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Trude ACB, Bunzl NB, Rehman ZN, Elbel B, Lau S, Talal LA, Weitzman BC. "I Don't Want an App to Do the Work for Me": A Qualitative Study on the Perception of Online Grocery Shopping From Small Food Retailers. J Acad Nutr Diet 2024; 124:804-822. [PMID: 38103594 DOI: 10.1016/j.jand.2023.12.005] [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: 04/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Small food retailers often stock energy-dense convenience foods, and they are ubiquitous in low-income urban settings. With the rise in e-commerce, little is known about the acceptability of online grocery shopping from small food retailers. OBJECTIVE To explore perceptions of the role of small food retailers (bodegas) in food access and the acceptability of online grocery shopping from bodegas among customers and owners in a diverse New York City urban neighborhood with low incomes. DESIGN In-depth interviews were conducted with bodega owners and adult customers between May and July 2022. PARTICIPANTS/SETTING Bodega owners who either had (n = 4) or had not (n = 2) implemented a locally designed online grocery system. Customers (n = 25) were recruited through purposive sampling and were eligible if they purchased at bodegas (>once per month), had low income (household income ≤130% of the federal poverty level or Supplemental Nutrition Assistance Program [SNAP] participants), and owned smartphones. ANALYSES PERFORMED All interviews were transcribed and analyzed in MAXQDA (Verbi Software, Berlin, Germany), using grounded theory. RESULTS To owners and customers, bodegas were seen as good neighbors providing culturally appropriate foods and an informal financial safety net. Their perceptions concerning food cost and availability of healthy foods in bodegas diverged. Although most perceived online grocery from bodegas as a positive community resource, they also believed it was not suited to their own community because of the bodega's proximity to customers' homes and the low digital literacy of some community members. Customers reported social norms of pride in not using online grocery shopping. Owners and customers believed the service would more likely be used if government benefits such as SNAP allowed payment for online orders. Both suggested improved outreach to increase program awareness and uptake. CONCLUSIONS Online grocery shopping from small food retailers may be acceptable in urban communities with low income and was perceived as a community resource. However, important barriers need to be addressed, such as social norms related to pride in not using online grocery services, digital literacy, program awareness, and allowing SNAP payment for online orders from bodegas.
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van Hoeven WS, Simons M, Czymoniewicz-Klippel MT, Veling H. Creating a healthy and sustainable food environment to promote plant-based food consumption: clear barriers and a gradual transition. BMC Public Health 2024; 24:1607. [PMID: 38886701 PMCID: PMC11181573 DOI: 10.1186/s12889-024-19121-5] [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: 04/15/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND A shift away from diets high in animal-based foods towards diets high in plant-based foods is desirable considering human health, environmental sustainability, and animal welfare. As the food environment plays a crucial role in shaping consumption patterns, understanding of how changes in the food environment can facilitate plant-based consumption is crucial for the so-called protein transition. The current study aims to garner insight into barriers and facilitators for food outlet managers to take action to stimulate plant-based consumption within a local food environment. METHODS Using a maximum-variation sample approach, we examined possible barriers and facilitators to promote plant-based consumption across different types of food outlets located within a geographically shared food environment (a city in the Netherlands). We conducted in-depth semi-structured interviews among food outlet managers and applied multi-stage thematic analysis to the interview transcripts. RESULTS Most managers underscored the urgency of shifting towards more plant-based diets, and perceived a growing demand for plant-based products. However, three barriers hindered most of them from taking decisive action: Managers' perception of low consumer demand for plant-based food options; fear of consumer resistance when stimulating plant-based food options; and limited behavioral agency to offer attractive plant-based food options. The few managers who made changes, or intend to make changes, are individuals with high intrinsic motivation, knowledge and skills. CONCLUSIONS The present work suggests the key for change towards a food environment stimulating plant-based consumption lies in addressing three (perceived) barriers shared among diverse outlets. These are partly different from barriers for stimulating healthy consumption in general. Furthermore, current changes appear to be driven incidentally by individuals who are motivated and able to stimulate more plant-based purchases among a small targeted group of consumers.
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Affiliation(s)
- Ward S van Hoeven
- Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Hollandseweg 1, 6700 EW, Wageningen, The Netherlands.
| | - Monique Simons
- Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Hollandseweg 1, 6700 EW, Wageningen, The Netherlands
| | - Melina T Czymoniewicz-Klippel
- Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Hollandseweg 1, 6700 EW, Wageningen, The Netherlands
| | - Harm Veling
- Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Hollandseweg 1, 6700 EW, Wageningen, The Netherlands
- Behavioural Science Institute, Radboud University, P.O. Box 9104, Thomas Van Aquinostraat 4, 6525 GD, Nijmegen, The Netherlands
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Chilón-Troncos RF, García-Salirrosas EE, Escobar-Farfán M, Millones-Liza DY, Villar-Guevara M. Predicting willingness to consume healthy brand foods using the theory of planned behavior: the role of nutritional literacy. Front Nutr 2024; 11:1353569. [PMID: 38638294 PMCID: PMC11025538 DOI: 10.3389/fnut.2024.1353569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The willingness to consume healthy foods has highlighted the growing importance of health, even more so when it comes to food choice, and predicting the willingness to consume foods of a healthy brand represents an action that leads to the practice of conscious eating habits, but what is behind this willingness? To answer this question and based on previous studies such as the theory of planned behavior and nutritional literacy, this study aimed to build a predictive model through an empirical study to examine the influence of nutritional literacy (NL) on attitude (ATT), subjective norm (SN) and perceived behavioral control (PBC), as well as to determine the influence of the three variables of the theory of planned behavior (TPB) on the willingness to consume healthy brand foods (WCHBF) in the Peruvian market. Methods The research focused on the population that stated that they were consumers of the Unión brand (a brand whose value proposition is the sale of healthy foods), obtaining 482 consumers. The study was conducted under a quantitative, non-experimental, cross-sectional design approach. Results The results support the existence of a positive and significant effect of NL on ATT, SN, and PBC, finding the exact behavior of SN and PBC in WCHBF; however, in the proposed model, it is observed that ATT has no impact on WCHBF. Conclusion Applying strategies that lead to a change in consumer behavior towards healthy brands is a matter of time and will. In this context, the findings indicate that nutritional literacy plays an essential role in the willingness to consume healthy foods, which sheds more light on the design of educational interventions and awareness campaigns that independently inform about nutritional benefits and empower consumers, allowing them to make informed and healthy choices.
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Affiliation(s)
| | | | - Manuel Escobar-Farfán
- Departamento de Administración, Facultad de Administración y Economía, Universidad de Santiago de Chile, Santiago, Chile
| | - Dany Yudet Millones-Liza
- Unidad de Ciencias Empresariales, Escuela de Posgrado, Universidad Peruana Unión, Lima, Peru
- Escuela Profesional de Administración, Facultad de Ciencias Empresariales, Universidad Peruana Unión, Lima, Peru
| | - Miluska Villar-Guevara
- Escuela Profesional de Administración, Facultad de Ciencias Empresariales, Universidad Peruana Unión, Juliaca, Peru
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van Burgel E, Fairweather M, Hill A, Christian M, Ferguson M, Lee A, Funston S, Fredericks B, McMahon E, Pollard C, Brimblecombe J. Development of a survey tool to assess the environmental determinants of health-enabling food retail practice in Aboriginal and Torres Strait Islander communities of remote Australia. BMC Public Health 2024; 24:442. [PMID: 38347471 PMCID: PMC10863203 DOI: 10.1186/s12889-024-17945-9] [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: 03/15/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Environmental factors can impact the ability of food retail businesses to implement best practice health-enabling food retail. METHODS We co-designed a short-item survey on factors influencing food retail health-enabling practice in a remote Australian setting. Publicly available submissions to an Australian Parliamentary Inquiry into food pricing and food security in remote Indigenous communities were coded using an existing remote community food systems assessment tool and thematically analysed. Themes informed survey questions that were then prioritised, refined and pre-tested with expert stakeholder input. RESULTS One-hundred and eleven submissions were coded, and 100 themes identified. Supply chain related data produced the most themes (n = 25). The resulting 26-item survey comprised questions to assess the perceived impact of environmental factors on a store's health-enabling practice (n = 20) and frequency of occurrence (n = 6). CONCLUSIONS The application of this evidence-informed, co-designed survey will provide a first-time cross-sectional analysis and the potential for ongoing longitudinal data and advocacy on how environmental factors affect the operations of remote stores.
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Affiliation(s)
- Emma van Burgel
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia.
| | - Molly Fairweather
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
| | - Amanda Hill
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
| | - Meaghan Christian
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
| | - Megan Ferguson
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Amanda Lee
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Sarah Funston
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Bronwyn Fredericks
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Emma McMahon
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Christina Pollard
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, 3168, Australia
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
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Zorbas C, Blake MR, Brown AD, Peeters A, Allender S, Brimblecombe J, Cameron AJ, Whelan J, Ferguson M, Alston L, Boelsen-Robinson T. A systems framework for implementing healthy food retail in grocery settings. BMC Public Health 2024; 24:137. [PMID: 38195419 PMCID: PMC10777568 DOI: 10.1186/s12889-023-17075-8] [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: 05/26/2023] [Accepted: 10/26/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Food retailers can be reluctant to initiate healthy food retail activities in the face of a complex set of interrelated drivers that impact the retail environment. The Systems Thinking Approach for Retail Transformation (START) is a determinants framework created using qualitative systems modelling to guide healthy food retail interventions in community-based, health-promoting settings. We aimed to test the applicability of the START map to a suite of distinct healthy food marketing and promotion activities that formed an intervention in a grocery setting in regional Victoria, Australia. METHODS A secondary analysis was undertaken of 16 previously completed semi-structured interviews with independent grocery retailers and stakeholders. Interviews were deductively coded against the existing START framework, whilst allowing for new grocery-setting specific factors to be identified. New factors and relationships were used to build causal loop diagrams and extend the original START systems map using Vensim. RESULTS A version of the START map including aspects relevant to the grocery setting was developed ("START-G"). In both health-promoting and grocery settings, it was important for retailers to 'Get Started' with healthy food retail interventions that were supported by a proof-of-concept and 'Focus on the customer' response (with grocery-settings focused on monitoring sales data). New factors and relationships described perceived difficulties associated with disrupting a grocery-setting 'Supply-side status quo' that promotes less healthy food and beverage options. Yet, most grocery retailers discussed relationships that highlighted the potential for 'Healthy food as innovation' and 'Supporting cultural change through corporate social responsibility and leadership'. CONCLUSIONS Several differences were found when implementing healthy food retail in grocery compared to health promotion settings. The START-G map offers preliminary guidance for identifying and addressing commercial interests in grocery settings that currently promote less healthy foods and beverages, including by starting to address business outcomes and supplier relationships.
