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Mayer ME, McAlister AR, Economos CD, Mack S, Plank K, Cash SB. Using coupons to encourage healthier child snack purchases in corner stores: results from the CHOMPS study. Front Nutr 2024; 11:1290710. [PMID: 38318473 PMCID: PMC10840137 DOI: 10.3389/fnut.2024.1290710] [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: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Objectives To examine youths' (ages 6-15 years) autonomous snack purchases in corner stores and pilot use of coupons to encourage more healthful snack purchases. Methods This pilot study involved four corner stores proximal to K-8 schools in Massachusetts. Kids-only coupons of varying discounts were provided in store and paired with simple visual and verbal economic and health messages. Observational data about youths' autonomous snack purchases was recorded pre- and post-intervention. Outcomes of interest were snack item, price, and nutrient content. Comparisons of purchase characteristics and nutritional content across intervention conditions were made using Chi-squared and t-tests. Results Across all stores, 2,973 purchase observations were recorded totaling approximately $6,000. Researchers estimated that about 55% of shoppers were 10-12 years old. Modest coupon usage (2.2% of purchases) was noted. However, candy purchases decreased, and the percentage of purchase events that included at least one healthier food item more than doubled, regardless of coupon use. Improvements in the nutritional content of snacks were also observed. Conclusion Kids-only coupons have the potential to assist with shifting autonomous snack purchase behavior in outside of school settings.
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Affiliation(s)
- Megan E. Mayer
- Department of Nutrition and Health Studies, Framingham State University, Framingham, MA, United States
| | - Anna R. McAlister
- Gerrish School of Business, Endicott College, Beverly, MA, United States
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Suzanne Mack
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kaela Plank
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Ruggles PR, Thomas JE, Poulos NS, Pasch KE. School-Level Socioeconomic Status and Nutrient Content of Outdoor Food/Beverage Advertisements. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6730. [PMID: 37754591 PMCID: PMC10530988 DOI: 10.3390/ijerph20186730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/28/2023]
Abstract
We examined if areas around schools with more students of lower socioeconomic status (SES) have more total food/beverage advertisements and/or more advertisements with poorer nutritional content as compared to areas around schools with fewer students with lower SES. All outdoor food/beverage advertisements within a half-mile radius of 47 middle and high schools in the United States were objectively documented in 2012 and coded for nutritional content. The total number of advertisements and the macronutrient and micronutrient contents (total calories, fat (g), protein (g), carbohydrate (g), sugar (g), and sodium (mg)) of food and beverage items depicted in the advertisements were calculated. In total, 9132 unique advertisements were recorded, with 3153 ads displaying food and beverages that could be coded for nutrient content. Schools located in areas of lower SES (≥60% students receiving free/reduced-price lunch) had significantly more advertisements displaying food and beverages that could be coded for nutrient content (z = 2.01, p = 0.04), as well as advertisements that contained more sodium (z = 2.20, p = 0.03), as compared to schools located in areas of higher SES. There were no differences in calorie, fat, protein, carbohydrate, or sugar content. Policies to reduce the prevalence of outdoor food and beverage advertising are warranted.
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Affiliation(s)
- Phoebe R. Ruggles
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Jacob E. Thomas
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Natalie S. Poulos
- School of Community and Rural Health, Heath Science Center, The University of Texas at Tyler, Tyler, TX 78708, USA
- Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Keryn E. Pasch
- Department of Kinesiology & Health Education, University of Texas at Austin, Austin, TX 78712, USA
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Tripicchio GL, Croce CM, Coffman DL, Pettinato C, Fisher JO. Age-related differences in eating location, food source location, and timing of snack intake among U.S. children 1-19 years. Int J Behav Nutr Phys Act 2023; 20:90. [PMID: 37495996 PMCID: PMC10369691 DOI: 10.1186/s12966-023-01489-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1-19 years (y). METHODS A cross-sectional analysis of snacking among 14,666 children in the 2007-2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1-2 y, preschooler 3-5 y, school-age 6-11 y, adolescent 12-19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am). RESULTS On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001). CONCLUSION Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1-19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns.
