socioeconomic policies, structural housing and neighbourhood policies, structural and agento-structural behavioural policies (facilitating behaviour) and agentic policies (focusing on information provision for behaviour change), acceptability was measured on a 7-point scale, preferences were measured using participants' top-5 policy choices. Regression analyses examined socioeconomic differences in acceptability and preferences based on education and income, controlling for age, gender, receiving welfare, and employment. RESULTS People in lower socioeconomic positions were more likely to accept and favour structural socioeconomic policies, whereas those in higher socioeconomic positions were more likely to accept and favour structural housing and neighbourhood, structural and agento-structural behavioural, and agentic policies. Socioeconomic differences were the largest for agentic policies. Overall, 83.3% preferred at least one structural socioeconomic policy, while only 32% preferred an agentic policy. Most preferred was eliminating taxes on fruits and vegetables, (preferred by 41.4%), and least preferred was a campaign promoting healthy nutrition (preferred by 3.9%). CONCLUSIONS These socioeconomic differences in policy support underscore the need for inclusive policymaking processes. Including the perspectives of people in lower socioeconomic positions helps to ensure that their needs are met.
Collapse
Affiliation(s)
- Sanne E Verra
- Faculty of Social and Behavioural Sciences, Universiteit Utrecht, Utrecht, Utrecht, Netherlands
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Gelderland, Netherlands
| | - John de Wit
- Faculty of Social and Behavioural Sciences, Universiteit Utrecht, Utrecht, Utrecht, Netherlands
| | - Carlijn B M Kamphuis
- Faculty of Social and Behavioural Sciences, Universiteit Utrecht, Utrecht, Utrecht, Netherlands
| |
Collapse
|
3
|
Carmignani F. Why nanny statism matters: evidence from the first wave of COVID-19. BMC Public Health 2024; 24:1963. [PMID: 39044203 PMCID: PMC11265364 DOI: 10.1186/s12889-024-19477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/14/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND A nanny state imposes restrictions on people's liberty and freedom of action in order to advance their interest and welfare. The extent to which this is desirable, or even ethically acceptable, is debated in the literature. This paper formulates and tests the following hypothesis: the more of a nanny a state has been in the past, the more likely it is that the incumbent government will respond to a new, unknown threat with interventions of a paternalist nature, irrespective of other factors that might contribute to shaping government's response. This hypothesis is then taken to the data using the first wave of COVID-19 as an empirical test. METHODS Data are collected from secondary sources for a sample of 99 countries. Nanny statism is measured by the number of paternalist laws and regulations adopted by a country in the past. The response to COVID is proxied by the time of adoption of control and containment measures and their stringency. The public health outcome is measured by the COVID-19 death toll at the end of June 2020. These variables, plus several controls, are then used to estimate a set of linear and probit regressions and a proportional hazard model of the timing of adoption of control and containment measures. RESULTS An increase in nanny statism by 0.1 (on a scale from 0 to 10) on average increases the probability of adoption of control and containment measures by 0.077 (i.e. 7.7 percentage points). The central tenement of the hypothesis is therefore consistent with the empirical evidence. The linear and probit regressions also show that there is no evidence of a significant effect of nanny statism on the stringency of the measures adopted. Irrespective of stringency, however, early adoption of control and containment measures is found to reduce the death toll of COVID-19 in the first half of 2020: an increase in nanny statism by 0.1 reduces the COVID death toll by approximately 7%. CONCLUSIONS A tradition of nanny statism potentially leads to a more timely and effective public policy response to a new, unknown crisis. Further tests of the hypothesis should look at the relationship between nanny statism and public health outcomes from natural disasters.
Collapse
Affiliation(s)
- Fabrizio Carmignani
- School of Business, University of Southern Queensland, Toowoomba, Australia.
| |
Collapse
|
4
|
Humphreys L, O'Flaherty C, Ambrosini GL. Public support for obesity prevention policies in Western Australia from 2012 to 2020: Findings from cross-sectional surveys. Health Promot J Austr 2024; 35:701-712. [PMID: 37674287 DOI: 10.1002/hpja.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/09/2023] [Accepted: 08/19/2023] [Indexed: 09/08/2023] Open
Abstract
ISSUE ADDRESSED This study explored trends in public support for obesity prevention policies in Western Australia (WA). METHODS A series of cross-sectional surveys of a representative sample of WA adults aged 25-49 years (N = 11 534) were undertaken between 2012 and 2020 as part of an evaluation of the LiveLighter® mass media campaign, a component of a statewide healthy lifestyle education and promotion programme. Computer-assisted telephone interviews were used to gauge support for a range of obesity prevention initiatives that could be implemented by government. RESULTS A majority of respondents supported a range of obesity prevention policies, including taxes on sugary drinks, urban planning regulations, food labelling and packaging regulations, restrictions on advertising and sponsorship, bans on the sale and marketing of unhealthy food and drink in retail environments and support for education and campaigns. Obesity prevention policies were highly supported by women, people with a healthy weight, and those who had completed secondary school. Support for regulation was high compared to other studies. Notably, there were significant increases in support between baseline and 2020 for 'taxing soft drinks and using the money to reduce the cost of healthy food' (72% cf. 80%) and 'restricting junk food promotions/advertisements on public transport' (73% cf. 83%). CONCLUSIONS There is substantial public support for regulatory action on obesity prevention in WA, providing strong rationale for government interventions to improve nutrition and reduce obesity. The LiveLighter® programme may have contributed to increases in support for obesity prevention policies in WA. SO WHAT?: There is potential to implement robust obesity prevention policies in WA.
Collapse
Affiliation(s)
- Lauren Humphreys
- Public and Aboriginal Health Division, Western Australian Department of Health, Perth, Australia
| | - Ciara O'Flaherty
- Public and Aboriginal Health Division, Western Australian Department of Health, Perth, Australia
| | - Gina L Ambrosini
- Public and Aboriginal Health Division, Western Australian Department of Health, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| |
Collapse
|
5
|
Ge R, You S, Zheng D, Zhang Z, Cao Y, Chang J. Global, regional, and national temporal trends of diet-related ischemic stroke mortality and disability from 1990 to 2019. Int J Stroke 2024; 19:665-675. [PMID: 38415357 DOI: 10.1177/17474930241237932] [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: 02/29/2024]
Abstract
BACKGROUND Stroke is the second leading cause of death and the third leading cause of disability in the general population worldwide. However, the changing trend of ischemic stroke burden attributable to various dietary risk factors has not been fully revealed and may contribute to a better understanding of stroke epidemiology. AIMS Our article aimed to evaluate the temporal trend of diet-related ischemic stroke burden to inform future research and policy-making. METHODS This analysis was based on the data from the Global Burden of Disease (GBD) Study 2019 (spanning years 1990 to 2019), and we used the joinpoint regression to model temporal trends in diet-related ischemic stroke burden across countries and regions of the world during the study period. Six specific dietary factors known to influence stroke risk, including sodium, red meat, fiber, vegetables, whole grains, and fruits, were evaluated in the GBD study to determine their individual and joint impact on ischemic stroke. The changing trend was primarily measured by the average annual percent change (AAPC). Age-standardized rates (ASRs) of mortality and years lived with disability (YLD) per 100,000 population were used to evaluate disease burden. Finally, the socioeconomic background, which was quantified as sociodemographic index (SDI), and its association with diet-related ischemic stroke burden were also explored with the Pearson correlation coefficient. RESULTS During the study period, the ischemic stroke ASR of mortality attributable to overall dietary risk decreased by an average of 1.6% per year, while the ASR of YLD decreased by an average of 0.2% per year. High sodium diet was still a key driver of diet-related ischemic stroke, accounting for 8.4% and 11.0% of deaths and disabilities, respectively, in 2019. In addition, we found a negative association between temporal evolution of stroke burden and socioeconomic background (r = -0.6603 for mortality and r = -0.4224 for disability, P < 0.001), which suggested that the developing countries with weak social and economic foundation faced greater challenges from the ongoing burden of diet-related strokes compared with developed countries. CONCLUSIONS Our study found declining trends and revealed the current status of diet-related ischemic stroke mortality and disability. Interdisciplinary countermeasures involving the development of effective food policies, evidence-based guidelines, and public education are needed in the future to combat this global epidemic. DATA ACCESS STATEMENT The data used for analysis were open-access and can be obtained from https://vizhub.healthdata.org/gbd-results/.