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Affiliation(s)
- Christina Zorbas
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia.
| | - Miranda R Blake
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Andrew D Brown
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Anna Peeters
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Steve Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Julie Brimblecombe
- Department of Nutrition and Dietetics, Monash University, 264 Ferntree Gully Rd, Notting Hill, VIC, Australia
| | - Adrian J Cameron
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Jill Whelan
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Megan Ferguson
- School of Public Health, The University of Queensland, St Lucia, QLD, Australia
| | - Laura Alston
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
- Deakin Rural Health, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Tara Boelsen-Robinson
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
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Prowse R, Lawlor N, Powell R, Neumann EM. Creating healthy food environments in recreation and sport settings using choice architecture: a scoping review. Health Promot Int 2023; 38:daad098. [PMID: 37705493 PMCID: PMC10500220 DOI: 10.1093/heapro/daad098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Recreation and sport settings (RSS) are ideal for health promotion, however, they often promote unhealthy eating. Choice architecture, a strategy to nudge consumers towards healthier options, has not been comprehensively reviewed in RSS and indicators for setting-based multi-level, multi-component healthy eating interventions in RSS are lacking. This scoping review aimed to generate healthy food environment indicators for RSS by reviewing peer-reviewed and grey literature evidence mapped onto an adapted choice architecture framework. One hundred thirty-two documents were included in a systematic search after screening. Data were extracted and coded, first, according to Canada's dietary guideline key messages, and were, second, mapped onto a choice architecture framework with eight nudging strategies (profile, portion, pricing, promotion, picks, priming, place and proximity) plus two multi-level factors (policy and people). We collated data to identify overarching guiding principles. We identified numerous indicators related to foods, water, sugary beverages, food marketing and sponsorship. There were four cross-cutting guiding principles: (i) healthy food and beverages are available, (ii) the pricing and placement of food and beverages favours healthy options, (iii) promotional messages related to food and beverages supports healthy eating and (iv) RSS are committed to supporting healthy eating and healthy food environments. The findings can be used to design nested, multipronged healthy food environment interventions. Future research is needed to test and systematically review the effectiveness of healthy eating interventions to identify the most promising indicators for setting-based health promotion in RSS.
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Affiliation(s)
- Rachel Prowse
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's NL A1B 3V6, Canada
| | - Natasha Lawlor
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's NL A1B 3V6, Canada
| | - Rachael Powell
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's NL A1B 3V6, Canada
| | - Eva-Marie Neumann
- Library Services Division, Health Canada, Jeanne Mance Building, 200 Eglantine Driveway, Tunney’s Pasture, Ottawa, ON K1A 0K9, Canada
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Paulsen L, Benz L, Müller C, Wallmann-Sperlich B, Bucksch J. Personal determinants of change agents' decision-making behavior in community health promotion: a qualitative study. BMC Public Health 2023; 23:1731. [PMID: 37670263 PMCID: PMC10481515 DOI: 10.1186/s12889-023-16590-y] [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: 09/27/2022] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Implementing environmental changes to promote healthier communities requires initial positive decisions by change agents from local politics and government. However, there is little research on what influences the change agents' decisions. This explorative, qualitative study aims to identify the personal determinants of the decision-making behavior of local change agents. METHODS We conducted semi-structured interviews to assess the personal determinants of decision-making behavior among 22 change agents from local politics and government. Relevant determinants were identified through a structured content analysis of the interview transcripts using the software MAXQDA 2020. RESULTS We found the following seven essential clusters of personal determinants of the decision-making behavior of change agents from local politics and government: Imprinting, socialization, and biography; experiences and involvement; attitudes and outcome expectations towards important issues and aspects; knowledge; emotions; personal benefits; and the perceived influences of others. CONCLUSIONS The identified personal determinants might serve as a source of understanding the decision-making behavior of change agents in community decision-making processes. Our findings can contribute to the effective planning and implementation of evidence-based multilevel interventions related to changing environmental conditions in communities and provide important information on which personal determinants should be considered when derive strategies for community health promotion within a systematic approach of developing an intervention program theory.
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Affiliation(s)
- Lisa Paulsen
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany.
| | - Lea Benz
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
| | - Christina Müller
- Institute of Sport Science, University of Würzburg, Judenbühlweg 11, 97082, Würzburg, Germany
| | | | - Jens Bucksch
- Department of Prevention and Health Promotion, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
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Whelan J, Brimblecombe J, Christian M, Vargas C, Ferguson M, McMahon E, Lee A, Bell C, Boelsen-Robinson T, Blake MR, Lewis M, Alston L, Allender S. CO-Creation and Evaluation of Food Environments to Advance Community Health (COACH). AJPM FOCUS 2023; 2:100111. [PMID: 37790671 PMCID: PMC10546519 DOI: 10.1016/j.focus.2023.100111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Food environments are a key determinant of food intake and diet-related health. This paper describes the development of an iterative, adaptive, context-specific framework for health-enabling food environments embedded in cocreation theory. Methods A 3-stage multimethod framework for the coproduction and prototyping of public health interventions was followed in an iterative manner during the development of the framework. These 3 stages were (1) evidence review, including systematic review, consultation with experts, and observation of current work; (2) codesign of the framework prototype with multiple stakeholders; and (3) coproduction through refinement of the prototype through stakeholder workshops and expert reviews with incorporation of researcher notes and workshop evaluation. We use the term prototype during the development phase and the term framework to report on the final product. Results COACH (CO-creation and evaluation of food environments to Advance Community Health) is a process framework that describes what best practice application of cocreation in health-enabling food retail environments should involve. COACH consists of 10 interdependent factors within a 4-phase continuous quality improvement cycle. The 4 phases of the cycle are engagement and governance establishment, communication and policy alignment, codesign and implementation, and monitoring and evaluation. Conclusions Utilizing cocreation theory represents an innovative step in research and practice to improve the healthiness of food retail environments. COACH provides a specific, unique, and comprehensive guide to the utilization of cocreation to improve the healthiness of food environments in practice.
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Affiliation(s)
- Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Medicine, Deakin University, Geelong, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Science, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Meaghan Christian
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Science, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Megan Ferguson
- School of Public Health, The University of Queensland, Brisbane, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - Emma McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - Amanda Lee
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Medicine, Deakin University, Geelong, Australia
| | - Tara Boelsen-Robinson
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Miranda R. Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Meron Lewis
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Laura Alston
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
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Lemke MK, Houghtaling B, Winkler MR, Hege A. Rethinking Efforts to Improve Dietary Patterns Among Long-Haul Truck Drivers: Transforming Truck Stop Retail Food Environments Through Upstream Change. Am J Health Promot 2023; 37:755-759. [PMID: 36719742 PMCID: PMC10330639 DOI: 10.1177/08901171231155050] [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: 02/01/2023]
Abstract
A multitude of upstream occupational exposures influence poor dietary patterns that contribute to cardiometabolic health disparities among long-haul truck drivers in the United States. Herein, we delineate the unique characteristics of the truck driving profession that shape dietary patterns. Next, we discuss current health promotion efforts and why they are unlikely to be sufficient for improving population-level dietary patterns. We then advocate for prioritizing health promotion efforts that target upstream factors that influence population dietary patterns and have the potential to holistically and sustainably support drivers' nutrition. Finally, we propose novel research directions to catalyze upstream-oriented health promotion efforts.
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Affiliation(s)
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Megan R. Winkler
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Adam Hege
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
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Vogel C, Dijkstra C, Huitink M, Dhuria P, Poelman MP, Mackenbach JD, Crozier S, Seidell J, Baird J, Ball K. Real-life experiments in supermarkets to encourage healthy dietary-related behaviours: opportunities, challenges and lessons learned. Int J Behav Nutr Phys Act 2023; 20:73. [PMID: 37340326 DOI: 10.1186/s12966-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Supermarkets are the primary source of food for many people yet their full potential as a setting to encourage healthy dietary-related behaviours remains underutilised. Sharing the experiences from research groups who have worked with supermarket chains to evaluate strategies that promote healthy eating could improve the efficiency of building such relationships and enhance the design quality of future research studies. METHODS A collective case study approach was used to synthesise experiences of engaging and sustaining research collaborations with national supermarket chains to test the effectiveness of health-focused in-store interventions. The collective narrative covers studies conducted in three high-income countries: Australia, the Netherlands and the United Kingdom. RESULTS We have distilled our experiences and lessons learned into six recommendations for conducting high quality public health research with commercial supermarket chains. These include: (i) using personal contacts, knowledge of supermarket activities and engaging executive management to establish a partnership and allowing time to build trust; (ii) using scientifically robust study designs with appropriate sample size calculations; (iii) formalising data exchange arrangements and allocating adequate resource for data extraction and re-categorisation; (iv) assessing effects at individual/households level where possible; (v) designing a mixed-methods process evaluation to measure intervention fidelity, dose and unintended consequences; and (vi) ensuring scientific independence through formal contract agreements. CONCLUSIONS Our collective experiences of working in non-financial partnerships with national supermarket chains could be useful for other research groups looking to develop and implement supermarket studies in an efficient manner. Further evidence from real-life supermarket interventions is necessary to identify sustainable strategies that can improve population diet and maintain necessary commercial outcomes.
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Affiliation(s)
- Christina Vogel
- Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Marlijn Huitink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Wageningen, 6700 EW, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute, De Boelelaan 1089a, 1081HV, Amsterdam, the Netherlands
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Jacob Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Vargas C, Whelan J, Feery L, Greenslade D, Farrington M, Brimblecombe J, Thuruthikattu F, Allender S. Developing Co-Creation Research in Food Retail Environments: A Descriptive Case Study of a Healthy Supermarket Initiative in Regional Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6077. [PMID: 37372664 DOI: 10.3390/ijerph20126077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
Research into the co-creation of healthy food retail is in its early stages. One way to advance co-creation research is to explore and understand how co-creation was applied in developing, implementing, and evaluating a heath-enabling initiative in a supermarket in regional Victoria, Australia. A case study design was used to explore and understand how co-creation was applied in the Eat Well, Feel Good Ballarat project. Six documents and reports related to the Eat Well, Feel Good Ballarat project were analyzed with findings from the focus groups and interviews. Motivations to develop or implement health-enabling supermarket initiatives differed among the participants. Participants considered that initial negotiations were insufficient to keep the momentum going and to propose the value to the retailers to scale up the project. Presenting community-identified needs to the supermarket helped gain the retailer's attention, whilst the co-design process helped the implementation. Showcasing the project to the community through media exposure kept the supermarket interested. Retailers' time constraints and staff turnover were considered significant barriers to partnership building. This case study contributes insights into applying co-creation to health-enabling strategies in food retail outlets using two co-creation frameworks.