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Affiliation(s)
- Gina L Tripicchio
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA.
| | - Christina M Croce
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
| | - Donna L Coffman
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC, USA
| | - Cameron Pettinato
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
| | - Jennifer O Fisher
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19140, USA
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Gell S, Pejkovic E, Heiss R. How (Un-)Healthy are Austrian school food environments? Evidence from focus groups and citizen science. Appetite 2023:106636. [PMID: 37390919 DOI: 10.1016/j.appet.2023.106636] [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: 12/21/2022] [Revised: 04/14/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Adolescents face high-choice school food environments that offer plenty of highly processed foods. Processed food producers target young people in their marketing, but there is limited data on the actual food supply inside and in the vicinity of Austrian schools and its impact on adolescent food choices. This study employs an innovative mixed-methods approach to explore adolescents' food choices. METHODS In Study 1, we conducted a citizen science study, with students as volunteer scientists. The students examined the food supply in and around their schools according to the Austrian food pyramid and categorized 953 food items in 144 food suppliers using photographs and descriptions. In Study 2, we explored students' food preferences in focus groups. We conducted four focus groups at four different schools in Tyrol, with 25 students (11 male, 14 female) between the ages of 12 and 15. We then linked the findings on individual preferences with the documented supply. RESULTS Study 1 found that the food supply in the investigated schools was predominantly categorized as unhealthy. The students categorized 46% as "unhealthy", 32% as "intermediate", and only 22% as "healthy". Study 2 identified three influential factors in students' food choices: 1) individual factors (such as taste and preferences), 2) social factors (such as mingling with peers), and 3) structural factors (such as physical environment and accessibility). CONCLUSION The study shows that unhealthy products cater to unhealthy preferences among adolescents and dominate current school food environments. Policies need to address unhealthy school food environments to address this issue. For instance, food supplies should be presented in an attractive ways, in fun places where students can mingle and express their identities.
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Affiliation(s)
- Sascha Gell
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation Universitätsstraße 15, 6020 Innsbruck, Austria.
| | - Emina Pejkovic
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation Universitätsstraße 15, 6020 Innsbruck, Austria.
| | - Raffael Heiss
- MCI | The Entrepreneurial School©, Center for Social & Health Innovation Universitätsstraße 15, 6020 Innsbruck, Austria.
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Kim L, Duh-Leong C, Nagpal N, Ortiz R, Katzow MW, Russ S, Halfon N. Supporting early childhood routines to promote cardiovascular health across the life course. Curr Probl Pediatr Adolesc Health Care 2023; 53:101434. [PMID: 37821292 PMCID: PMC10842608 DOI: 10.1016/j.cppeds.2023.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Optimal cardiovascular health is an essential component of human health and well-being across the life course. Heart healthy practices around diet, physical activity, and sleep early in childhood have the potential to greatly improve lifespan and quality (Mehta et al., 2020). Early childhood routines, defined as functional practices that are predictable and repeatable, predict positive growth and development across the lifecourse (Fiese et al., 2002; Ferretti and Bub, 2017; Spagnola and Fiese, 2007). The American Heart Association has identified key heart healthy routines, such as daily regular activities including diet, physical activity, and sleep that promote cardiovascular health (Lloyd-Jones et al., 2022). Integrating the strength-based relational aspects of routines with the acquisition of cardiovascular health development capabilities allows children to establish their own optimal cardiovascular health trajectory early on. A systematic life course approach to supporting heart healthy routines in early childhood would inform clinical, research, and policy strategies to promote long-term cardiovascular health, and contribute to reducing inequalities in cardiovascular outcomes.
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Affiliation(s)
- Leah Kim
- NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Nikita Nagpal
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Robin Ortiz
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Michelle W Katzow
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA; Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Shirley Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA, USA; Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA, USA; Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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Maloney EK, Bleakley A, Stevens R, Ellithorpe M, Jordan A. Urban Youth Perceptions of Sports and Energy Drinks: Insights for Health Promotion Messaging. HEALTH EDUCATION JOURNAL 2023; 82:324-335. [PMID: 37223247 PMCID: PMC10205042 DOI: 10.1177/00178969231157699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Objective This study aimed to examine urban adolescents' beliefs about sports and energy drinks to identify factors for health messaging to discourage youth consumption. Design Focus group study involving thirty-four adolescents in urban areas (12 female, 12 male, and 10 unreported sex; 19 Hispanic, 11 Non-Hispanic Black, 2 Asian, and 1 unknown race or ethnicity). Setting Four focus groups were conducted with adolescents in urban areas. Method Each on-time moderated group discussion was structured to generate an inventory of attitudinal, normative and efficacy beliefs associated with sports and energy drink consumption and reduction. Thematic analysis was used to analyse the data. Results Attitudinal and normative beliefs were more positive towards sports drink consumption and energy drink reduction. Misperceptions about the need for sports drinks to avoid dehydration during physical activity were evident. Product accessibility and advertising pervasiveness were facilitators influencing consumption and barriers to reduction for both products. Conclusion Results highlight important differences in perceptions about sports and energy drinks that indicate the need for different approaches and messages for interventions designed to curb consumption of these products. Recommendations for message design are provided.