Collapse
Affiliation(s)
- Rongguang Ge
- Department of Neurology and Clinical Research Center of Neurological Disease, Soochow Medical College, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology and Clinical Research Center of Neurological Disease, Soochow Medical College, The Second Affiliated Hospital of Soochow University, Suzhou, China
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Danni Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Zengli Zhang
- Department of Occupational and Environmental Health, School of Public Health, Soochow Medical College, Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Clinical Research Center of Neurological Disease, Soochow Medical College, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Chang
- Department of Occupational and Environmental Health, School of Public Health, Soochow Medical College, Soochow University, Suzhou, China
| |
Collapse
|
6
|
Harris JL, Taillie LS. More than a Nuisance: Implications of Food Marketing for Public Health Efforts to Curb Childhood Obesity. Annu Rev Public Health 2024; 45:213-233. [PMID: 38109516 DOI: 10.1146/annurev-publhealth-090419-102616] [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: 12/20/2023]
Abstract
Fifteen years ago, public health experts urged industry, governments, and advocates to take action to dramatically improve the unhealthy food-marketing environment surrounding children in order to address the global childhood obesity crisis. Since then, research has confirmed that food marketing to children has far-reaching negative effects on their diets and health, takes advantage of adolescent vulnerabilities, and contributes to health disparities. In addition, digital marketing has profoundly changed young people's engagement with brands. Moreover, reliance on industry self-regulation as a solution has proven ineffective. Government-led policies have been more successful, but they remain limited in scope and challenging to adopt and implement. New approaches are necessary to increase public and policy maker awareness that food marketing is more than a nuisance, that it threatens the long-term health of children and adolescents worldwide, and that meaningful governmental action is urgently required to curtail industry's negative impact on young people's well-being.
Collapse
Affiliation(s)
- Jennifer L Harris
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, Connecticut, USA;
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
7
|
Nuss T, Chen YJM, Scully M, Hickey K, Martin J, Morley B. Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products. Health Promot J Austr 2024; 35:332-339. [PMID: 37286359 DOI: 10.1002/hpja.755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
ISSUE ADDRESSED This study assessed Australian adults' attitudes towards government actions to protect children from digital marketing of unhealthy food and drink products. METHODS An online survey was undertaken by Australian adults aged 18-64 recruited via two national panels in December 2019 (N = 2044). RESULTS Most respondents (69%) agreed the Government should protect children from unhealthy food and drink marketing and advertising broadly. Those who agreed most commonly indicated children should be protected up to age 16 (34%) or 18 (24%). There was widespread support for government actions to stop unhealthy food and drink marketing on digital platforms (e.g., internet sites) (68%-69%) and various digital marketing techniques (e.g., advertising by brands on social media) (56%-71%). A total ban on targeting unhealthy food and drink marketing to children online received the highest level of support (76%). Most respondents (81%) disagreed unhealthy food and drink companies should be able to collect children's personal information for marketing purposes. Support for examined actions was generally higher among older adults, more educated adults and more frequent internet users, lower among males, and similar between parents and non-parents. CONCLUSIONS There is public perception that the government is responsible for protecting children, well into adolescence, from unhealthy food and drink marketing broadly. Widespread public support extends to specific actions to reduce children's exposure to digital marketing of unhealthy food and drink products. SO WHAT?: Implementation of policies to protect children from digital marketing of unhealthy food and drink products would be well received by the Australian public.
Collapse
Affiliation(s)
- Tegan Nuss
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Yan Jun Michelle Chen
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | - Maree Scully
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| | | | - Jane Martin
- Food For Health Alliance, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria, Australia
| |
Collapse
|
8
|
Lei X, MacKenzie C. Quantifying the risk of mass shootings at specific locations. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024; 44:868-882. [PMID: 37607802 DOI: 10.1111/risa.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Mass shootings are horrific events that annually take scores of innocent lives in the United States. Federal, state, and local governments as well as educational, religious, and private-sector organizations propose and enact polices and strategies to protect people from and during active shooter situations. A probabilistic risk assessment of a mass shooting for a specific organization, jurisdiction, or location can be the first step toward evaluating the effectiveness of risk mitigation strategies and determining which strategies might be most appropriate for a location. This article proposes a novel hierarchical method to assess the probability of a mass shooting at specific locations based on available historical data. First, the method generates a probability distribution over the annual number of mass shootings in the United States. Second, the article uses this national number of mass shootings to determine the risk for each state. Third, the state risk assessment is decomposed to calculate the probability of a mass shooting in a specific location such as a school. Multiple ways to assess the risk are presented, leading to slightly different probability assessments for a location. Results indicate that annual probability of a mass shooting in the largest high school in California is on the order of10 - 6 - 10 - 5 $10^{-6}-10^{-5}$ , and the annual probability of a mass shooting in the largest high school in Iowa is about half as likely as in the California school.
Collapse
Affiliation(s)
- Xue Lei
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, Iowa, USA
| | - Cameron MacKenzie
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, Iowa, USA
| |
Collapse
|
9
|
Lemken D, Wahnschafft S, Eggers C. Public acceptance of default nudges to promote healthy and sustainable food choices. BMC Public Health 2023; 23:2311. [PMID: 37993839 PMCID: PMC10664270 DOI: 10.1186/s12889-023-17127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Default nudges are an increasingly prominent tool for promoting healthy and sustainable food choices; however, questions of acceptance remain. While default nudges are more acceptable to the public than traditionally paternalistic tools that aim to restrict choice, they are also the least acceptable amongst nudging strategies. Little research has investigated the aspects of default nudge design that can be leveraged to better uphold freedom of choice, increase public acceptance, and therefore heighten legitimacy of default nudges. Consequently, this study examines public acceptance of five food choice default nudges with demonstrated precedent of effectiveness, as drawn from research studies and/or real-world policies, along with a design variation of each anticipated to increase acceptance. Three drivers of acceptance - perceived intrusiveness, perceived effectiveness, and own behavior - are examined. METHODS An online survey was administered in Germany (N = 451) to a sample representative of the adult population on quotas of age, gender and income. Acceptance and drivers were measured using seven-point Likert scales. Significant differences in median acceptance of the nudge were determined and displayed graphically. Ten proportional odds ordered logit models were applied and estimated using a maximum likelihood approach to investigate the mechanisms of nudge acceptance. RESULTS Examined changes in nudge design, particularly decreasing costliness of opting out and increasing transparency, increased the acceptance of three of the five nudges (N2.2: p = 0.000; N3.2: p = 0.000; N4.2: p = 0.008). Perceived intrusiveness emerged as the most prominent driver of acceptance (negative relationship), followed by perceived effectiveness (positive relationship). Own engagement in the target behavior of the nudge and socio-demographic variables demonstrated negligible impact on acceptance. CONCLUSIONS Mitigating the costliness of opting out and improving nudge transparency emerge as key opportunities for choice architects to improve public acceptance, and thereby potentially identify 'sweet spots' in designing default nudges that are both effective and acceptable. The protection of individual freedom of choice and effectiveness are key aspects for choice architects to communicate to increase acceptance.
Collapse
Affiliation(s)
- Dominic Lemken
- Institute for Food and Resource Economics, University of Bonn, Nußallee 21, 53115, Bonn, Germany
| | - Simone Wahnschafft
- Research Training Group in Sustainable Food Systems, University of Göttingen, Heinrich- Düker-Weg 12, 37073, Göttingen, Germany.
| | | |
Collapse
|
10
|
Quevedo KL, Jáuregui A, Nieto C, Ortiz-Panozo E, Contreras-Manzano A, Barquera S, Vanderlee L, White CM, Hammond D. Public support for food policies in Mexican adults: Findings from the International Food Policy Study, 2017-2021. Prev Med 2023; 175:107710. [PMID: 37775082 PMCID: PMC10644906 DOI: 10.1016/j.ypmed.2023.107710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
Deaths attributable to unhealthful eating underscore the need to improve dietary patterns through upstream, policy-led solutions. The approval and successful implementation of food policies is partly determined by their public acceptance. Little is known about public support for food policies in Mexico. We aimed to investigate the level of public support for 30 food policies, grouped into 5 domains, and their associated characteristics among Mexican adults. Data are from the 2017-2021 International Food Policy Study (IFPS), a cross-sectional web-based survey of adults. Differences in public support across years were estimated using linear regression models. The association between demographic characteristics and policy support was analyzed using multivariate logistic regression models. The highest mean support was for the subsidies and benefits domain, followed by the labelling and reformulation domain. The level of support varied across years and policy domains. Support was higher in 2019 compared to 2017 and 2018, and subsequently lower in 2020 and 2021 compared to previous years. Older age was associated with greater support across all domains (OR ranged from 0.002 to 0.004, p < 0.01). Female participants and those selfidentifying as indigenous showed greater support for certain policy domains, whereas higher income adequacy was associated with lower support for other policy domains. In Mexico, support for food policies varies across subpopulations. Our findings may serve as a guide to the development and promotion of food policies in Mexico, as well as to improve their feasibility and success.
Collapse
Affiliation(s)
- Kathia Larissa Quevedo
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Alejandra Contreras-Manzano
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico; National Council for Humanities, Science and Technology, 1528 de los Insurgentes Avenue, Crédito Constructor, Benito Juárez 03940, Mexico City, Mexico.
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Lana Vanderlee
- School of Nutrition, Université Laval, 2440 boulevard Hochelaga, Quebec, QC G1V 0A6, Canada.