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Affiliation(s)
- Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia
| | - Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia
| | - Louise Feery
- Ballarat Community Health, Ballarat, VIC 3350, Australia
| | | | | | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia
| | | | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia
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12
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Vargas C, Brimblecombe J, Allender S, Whelan J. Co-creation of health-enabling initiatives in food retail: academic perspectives. BMC Public Health 2023; 23:953. [PMID: 37231441 DOI: 10.1186/s12889-023-15771-z] [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: 07/15/2022] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Co-creation of healthy food retail comprises the systematic collaboration between retailers, academics and other stakeholders to improve the healthiness of food retail environments. Research into the co-creation of healthy food retail is in its early stages. Knowledge of the roles and motivations of stakeholders in intervention design, implementation and evaluation can inform successful co-creation initiatives. This study presents academic experiences of stakeholder roles and motivations in the co-creation of healthy food retail environments. METHODS Purposive sampling of academics with research experience in the co-creation of healthy food retail initiatives. Semi-structured interviews conducted between October and December 2021 gathered participants' experiences of multi-stakeholder collaborative research. Thematic analysis identified enablers, barriers, motivations, lessons and considerations for future co-creation of healthy food retail. RESULTS Nine interviewees provided diverse views and applications of co-creation research in food retail environments. Ten themes were grouped into three overarching areas: (i) identification of stakeholders required for changes to healthier food retail; (ii) motivations and interactions, which included the intrinsic desire to build healthier communities along with recognition of their work; and (iii) barriers and enablers included adequate resourcing, effective and trusting working relationships and open communications. CONCLUSION This study provides insights that could help future co-creation in healthy food retail environments. Trusting and respectful relationships and reciprocal acknowledgement between stakeholders are key practices in the co-creation process. These constructs should be considered in developing and testing a model that helps to systematically co-create healthy food retail initiatives that ensure all parties meet their needs while also delivering research outcomes.
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Affiliation(s)
- Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia.
- , Locked Bag 20000, Geelong, VIC, 3220, Australia.
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University Clayton, Clayton, VIC, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
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Häyry M, Ahola-Launonen J, Takala T. Let the Chips Fall! Public Nudging Arrangements, Coercion, and the Role of Independent Shopkeepers. SOCIETY 2023; 60:1-14. [PMID: 37362038 PMCID: PMC10177725 DOI: 10.1007/s12115-023-00844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/28/2023]
Abstract
Nudging, according to its inventors and defenders, is supposed to provide a non-coercive way of changing human behavior for the better-a freedom-respecting form of "libertarian paternalism." Its original point was to complement coercive modes of influence without any need of justification in liberal frameworks. This article shows, using the example of food-product placement in grocery stores, how this image is deceptive. Although nudging practices may not restrict the freedom of consumers, nudging arrangements by public health authorities do restrict the freedom of shopkeepers in standard liberal senses. Libertarianism cannot justify this coercion, and the creed is best left out of the equation as the ideological ruse that it, in this discussion, is. Other liberal theories can justify the coercion, but on grounds that can also be applied to other methods of public health promotion by subsidies and regulation. This result reaffirms that nudging should be seen to complement, not to replace, those other methods.
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Affiliation(s)
- Matti Häyry
- Aalto University School of Business, PO Box 21210, FI-00076 Aalto, Finland
| | | | - Tuija Takala
- Aalto University School of Business, PO Box 21210, FI-00076 Aalto, Finland
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14
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Day G, Collins J, Twohig C, De Silva K, Brimblecombe J. Towards healthy food retail: An assessment of public health nutrition workforce capacity to work with stores. Aust N Z J Public Health 2023; 47:100056. [PMID: 37182502 DOI: 10.1016/j.anzjph.2023.100056] [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: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE This article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet. METHODS Convergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisations that provide a nutrition professional service to food retail stores in remote Australia. The study participants include 11 nutrition professionals and eight organisation representatives, including managers, organisation directors and policy officers. Systems-mapping and thematic analysis of the in-depth interviews were conducted using a capacity development framework. Descriptive analysis was applied to pre-interview survey and mapping data. RESULTS A gap between the aspirational work and current capacity of nutrition professionals to engage effectively with stores was identified. Engagement with stores to improve population health was valued by organisations. Dominance of the medical health model limited organisation strategic support for store work and created barriers. Key barriers included the limited access to training, decision-support tools, information, financial resources and organisational structures that directed store work. CONCLUSIONS Provision of adequate store-specific training, resources and organisational support may empower the nutrition professional workforce to be powerful leaders in co-design for healthy food retail. IMPLICATIONS FOR PUBLIC HEALTH Building capacity for this critical workforce to engage in food retail practice change must consider the influence of the broader health system and employer organisations and need for access to evidence-based decision-support tools.
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Affiliation(s)
- Georgia Day
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Cliona Twohig
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation (ALPA), 70 O'Sullivan Circuit, East Arm, Northern Territory, 0822, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia; Menzies School of Health Research, John Mathews Building (58), Royal Darwin Hospital Campus, 58 Rocklands Dr, Tiwi, NT, 0810, Australia.
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Mjöberg M, Lissner L, Hunsberger M. Supermarket promotions in Western Sweden are incompatible with Nordic dietary recommendations and differ by area-level socioeconomic index. BMC Public Health 2023; 23:795. [PMID: 37118718 PMCID: PMC10148457 DOI: 10.1186/s12889-023-15729-1] [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: 02/20/2023] [Accepted: 04/22/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Large supermarket chains produce weekly advertisements to promote foods and influence consumer purchases. The broad consumer reach of these ads presents an opportunity to promote foods that align with dietary recommendations. Thus, the aim of this study was to investigate the health quality of supermarkets' weekly food promotions in a large region of Sweden with attention to more and less advantaged socioeconomic index areas. METHODS Analysis of weekly advertisements from 122 individual stores, representing seven chains, was carried out in a large region of Sweden from 2-29 March in 2020. Food promotions were divided into categories according to the Nordic Nutrition Recommendations and World Health Organization Regional Office for Europe's nutrient profile model, and defined as 'most healthy', 'healthy', 'unhealthy' and 'most unhealthy'. A mean socioeconomic index was used to classify each store location to determine whether proportions of the 'most unhealthy' foods differed between more advantaged and more disadvantaged socioeconomic index areas. RESULTS In total, 29,958 food items were analyzed. Two-thirds of promotions belonged to the food groups considered 'most unhealthy' and 'unhealthy'. In the 'most unhealthy' food group 'sugar-rich beverages and foods' constituted approximately 23.0% of the promotions. Food promotions had 25% increased odds to be from the 'most unhealthy' group (odds ratio 1.25, confidence interval 1.17, 1.33) in more disadvantaged socioeconomic index areas. This association could be explained by the supermarket chain the stores belonged to. CONCLUSIONS Our findings indicate that Swedish supermarkets promote a large proportion of unhealthy foods as classified by the Nordic Nutrition Recommendations. We also observe that certain national supermarket chains tend to locate their stores in more disadvantaged areas and promote a greater proportion of unhealthy foods in their weekly advertisements compared to the more advantaged areas. There is an urgent need for supermarkets to shift promotions toward healthier food items.
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Affiliation(s)
- Melissa Mjöberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monica Hunsberger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Winkler LL, Toft U, Glümer C, Bloch P, Buch-Andersen T, Christensen U. Involving supermarkets in health promotion interventions in the Danish Project SoL. A practice-oriented qualitative study on the engagement of supermarket staff and managers. BMC Public Health 2023; 23:706. [PMID: 37072841 PMCID: PMC10111755 DOI: 10.1186/s12889-023-15501-5] [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: 05/09/2022] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Supermarkets have been suggested as relevant settings for environmental and educational initiatives encouraging healthier shopping and eating decisions, but in the literature, limited attention has been paid to the context, perspectives, and everyday practices of supermarket staff. The aim of this study was to examine the engagement of supermarket staff in a health promotion project from a practice-oriented perspective. METHODS The study was based on qualitative data collected in the supermarket setting of Project SoL; a community-based health promotion project in Denmark. We conducted 26 in-depth interviews with store managers and other key staff members in seven participating supermarkets. In addition, we collected data on planning, implementation, and perceptions of supermarket staff of in-store interventions and other project-related activities. These field data included short telephone interviews, observational notes, photos, and audiotapes of meetings. Data were analysed from the perspective of practice theory. RESULTS Although supermarket staff found community-based health promotion meaningful to engage in, the study observed that their engagement was challenged by a business mindset, practical routines and structural requirements favouring sales promotion over health promotion. Nevertheless, there were also examples of how health promotion activities and ways of thinking were successfully incorporated in everyday staff practices during and after Project SoL. CONCLUSIONS Our findings point to both potentials and challenges for using supermarkets as settings for health promotion. The voluntary engagement of supermarket staff in community-based health projects cannot stand alone but should be supplemented by more long-lasting strategies and policies regulating this and other food environments. Context-sensitive and practice-oriented analyses in local food environments could inform such strategies and policies to make sure they target unwanted elements and practices and not just individual behavior.
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Affiliation(s)
- Lise L Winkler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark.
| | - Ulla Toft
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Charlotte Glümer
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
- Center for Diabetes, Vesterbrogade 121, 3rd floor, København V, 1620, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark
| | - Tine Buch-Andersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, København K, 1123, Denmark
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Houghtaling B, Misyak S, Serrano E, Dombrowski RD, Holston D, Singleton CR, Harden SM. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework to Advance the Science and Practice of Healthy Food Retail. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:245-251. [PMID: 36642585 DOI: 10.1016/j.jneb.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 06/17/2023]
Abstract
Although healthy food retail strategies are widely used, there appears to be a limited understanding of the processes and determinants for successful adoption, implementation, and sustainment. To fill this gap, we recommend the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to be used to advance the science and practice of healthy food retail. In this perspective, we: (1) introduce EPIS and describe why it was chosen as a recommended implementation science framework for healthy food retail, (2) highlight healthy food retail evidence supporting EPIS, and (3) discuss research and practice needs moving forward.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE; Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA; School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA.
| | - Sarah Misyak
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA
| | - Elena Serrano
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA
| | - Rachael D Dombrowski
- College of Education, Health and Human Services, California State University San Marcos, San Marcos, CA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, LA
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Samantha M Harden
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA
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Brimblecombe J, Miles B, Chappell E, De Silva K, Ferguson M, Mah C, Miles E, Gunther A, Wycherley T, Peeters A, Minaker L, McMahon E. Implementation of a food retail intervention to reduce purchase of unhealthy food and beverages in remote Australia: mixed-method evaluation using the consolidated framework for implementation research. Int J Behav Nutr Phys Act 2023; 20:20. [PMID: 36803988 PMCID: PMC9938595 DOI: 10.1186/s12966-022-01377-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/08/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Adoption of health-enabling food retail interventions in food retail will require effective implementation strategies. To inform this, we applied an implementation framework to a novel real-world food retail intervention, the Healthy Stores 2020 strategy, to identify factors salient to intervention implementation from the perspective of the food retailer. METHODS A convergent mixed-method design was used and data were interpreted using the Consolidated Framework for Implementation Research (CFIR). The study was conducted alongside a randomised controlled trial in partnership with the Arnhem Land Progress Aboriginal Corporation (ALPA). Adherence data were collected for the 20 consenting Healthy Stores 2020 study stores (ten intervention /ten control) in 19 communities in remote Northern Australia using photographic material and an adherence checklist. Retailer implementation experience data were collected through interviews with the primary Store Manager for each of the ten intervention stores at baseline, mid- and end-strategy. Deductive thematic analysis of interview data was conducted and informed by the CFIR. Intervention adherence scores derived for each store assisted interview data interpretation. RESULTS Healthy Stores 2020 strategy was, for the most part, adhered to. Analysis of the 30 interviews revealed that implementation climate of the ALPA organisation, its readiness for implementation including a strong sense of social purpose, and the networks and communication between the Store Managers and other parts of ALPA, were CFIR inner and outer domains most frequently referred to as positive to strategy implementation. Store Managers were a 'make-or-break' touchstone of implementation success. The co-designed intervention and strategy characteristics and its perceived cost-benefit, combined with the inner and outer setting factors, galvanised the individual characteristics of Store Managers (e.g., optimism, adaptability and retail competency) to champion implementation. Where there was less perceived cost-benefit, Store Managers seemed less enthusiastic for the strategy. CONCLUSIONS Factors critical to implementation (a strong sense of social purpose; structures and processes within and external to the food retail organisation and their alignment with intervention characteristics (low complexity, cost advantage); and Store Manager characteristics) can inform the design of implementation strategies for the adoption of this health-enabling food retail initiative in the remote setting. This research can help inform a shift in research focus to identify, develop and test implementation strategies for the wide adoption of health-enabling food retail initiatives into practice. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN 12,618,001,588,280.