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Affiliation(s)
- Erin K. Maloney
- Department of Communication, University of Delaware, Newark, DE, USA
| | - Amy Bleakley
- Department of Communication, University of Delaware, Newark, DE, USA
| | - Robin Stevens
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication and Journalism, University of Southern California, Los Angeles, CA, USA
| | - Morgan Ellithorpe
- Department of Communication, University of Delaware, Newark, DE, USA
- College of Arts and Sciences Department of Communication, Michigan State University, Lansing, MI, USA
| | - Amy Jordan
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
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Sánchez BN, Fu H, Matsuzaki M, Sanchez-Vaznaugh E. Characterizing food environments near schools in California: A latent class approach simultaneously using multiple food outlet types and two spatial scales. Prev Med Rep 2022; 29:101937. [PMID: 35928596 PMCID: PMC9344015 DOI: 10.1016/j.pmedr.2022.101937] [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: 12/29/2021] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
It is challenging to evaluate associations between the food environment near schools with either prevalence of childhood obesity or with socioeconomic characteristics of schools. This is because the food environment has many dimensions, including its spatial distribution. We used latent class analysis to classify public schools in urban, suburban, and rural areas in California into food environment classes based on the availability and spatial distribution of multiple types of unhealthy food outlets nearby. All urban schools had at least one unhealthy food outlet nearby, compared to seventy-two percent of schools in rural areas did. Food environment classes varied in the quantity of available food outlets, the relative mix of food outlet types, and the outlets' spatial distribution near schools. Regardless of urbanicity, schools in low-income neighborhoods had greater exposure to unhealthy food outlets. The direction of associations between food environment classes and school size, type, and race/ethnic composition depends on the level of urbanicity of the school locations. Urban schools attended primarily by African American and Asian children are more likely to have greater exposures to unhealthy food outlets. In urban and rural but not suburban areas, schools attended primarily by Latino students had more outlets offering unhealthy foods or beverages nearby. In suburban areas, differences in the spatial distribution of food outlets indicates that food outlets are more likely to cluster near K-12 schools and high schools compared to elementary schools. Intervention design and future research need to consider that the associations between food environment exposures and school characteristics differ by urbanicity.
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Affiliation(s)
- Brisa N. Sánchez
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA 19104, USA
| | - Han Fu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48104, USA
| | - Mika Matsuzaki
- Department of International Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Emma Sanchez-Vaznaugh
- Health Education Department, San Francisco State University, San Francisco, CA 94132, USA
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8
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Islam MR, Rahman SM, Rahman MM, Pervin J, Rahman A, Ekström EC. Gender and socio-economic stratification of ultra-processed and deep-fried food consumption among rural adolescents: A cross-sectional study from Bangladesh. PLoS One 2022; 17:e0272275. [PMID: 35901170 PMCID: PMC9333446 DOI: 10.1371/journal.pone.0272275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although consumption of ultra-processed and deep-fried foods among adolescents is a global health concern, little is known about its gender and socio-economic stratification in rural settings of low- and middle-income countries. We, thus, aimed to describe ultra-processed and deep-fried food consumption among rural adolescents by gender and socio-economic factors, and to explore their relative importance in shaping consumption. Methods This cross-sectional study drew on data from a household survey in Matlab, a rural sub-district in Bangladesh. The analytic sample comprised 2463 adolescents. We assessed consumption of four ultra-processed food groups: ready-to-eat or “instant” foods; confectionery, sweets and similar packaged products; savory snacks; sugar-sweetened beverage; and of deep-fried foods with a 24-hour, qualitative recall. Asset scores were constructed. Proportion of consumption was calculated and compared by gender and household wealth. Logistic regression models were fitted to isolate socio-demographic variables associated with consumption. Results Approximately 83% (81.5–84.4) adolescents consumed at least one ultra-processed or deep-fried item. Confectioneries were the most consumed (53.5%), whereas sugar-sweetened beverage was the least consumed (12%) group. Boys had greater odds of consumption than girls for all food groups. The association was strongest for sugar-sweetened beverage (adjusted odds ratio = 2.57; 95% CI: 1.97, 3.37), followed by deep-fried foods (adjusted odds ratio = 1.96; 95% CI: 1.66, 2.32) and ready-to-eat foods (adjusted odds ratio = 1.85; 95% CI: 1.45, 2.38). Belonging to the richest households was associated with ready-to-eat food consumption (adjusted odds ratio = 1.55; 95% CI: 1.12, 2.16). Adolescents with higher educational attainment had lower odds of consuming sugar-sweetened beverage (adjusted odds ratio = 0.73; 95% CI: 0.54, 0.98). Conclusion Consumption of packaged confectioneries, savory snacks, and deep-fried foods appeared common, while SSB consumption was relatively low. Role of gender was pre-eminent as consumption was more likely among boys across the food groups. This may disproportionately expose them to the risk of diet-related non-communicable diseases.