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| |
Collapse
|
11
|
Dhuria P, Muir S, Lawrence W, Roe E, Crozier S, Cooper C, Baird J, Vogel C. Women Consumers' Views on Legislation to Restrict Prominent Placement and Multibuy Promotions of High Fat, Sugar, and Salt Products in England: A Qualitative Perspective. Int J Health Policy Manag 2023; 12:7597. [PMID: 38618804 PMCID: PMC10590244 DOI: 10.34172/ijhpm.2023.7597] [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: 08/05/2022] [Accepted: 08/15/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND As part of the childhood obesity strategy, the UK Government has introduced regulations to restrict the ways high fat salt and sugar (HFSS) products can be promoted in retail settings from October 2022. This study explored (i) consumers' views on the likely impact of the UK legislation restricting the placement and promotion of HFSS products on their shopping behaviours and (ii) consumers' beliefs about who is responsible for healthy eating. METHODS Using a cross-sectional study design, qualitative semi-structured telephone interviews were conducted with a purposive sample of women who shopped at a discount supermarket. Thematic analysis was employed to identify key themes. RESULTS Participants' (n = 34) had a median age of 35 years and over half were in paid employment. Five themes were identified: (1) The legislation is acceptable, but people can still (and should be able to) buy HFSS items; (2) The legislation is likely to have more impact on shoppers who do not plan their shopping; (3) Affordability of healthy food is just as, or more, important than the legislation; (4) It's up to the individual to eat healthily; and (5) Government and retailers can better support consumers to make healthy choices. CONCLUSION Most participants were optimistic about the incoming regulations and believed that it would support consumers to make healthier food choices. Many raised concerns, however, that the high price of healthy foods and continued availability of unhealthy foods within the stores could undermine the legislation's benefits. Coupling the legislation with interventions to promote and reduce the costs of healthier products would go some way to ensure its success. Raising awareness about marketing strategies that play into consumer concerns for cost and autonomy could further increase acceptance of the policy.
Collapse
Affiliation(s)
- Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Sarah Muir
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Emma Roe
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
| | - Christina Vogel
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK
- Centre for Food Policy, City, University of London, London, UK
| |
Collapse
|
12
|
Curley C, Eddie R, Tallis K, Lane TS, Yazzie D, Sanderson PR, Lorts C, Shin S, Behrens TK, George C, Antone-Nez R, Ashley C, de Heer HD. The Navajo Nation Healthy Diné Nation Act: Community Support of a 2% Tax on Unhealthy Foods. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:622-632. [PMID: 37253351 PMCID: PMC10363222 DOI: 10.1097/phh.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT The Healthy Diné Nation Act (HDNA) of 2014 included a 2% tax on foods of little-to-no-nutritious value ("junk foods") on the Navajo Nation. The law was the first ever in the United States and any Indigenous nation worldwide with a population at a high risk for common nutrition-related conditions. To date, research on community support for food tax legislation among Indigenous nations is entirely lacking. OBJECTIVE To assess the extent of support for the HDNA and factors associated with support including sociodemographic variables, knowledge of the HDNA, nutrition intake, and pricing preferences. DESIGN Cross-sectional survey. SETTING The Navajo Nation. PARTICIPANTS A total of 234 Navajo Nation community members across 21 communities. OUTCOME MEASURES The percentage of participants who were supportive of the HDNA. RESULTS Participants were 97% Navajo, on average middle-aged, 67% reported an income below $25 000 annually, and 69.7% were female. Half of the respondents said they "support" (37.4%) or "strongly support" (13.0%) the tax, while another 35% of people said they were neutral or somewhat supportive; 15% did not support the tax. Participants with higher income ( P = .025) and education ( P = .026) and understanding of the legislation ( P < .001 for "very well" vs "not at all") had increased odds of greater support, as did people who believed that the HDNA would make Navajo people healthier (vs not, P < .001). Age, gender, language, and reported nutrition intake (healthy or unhealthy) were not associated with HDNA support, but participants willing to pay 5% or 12%-15% higher prices for fast food and soda had increased odds of greater support ( P values range from .023 to <.001). CONCLUSIONS The majority of Navajo community members surveyed were moderately supportive of the Navajo Nation tax on unhealthy foods. Higher income and education and understanding of the law were associated with greater support, but nutrition intake was not.
Collapse
Affiliation(s)
- Caleigh Curley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Regina Eddie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Kristen Tallis
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Taylor S. Lane
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Del Yazzie
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Priscilla R. Sanderson
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Cori Lorts
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Sonya Shin
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Timothy K. Behrens
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Carmen George
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Ramona Antone-Nez
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Christine Ashley
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| | - Hendrik D. de Heer
- Department of Health Sciences (Ms Curley and Drs Lane, Sanderson, Lorts, and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona (Ms Curley); Johns Hopkins School of Public Health, Chinle, Arizona (Ms Tallis); Navajo Epidemiology Center (Mr Yazzie and Ms Antone-Nez), Navajo Department of Health (Ms Ashley), Window Rock, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George) College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens)
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Toumpakari Z, Valerino-Perea S, Willis K, Adams J, White M, Vasiljevic M, Ternent L, Brown J, Kelly MP, Bonell C, Cummins S, Majeed A, Anderson S, Robinson T, Araujo-Soares V, Watson J, Soulsby I, Green D, Sniehotta FF, Jago R. Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study. Int J Behav Nutr Phys Act 2023; 20:64. [PMID: 37259093 DOI: 10.1186/s12966-023-01465-7] [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: 11/14/2022] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. METHODS We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. RESULTS We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. CONCLUSIONS Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.
Collapse
Affiliation(s)
- Z Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
| | - S Valerino-Perea
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - K Willis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M Vasiljevic
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - L Ternent
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - J Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - M P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - C Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - S Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - S Anderson
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - T Robinson
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- The National Institute for Health Research, Applied Research Collaboration Northeast and North Cumbria (NIHR ARC NENC), St Nicholas' Hospital, Newcastle Upon Tyne, Jubilee Road, Gosforth, NE3 3XT, UK
| | - V Araujo-Soares
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Faculty of Behavioural, Management and Social Sciences, Department of Health Technology and Services Research, University of Twente, Twente, The Netherlands
| | - J Watson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
- South Gloucestershire Council, Badminton Road, Yate, Bristol, BS37 5AF, UK
| | - I Soulsby
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
| | - D Green
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - F F Sniehotta
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- Department for Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - R Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Applied Research Collaboration West (NIHR ARC West), The National Institute for Health Research, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS1 2NT, UK
| |
Collapse
|
15
|
Zorbas C, Martino F, Heneghan T, Potter J, Chisholm M, Cameron AJ, Sacks G, Ananthapavan J, Backholer K. Perceptions towards unhealthy food sponsorship in junior sports in Victoria, Australia. Aust N Z J Public Health 2023; 47:100024. [PMID: 36907000 DOI: 10.1016/j.anzjph.2023.100024] [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: 06/01/2022] [Revised: 11/21/2022] [Accepted: 12/11/2022] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVE To explore Victorian parents' and club officials' engagement with, and attitudes towards, the sponsorship of junior sports by unhealthy food and beverage companies. METHODS We conducted online surveys with 504 parents of children participating in junior sports and 16 semi-structured interviews with junior sports club officials (from clubs that accepted unhealthy food sponsorship) in Victoria, Australia. RESULTS Most parents were concerned about children's exposure to sponsorship by unhealthy local (58% extremely, very or moderately concerned) and large food companies (63%) in junior sports. The views of sporting club officials were grouped into four themes: (1) the existing funding challenges for junior sports, (2) how junior sports sponsorship is community dependent, (3) how the perceived risks of sponsorship by unhealthy food companies are low and (4) the need for high-level regulations and support to transition towards healthier junior sports sponsorship. CONCLUSIONS Transitioning towards healthier junior sports sponsorship may be hindered by insufficient funding models and low concern for such actions by community leaders. IMPLICATIONS FOR PUBLIC HEALTH Policy actions from higher-level sporting governing bodies and governments are likely to be necessary to reduce harmful junior sports sponsorship, alongside restrictions on the marketing of unhealthy foods through other media and settings.