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Affiliation(s)
- Julie Brimblecombe
- Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia. .,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT, 0810, Australia. .,School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD, 4006, Australia.
| | - Bethany Miles
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia
| | - Emma Chappell
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia ,grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD 4006 Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation, 70 O’Sullivan Cct, East Arm, NT 0828 Australia
| | - Megan Ferguson
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia ,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia ,grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD 4006 Australia
| | - Catherine Mah
- grid.55602.340000 0004 1936 8200Dalhousie University, 5850 College Street, Second Floor, PO Box 15000, Halifax, NS B3H 4R2 Canada ,grid.17063.330000 0001 2157 2938University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Eddie Miles
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
| | - Anthony Gunther
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
| | - Thomas Wycherley
- grid.1026.50000 0000 8994 5086Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, North Terrace, Adelaide, South Australia 5000 Australia
| | - Anna Peeters
- grid.1021.20000 0001 0526 7079Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Leia Minaker
- grid.46078.3d0000 0000 8644 1405School of Planning, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Emma McMahon
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia ,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
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Middel CN, Schuitmaker-Warnaar TJ, Mackenbach JD, Broerse JE. Designing a Healthy Food-Store Intervention; A Co-Creative Process Between Interventionists and Supermarket Actors. Int J Health Policy Manag 2022; 11:2175-2188. [PMID: 34634882 PMCID: PMC9808264 DOI: 10.34172/ijhpm.2021.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Without consideration for the food system in which healthy food-store interventions (HFIs) are implemented, their effects are likely to be unsustainable. Co-creation of HFIs by interventionists and food-store actors may improve contextual fit and therefore the effectiveness and sustainability of interventions, but there are few case studies on the topic. This study aims to provide insights into the integration of knowledge from contextual actors into HFI designs, through a co-creative process, to illustrate potential challenges, advantages, and outcomes. METHODS We describe the co-creative design of an HFI in a Dutch supermarket chain, conducted through three increasingly in-depth design phases. Each phase consisted of a cycle of theorizing (gather insights from literature, feedback, and pilot studies), building (develop intervention designs), and evaluating (interviews or workshops with supermarket actors, to explore barriers and facilitators for sustainable implementation), feeding back into the next phase (drafting adapted intervention designs, based on feedback, and research input). Interview transcripts underwent a qualitative content analysis. RESULTS We co-creatively designed four types of interventions to promote healthier food choices in supermarkets: (1) price strategies, (2) product presentation and positioning, (3) signage, and (4) interactive messaging. Interventions were aligned with the culture, structures and practices of the supermarket chain, while simultaneously challenging these system characteristics. For example, the idea of price promotions on healthy foods was well-received and encountered only practical barriers, which were easily resolved. However, the specification of tax-like price increases on unhealthy foods led to substantial resistance on cultural and commercial grounds, which were resolved through support from a key supermarket actor. CONCLUSION Our results illustrate the potential benefits of co-creation approaches in HFI design. We reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes.
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Affiliation(s)
- Cédric N.H. Middel
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Joreintje D. Mackenbach
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Upstream Team, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jacqueline E.W. Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hedrick VE, Farris AR, Houghtaling B, Mann G, Misyak SA. Validity of a Market Basket Assessment Tool for Use in Supplemental Nutrition Assistance Program Education Healthy Retail Initiatives. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:776-783. [PMID: 35623937 DOI: 10.1016/j.jneb.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the validity of the Market Basket Analysis Tool (MBAT) for food environment quality within various retail environments compared to the Nutrition Environment Measures Survey in Stores (NEMS-S). METHODS In-store assessments using the MBAT and the NEMS-S on the same day in a given store were conducted in grocery stores, corner stores, pharmacies, and dollar stores in a metropolis, and urban and rural counties across 4 states: Louisiana, Mississippi, North Carolina, and Virginia. Descriptive statistics, correlations, and ANOVAs were used to assess store location, store type differences, and MBAT and NEMS-S scores. RESULTS Market Basket Analysis Tool and NEMS-S data were collected from 114 stores. Market Basket Analysis Tool and NEMS-S total and all individual component scores were significantly correlated (r = 0.84, P ≤ 0.0001; r range, 0.51-0.88; P ≤ 0.0001). CONCLUSIONS AND IMPLICATIONS The MBAT offers a methodology to measure the food retail environment focusing on the availability of healthful food items with a reduced training time and streamlined data collection compared with the NEMS-S. Future work can assess the completion time of the MBAT compared with the NEMS-S and the ability of the MBAT to detect changes in food environment quality post healthy food retail interventions.
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Affiliation(s)
- Valisa E Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA.
| | - Alisha R Farris
- Department of Nutrition and Health Care Management, Appalachian State University, Boone, NC
| | - Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University AgCenter, Baton Rouge, LA
| | - Georgianna Mann
- Department of Nutrition and Hospitality Management, University of Mississippi, University, MS
| | - Sarah A Misyak
- Virginia Cooperative Extension Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA
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Batista CHK, Leite FHM, Borges CA. Association between advertising patterns and ultra-processed food in small markets. CIENCIA & SAUDE COLETIVA 2022; 27:2667-2678. [PMID: 35730837 DOI: 10.1590/1413-81232022277.19122021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
Abstract
This article aims to characterize the advertising appeals present in the food environment to market ultra-processed foods and to analyze the nutritional profile of these foods according to PAHO criteria and the presence of food additives. Cross-sectional study, with data audited in 20 small supermarkets in São Paulo. The INFORMAS protocol was used to classify the advertising messages. The foods were classified according to NOVA. The PAHO profile model was used to classify foods high in critical nutrients. Advertising patterns were identified by factor analysis. The association between patterns and food groups was investigated by linear regression. More than 95% of the ultraprocessed foods had at least 1 critical nutrient in excess. There was a positive association between the new brand, fun and advantageous pattern with snacks, ready-made products, dairy products and cookies; between the new brand and suggested use pattern with dairy products. The standardization of food advertising in small retail stores is associated with offering snacks, dairy products, ready-to-eat foods and cookies, products that exceed critical nutrients.
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Affiliation(s)
- Carolina Hatsuko Kikuta Batista
- Programa de Graduação em Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715, Cerqueira César. 01243-904 São Paulo SP Brasil.
| | - Fernanda Helena Marrocos Leite
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo. Programa de Pós-Graduação em Saúde Global e Sustentabilidade, Faculdade de Saúde Pública, Universidade de São Paulo. São Paulo SP Brasil
| | - Camila Aparecida Borges
- Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo. São Paulo SP Brasil
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22
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Houghtaling B, Englund T, Chen S, Pradhananga N, Kraak VI, Serrano E, Harden SM, Davis GC, Misyak S. Supplemental Nutrition Assistance Program (SNAP)-authorized retailers received a low score using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. BMC Public Health 2022; 22:1225. [PMID: 35725448 PMCID: PMC9208119 DOI: 10.1186/s12889-022-13624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 06/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) supports Americans with lower income to purchase dietary products at authorized retailers. This research aimed to evaluate SNAP-authorized retailers' public commitments in support of nutrition security and to examine differences between traditional grocers and nontraditional (e.g., convenience, drug, dollar) SNAP-authorized retailers' public commitments. METHODS Prominent United States (U.S.) SNAP-authorized retailers nationally and in two U.S. states (California and Virginia) were identified based on number of store locations (n = 61). Public information available in grey literature were reviewed and scored using the Business Impact Assessment for Obesity and population-level nutrition (BIA-Obesity) tool. SNAP-authorized retailers were classified as traditional (e.g., grocery) or nontraditional (e.g., non-grocery) retailers. Total BIA-Obesity from 0 to 615, representing low to optimal support) and category scores were calculated for corporate strategy, relationships with external organizations, product formulation, nutrition labeling, product and brand promotion, and product accessibility. Descriptive statistics were used to describe BIA-Obesity scores overall and by category. Mann-Whitney U was used to test for potential differences in median BIA-Obesity total scores between traditional and nontraditional SNAP-authorized retailers (a priori, p < 0.05). RESULTS Average total BIA-Obesity scores for SNAP-authorized retailers ranged from 0 to 112 (16.5 ± 23.3). Total BIA-Obesity scores for traditional SNAP-authorized retailers (32.7 ± 33.6; median 25) were higher than nontraditional SNAP-authorized retailer scores (11.2 ± 16; median 5) (p = 0.008). For BIA-Obesity categories, average scores were highest for the category relationships with external organizations (8.3 ± 10.3) and lowest for promotion practices (0.6 ± 2.1). CONCLUSIONS Results of this research underscore a dearth of available evidence and substantial opportunity for improvement regarding SNAP-authorized retailer strategies to support nutrition security among Americans with lower income.