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Affiliation(s)
| | - Syed Moshfiqur Rahman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Monjur Rahman
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jesmin Pervin
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Anisur Rahman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Gangrade N, St Fleur K, Leak TM. Factors That Influence Snacking Behaviors of Adolescents From Urban Communities: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:521-531. [PMID: 35351357 DOI: 10.1016/j.jneb.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To qualitatively explore factors that influence snacking behaviors of adolescents from urban communities. DESIGN One-time, semistructured phone interviews based on Social Cognitive Theory. SETTING Boys and Girls Club in New York City. PARTICIPANTS A total of 30 adolescents (aged 12-18 years; mean age 15.2 years, mostly female [57%], and Black or African American [83%]) were purposively recruited. This sample is representative of adolescent members at this Boys and Girls Club in New York City. PHENOMENON OF INTEREST Adolescents were asked about personal, environmental, and behavioral factors influencing snacking. ANALYSIS Interviews were audio-recorded, transcribed, and transcripts were analyzed using the thematic analysis approach in NVivo (version 12). RESULTS In terms of personal factors, adolescents' snacking was influenced by preference (eg, taste and brand), health benefits, and health concerns. Regarding the social environment, adolescents remarked that snacking with peers promoted unhealthy snacking, while snacking, with family promoted healthier snacking. The family culture was also a salient factor. In addition, adolescents discussed how proximity to corner stores in their physical environment fostered unhealthy snacking. Finally, behavioral factors that influenced frequent snacking were high self-efficacy and food autonomy. CONCLUSIONS AND IMPLICATIONS Snacking among adolescents from urban communities is influenced by preference, health, family/peer influence, neighborhood availability/access, and high autonomy. These factors can be targeted in interventions to improve snacking among this demographic.
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Affiliation(s)
- Navika Gangrade
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
| | | | - Tashara M Leak
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
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10
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Rosales Chávez JB, Jehn M, Lee RE, Ohri-Vachaspati P, Ortiz-Hernandez L, Romo-Aviles M, Bruening M. Development and Interrater Reliability of a Street Food Stand Assessment Tool. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1072-1080. [PMID: 34362667 DOI: 10.1016/j.jneb.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To design and test the interrater reliability of a Street Food Stand Assessment Tool (SFSAT). DESIGN Variables were adapted from validated assessment tools, field observations, and the Mexican Dietary Guidelines. Two researchers tested the SFSAT by observing street food stands (SFS) in 3 middle- to high-income neighborhoods. SETTING Mexico City. PARTICIPANTS Fifty-two SFS. VARIABLES MEASURED The SFSAT contains 14 items for SFS characteristics and 44 items for food and beverages. ANALYSIS Percent agreement and kappa interrater reliability scores were calculated for each variable. RESULTS Almost perfect kappa interrater reliability scores (0.81-1.00) were reported for 62.7% of SFS characteristic items. Interrater reliability scores for food and beverage availability and variety ranged from 0.00-1.00, whereas the percent agreement for these items ranged from 59.6%-100.0%. CONCLUSIONS AND IMPLICATIONS The SFSAT is a reliable assessment tool to measure the availability and variety of street foods and beverages in Mexico City. Future research can update and adapt the SFSAT to the street food environment of other cities-in Mexico and abroad.
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Affiliation(s)
- Jose B Rosales Chávez
- School of Geographical Sciences and Urban Planning, Arizona State University, Tempe, AZ.