Collapse
Affiliation(s)
- Christina Zorbas
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia.
| | - Florentine Martino
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - Tara Heneghan
- The Victorian Health Promotion Foundation (VicHealth), Australia
| | - Jane Potter
- The Victorian Health Promotion Foundation (VicHealth), Australia
| | - Melanie Chisholm
- The Victorian Health Promotion Foundation (VicHealth), Australia
| | - Adrian J Cameron
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - Gary Sacks
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - Jaithri Ananthapavan
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia; Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia
| | - Kathryn Backholer
- Deakin University, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Geelong, Australia
| |
Collapse
|
16
|
Grummon AH, Musicus AA, Salvia MG, Thorndike AN, Rimm EB. Impact of Health, Environmental, and Animal Welfare Messages Discouraging Red Meat Consumption: An Online Randomized Experiment. J Acad Nutr Diet 2023; 123:466-476.e26. [PMID: 36223865 PMCID: PMC10166581 DOI: 10.1016/j.jand.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Reducing red meat consumption is a key strategy for curbing diet-related chronic diseases and mitigating environmental harms from livestock farming. Messaging interventions aiming to reduce red meat consumption have focused on communicating the animal welfare, health, or environmental harms of red meat. Despite the popularity of these 3 approaches, it remains unknown which is most effective, as limited studies have compared them side by side. OBJECTIVE Our aim was to evaluate responses to red-meat-reduction messages describing animal welfare, health, or environmental harms. DESIGN This was an online randomized experiment. PARTICIPANTS In August 2021, a convenience sample of US adults was recruited via an online panel to complete a survey (n = 2,773 nonvegetarians and vegans were included in primary analyses). INTERVENTION Participants were randomly assigned to view 1 of the 4 following messages: control (neutral, non-red meat message), animal welfare, health, or environmental red-meat-reduction messages. MAIN OUTCOME MEASURES After viewing their assigned message, participants ordered hypothetical meals from 2 restaurants (1 full service and 1 quick service) and rated message reactions, perceptions, and intentions. STATISTICAL ANALYSES PERFORMED Logistic and linear regressions were performed. RESULTS Compared with the control message, exposure to the health and environmental red-meat-reduction messages reduced red meat selection from the full-service restaurant by 6.0 and 8.8 percentage points, respectively (P = .02 and P < .001, respectively), while the animal welfare message did not (reduction of 3.3 percentage points, P = .20). None of the red-meat-reduction messages affected red meat selection from the quick-service restaurant. All 3 red-meat-reduction messages elicited beneficial effects on key predictors of behavior change, including emotions and thinking about harms. CONCLUSIONS Red-meat-reduction messages, especially those describing health or environmental harms, hold promise for reducing red meat selection in some types of restaurants. Additional interventions may be needed to discourage red meat selection across a wider variety of restaurants, for example, by making salient which menu items contain red meat.
Collapse
Affiliation(s)
- Anna H Grummon
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Meg G Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
17
|
Yin E, Cameron AJ, Schultz S, White CM, Vanderlee L, Hammond D, Sacks G. Public Support for Nutrition-Related Actions by Food Companies in Australia: A Cross-Sectional Analysis of Findings from the 2020 International Food Policy Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4054. [PMID: 36901060 PMCID: PMC10002083 DOI: 10.3390/ijerph20054054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Unhealthy food environments contribute to unhealthy population diets. In Australia, the government currently relies on voluntary food company actions (e.g., related to front-of-pack labelling, restricting promotion of unhealthy foods, and product formulation) as part of their efforts to improve population diets, despite evidence that such voluntary approaches are less effective than mandatory policies. This study aimed to understand public perceptions of potential food industry nutrition-related actions in Australia. An online survey was completed by 4289 Australians in 2020 as part of the International Food Policy Study. The level of public support was assessed for six different nutrition-related actions related to food labelling, food promotion, and product formulation. High levels of support were observed for all six company actions, with the highest support observed for displaying the Health Star Rating on all products (80.4%) and restricting children's exposure to online promotion of unhealthy food (76.8%). Findings suggest the Australian public is strongly supportive of food companies taking action to improve nutrition and the healthiness of food environments. However, given the limitations of the voluntary action from food companies, mandatory policy action by the Australian government is likely to be needed to ensure company practices align with public expectations.
Collapse
Affiliation(s)
- Ebony Yin
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Adrian J. Cameron
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Sally Schultz
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Christine M. White
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Lana Vanderlee
- School of Nutrition, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Gary Sacks
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| |
Collapse
|
18
|
An examination of public support for 35 nutrition interventions across seven countries. Eur J Clin Nutr 2023; 77:235-245. [PMID: 36167980 PMCID: PMC9908538 DOI: 10.1038/s41430-022-01211-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Public support for evidence-based nutrition interventions can be an important determinant of government willingness to develop and implement such interventions. The aim of this study was to assess support for a broad range of nutrition interventions across seven countries: Australia, Canada, China, India, New Zealand, the United Kingdom, and the United States. Assessed interventions included those relating to food availability, affordability, reformulation, labelling, and promotion. METHODS Approximately 1000 adults per country (total n = 7559) completed an online survey assessing support for 35 nutrition interventions/policies. ANOVA analyses were used to identify differences between countries on overall levels of support and by intervention category. Multiple regression analyses assessed demographic and diet-related factors associated with higher levels of support across the total sample and by country. RESULTS Substantial levels of public support were found for the assessed interventions across the seven countries and five intervention categories. The highest levels were found in India (Mean across all interventions of 4.16 (standard deviation (SD) 0.65) on a 5-point scale) and the lowest in the United States (Mean = 3.48, SD = 0.83). Support was strongest for interventions involving food labelling (Mean = 4.20, SD = 0.79) and food reformulation (Mean = 4.17, SD = 0.87), and weakest for fiscal interventions (Mean = 3.52, SD = 1.06). Consumer characteristics associated with stronger support were higher self-rated health, higher educational attainment, female sex, older age, and perceptions of consuming a healthy diet. CONCLUSION The results indicate substantial support for a large range of nutrition interventions across the assessed countries, and hence governments could potentially be more proactive in developing and implementing such initiatives.
Collapse
|
19
|
Scheidmeir M, Kubiak T, Luszczynska A, Wendt J, Scheller DA, Meshkovska B, Müller-Stierlin AS, Forberger S, Łobczowska K, Neumann-Podczaska A, Wieczorowska-Tobis K, Zeeb H, Steinacker JM, Woods CB, Lakerveld J. Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes. Eur J Public Health 2022; 32:iv32-iv49. [PMID: 36444105 PMCID: PMC9897019 DOI: 10.1093/eurpub/ckac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents. METHODS A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science). RESULTS Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability. CONCLUSION Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
Collapse
Affiliation(s)
- Marie Scheidmeir
- Correspondence: Marie Scheidmeir, Department of Health Psychology, Johannes Gutenberg University, Binger Str. 14-16, 55122 Mainz, Germany, Tel: +49 6131 39 39 132, e-mail:
| | - Thomas Kubiak
- Department of Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Janine Wendt
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences (UiO-PHN), University of Oslo, Oslo, Norway
| | | | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Karolina Łobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland
| | | | | | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
20
|
Boelsen-Robinson T, Thow AM, Lee N, Gill T, Colagiuri S. Gambling, fast food and alcohol sponsorship in elite sport - perspectives from Australian sporting fans. BMC Public Health 2022; 22:2155. [PMID: 36419011 PMCID: PMC9685834 DOI: 10.1186/s12889-022-14479-w] [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: 07/12/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Public health bodies in Australia remain concerned about marketing of unhealthy commodities; namely unhealthy food, alcohol and gambling products. Children are particularly susceptible to the influence of unhealthy commodity marketing. This study explored adults' perceptions of unhealthy commodities sponsorship in elite sport and policies to restrict them. METHODS Four focus groups of 7-8 frequent sport spectators were recruited, including parents and non-parents, and located in inner and outer suburbs of Sydney, Australia. Results were analysed thematically. RESULTS Participants identified the contradictions of healthy messages of sport and unhealthy commodities, while highlighting the commercial value of sport sponsorship to sporting clubs. There is concern around children's exposure to effective and integrated marketing techniques when viewing sport, which encouraged unhealthy habits. Support for restricting sponsorship related to perceived product harm, with gambling viewed as having the greatest health impact. Participants were supportive of policies that reduced exposure of unhealthy commodities to children, but were concerned about the financial risk to sporting clubs. Governments and sports associations were identified as holding responsibility for enacting changes. CONCLUSION A number of options were identified for advocates to gain public and political traction to reduce unhealthy commodity sponsorship. There is potential for shifts away from unhealthy sponsorship by both governments and sports associations.