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, 70803, US.
| | - Tessa Englund
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, US
| | - Susan Chen
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, CA, 95192, US
| | - Nila Pradhananga
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, 70803, US
| | - Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| | - Elena Serrano
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US.,The Virginia Cooperative Extension Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
| | - George C Davis
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US.,Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA, 24061, US
| | - Sarah Misyak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US.,The Virginia Cooperative Extension Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24061, US
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23
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Lobczowska K, Banik A, Forberger S, Kaczmarek K, Kubiak T, Neumann-Podczaska A, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Bekker MPM, Zeeb H, Luszczynska A. Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity. BMC Public Health 2022; 22:1055. [PMID: 35619065 PMCID: PMC9137101 DOI: 10.1186/s12889-022-13340-4] [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: 06/18/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. Methods Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. Results Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). Conclusions These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13340-4.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Krzysztof Kaczmarek
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Agnieszka Neumann-Podczaska
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, bode 60, 6700 EW, Wageningen, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland. .,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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24
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Cost-Benefit and Cost-Utility Analyses to Demonstrate the Potential Value-for-Money of Supermarket Shelf Tags Promoting Healthier Packaged Products in Australia. Nutrients 2022; 14:nu14091919. [PMID: 35565886 PMCID: PMC9103654 DOI: 10.3390/nu14091919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
The supermarket environment impacts the healthiness of food purchased and consumed. Shelf tags that alert customers to healthier packaged products can improve the healthiness of overall purchases. This study assessed the potential value-for-money of implementing a three-year shelf tag intervention across all major supermarket chains in Australia. Cost-benefit analyses (CBA) and cost-utility analyses (CUA) were conducted based on results of a 12-week non-randomised controlled trial of a shelf tag intervention in seven Australian supermarkets. The change in energy density of all packaged foods purchased during the trial was used to estimate population-level changes in mean daily energy intake. A multi-state, multiple-cohort Markov model estimated the subsequent obesity-related health and healthcare cost outcomes over the lifetime of the 2019 Australian population. The CBA and CUA took societal and healthcare sector perspectives, respectively. The intervention was estimated to produce a mean reduction in population body weight of 1.09 kg. The net present value of the intervention was approximately AUD 17 billion (B). Over 98% of the intervention costs were borne by supermarkets. CUA findings were consistent with the CBA-the intervention was dominant, producing both health benefits and cost-savings. Shelf tags are likely to offer excellent value-for-money from societal and healthcare sector perspectives.
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25
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Trujillo Lalla A, George C, Bancroft C, Edison T, Ricks A, Tabb K, Sandman S, Salt SK, Curley C, de Heer H“D, Curley CA, Yazzie D, Shin SS. Shopper Purchasing Trends at Small Stores on the Navajo Nation since the Passage of the Healthy Diné Nation Act Tax: A Multi-Year Cross-sectional Survey. Curr Dev Nutr 2022; 6:nzac040. [PMID: 35592518 PMCID: PMC9113337 DOI: 10.1093/cdn/nzac040] [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: 04/14/2021] [Revised: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background In 2014, the Navajo Nation passed the Healthy Diné Nation Act (HDNA), which applies an additional 2% tax on unhealthy foods and beverages and a waiver of Navajo sales tax on healthy foods and beverages. However, the HDNA's impact on purchasing behavior has not been explored. Objectives We assessed beverage and produce purchasing trends among shoppers at small Navajo stores between 2017 and 2019, shopper characteristics associated with buying water, and whether HDNA awareness was associated with purchasing behaviors. Methods A total of 332 shoppers at 34 stores in 2017 and 274 shoppers at 44 stores in 2019 were surveyed to assess HDNA awareness and same-day purchasing of water, sugar-sweetened beverages (SSBs), fruits, and vegetables. Hypotheses were tested using chi-square analyses and multivariate analysis. Results Water purchasing among respondents increased significantly from 2017 to 2019 (24.4% to 32.8%; P = 0.03). Shoppers in 2019 were 1.5 times more likely to purchase water compared with 2017 (adjusted P = 0.01). There was a trend toward reduced SSB purchasing (85.8% in 2017, 80.3% in 2019, P = 0.068), while produce purchasing remained unchanged over time, at approximately 17%. Shoppers were more likely to buy water if they relied on that store for the majority of their groceries (P = 0.006) and if they did not have their own transportation to get to the store (P = 0.004). Most shoppers (56.6%) were aware of the HDNA; of these, 35.6% attributed healthier habits to the HDNA, most commonly buying more healthy drinks (49.2%), fewer unhealthy drinks (37.7%), more healthy snacks (31.1%), and fewer unhealthy snacks (26.2%). Conclusions Shopper habits at small stores located on the Navajo Nation have shifted towards healthier purchasing from 2017 to 2019. Shoppers who were aware of the HDNA reported purchasing more healthy and fewer unhealthy food and drinks as a result of this legislation.
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Affiliation(s)
- Amber Trujillo Lalla
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Carmen George
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Carolyn Bancroft
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Tierra Edison
- Community Outreach and Patient Empowerment, Gallup, NM, USA
- Diné College, Tsaile, AZ, USA
| | - Audrey Ricks
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kayla Tabb
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sharon Sandman
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Shine K Salt
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Cameron Curley
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | | | - Caleigh A Curley
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Del Yazzie
- Navajo Epidemiology Center, the Navajo Nation Department of Health, Window Rock, AZ, USA
| | - Sonya Sunhi Shin
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
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26
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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.
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27
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Vilme H, Paul CJ, Duke NN, Campbell SD, Sauls D, Muiruri C, Skinner AC, Bosworth H, Dokurugu YM, Fay JP. Using geographic information systems to characterize food environments around historically black colleges and universities: Implications for nutrition interventions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:818-823. [PMID: 32569511 PMCID: PMC8477389 DOI: 10.1080/07448481.2020.1767113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 05/19/2023]
Abstract
ObjectiveTo understand the distribution of healthy and unhealthy food stores near historically black colleges and universities (HBCUs). Participants and methods: Using ArcGIS Pro's network analysis tools and ReferenceUSA database, this study characterized the healthy (favorable) and unhealthy (unfavorable) retail food stores within a 5-mile radius, 15-min driving, and 15-min walking distance from each HBCU in North Carolina. Results: Most retail food stores within a 5-mile buffer radius of the 10 HBCUs in North Carolina were unfavorable. Within 15-min driving from each HBCU, 1082 stores (76.0%) were unfavorable food stores, while 332 (24.0%) were favorable. Additionally, there were four favorable and 35 unfavorable retail food stores within the 15-min walking distance of each HBCU. Conclusions: Favorable food retail stores around HBCUs in North Carolina are limited. Researchers, policy makers, and community stakeholders should work together to improve food environments surrounding HBCUs.
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Affiliation(s)
- Helene Vilme
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christopher J. Paul
- Department of Public Administration, North Carolina Central University, Durham, North Carolina, USA
| | - Naomi N. Duke
- Internal Medicine, Pediatrics, Adolescent Medicine, Division of Primary Care, Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | | | - Derrick Sauls
- Department of Public Health and Exercise Science, Saint Augustine's University, Raleigh, North Carolina, USA
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Asheley C. Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hayden Bosworth
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
- VA Durham Healthcare System, Durham, North Carolina, USA
- Health Services Research and Development, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina, USA
| | - Yussif M. Dokurugu
- College of Pharmacy and Pharmaceutical Science, Department of Epidemiology and Biostatistics, Florida A&M University, Tallahassee, Florida, USA
| | - John P. Fay
- Nicholas School of the Environment, Division of Environmental Sciences & Policy, Duke University, Durham, North Carolina, USA
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28
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Scaciota LL, Jaime PC, Borges CA. Development and validation of a guide to support public managers and retailers in promoting a healthy food environment. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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29
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Kebede A, Jirström M, Worku A, Alemu K, Berhane HY, Turner C, Ekström EC, Berhane Y. Residential Food Environment, Household Wealth and Maternal Education Association to Preschoolers' Consumption of Plant-Based Vitamin A-Rich Foods: The EAT Addis Survey in Addis Ababa. Nutrients 2022; 14:296. [PMID: 35057477 PMCID: PMC8778225 DOI: 10.3390/nu14020296] [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: 12/15/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/29/2022] Open
Abstract
Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children's diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children's diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers' consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.
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Affiliation(s)
- Adane Kebede
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia
| | - Magnus Jirström
- Department of Human Geography, Lund University, 223 62 Lund, Sweden;
| | - Alemayehu Worku
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa 1176, Ethiopia;
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar P.O. Box 196, Ethiopia;
| | - Hanna Y. Berhane
- Department of Nutrition and Behavioral Sciences, Addis Continental Institute of Public Health, Addis Ababa 26751/1000, Ethiopia;
- Department of Women’s and Children Health, Uppsala University, 751 85 Uppsala, Sweden; (E.-C.E.); (Y.B.)
| | - Christopher Turner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK;
| | - Eva-Charlotte Ekström
- Department of Women’s and Children Health, Uppsala University, 751 85 Uppsala, Sweden; (E.-C.E.); (Y.B.)
| | - Yemane Berhane
- Department of Women’s and Children Health, Uppsala University, 751 85 Uppsala, Sweden; (E.-C.E.); (Y.B.)
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa 26751/1000, Ethiopia
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Gupta A, Alston L, Needham C, Robinson E, Marshall J, Boelsen-Robinson T, Blake MR, Huggins CE, Peeters A. Factors Influencing Implementation, Sustainability and Scalability of Healthy Food Retail Interventions: A Systematic Review of Reviews. Nutrients 2022; 14:294. [PMID: 35057476 PMCID: PMC8780221 DOI: 10.3390/nu14020294] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 01/08/2023] Open
Abstract
The aim of this systematic review of reviews was to synthesise the evidence on factors influencing the implementation, sustainability and scalability of food retail interventions to improve the healthiness of food purchased by consumers. A search strategy to identify reviews published up until June 2020 was applied to four databases. The Risk of Bias in Systematic Review tool was used. Review findings were synthesised narratively using the socio-ecological model. A total of 25 reviews met the inclusion criteria. A number of factors influenced implementation; these included retailers' and consumers' knowledge and preferences regarding healthy food; establishing trust and relationships; perceived consumer demand for healthy food; profitability; store infrastructure; organizational support, including resources; and enabling policies that promote health. Few reviews reported on factors influencing sustainability or scalability of the interventions. While there is a large and rapidly growing body of evidence on factors influencing implementation of interventions, more work is needed to identify factors associated with their sustainability and scalability. These findings can be used to develop implementation strategies that consider the multiple levels of influence (individual, intrapersonal and environmental) to better support implementation of healthy food retail interventions.
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Affiliation(s)
- Adyya Gupta
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Laura Alston
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
- Deakin Rural Health, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia
| | - Cindy Needham
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Ella Robinson
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Josephine Marshall
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Tara Boelsen-Robinson
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Miranda R. Blake
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Catherine E. Huggins
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
| | - Anna Peeters
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia; (L.A.); (C.N.); (E.R.); (J.M.); (T.B.-R.); (M.R.B.); (C.E.H.); (A.P.)