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ
| | | | - Luis Ortiz-Hernandez
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Ciudad de México, México
| | - Mariana Romo-Aviles
- Departamento de Atención a la Salud, Universidad Autónoma Metropolitana Xochimilco, Ciudad de México, México
| | - Meg Bruening
- College of Health Solutions, Arizona State University, Tempe, AZ
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Lewis EC, Harper KM, Poirier LK, Gittelsohn J. Feasibility of using mobile point-of-sale technology in Baltimore City corner stores tracking sales: A brief report. J Public Health Res 2021; 11:2607. [PMID: 34711045 PMCID: PMC8883529 DOI: 10.4081/jphr.2021.2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Small food retail stores in many underserved urban settings keep no electronic records, making documentation of program impact on sales difficult to obtain. We examined the feasibility of introducing a point-of-sale tablet (POST) application to track sales of foods and beverages in Baltimore City corner stores. A sample of four geographically and ethnically diverse corner store owners were trained to use POST to track sales of 14 items for eleven days. Feasibility was documented via a structured survey and open-ended interviews. POST had high economic and cultural acceptability, operability, and perceived sustainability, regardless of language differences or familiarity with mobile technology. All store owners reported willingness to use POST again. It is feasible to train corner store owners to use a point-of-sale application for sales monitoring. An upcoming trial will help to ensure that POST provides sufficient value added for corner store owners.
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Affiliation(s)
- Emma C Lewis
- Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Batlimore, MD.
| | - Kaitlyn M Harper
- Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Batlimore, MD.
| | - Lisa K Poirier
- Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Batlimore, MD.
| | - Joel Gittelsohn
- Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Batlimore, MD.
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12
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Trapp GSA, Hooper P, Thornton L, Kennington K, Sartori A, Hurworth M, Billingham W. Association between food-outlet availability near secondary schools and junk-food purchasing among Australian adolescents. Nutrition 2021; 91-92:111488. [PMID: 34626957 DOI: 10.1016/j.nut.2021.111488] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to investigate the association between food-outlet availability near Australian secondary schools and frequency of Australian students' discretionary food purchases. METHODS Secondary-school students in Perth (Western Australia) reported the frequency of their discretionary food purchases from food outlets near their school (17 schools, n = 2389 students grades 7-12, ages 12-17 y). Food-outlet availability was sourced from local governments, then geocoded. A mixed-effects model was used in analyses. RESULTS Almost half of students (45%) purchased discretionary foods from food outlets near their secondary school at least weekly. Only the density of top-ranking fast-food chain outlets near secondary schools was associated with a significant increase in the frequency of discretionary food purchases. CONCLUSIONS Availability of major fast-food chains near Australian secondary schools appears to be a key driver of Australian students' discretionary food purchasing. Restricting these outlets near schools may help reduce adolescents' discretionary food intake.
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Affiliation(s)
- Gina S A Trapp
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia; School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.
| | - Paula Hooper
- The Australian Urban Design Research Centre, School of Design, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Lukar Thornton
- School of Exercise & Nutrition Science, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Kelly Kennington
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Ainslie Sartori
- Cancer Council Western Australia, Subiaco, Western Australia, Australia
| | - Miriam Hurworth
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia
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13
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U.S. Adolescents' Diet Consumption Patterns Differ between Grocery and Convenience Stores: National Health and Nutrition Examination Survey 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168474. [PMID: 34444223 PMCID: PMC8394683 DOI: 10.3390/ijerph18168474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/07/2021] [Indexed: 11/16/2022]
Abstract
Among U.S. adolescents, foods/beverages that are store-bought (i.e., from grocery and convenience stores) are significant contributors of energy intake. However, it remains unclear (1) what foods/beverages are consumed by U.S. adolescents from grocery and convenience stores and (2) if there are differences in foods/beverages consumed by store type. Therefore, we analyzed 29,216 eating occasions from adolescents (12–19 years; n = 4065) in the National Health and Nutrition Examination Survey 2011–2018 to report food/beverage groups and nutrients consumed from grocery and convenience stores. Differences in food/beverage groups and nutrient densities by store type were calculated using multiple logistic and linear regressions. Adolescents were more likely to consume “Beverages” and “Snacks and Sweets” and less likely to consume “Grains”, “Protein”, “Milk and Dairy”, “Condiments and Sauces”, and “Fruits” from convenience compared to grocery stores (all p < 0.0025). Foods/beverages from convenience stores were higher in carbohydrates, total sugar, and added sugar and lower in protein, fat, saturated fat, sodium, and fiber than those from grocery stores (all p < 0.0025). In conclusion, while foods/beverages from convenience stores are more energy-dense and nutrient-poor, there is a critical need to increase the availability, accessibility, and affordability of healthier foods/beverages in both store types to encourage healthier dietary behaviors among U.S. adolescents.