Collapse
Affiliation(s)
- Tara Boelsen-Robinson
- Charles Perkins Centre, Faculty of Medicine and Health, Boden Initiative, University of Sydney, Sydney, 2006, NSW, Australia. .,Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, NSW, Australia. .,Global Obesity Centre, Deakin University, Institute for Health Transformation, Geelong, VIC, Australia.
| | - Anne-Marie Thow
- Menzies Centre for Health Policy and Economics, School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Nancy Lee
- Charles Perkins Centre, University of Sydney, Sydney, 2006, NSW, Australia
| | - Tim Gill
- Charles Perkins Centre, Faculty of Medicine and Health, Boden Initiative, University of Sydney, Sydney, 2006, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, Faculty of Medicine and Health, Boden Initiative, University of Sydney, Sydney, 2006, NSW, Australia
| |
Collapse
|
21
|
Christian D, Maharjan M, Kotov A, Cotter T, Mullin S, Nurse V, McGaw B, Chen D, Puri P, Wang S, Negi NS, Murukutla N. How the "Are We Drinking Ourselves Sick?" Communication Campaign Built Support for Policy Action on Sugary Drinks in Jamaica. Nutrients 2022; 14:nu14142866. [PMID: 35889823 PMCID: PMC9318558 DOI: 10.3390/nu14142866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This study assesses the effectiveness of a campaign “Are We Drinking Ourselves Sick?” that ran nationally in Jamaica in four phases from 2017 to 2019 to increase knowledge about the harms of sugary drinks, shift attitudes, and build support for policy actions to address sugary drink consumption, including a tax and a ban in schools. Methods: Campaign impact was measured in representative cross-sectional household surveys of adults ages 18 to 55. A baseline survey was conducted before the launch of the campaign (n = 1430). Evaluation surveys were conducted mid-campaign (n = 1571) and post-campaign (n = 1500). Campaign impact was assessed by comparing changes across survey periods on key knowledge, attitudinal and policy support outcome indicators. The independent association between campaign awareness and outcomes was analyzed using logistic regression analyses. Results: The campaign was recalled by more than 80% of respondents and was well-received with 90% or more respondents describing it as believable and relevant. There was a decline in knowledge on the harms of sugary drinks from the baseline to post-campaign period, notably on risks of diabetes (adjusted odds ratio or AOR = 0.62, p < 0.001), overweight and obesity (AOR = 0.58, p < 0.001), and heart disease (AOR = 0.79, p < 0.003). However, post-campaign awareness was independently associated in logistic regression analysis with improved knowledge of the harms of sugary drinks, including risks of diabetes (AOR = 1.45, p = 0.019), overweight or obesity (AOR = 1.65, p = 0.001), and heart disease (AOR = 1.44, p = 0.011). Support for government action remained high across survey waves (≥90%), and campaign awareness was independently associated with increased policy support for sugary drinks taxes (Mid-campaign: AOR = 1.43, p = 0.019; post-campaign: AOR = 1.46, p = 0.01) and restrictions on sugary drinks in schools (AOR = 1.55, p = 0.01). Conclusion: This study demonstrates the role that media campaigns can play in maintaining knowledge and concern about the health harms of sugary drinks and increasing support for policy passage.
Collapse
Affiliation(s)
- Donnelle Christian
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Meena Maharjan
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
- Correspondence:
| | - Alexey Kotov
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Trish Cotter
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Sandra Mullin
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Vonetta Nurse
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Barbara McGaw
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Deborah Chen
- Global Health Advocacy Project, The Heart Foundation of Jamaica, 28 Beechwood Avenue P.O. Box 338, Kingston 5, Jamaica; (V.N.); (B.M.); (D.C.)
| | - Pallavi Puri
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Shuo Wang
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Nalin Singh Negi
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| | - Nandita Murukutla
- Policy Advocacy and Communication Division, Vital Strategies, New York, NY 10005, USA; (D.C.); (A.K.); (T.C.); (S.M.); (P.P.); (S.W.); (N.S.N.); (N.M.)
| |
Collapse
|
22
|
Christensen JF, Farahi F, Vartanian M, Yazdi SHN. Choice Hygiene for "Consumer Neuroscientists"? Ethical Considerations and Proposals for Future Endeavours. Front Neurosci 2022; 15:612639. [PMID: 35769947 PMCID: PMC9234163 DOI: 10.3389/fnins.2021.612639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Is the use of psychological and neuroscientific methods for neuromarketing research always aligned with the principles of ethical research practice? Some neuromarketing endeavours have passed from informing consumers about available options, to helping to market as many products to consumers as possible. Needs are being engineered, using knowledge about the human brain to increase consumption further, regardless of individual, societal and environmental needs and capacities. In principle, the ground ethical principle of any scientist is to further individual, societal and environmental health and well-being with their work. If their findings can be used for the opposite, this must be part of the scientist's considerations before engaging in such research and to make sure that the risks for misuse are minimised. Against this backdrop, we provide a series of real-life examples and a non-exhaustive literature review, to discuss in what way some practices in the neuromarketing domain may violate the Helsinki Declaration of Experimentation with Human Subjects. This declaration was set out to regulate biomedical research, but has since its inception been applied internationally also to behavioural and social research. We illustrate, point by point, how these ground ethical principles should be applied also to the neuromarketing domain. Indisputably, the growth in consumption is required due to current prevalent economical models. Thus, in the final part of the paper, we discuss how alternative models may be promotable to a larger public, aided by more ethical marketing endeavours, based on neuroscientific discoveries about the human brain. We propose this as a philosophical question, a point of discussion for the future, to make neuromarketing as a discipline, fit for the future, respecting the ethical implications of this research.
Collapse
Affiliation(s)
- Julia F. Christensen
- Department for Language and Literature, Max-Planck-Institute for Empirical Aesthetics, Frankfurt, Germany
| | | | | | | |
Collapse
|
23
|
Hammond D, Vanderlee L, White CM, Acton RB, White M, Roberto CA, Cameron A, Sacks G, Kirkpatrick S, Dubin J, Adams J, Jauregui A, Thrasher JF. The Conceptual Framework for the International Food Policy Study: Evaluating the Population-Level Impact of Food Policy. J Nutr 2022; 152:1S-12S. [PMID: 35274695 PMCID: PMC9188864 DOI: 10.1093/jn/nxac042] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labeling, and taxation of less healthy foods. There is a need to evaluate and inform the implementation of these policies, including their impacts on marginalized population subgroups. The International Food Policy Study (IFPS) consists of repeated cross-sectional surveys conducted in 5 high- and upper-middle-income countries: Australia, Canada, Mexico, the United Kingdom, and the United States. In each country, approximately 4000 adults and 1200 children and youth (aged 10-17) were recruited from a global commercial panel to complete an online survey using consistent measures and methodologies across countries. The first annual IFPS surveys were conducted in 2017 with adults; annual surveys for young people aged 10-17 were launched in 2019 in the same countries, as well as in Chile. The design of the IFPS surveys creates a framework for evaluating "natural experiments" in food policies, including comparisons over time within countries implementing the policy and comparisons with countries in which the policy was not implemented. IFPS surveys have 3 primary areas of focus: 1) knowledge, attitudes, and beliefs associated with specific policies; 2) diet-related behaviors; and 3) dietary intake, including 24-hour dietary recalls for adults in 4 of the 5 countries. Surveys also assess food insecurity, income adequacy, sex and gender, race/ethnicity, and a range of other measures to assess trends among priority subgroups. Overall, the IFPS project has the potential to address important gaps in national monitoring surveys for dietary patterns, and to evaluate the impacts of novel food policies implemented in any of the 5 countries over the study period.
Collapse
Affiliation(s)
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrian Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sharon Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- Department Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alejandra Jauregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
24
|
Ganson KT, Nagata JM, Rodgers RF, Cunningham ML, Lavender JM, Murray SB, Hammond D. Weight gain attempts and substance use behaviors among adults across five countries. Body Image 2022; 41:375-383. [PMID: 35525156 DOI: 10.1016/j.bodyim.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
Weight gain attempts are common among adolescents, yet a paucity of research has explored these behaviors among adults, particularly in relation to substance use behaviors. To address this gap in the literature, pooled data from the 2018 and 2019 International Food Policy Study (N = 42,108) were analyzed. The association of weight gain attempts in the past 12 months with four important and relatively common substance use behaviors (alcohol use, binge-drinking, cigarette smoking, marijuana use) was examined using multiple modified Poisson regression analyses that adjusted for theoretically relevant covariates. Among men and women, weight gain attempts were associated with a higher likelihood of cigarette smoking in the past 30 days, marijuana use in the past 12 months, and binge-drinking one or more times per month in the past 12 months among men only. Among women, weight gain attempts were associated with a lower likelihood of alcohol use one or more times per month in the past 12 months. Our findings contribute to the literature demonstrating that substance use behaviors are more prevalent among adults who report weight gain attempts in a large international sample.
Collapse
Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | | | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA; Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA; Metis Foundation, San Antonio, TX, USA
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
25
|
Yi S, Kanetkar V, Brauer P. Customer support for nudge strategies to promote fruit and vegetable intake in a university food service. BMC Public Health 2022; 22:706. [PMID: 35399080 PMCID: PMC8994925 DOI: 10.1186/s12889-022-13054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diverse nudges, also known as choice architectural techniques, have been found to increase fruit and vegetable (FV) selection in both lab and field studies. Such strategies are unlikely to be adopted in mass eating settings without clear evidence of customer support; confirmation in specific contexts is needed. Inspired by the Taxonomy of Choice Architecture, we assessed support for eight types of nudging to increase the choice of FV-rich foods in a university food service. We also explored whether and to what extent nudge support was associated with perceived effectiveness and intrusiveness. Methods An online survey was conducted with students who used on-campus cafeterias. Multiple recruitment methods were used. Participants were given 20 specific scenarios for increasing FV selection and asked about their personal support for each nudge, as well as perceived intrusiveness and effectiveness. General beliefs about healthy eating and nudging were also measured. Results were assessed by repeated measures ANOVA for the 8 nudge types. Results All nudge scenarios achieved overall favourable ratings, with significant differences among different types of nudging by the 298 respondents. Changing range of options (type B3) and changing option-related consequences (type B4) received the highest support, followed by changing option-related effort (type B2) and making information visible (type A2). Translating information (type A1), changing defaults (type B1) and providing reminders or facilitating commitment (type C) were less popular types of nudging. Providing social reference points (type A3) was least supported. Support for nudge types was positively associated with the belief that food services have a role in promoting healthy eating, perceived importance of FV intake, trustworthiness of the choice architect and female gender. Lastly, support for all types of nudges was positively predicted by perceived effectiveness of each nudge and negatively predicted by perceived intrusiveness above and beyond the contribution of general beliefs about healthy eating and nudging. Conclusions Findings from the current study indicate significant differences in support for nudge techniques intended to increase FV selection among university cafeteria users. These findings offer practical implications for food service operators as well as public health researchers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13054-7.