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Lobczowska K, Banik A, Brukalo K, Forberger S, Kubiak T, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Wieczorowska-Tobis K, Bekker MPM, Zeeb H, Luszczynska A. Meta-review of implementation determinants for policies promoting healthy diet and physically active lifestyle: application of the Consolidated Framework for Implementation Research. Implement Sci 2022; 17:2. [PMID: 34991624 PMCID: PMC8734337 DOI: 10.1186/s13012-021-01176-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although multiple systematic reviews indicate that various determinants (barriers and facilitators) occur in the implementation processes of policies promoting healthy diet, physical activity (PA), and sedentary behavior (SB) reduction, the overarching synthesis of such reviews is missing. Applying the Consolidated Framework for Implementation Research (CFIR), this meta-review aims to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings. METHODS A meta-review of published systematic scoping or realist reviews (k = 25) and stakeholder documents (k = 17) was conducted. Data from nine bibliographic databases and documentation of nine major stakeholders were systematically searched. Included reviews (72%) and stakeholder documents (100%) provided qualitative synthesis of original research on implementation determinants of policies promoting healthy diet or PA or SB reduction, and 28% of reviews provided some quantitative synthesis. Determinants were considered strongly supported if they were indicated by ≥ 60.0% of included reviews/stakeholder documents. RESULTS Across the 26 CFIR-based implementation determinants, seven were supported by 66.7-76.2% of reviews/stakeholder documents. These determinants were cost, networking with other organizations/communities, external policies, structural characteristics of the setting, implementation climate, readiness for implementation, and knowledge/beliefs of involved individuals. Most frequently, published reviews provided support for inner setting and individual determinants, whereas stakeholder documents supported outer and inner setting implementation determinants. Comparisons between policies promoting healthy diet with PA/SB policies revealed shared support for only three implementation determinants: cost, implementation climate, and knowledge/beliefs. In the case of healthy diet/PA/SB policies targeting school settings, 14 out of 26 implementation determinants were strongly supported. CONCLUSIONS The strongly supported (i.e., systematically indicated) determinants may guide policymakers and researchers who need to prioritize potential implementation determinants when planning and monitoring the implementation of respective policies. Future research should quantitatively assess the importance or role of determinants and test investigate associations between determinants and progress of implementation processes. TRIAL REGISTRATION PROSPERO, # CRD42019133341.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Katarzyna Brukalo
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, Bode 60, 6700 EW, Wageningen, the Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland.
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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Batista CHK, Leite FHM, Borges CA. Association between advertising patterns and ultra-processed food in small markets. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022277.19122021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This article aims to characterize the advertising appeals present in the food environment to market ultra-processed foods and to analyze the nutritional profile of these foods according to PAHO criteria and the presence of food additives. Cross-sectional study, with data audited in 20 small supermarkets in São Paulo. The INFORMAS protocol was used to classify the advertising messages. The foods were classified according to NOVA. The PAHO profile model was used to classify foods high in critical nutrients. Advertising patterns were identified by factor analysis. The association between patterns and food groups was investigated by linear regression. More than 95% of the ultraprocessed foods had at least 1 critical nutrient in excess. There was a positive association between the new brand, fun and advantageous pattern with snacks, ready-made products, dairy products and cookies; between the new brand and suggested use pattern with dairy products. The standardization of food advertising in small retail stores is associated with offering snacks, dairy products, ready-to-eat foods and cookies, products that exceed critical nutrients.
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Anderson E, Wei R, Liu B, Plummer R, Kelahan H, Tamez M, Marrero A, Bhupathiraju S, Mattei J. Improving Healthy Food Choices in Low-Income Settings in the United States Using Behavioral Economic-Based Adaptations to Choice Architecture. Front Nutr 2021; 8:734991. [PMID: 34692747 PMCID: PMC8526839 DOI: 10.3389/fnut.2021.734991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 12/27/2022] Open
Abstract
Low diet quality is a significant public health problem in the United States, especially among low-income populations. The food environment influences dietary choices. When applied to eating behavior, behavioral economics (BE) recognizes that decision biases instigated by a food environment saturated with unhealthy foods may lead people to purchase such foods, even when they possess the necessary information and skills to make healthy dietary choices. Choice architecture, a BE concept that involves modifying the appeal or availability of choices to “nudge” people toward a certain choice, retains freedom of choice but makes unhealthy options less convenient or visible. Choice architecture has been demonstrated to influence food choices in various settings, including supermarkets, convenience stores, and food pantries. These modifications are low-cost and feasible to implement, making them a viable strategy to help “nudge” patrons toward healthier choices in food establishments serving low-income populations, including food pantries and retailers accepting the Supplemental Nutrition Assistance Program. This narrative review searched, appraised, and underscored the strengths and limitations of extant research studies that used choice architecture adaptations to influence food choices among low-income populations in the United States. Findings from studies in food pantry settings suggest the potential of BE strategies to improve the healthfulness of food choices and dietary intake in low-income populations. In food retail settings, research suggests that BE strategies increase sales of healthy foods, like fruits and vegetables. We identify new areas of research needed to determine if BE-based modifications in low-income settings have sustained impacts on diet quality.
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Affiliation(s)
- Emma Anderson
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Ruobin Wei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Binkai Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rachel Plummer
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Heather Kelahan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Abrania Marrero
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa Bhupathiraju
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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Changes in food pricing and availability on the Navajo Nation following a 2% tax on unhealthy foods: The Healthy Diné Nation Act of 2014. PLoS One 2021; 16:e0256683. [PMID: 34473739 PMCID: PMC8412325 DOI: 10.1371/journal.pone.0256683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION In 2014, the Navajo Nation Healthy Diné Nation Act (HDNA) was passed, combining a 2% tax on foods of 'minimal-to-no-nutritional value' and waiver of 5% sales tax on healthy foods, the first-ever such tax in the U.S. and globally among a sovereign tribal nation. The aim of this study was to measure changes in pricing and food availability in stores on the Navajo Nation following the implementation of the HDNA. METHODS Store observations were conducted in 2013 and 2019 using the Nutrition Environment Measurement Survey-Stores (NEMS-S) adapted for the Navajo Nation. Observations included store location, type, whether healthy foods or HDNA were promoted, and availability and pricing of fresh fruits and vegetables, canned items, beverages, water, snacks and traditional foods. Differences between 2013 and 2019 and by store type and location were tested. RESULTS The matched sample included 71 stores (51 in the Navajo Nation and 20 in border towns). In 2019, fresh produce was available in the majority of Navajo stores, with 71% selling at least 3 types of fruit and 65% selling at least 3 types of vegetables. Compared with border town convenience stores, Navajo convenience stores had greater availability of fresh vegetables and comparable availability of fresh fruit in 2019. The average cost per item of fresh fruit decreased by 13% in Navajo stores (from $0.88 to $0.76) and increased in border stores (from $0.63 to $0.73), resulting in comparable prices in Navajo and border stores in 2019. While more Navajo stores offered mutton, blue corn and wild plants in 2019 compared to 2013, these changes were not statistically significant. DISCUSSION The findings suggest modest improvements in the Navajo store environment and high availability of fruits and vegetables. Navajo stores play an important role in the local food system and provide access to local, healthy foods for individuals living in this rural, tribal community.
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Singleton CR, Adeyemi OS, Parab KV, Roehll AM, Flores E, Adams AM, Quintiliani LM, Bell BM, Dulin-Keita A. Society of Behavioral Medicine (SBM) position statement: provide funding for incentive programs to expand healthy food offerings in SNAP-authorized small food stores. Transl Behav Med 2021; 11:1283-1285. [PMID: 33200771 DOI: 10.1093/tbm/ibaa111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Individuals and families with limited access to healthy foods often experience increased risk for poor diet and chronic disease. Low-income communities are more likely to have a large number of small food stores (e.g., corner stores and dollar stores) compared to higher-income communities. Since many of these small food stores participate in the Supplemental Nutrition Assistance Program (SNAP), increasing healthy food offerings in these stores may expand healthy food retail in low-income communities. We recommend the provision of funding for incentive programs that encourage SNAP-authorized small food stores in low-income communities to expand their healthy food offerings. This programming should (a) provide seed grants to store owners to develop or reconfigure store infrastructure, (b) offer store owners technical assistance and educational materials on marketing strategies for promoting healthy food items to customers, and (c) give a tax break to SNAP-authorized small food stores in low-income communities that maintain a predetermined minimum stock of U.S. Department of Agriculture-recognized staple foods.
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Affiliation(s)
- Chelsea R Singleton
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Oluwafikayo S Adeyemi
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kaustubh V Parab
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Alexandra M Roehll
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Edson Flores
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ashley M Adams
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Lisa M Quintiliani
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Brooke M Bell
- Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, CA, USA
| | - Akilah Dulin-Keita
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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Gray HL, Berumen JH, Lovett SM, Himmelgreen D, Biswas D, Bohn J, Peacock C, Buro AW. A Mixed-methods Study to Understand Food Environments and Grocery Shopping Patterns of Community Residents in Underserved Neighborhoods in Tampa, Florida. Ecol Food Nutr 2021; 60:435-453. [PMID: 33356564 DOI: 10.1080/03670244.2020.1862098] [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: 10/22/2022]
Abstract
A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Jessica H Berumen
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Sharonda M Lovett
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - David Himmelgreen
- Department of Anthropology and the Center for the Advancement of Food Security & Healthy Communities, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Dipayan Biswas
- School of Marketing and Innovation, Muma College of Business, University of South Florida, Tampa, Florida, USA
| | - Joe Bohn
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | | | - Acadia W Buro
- College of Public Health, University of South Florida, Tampa, Florida, USA
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Gillespie R, DeWitt E, Norman-Burgdolf H, Dunnaway B, Gustafson A. Community-Based Efforts Aim to Improve the Food Environment within a Highly Obese Rural Appalachian County. Nutrients 2021; 13:nu13072200. [PMID: 34206825 PMCID: PMC8308232 DOI: 10.3390/nu13072200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/22/2022] Open
Abstract
Rural communities in Appalachia are displaying increased obesity prevalence, yet traditional interventions have not provided a broad enough impact to improve dietary consumption patterns. Therefore, expanding efforts that address the food environment and incorporate behavioral nudges through community-developed marketing strategies may be a viable mechanism to improve food and beverage choices within this unique population. This study installed shelf-wobblers across n = 5 gas stations in one rural Appalachian county in Kentucky. Smart Snacks were identified from store inventory lists utilizing the CDC Food Service Guideline for Federal Facilities calculator and were categorized into high-protein snacks, low-fat carbohydrate snacks, meal replacement snacks, and no-calorie beverages. NEMS-CS audits were conducted, and monthly sales data was collected at baseline and for six months thereafter for each store location. A difference-in-difference model was used, adjusting for total sales or total mean sales for each Smart Snack model to assess the percentage change within and between stores. Overall, percent change in mean sales and total sales across all stores resulted in a percentage increase of sales of Smart Snack items following wobbler installment. This study provides unique insight into how a community-driven approach to marketing can influence the sale of healthier food and beverage items.
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Affiliation(s)
- Rachel Gillespie
- Family Consumer Sciences Extension, University of Kentucky, Lexington, KY 40506, USA;
- Correspondence: ; Tel.: +1-859-257-7793
| | - Emily DeWitt
- Family Consumer Sciences Extension, University of Kentucky, Lexington, KY 40506, USA;
| | - Heather Norman-Burgdolf
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA; (H.N.-B.); (B.D.); (A.G.)
| | - Brynnan Dunnaway
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA; (H.N.-B.); (B.D.); (A.G.)