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14
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Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005-2018. Nutrients 2021; 13:nu13082530. [PMID: 34444690 PMCID: PMC8399168 DOI: 10.3390/nu13082530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
Snacking contributes a significant portion of adolescents’ daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2005–2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories “Milk and Dairy” (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and “Fruits” (aOR: 0.62, 95% CI: 0.50–0.78; p = 0.001) as snacks and higher odds of consuming “Beverages” (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3–3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.
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15
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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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Leak TM, Gangrade N, Setiono FJ, Mudrak E. Facilitators and Barriers to Preparing and Selling Whole Grain Snack Packs in New York City Corner Stores Participating in a Healthy Retail Program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1785363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tashara M. Leak
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Navika Gangrade
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | - Erika Mudrak
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY, USA
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17
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Rummo PE, Wu E, McDermott ZT, Schwartz AE, Elbel B. Relationship between retail food outlets near public schools and adolescent obesity in New York City. Health Place 2020; 65:102408. [PMID: 32861053 PMCID: PMC7540254 DOI: 10.1016/j.healthplace.2020.102408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 05/18/2020] [Accepted: 08/02/2020] [Indexed: 12/22/2022]
Abstract
Using objectively-measured height and weight data from academic years 2009-2013 (n = 1,114,010 student-year observations), we estimated the association between the food outlet in closest proximity to schools and the likelihood of obesity among New York City public high school students. Obesity risk was higher for students with a corner store as the nearest option to schools, regardless of whether other food outlet types were located within a quarter mile or a half mile of schools (i.e., benchmarks for zoning policies). Policymakers may want to consider introducing healthier food options near schools, in conjunction with programs to support changes within corner stores.
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Affiliation(s)
- Pasquale E Rummo
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Erilia Wu
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Zachary T McDermott
- Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | | | - Brian Elbel
- Department of Population Health, New York University School of Medicine, New York, NY, USA; Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA.
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18
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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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19
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Kids in a Candy Store: An Objective Analysis of Children's Interactions with Food in Convenience Stores. Nutrients 2020; 12:nu12072143. [PMID: 32708485 PMCID: PMC7400802 DOI: 10.3390/nu12072143] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 01/18/2023] Open
Abstract
Increasing rates of childhood obesity worldwide has focused attention on the obesogenic food environment. This paper reports an analysis of children's interactions with food in convenience stores. Kids'Cam was a cross-sectional study conducted from July 2014 to June 2015 in New Zealand in which 168 randomly selected children aged 11-14 years old wore a wearable camera for a 4-day period. In this ancillary study, images from children who visited a convenience store were manually coded for food and drink availability. Twenty-two percent of children (n = 37) visited convenience stores on 62 occasions during the 4-day data collection period. Noncore items dominated the food and drinks available to children at a rate of 8.3 to 1 (means were 300 noncore and 36 core, respectively). The food and drinks marketed in-store were overwhelmingly noncore and promoted using accessible placement, price offers, product packaging, and signage. Most of the 70 items purchased by children were noncore foods or drinks (94.6%), and all of the purchased food or drink subsequently consumed was noncore. This research highlights convenience stores as a key source of unhealthy food and drink for children, and policies are needed to reduce the role of convenience stores in the obesogenic food environment.
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20
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Matsuzaki M, Sánchez BN, Acosta ME, Botkin J, Sanchez-Vaznaugh EV. Food environment near schools and body weight-A systematic review of associations by race/ethnicity, gender, grade, and socio-economic factors. Obes Rev 2020; 21:e12997. [PMID: 32026567 PMCID: PMC7058504 DOI: 10.1111/obr.12997] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
Abstract
Previous research reported modest associations between food environments near schools and adiposity among children overall. The associations within sociodemographic subgroups have not been synthesized. This review assessed the evidence on the associations between food environments near schools and childhood obesity within different demographic and socio-economic subgroups. PubMed and Scopus databases were searched to identify studies published in English between January 1, 1980, and April 25, 2019, examining the presence of fast food outlets, convenience stores, supermarkets, and grocery stores near schools and measures of overweight/obesity by race/ethnicity, gender, grade, and income level. Twelve cross-sectional and two ecological studies were included. Fast food outlets were most commonly examined (n = 12). The associations between fast food outlets near schools and obesity were generally positive among Latino, white, and African American students and across grade levels, although the strengths of evidence varied. The directions of association were mixed among Asian children. Three studies reported generally positive associations between convenience stores and obesity among Latino and African American children and mixed associations among white and Asian children. Longitudinal studies are needed in addition to studies examining underlying mechanisms of the differential influence of food environments near schools within each subgroup.