Collapse
|
26
|
Howse E, Cullerton K, Grunseit A, Bohn-Goldbaum E, Bauman A, Freeman B. Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods. Health Res Policy Syst 2022; 20:26. [PMID: 35246170 PMCID: PMC8895540 DOI: 10.1186/s12961-022-00829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.
Collapse
Affiliation(s)
- Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia. .,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katherine Cullerton
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Erika Bohn-Goldbaum
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| |
Collapse
|
27
|
Cranney L, Thomas M, Cobcroft M, Drayton B, Rissel C, Bauman A, Phongsavan P. Community support for policy interventions targeting unhealthy food environments in public institutions. Health Promot J Austr 2021; 33:618-630. [PMID: 34921699 DOI: 10.1002/hpja.567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions. METHODS An online cross-sectional survey was completed by 2,006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal, and behavioral characteristics. RESULTS Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n=7) initiatives. Support for food environment policies was highest for schools (76-82%) and hospitals (67-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support. CONCLUSION There is significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.
Collapse
Affiliation(s)
- Leonie Cranney
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Sydney, New South Wales, Australia.,The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Margaret Thomas
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Sydney, New South Wales, Australia.,The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | | | - Bradley Drayton
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Sydney, New South Wales, Australia
| | - Chris Rissel
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Sydney, New South Wales, Australia.,The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Adrian Bauman
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Sydney, New South Wales, Australia.,The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| | - Philayrath Phongsavan
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Prevention Research Collaboration, Sydney, New South Wales, Australia.,The University of Sydney, Charles Perkins Centre, Sydney, New South Wales, Australia
| |
Collapse
|
28
|
A Proposed Research Agenda for Promoting Healthy Retail Food Environments in the East Asia-Pacific Region. Curr Nutr Rep 2021; 10:267-281. [PMID: 34894342 DOI: 10.1007/s13668-021-00381-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW This paper aimed to summarise existing literature on strategies to improve the healthiness of retail food environments in the East Asia and Pacific (EAP) region, and propose a prioritised research agenda on this topic. RECENT FINDINGS Little research on retail food environments has been conducted in the EAP region. Several approaches for measuring retail food environments were identified, although none have been tailored to the EAP context. A small number of policies and initiatives to promote healthy retail food environments have been implemented in EAP. Lessons learnt from successful implementation of initiatives in other regions could be applied in EAP. Retail food environments have a strong influence on food choices and health outcomes. Research can contribute to efforts to improve the healthiness of retail food environments in EAP by (1) describing the current state of retail food environments to highlight areas of good practice and concern and (2) identifying policies and initiatives that are likely to be effective, and mechanisms for their successful implementation.
Collapse
|
29
|
Benchmarking for accountability on obesity prevention: evaluation of the Healthy Food Environment Policy Index (Food-EPI) in Australia (2016-2020). Public Health Nutr 2021; 25:488-497. [PMID: 34706789 PMCID: PMC8883784 DOI: 10.1017/s136898002100447x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective: Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016–2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. Design: A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. Setting: Australia. Participants: Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020. Results: The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies. Conclusions: Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.
Collapse
|
30
|
Ganson KT, Nagata JM, Lavender JM, Rodgers RF, L Cunningham M, Murray SB, Hammond D. Prevalence and correlates of weight gain attempts across five countries. Int J Eat Disord 2021; 54:1829-1842. [PMID: 34415082 DOI: 10.1002/eat.23595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the prevalence and correlates of weight gain attempts in a pooled sample of adults aged 18 and older from Canada, Australia, the United Kingdom, the United States, and Mexico. METHOD Data collected during 2 years (2018 and 2019) of the International Food Policy Study (N = 42,108) were analyzed. Unadjusted 12-month prevalence of weight gain attempts was estimated based on body mass index (BMI; kg/m2 ), weight perception, country, survey year, and sex. Logistic regression analyses were estimated to determine the sociodemographic correlates (age, race/ethnicity, education, BMI, weight perception, weight perception accuracy, and self-rated mental health) of weight gain attempts among the pooled sample stratified by sex. RESULTS Men (10.4%) were significantly more likely than women (5.4%) to report weight gain attempts (p < .001). Nearly one in five (17.1%) men with a BMI in the "normal" range (≥18.5 to <25.0) reported weight gain attempts. Among both men and women, minority group identity was associated with higher odds, while older age and higher BMI category were associated with lower odds, of reporting weight gain attempts. Country differences over the two survey years showed the prevalence of weight gain attempts in 2019 (vs. 2018) was higher among women in Australia (p < .05) and men in the United States (p < .01). DISCUSSION Weight gain attempts are more common among men, compared to women, across five countries, potentially reflecting the global salience of the pursuit of a muscular body.
Collapse
Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, Maryland, USA.,Metis Foundation, San Antonio, Texas, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
31
|
Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. [Implementación de políticas de prevención y control de la obesidad infantil en Estados Unidos y Latinoamérica: lecciones para la investigación y la práctica transfronterizas]. Obes Rev 2021; 22 Suppl 5:e13347. [PMID: 34708536 DOI: 10.1111/obr.13347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU
| | - Mireya Vilar-Compte
- Instituto de Investigaciones para el Desarrollo con Equidad (EQUIDE), Universidad Iberoamericana, Ciudad de México, México
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, EE. UU.,Yale School of Medicine, New Haven, Connecticut, EE. UU
| | - Olga L Sarmiento
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Camila Corvalan
- Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, EE. UU
| |
Collapse
|
32
|
Adams J, Pell D, Penney TL, Hammond D, Vanderlee L, White M. Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017-2019). BMJ Open 2021; 11:e051677. [PMID: 34561262 PMCID: PMC8475144 DOI: 10.1136/bmjopen-2021-051677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation. DESIGN Repeat cross-sectional online survey. SETTING The UK. PARTICIPANTS UK respondents to the International Food Policy Study aged 18-64 years who provided information on all variables of interest in November-December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284). OUTCOME MEASURES Self-reported support for, and perceived effectiveness of, the SDIL. RESULTS The adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar. CONCLUSIONS We found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.
Collapse
Affiliation(s)
- Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - David Pell
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Midlands Region, NHS RightCare, Newcastle upon Tyne, UK
| | - Tarra L Penney
- School of Global Health, York University Faculty of Health, Toronto, Ontario, Canada
| | - David Hammond
- School of Public Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- School of Nutrition, Laval University, Quebec, Quebec, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
33
|
Dale MJ, Carroll SJ, Daniel M. The conflict between Public Health and 'Big Food': A Counterinsurgency? Health Promot J Austr 2021; 33:614-617. [PMID: 34543486 DOI: 10.1002/hpja.544] [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: 06/09/2020] [Revised: 04/21/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
This commentary characterises as an insurgency those elements of the Food Industry seeking to retain and expand industry profit-making opportunity with scant regard to the effect on public health and wellbeing. Premised on a conflict in which the battlespace encompasses the drivers of (un)healthful behaviour, our view encourages opponents of Food Industry methods to consider an approach based on analogy of successful Counter-Insurgency strategies to a health promotion context.
Collapse
Affiliation(s)
- Michael J Dale
- Australian Geo-Spatial Health Laboratory, Health Research Institute, University of Canberra, ACT, Australia
| | - Suzanne J Carroll
- Australian Geo-Spatial Health Laboratory, Health Research Institute, University of Canberra, ACT, Australia
| | - Mark Daniel
- Australian Geo-Spatial Health Laboratory, Health Research Institute, University of Canberra, ACT, Australia.,Department of Medicine, The University of Melbourne, St Vincent's Hospital, Melbourne, Vic, Australia
| |
Collapse
|
34
|
Watson WL, Sarich P, Hughes C, Dessaix A. Monitoring changes in community support for policies on obesity prevention. Aust N Z J Public Health 2021; 45:482-490. [PMID: 34411393 DOI: 10.1111/1753-6405.13153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 05/01/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the New South Wales (NSW) community's support for obesity prevention policies and concern for food marketing and promotion issues, and to determine any demographic differences or changes over time. METHODS In 2013 (n=2474), 2016 (n=1602) and 2019 (n=1613) a sample of adults who were representative of the NSW population for age, gender, education and location was asked about support for policy initiatives that influence the food environment. Analysis identified the characteristics of those who supported policies and variation in support over time. RESULTS There were limited changes in support over time; however, support for many policies was strong and sustained. In 2019, support was highest for regulation of claims about nutrition (77.2%), and health warning labels (75.7%). Support for a ban on unhealthy food advertising that targets children (64.6%) had decreased since 2013. Women, older people and those who were aware that obesity was a risk factor for cancer were generally more likely to support policies. Parents were more likely than non-parents to be concerned about positioning unhealthy food at supermarket checkouts (OR 1.32) and unhealthy outdoor advertisements (OR 1.22). Concern increased in 2019 for unhealthy marketing on the internet (OR 1.21). CONCLUSIONS This study shows public support for policy options at moderate to high levels but not increasing in the six-year study period. Implications for public health: These results form part of a package that, along with the well-established evidence, makes the case for policy action in Australia.