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY 40506, USA; (H.N.-B.); (B.D.); (A.G.)
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Lynch M, Graham M, Taylor K, Mah CL. Corner Store Retailers' Perspectives on a Discontinued Healthy Corner Store Initiative. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021:272684X211004930. [PMID: 33823687 DOI: 10.1177/0272684x211004930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Making fresh fruits and vegetables (FFV) more widely available has been a prominent focus of healthy retail interventions and may have an important role in improving food access and diet quality at the population level. 'Healthy retail' interventions in corner/convenience stores (CS) are increasingly being adopted by public health practitioners to address the diet-related risk factors, improve food access at the community level, and change food retail environments. Private sector retailers are integral to the success of public health retailing interventions, making their perspectives and experiences critical. There is a particular need for greater evidence from retailers in settings where evaluations of these interventions have yielded null or mixed results. Through semi-structured interviews with 8 CS retailers (7 from urban settings and 1 from rural) in Ottawa, Ontario, Canada, this study aimed to describe experiences and critical factors regarding the feasibility and sustainability of a healthy CS program that was not sustained following the pilot testing phase, with a specific focus on the sale of FFV. Thematic analysis was used to analyze the interview data, which indicated that retailers faced two dominant challenges with selling FFV in CS: both relate to how these stores are embedded in the larger local and global food system. We join others in arguing that efforts and support for retail interventions aiming to increase the availability of FFV in CS need to address the structure and relations of the food system, as an upstream determinant of CS retailer interest and motivation.
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Affiliation(s)
- Meghan Lynch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marketa Graham
- Chronic Disease and Injury Prevention Unit, Ottawa Public Health, Ottawa, Ontario, Canada
| | - Krystal Taylor
- Chronic Disease and Injury Prevention Unit, Ottawa Public Health, Ottawa, Ontario, Canada
| | - Catherine L Mah
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
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Houghtaling B, Holston D, Szocs C, Penn J, Qi D, Hedrick V. A rapid review of stocking and marketing practices used to sell sugar-sweetened beverages in U.S. food stores. Obes Rev 2021; 22:e13179. [PMID: 33331094 PMCID: PMC7988563 DOI: 10.1111/obr.13179] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/28/2020] [Accepted: 11/15/2020] [Indexed: 12/29/2022]
Abstract
Sugar-sweetened beverages (SSBs) are a primary source of added sugars in the American diet. Habitual SSB consumption is associated with obesity and noncommunicable disease and is one factor contributing to U.S. health disparities. Public health responses to address marketing-mix and choice-architecture (MMCA) strategies used to sell SSB products may be required. Thus, our goal was to identify original research about stocking and marketing practices used to sell SSB in U.S. food stores. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the World Health Organization (WHO) protocol for rapid reviewing. We searched six databases and Google Scholar using key terms focused on store type and SSB products. We characterized results using an MMCA framework with categories place, profile, portion, pricing, promotion, priming or prompting, and proximity. Our search resulted in the identification of 29 articles. Most results focused on profile (e.g., SSB availability) (n = 13), pricing (e.g., SSB prices or discounts) (n = 13), or promotion (e.g., SSB advertisements) (n = 13) strategies. We found some evidence of targeted MMCA practices toward at-risk consumers and differences by store format, such as increased SSB prominence among supermarkets. The potential for systematic variations in MMCA strategies used to sell SSB requires more research. We discuss implications for public health, health equity, and environmental sustainability.
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Denise Holston
- School of Nutrition and Food Sciences, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Courtney Szocs
- E.J. Ourso College of Business, Louisiana State University, Baton Rouge, LA, USA
| | - Jerrod Penn
- Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Danyi Qi
- Agricultural Economics and Agribusiness, Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, LA, USA
| | - Valisa Hedrick
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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Consumer Food Environment Healthiness Score: Development, Validation, and Testing between Different Types of Food Retailers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073690. [PMID: 33916263 PMCID: PMC8037126 DOI: 10.3390/ijerph18073690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/13/2021] [Accepted: 03/30/2021] [Indexed: 01/04/2023]
Abstract
The aim of this study was to develop and validate a scoring system, based on AUDITNOVA, to assess the healthiness of the consumer food environment, considering food availability, price, advertising, and placement strategies. Audited data of 650 food retailers were used to develop, validate, and test the consumer food environment healthiness score. To compose the score, the reference was the Dietary Guidelines for the Brazilian Population. The total and subscores were standardized for a scale from 0 to 100. Construct validity was assessed using the Kruskal–Wallis Dunn tests. Cronbach’s alpha coefficients were calculated to determine the consistency of the scores. The median score was 33.7 (p25 = 26.9; p75 = 42.1). The public and private specialized indoor fresh food markets showed the highest medians; otherwise, bakeries and food retailers with the predominant sale of ultra-processed foods showed the lowest. The score was able to satisfactorily classify the extreme food retailer groups by the predominant sale of fresh or minimally processed foods and the predominant sale of ultra-processed foods. The results of Cronbach’s alpha showed excellent internal consistency (α = 0.91). The score helped to provide an overall assessment of consumer food environment healthiness and was able to classify food retailer groups as healthy and unhealthy according to the degree of processing of the available foods.
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Carins J, Bogomolova S. Co-designing a community-wide approach to encouraging healthier food choices. Appetite 2021; 162:105167. [PMID: 33596438 DOI: 10.1016/j.appet.2021.105167] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
This research offers a novel perspective on encouraging healthier food choices through a community-wide approach. Using five co-design workshops with consumers and supermarket staff, and the abductive synthesis of qualitative data, this study uncovered the role of community in encouraging greater food well-being and allied behaviours. The results reveal rather critical consumer views on past paternalistic health promotion campaigns and offer alternative strategies for designing more balanced and holistic programs. Such a holistic approach can ensure more sustained programs, as they aim to achieve broader social, mental and physical health, and economic benefits, not just nutrition outcomes. The research offers practical recommendations on modifying retail marketing space, and the broader community setting, to create an environment where consumers find it easier, convenient, more socially desirable and pleasurable to make healthier choices.
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Affiliation(s)
- Julia Carins
- Social Marketing @ Griffith, Griffith Business School, Griffith University. 170 Kessels Road, Nathan, QLD, 4111, Australia.
| | - Svetlana Bogomolova
- Ehrenberg-Bass Institute for Marketing Science, UniSA Business, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia.
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Glanz K, Chung A, Morales KH, Kwong PL, Wiebe D, Giordano DP, Brensinger CM, Karpyn A. The healthy food marketing strategies study: design, baseline characteristics, and supermarket compliance. Transl Behav Med 2020; 10:1266-1276. [PMID: 33421079 DOI: 10.1093/tbm/ibaa078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Identifying effective strategies to promote healthy eating and reduce obesity is a priority in the USA, especially among low-income and minority groups, who often have less access to healthy food and higher rates of obesity. Efforts to improve food access have led to more supermarkets in low-income, ethnically diverse neighborhoods. However, this alone may not be enough to reduce food insecurity and improve residents' diet quality and health. This paper summarizes the design, methods, baseline findings, and supermarket in-store marketing strategy compliance for a randomized trial of the impact of healthy food marketing on the purchase of healthier "target" food items. Thirty-three supermarkets in low-income, high-minority neighborhoods in the metropolitan Philadelphia area were matched on store size and percentage of sales from government food assistance programs and randomly assigned to the intervention or control group. Healthy marketing strategies, including increased availability of healthier "target" products, prime shelf-placement and call-out promotion signs, and reduced availability of regular "comparison" products, were implemented in 16 intervention stores for an 18 month period for over 100 individual food items. Six product categories were studied: bread, checkout cooler beverages, cheese, frozen dinners, milk, and salty snacks. The primary outcome measure was weekly sales per store in each product category for 1 year preintervention and 18 months during the intervention. Compliance with the marketing strategies was assessed twice per month for the first 6 months and once a month thereafter. Store and neighborhood characteristics were not significantly different between control and intervention stores. Intercept surveys with customers to assess shopping habits and grocery marketing environment assessments to examine the food promotion environment were completed in the same six food categories. In intercept surveys, 51.0% of shoppers self-identified as overweight and 60.6% wanted to change their weight. Shoppers who typically purchased one type of food over another commonly did so out of habit or because the item was on sale. Findings revealed that preintervention sales of healthier "target" or regular "comparison" items did not differ between intervention and control stores for 1 year prior to intervention implementation. Rates of compliance with the healthy marketing strategies were high, averaging 76.5% over the first 12 months in all 16 stores. If healthy in-store marketing interventions are effective in this scaled-up, longer-term study, they should be translated into wider use in community supermarkets.
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Affiliation(s)
- Karen Glanz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Annie Chung
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Knashawn H Morales
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pui L Kwong
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas Wiebe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Donna Paulhamus Giordano
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Research in Education and Social Policy, University of Delaware, Newark, DE, USA
| | | | - Allison Karpyn
- Center for Research in Education and Social Policy, University of Delaware, Newark, DE, USA
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Food availability and advertising within food outlets around primary healthcare services in Brazil. J Nutr Sci 2020; 9:e49. [PMID: 33244401 PMCID: PMC7681171 DOI: 10.1017/jns.2020.45] [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: 02/17/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 12/03/2022] Open
Abstract
The consumer food environment is changing: an extensive variety of foods are now available in most markets, offering palatability, convenience and novelty. However, little is known about the availability and advertising of food items within food outlets, especially among developing countries. The present study examined these dimensions in 281 food outlets located around eighteen primary healthcare services in Belo Horizonte, Brazil, in 2013. These establishments were classified as large-chain supermarkets; specialised fruits and vegetable (F&V) markets; and local grocery stores, convenience stores or bakeries. Availability of F&V, availability of ultra-processed foods (UPF) and food advertising were compared across the food outlet categories by applying the χ2 test. Almost 60 % of the food outlets were specialised F&V markets, 21⋅4 % were large-chain supermarkets and 19⋅2 % were local grocery stores, convenience stores or bakeries. Almost 80 % contained at least eight types of fruits and vegetables, and 60 % contained UPF. Food advertisement was absent in 59⋅8 % of the food outlets, 19⋅6 % were advertising only F&V and 17⋅4 % were advertising only UPF. Higher F&V availability was noted inside specialised F&V markets and large-chain supermarkets than local grocery stores, convenience stores or bakeries. Advertising of F&V was more common within specialised F&V markets. However, large-chain supermarkets and local grocery stores, convenience stores or bakeries contained more frequent UPF food advertising isolated: 38⋅3 and 35⋅2 %, respectively. Therefore, the availability and advertising of food items within food outlets around primary healthcare services are different according to the type of food outlet.
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Houghtaling B, Serrano E, Chen S, Kraak VI, Harden SM, Davis GC, Misyak S. Supplemental Nutrition Assistance Program (SNAP)-Authorized Retailers' Perceived Costs to Use Behavioral Economic Strategies to Encourage Healthy Product Sales. Ecol Food Nutr 2020; 60:212-224. [PMID: 33164562 DOI: 10.1080/03670244.2020.1833873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
SNAP-authorized retailers could use marketing-mix and choice-architecture (MMCA) strategies to improve SNAP purchases, but associated costs are unknown. Perceived cost and inconvenience to implement eight MMCA strategies were assessed among 29 U.S. retailers. Differences in perspective were explored (owners vs. managers, corporate vs. independent retailers, and by format). Place changes (e.g., added refrigeration) were perceived more costly and prompting (e.g., shelf labeling) less costly. Managers rated the perceived inconvenience to make proximity changes higher than owners (3.78 ± 1.4 and 2.33 ± 1.2, respectively) (p < .05). Results can inform strategies to improve the adoption and implementation of healthy food retail programs.
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Affiliation(s)
- Bailey Houghtaling
- School of Nutrition and Food Sciences, Louisiana State University (LSU) & LSU Agricultural Center, Baton Rouge, Louisiana, USA
| | - Elena Serrano
- Virginia Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Susan Chen
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
| | - George C Davis
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA.,Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, Virginia, USA
| | - Sarah Misyak
- Virginia Family Nutrition Program, Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia, USA
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Understanding the Intersection of Race/Ethnicity, Socioeconomic Status, and Geographic Location: A Scoping Review of U.S. Consumer Food Purchasing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207677. [PMID: 33096828 PMCID: PMC7593902 DOI: 10.3390/ijerph17207677] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/11/2023]
Abstract
Disparities in diet quality persist in the U.S. Examining consumer food purchasing can provide unique insight into the nutritional inequities documented by race/ethnicity, socioeconomic status (SES), and geographic location (i.e., urban vs. rural). There remains limited understanding of how these three factors intersect to influence consumer food purchasing. This study aimed to summarize peer-reviewed scientific studies that provided an intersectional perspective on U.S. consumer food purchasing. Thirty-four studies were examined that presented objectively measured data on purchasing outcomes of interest (e.g., fruits, vegetables, salty snacks, sugar-sweetened beverages, Healthy Eating Index, etc.). All studies were of acceptable or high quality. Only six studies (17.6%) assessed consumer food purchases at the intersection of race/ethnicity, SES, or geographic location. Other studies evaluated racial/ethnic or SES differences in food purchasing or described the food and/or beverage purchases of a targeted population (example: low-income non-Hispanic Black households). No study assessed geographic differences in food or beverage purchases or examined purchases at the intersection of all three factors. Overall, this scoping review highlights the scarcity of literature on the role of intersectionality in consumer food and beverage purchasing and provides recommendations for future studies to grow this important area of research.
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Lacko A, Ng SW, Popkin B. Urban vs. Rural Socioeconomic Differences in the Nutritional Quality of Household Packaged Food Purchases by Store Type. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7637. [PMID: 33092077 PMCID: PMC7589700 DOI: 10.3390/ijerph17207637] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022]
Abstract
The U.S. food system is rapidly changing, including the growth of mass merchandisers and dollar stores, which may impact the quality of packaged food purchases (PFPs). Furthermore, diet-related disparities exist by socioeconomic status (SES) and rural residence. We use data from the 2010-2018 Nielsen Homescan Panel to describe the nutritional profiles of PFPs by store type and to assess whether these vary by household urbanicity and SES. Store types include grocery stores, mass merchandisers, club stores, online shopping, dollar stores, and convenience/drug stores. Food and beverage groups contributing the most calories at each store type are estimated using survey-weighted means, while the associations of urbanicity and SES with nutritional quality are estimated using multivariate regression. We find that households that are customers at particular store types purchase the same quality of food regardless of urbanicity or SES. However, we find differences in the quality of foods between store types and that the quantity of calories purchased at each store type varies according to household urbanicity and SES. Rural shoppers tend to shop more at mass merchandisers and dollar stores with less healthful PFPs. We discuss implications for the types of store interventions most relevant for improving the quality of PFPs.
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Affiliation(s)
- Allison Lacko
- The Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA; (S.W.N.); (B.P.)
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A Model Depicting the Retail Food Environment and Customer Interactions: Components, Outcomes, and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207591. [PMID: 33086537 PMCID: PMC7589434 DOI: 10.3390/ijerph17207591] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/06/2020] [Accepted: 10/16/2020] [Indexed: 12/26/2022]
Abstract
The retail food environment (RFE) has important implications for dietary intake and health, and dramatic changes in RFEs have been observed over the past few decades and years. Prior conceptual models of the RFE and its relationships with health and behavior have played an important role in guiding research; yet, the convergence of RFE changes and scientific advances in the field suggest the time is ripe to revisit this conceptualization. In this paper, we propose the Retail Food Environment and Customer Interaction Model to convey the evolving variety of factors and relationships that convene to influence food choice at the point of purchase. The model details specific components of the RFE, including business approaches, actors, sources, and the customer retail experience; describes individual, interpersonal, and household characteristics that affect customer purchasing; highlights the macro-level contexts (e.g., communities and nations) in which the RFE and customers behave; and addresses the wide-ranging outcomes produced by RFEs and customers, including: population health, food security, food justice, environmental sustainability, and business sustainability. We believe the proposed conceptualization helps to (1) provide broad implications for future research and (2) further highlight the need for transdisciplinary collaborations to ultimately improve a range of critical population outcomes.
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Winkler MR, Lenk KM, Erickson DJ, Caspi CE, Laska MN. Longitudinal Fruit and Vegetable Sales in Small Food Retailers: Response to a Novel Local Food Policy and Variation by Neighborhood Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155480. [PMID: 32751326 PMCID: PMC7432731 DOI: 10.3390/ijerph17155480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/18/2022]
Abstract
Small food retailers, including corner/convenience stores, pharmacies, gas-marts, and dollar stores, have historically stocked limited fruits and vegetables, though this may be changing. We examined increases in sales, customer purchasing, and stocking of fresh and/or frozen fruits and vegetables in small food stores over time and in relation to: (a) a local food policy (the Minneapolis Staple Foods Ordinance) and (b) neighborhood socioeconomic status (SES). We used longitudinal data (2014–2017) from 147 randomly-sampled stores in Minneapolis/St. Paul, USA, collected using interviewer-administered manager surveys (measuring sales and stocking) and customer intercepts/observations (measuring purchasing, n = 3039). The local policy required Minneapolis stores to meet minimum stocking standards for fresh/frozen produce and other healthy foods. No ordinance existed in St. Paul. Mixed regression models examined overall change over time and change by city and neighborhood SES. We observed significant increases over time (p < 0.05) in sales and purchasing of fresh fruit and in stocking of fresh fruit, frozen fruit, and frozen vegetables. We did not identify consistent statistical evidence for differential change in sales, purchasing, or stocking by city or neighborhood SES. Key study findings suggest limited differential effects of the local ordinance and/or neighborhood SES. However, findings also indicate significant time trends for some products, including consistent improvements in sales, customer purchasing, and stocking of fresh fruit. Given the ready-to-eat convenience of many fresh fruits and their broad appeal, fresh fruit appears a promising target for advancing the healthfulness of small food retailers.
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Affiliation(s)
- Megan R. Winkler
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (K.M.L.); (D.J.E.); (M.N.L.)
- Correspondence:
| | - Kathleen M. Lenk
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (K.M.L.); (D.J.E.); (M.N.L.)
| | - Darin J. Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (K.M.L.); (D.J.E.); (M.N.L.)
| | - Caitlin E. Caspi
- Department of Family Medicine and Community Health, Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
| | - Melissa N. Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (K.M.L.); (D.J.E.); (M.N.L.)
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Increasing Access to WIC through Discount Variety Stores: Findings from Qualitative Research. J Acad Nutr Diet 2020; 120:1654-1661.e1. [PMID: 32565397 DOI: 10.1016/j.jand.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many low-income neighborhoods do not include a full-service grocery store. In these communities, discount variety stores (DVS) can be convenient points of food access. However, no identified DVS are authorized to accept Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC) benefits. OBJECTIVE One national DVS retailer implemented WIC in 10 stores located in low-income communities in North Carolina over a 10-month pilot period to assess WIC feasibility. METHODS To better understand the facilitators and barriers to WIC implementation from the perspective of DVS staff, we analyzed 36 in-depth interviews with employees of this DVS chain at corporate, manager, and store clerk levels. RESULTS Most participants provided positive feedback about implementing and offering WIC. Many store employees had personal experience participating in WIC, which increased their understanding of the WIC shopping experience. Store staff's prior WIC participation and customers' proximity to DVS locations were facilitators to implementation. Primary barriers included limited choice of store products for customers, complicated or unclear labeling of WIC products, and difficulty training employees to process WIC vouchers. CONCLUSIONS These findings suggest that whereas most employees viewed WIC positively, barriers related to product selection and training must be addressed. Notably, North Carolina's recent change to an electronic system to process WIC transactions requires minimal manual employee training and should address several barriers to implementation. However, the computer system upgrades necessary to accept electronic WIC transactions may be a barrier for DVS to continued WIC acceptance. Future research is needed to evaluate implementation of electronic WIC transactions in DVS.
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Availability of Supplemental Nutrition Assistance Program-authorised retailers' voluntary commitments to encourage healthy dietary purchases using marketing-mix and choice-architecture strategies. Public Health Nutr 2020; 23:1745-1753. [PMID: 32178757 DOI: 10.1017/s1368980019004154] [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] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine public commitments for encouraging United States consumers to make healthy dietary purchases with their Supplemental Nutrition Assistance Program (SNAP) benefits among of prevalent SNAP-authorised retailers. SETTING National SNAP-authorised retail landscape in addition to stores located in California and Virginia, two states targetted for a Partnership for a Healthier America pilot social marketing campaign. PARTICIPANTS SNAP-authorised retailers with the most store locations in selected settings. DESIGN A review of retailers' publicly available business information was conducted (November 2016-February 2017). Webpages and grey literature sources were accessed to identify corporate social responsibility (CSR) reports and commitments describing strategies to encourage healthy consumer purchases aligned with the 2015-2020 Dietary Guidelines for Americans. Evidence was organised using a marketing-mix and choice-architecture (MMCA) framework to characterise strategies used among eight possible types (i.e. place, profile, portion, pricing, promotion, priming, prompting and proximity). RESULTS Of the SNAP-authorised retailers (n 38) reviewed, more than half (n 20; 52·6 %) provided no information in the public domain relevant to the research objective. Few retailers (n 8; 21·1 %) had relevant CSR information; grey literature sources (n 52 articles across seventeen retailers) were more commonly identified. SNAP-authorised retailers in majority committed to increasing the number of healthy products available for purchase (profile). CONCLUSIONS Substantial improvements are needed to enhance the capacity and commitments of SNAP-authorised retailers to use diverse strategies to promote healthy purchases among SNAP recipients. Future research could explore feasible approaches to improve dietary behaviours through sector changes via public-private partnerships, policy changes, or a combination of government regulatory and voluntary business actions.
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