Collapse
Affiliation(s)
| | - Peter Sarich
- The Daffodil Centre, The University of Sydney, New South Wales, a joint venture with Cancer Council NSW
| | | | | |
Collapse
|
35
|
Gómez-Donoso C, Sacks G, Vanderlee L, Hammond D, White CM, Nieto C, Bes-Rastrollo M, Cameron AJ. Public support for healthy supermarket initiatives focused on product placement: a multi-country cross-sectional analysis of the 2018 International Food Policy Study. Int J Behav Nutr Phys Act 2021; 18:78. [PMID: 34127002 PMCID: PMC8201822 DOI: 10.1186/s12966-021-01149-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food retail environments have an influential role in shaping purchasing behavior and could contribute to improving dietary patterns at a population level. However, little is known about the level of public support for different types of initiatives to encourage healthy food choices in supermarkets, and whether this varies across countries or context. The current study aimed to explore the level of support for three potential supermarket initiatives focused on product placement across five countries, and factors that may influence this support. METHODS A total of 22,264 adults from Australia, Canada, Mexico, the United Kingdom and the United States (US) provided information on support for three supermarket initiatives related to product placement (targeting product positioning: 'checkouts with only healthy products', 'fewer end-of-aisle displays containing unhealthy foods or soft drinks' or availability: 'more shelf space for fresh and healthier foods') as part of the online 2018 International Food Policy Study. The proportion of respondents that supported each initiative was assessed across countries, and multivariable logistic regression analyses were conducted to evaluate the influence of sociodemographic factors on support. RESULTS The initiative that received the highest support was 'more shelf space for fresh and healthier foods': 72.0% [95% CI 71.3-72.7], whereas 'checkouts with only healthy products' received the lowest support: 48.6% [95% CI 47.8-49.4]. The level of support differed between countries (p < 0.001 for all initiatives), with the US generally showing the lowest support and Mexico the highest. Noteworthy, in the overall sample, there was not much opposition to any of the initiatives (2.5-14.2%), whereas there was a large proportion of neutral responses (25.5-37.2%). Respondents who were older, female, highly educated, and those who reported having more nutrition knowledge tended to be more supportive, with several differences between countries and initiatives. CONCLUSIONS Most people in the assessed five countries showed a generally high level of support for three placement initiatives in supermarkets to encourage healthy food choices. Support varied by type of initiative (i.e., product positioning or availability) and was influenced by several factors related to country context and sociodemographic characteristics. This evidence could prompt and guide retailers and policy makers to take stronger action to promote healthy food choices in stores.
Collapse
Affiliation(s)
- Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia
| | - Lana Vanderlee
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels, École de nutrition, Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia.
| |
Collapse
|
36
|
Pérez-Escamilla R, Vilar-Compte M, Rhodes E, Sarmiento OL, Corvalan C, Sturke R, Vorkoper S. Implementation of childhood obesity prevention and control policies in the United States and Latin America: Lessons for cross-border research and practice. Obes Rev 2021; 22 Suppl 3:e13247. [PMID: 33951275 PMCID: PMC8365637 DOI: 10.1111/obr.13247] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby-Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases.
Collapse
Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Mexico City, Mexico
| | - Elizabeth Rhodes
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA.,Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Camila Corvalan
- Institute of Nutrition, Universidad de Chile, Santiago, Chile
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
37
|
Cerezo-Prieto M, Frutos-Esteban FJ. [Towards healthy pathways: Effect of nutrition labels on eating behaviours in a university canteen]. Aten Primaria 2021; 53:102022. [PMID: 33812319 PMCID: PMC8050358 DOI: 10.1016/j.aprim.2021.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/02/2022] Open
Abstract
Objetivo Evaluar la efectividad de incluir información nutricional y de propiedades de los alimentos en un comedor universitario de Salamanca (España), para promover las conductas alimentarias saludables. Diseño Estudio experimental y correlacional transversal. Emplazamiento Comedor universitario de Salamanca (España). Participantes En el experimento se recogió información de la elección de 1.122 menús por parte de estudiantes universitarios. El cuestionario fue respondido por 48 estudiantes universitarios que participaron en el experimento. Medidores principales Metodología mixta (experimento de campo y cuestionario en línea). La variable independiente fue la inclusión o no de información nutricional de los menús. Con el cuestionario se evaluó la actitud de los estudiantes sobre este tipo de herramientas. Resultados El experimento muestra una mejora en la dieta de los estudiantes universitarios con la inclusión de elementos informativos que apelan a la elección más saludable, aumentando su consumo de fruta, verduras, legumbres, pescado y carne blanca. Los encuestados mostraron un alto grado de receptividad de estas herramientas para la promoción de la salud. A pesar de esto, su autopercepción de mejoría de la dieta era más optimista que lo cuantificado en el experimento. Los estudiantes universitarios muestran un grado de aprobación muy alto frente a otras herramientas de promoción de alimentación saludable, especialmente aquellas de carácter educativo e informativo. Se comprobó que una preocupación mayor por la dieta estaba asociada con un mayor apoyo de estas herramientas. Conclusión Existe una mejora en la alimentación de los estudiantes universitarios y una actitud positiva frente a herramientas de promoción de la salud, especialmente por parte de quienes tienen una autopercepción más saludable. Es necesario emplear nuevas herramientas basadas en las ciencias conductuales en la promoción de la salud, por parte de la industria privada y las entidades públicas.
Collapse
|
38
|
Kirk SFL, Olstad DL, McIsaac JLD, Prowse RJL, Caswell S, Hanning R, Raine KD, Mâsse LC, Naylor PJ. Appetite for change? Facilitators and barriers to nutrition guideline implementation in Canadian recreational facilities. Health Promot Int 2021; 36:1672-1682. [PMID: 33615376 DOI: 10.1093/heapro/daab017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect healthy eating guidelines. This study sought to describe facilitators and barriers to implementing provincial nutrition guidelines in recreation and sports facilities in three Canadian provinces with nutrition guidelines. Semi-structured interviews were analysed thematically to identify facilitators and barriers to implementing provincial nutrition guidelines. Facilitators and barriers were then categorised using a modified "inside out" socio-ecological model that places health-related and other social environments at the centre. A total of 32 semi-structured interviews were conducted at two time-points across the three guideline provinces. Interview participants included recreation staff managers, facility committee or board members and recreation volunteers. Eight facilitators and barriers were identified across five levels of the inside out socio-ecological model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Findings reinforce the importance of top down (clear expectations regarding guideline implementation at the time of approval) and bottom up (need for buy-in from multiple stakeholders) approaches to ensure successful implementation of nutrition guidelines. The application of a modified socio-ecological model allowed for a more nuanced understanding of leverage points to support successful guideline implementation. Lay summary Healthy eating is an important behaviour for preventing chronic diseases. Supporting people to access healthy foods in places where they live, learn, work or play is a public health priority. Recreation and sports facilities are a setting where people can be physically active. Unfortunately, the food environment in these settings may not reflect nutrition guidelines. In this study, we interviewed key stakeholders from recreation and sports facilities in three Canadian provinces who had put guidelines for healthy eating in place. We used a specific framework to do this called the inside out socio-ecological model. Eight facilitators and barriers were identified using this model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Our findings can help people working in recreation and sports facilities to identify issues that may help or hinder healthy food provision in these settings.
Collapse
Affiliation(s)
- Sara F L Kirk
- Healthy Populations Institute
- School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, Canada B3H 4R2
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
| | - Jessie-Lee D McIsaac
- Healthy Populations Institute
- Faculty of Education and Department of Child and Youth Study, Mount Saint Vincent University, Halifax, NS, Canada B3M 2J6
| | - Rachel J L Prowse
- School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada T6G 1C9
| | - Susan Caswell
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada N2L 3G1
| | - Rhona Hanning
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada N2L 3G1
| | - Kim D Raine
- School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada T6G 1C9
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4
| | - P J Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3015, Stn CSC, Victoria, BC, Canada V8W 3P1
| |
Collapse
|
39
|
Cullerton K, Baker P, Adsett E, Lee A. What do the Australian public think of regulatory nutrition policies? A scoping review. Obes Rev 2021; 22:e13106. [PMID: 32748480 DOI: 10.1111/obr.13106] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 12/31/2022]
Abstract
Effective government policies are crucial to creating healthy food environments. However, changing public policy is a slow and challenging process involving many competing factors. One cited factor is public opinion towards a proposed policy. This study aimed to systematically explore public opinion on regulatory nutrition policy issues in Australia from 2009 to 2019, to determine whether low levels of public opinion corresponded with the low levels of regulatory policy action in this country. We found that there was varying levels of public support in Australia for public health nutrition action. Regulatory- and legislative-based policies generally had moderate to high levels of support except for food and drink taxes, which had low to moderate support. Despite high levels of public support for certain policy initiatives, national public health nutrition policy in Australia has not evolved consistently with the level of public support nor the evidence base over the past decade indicating other more important factors at play in policymaking.
Collapse
Affiliation(s)
- Katherine Cullerton
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Eloise Adsett
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Lee
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
40
|
Hall MG, Grummon AH, Lazard AJ, Maynard OM, Taillie LS. Reactions to graphic and text health warnings for cigarettes, sugar-sweetened beverages, and alcohol: An online randomized experiment of US adults. Prev Med 2020; 137:106120. [PMID: 32437703 PMCID: PMC7713698 DOI: 10.1016/j.ypmed.2020.106120] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/19/2020] [Accepted: 04/26/2020] [Indexed: 12/20/2022]
Abstract
We aimed to examine reactions to graphic versus text-only warnings for cigarettes, SSBs, and alcohol. A convenience sample of US adults completed an online survey in 2018 (n = 1352 in the analytic sample). We randomly assigned participants to view a: 1) text-only warning without efficacy information (i.e., message intended to increase consumers' confidence in their ability to stop using the product), 2) text-only warning with efficacy information, 3) graphic warning without efficacy information, or 4) graphic warning with efficacy information. Participants viewed their assigned warning on cigarettes, SSBs, and alcohol, in a random order. Across product types, graphic warnings were perceived as more effective than text-only warnings (p < .001) and led to lower believability, greater reactance (i.e., resistance), more thinking about harms, and lower product appeal (all p < .05); policy support did not differ. Compared to SSB and alcohol warnings, cigarette warnings led to higher perceived message effectiveness, believability, fear, thinking about harms, policy support, and greater reductions in product appeal (all p < .05). The efficacy information did not influence any outcomes. Graphic warnings out-performed text-only warnings on key predictors of behavior despite causing more reactance.
Collapse
Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA.
| | - Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA; Center for Population and Development Studies, Harvard TH Chan School of Public Health, Cambridge, MA, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Lindsey Smith Taillie
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
41
|
Kao KE, Jones AC, Ohinmaa A, Paulden M. The health and financial impacts of a sugary drink tax across different income groups in Canada. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100869. [PMID: 32442926 DOI: 10.1016/j.ehb.2020.100869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Overconsumption of sugar-sweetened beverages (SSBs) contributes to childhood and adult obesity and numerous related diseases, including heart disease, strokes, cancers, and type 2 diabetes. It also increases healthcare costs. Sugary drink taxes have been implemented in several countries to curb sugar intake. However, there is a concern that sugary drink taxes are regressive. This study assessed the health and financial impacts of a simulated sugary drink tax across different income groups in Canada. METHODS A proportional multi-state life table-based Markov model simulated the 2016 Canadian population by income quintile. The model applied a 20 % tax on sugary drinks and determined the effects on type 2 diabetes and BMI-related diseases compared to no intervention. The income-specific parameters modelled included: population demographics; cross- and own-price elasticities; mean BMI; sugary drink consumption; mortality; and disease epidemiology. RESULTS A 20 % sugary drink tax was estimated to reduce the consumption of sugary drinks by an average of around 15 %, with a greater reduction in the lowest income quintile. The estimated mean reduction in BMI ranged from 0.21 to 0.33, dependent upon sex and income quintile; these reductions were greater among the lower income quintiles for both females and males. The 20 % sugary drink tax was estimated to avert approximately 690,000 DALYs over a lifetime among the 2016 Canadian adult population; estimated DALYs averted were approximately 156,000, 140,000, 137,000, 134,000, and 125,000 for the lowest through to the highest income quintile, respectively. Lifetime health care savings were estimated to be $2.27bn, $2.16bn, $2.17bn, $2.12bn, and $1.98bn for the lowest through to the highest income quintile, respectively. The estimated annual tax burden for the 2016 Canadian population was $1.4bn. The average absolute tax burden was estimated to be $39.00 to $44.30 per person, with the middle-income quintile bearing the heaviest absolute tax burden. The lowest income quintile would pay the highest proportion of income in tax, implying that the tax is regressive. CONCLUSIONS Low-income Canadians would gain the most health benefit from a sugary drinks tax. However, the lowest income quintile would also pay the largest proportion of income in tax. A tax on sugary drinks is therefore financially regressive but forecast to reduce health disparities across Canada.
Collapse
Affiliation(s)
- Kai-Erh Kao
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Amanda C Jones
- Department of Public Health, University of Otago, PO Box 7343, Newtown, Wellington 6242, New Zealand
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
| | - Mike Paulden
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
| |
Collapse
|
42
|
The Acceptance of Key Public Health Interventions by the Polish Population Is Related to Health Literacy, But Not eHealth Literacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155459. [PMID: 32751180 PMCID: PMC7432801 DOI: 10.3390/ijerph17155459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 12/16/2022]
Abstract
Background: Public health and health promotion rely on many different interventions, which range from health education and communication, through community mobilisation and changes to environmental conditions, to legal and fiscal actions. The introduction of the increased tax on sugar-sweetened beverages (SSB), popularly called sugar tax (ST), and a mandatory programme of vaccinations are the strategies inciting the most vivid discussions in Polish society. The study was intended to assess the determinants of the attitudes of Polish society regarding the ST and to vaccinations. Methods: For the analysis, the data originating from the survey of a representative adult sample of Polish society (n = 1000) was used. The survey was based on computer-assisted telephone interviewing (CATI). The assessment of the relationships between the selected variables and the opinions about the introduction of the ST and the safety and effectiveness of vaccinations were carried out using the chi2 test and univariate logistic regression models. Results: The acceptance of the ST and vaccination showed a significant relationship to the level of health literacy (HL) but not to eHealth literacy (eHL). Respondents having a higher rather than lower HL; older rather than younger; married rather than singles; retired, or on a disability pension, rather than vocationally active and nonusers of the Internet rather than users were more likely to show an acceptance for both interventions. Those more frequently using health care services and those with chronic diseases showed a greater belief in the safety and effectiveness of vaccinations. Conclusions: The relationship between the opinions of the two public health interventions analysed and the sociodemographic variables demonstrated similar patterns. Interestingly, the opinions were associated only with HL and not with eHL and users of the Internet were more sceptical about the interventions.
Collapse
|
43
|
Attitudes of sports organisation members to junk food sponsorship. Public Health 2020; 185:212-217. [PMID: 32653631 DOI: 10.1016/j.puhe.2020.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/02/2020] [Accepted: 04/30/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To explore sports organisation members' attitudes to sponsorship of sport by energy-dense, nutrient-poor food and drink ('junk food') brands. STUDY DESIGN The study design is a cross-sectional study. METHODS An online survey of adult members of three sports organisations that did not accept junk food sponsorship in Victoria, Australia in 2018: one was responsible for an elite team in a national competition (5000-10,000 members); one managed a team sport competition across Victoria (50,000-100,000 registered junior and adult participants, referees and coaches); and one administered a junior team sport competition for boys and girls in a major city (10,000-15,000 participants). RESULTS Most (71%) of the 2224 respondents reported it was important/very important that their organisation did not accept junk food sponsorship. A higher proportion was concerned/very concerned about junk food companies sponsoring children's sport (60%) compared with such companies sponsoring elite (49%, P < 0.001) or community adult (39%, P < 0.001) sport. A higher proportion of respondents were likely/very likely to support a policy that restricted junk food sponsorship of children's sport (84%), compared with a policy restricting sponsorship of elite (76%, P > 0.001) and adult community (74%, P > 0.001) sport. Two-thirds of respondents supported restricting junk food companies from sponsoring sport, even if fees for children's (66%) and community adult (65%) sport increased, or if membership and attendance costs for elite sport supporters increased (63%). CONCLUSIONS In the Australian context of this study, junk food sponsorship of sport, particularly children's sport, is a concern to members of sports organisations. Although still high, support for restricting such sponsorship declines if members perceive it will lead to increases in participation costs and decreases in participation opportunities. Initiatives restricting junk food sponsorship of sport are likely to receive strong support from the sports community, particularly when the focus is on children's sport, and participation costs and opportunities are not negatively impacted.
Collapse
|