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Affiliation(s)
- Mika Matsuzaki
- Department of Health Education, San Francisco State University, San Francisco, California, USA
| | - Brisa N Sánchez
- Department of Biostatistics, Drexel University, Philadelphia, Pennsylvania
| | - Maria Elena Acosta
- Department of Health Education, San Francisco State University, San Francisco, California, USA
| | | | - Emma V Sanchez-Vaznaugh
- Department of Health Education, San Francisco State University, San Francisco, California, USA.,Health Equity Institute, San Francisco State University, San Francisco, California, USA.,Center for Health Equity, University of California, San Francisco, California, USA
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21
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Relationship between different levels of the Mexican food environment and dietary intake: a qualitative systematic review. Public Health Nutr 2020; 23:1877-1888. [DOI: 10.1017/s1368980019004294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AbstractObjective:To investigate the possible associations between the food environment and dietary intake in the Mexican population.Design:Four databases (PubMed, PsychInfo, Web of Science and SCIelo) were used to retrieve relevant articles using an open timeframe. Articles were reviewed if they contained a systematic measure (i.e. food checklist) of the food environment (e.g. food availability) and dietary intake.Setting:Urban and rural communities in Mexico.Participants:Population-based studies of Mexican communities.Results:Twenty studies that assessed at least one food environment level, and at least one dietary outcome, were reviewed. Findings from these studies showed that changes in the Mexican food environment seem to be associated with higher availability of energy-dense foods. Energy-dense foods can be linked to a high consumption in household, environment and community food environments. When both nutrient-dense and energy-dense foods were present, individuals were more likely to consume foods with added sugars, fats and salt options than nutrient-dense items.Conclusions:The various levels of the food environment (i.e. household, school, community) exposed participants to energy-dense foods. Although nutrient-dense foods were present in all three levels, individuals were more likely to consume energy-dense food items. Not all three levels of the food environment are well represented in the urban and rural settings. Most studies on the community food environment were done in rural areas, whereas most studies on the school food environment were done in urban settings. Additional rigorously designed studies are needed to document the relationship between the food environment and dietary intake in the Mexican population.
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22
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Differences in Diet Quality and Snack Intakes Among Non-Hispanic White and Mexican American Adolescents from Different Acculturation Groups. J Racial Ethn Health Disparities 2020; 7:1090-1099. [PMID: 32144631 DOI: 10.1007/s40615-020-00732-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
Mexican American adolescents have an increased risk for obesity compared to non-Hispanic whites (NHWs), especially as their degree of acculturation increases. Snack intakes can impact diet quality and may affect obesity risk, yet little is known about differences in snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study compared diet quality and snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study used cross-sectional data from 3636 Mexican American and NHW adolescents in the 2005-2014 National Health and Nutrition Examination Survey. Acculturation was defined based on generational status and language use. Outcomes were Healthy Eating Index-2015 (HEI-2015) score, daily energy intake from snacks, snack frequency, energy value of snacks, and percent contribution of snacks to total daily energy. Analysis of covariance was used to compare outcomes across groups, after adjustment for sex and income. In the full sample, mean HEI-2015 score was 45 ± 0.4. Non-Hispanic white adolescents had modestly poorer diet quality compared to US-born adolescents with a foreign-born parent and Mexican-born adolescents (P < 0.001). Mean daily snack intake was 583 ± 16 kcal. Items in the Snacks and Sweets and Beverages categories contributed more than half of the energy provided by snacks. Non-Hispanic white adolescents had a greater total snack intake compared to all language use at home groups, except equal Spanish and English use. Improving the types of foods consumed as snacks has the potential to partially mitigate differences in snack intakes and diet quality among non-Hispanic white and Mexican American adolescents.
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23
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Zhou S, Cheng Y, Cheng L, Wang D, Li Q, Liu Z, Wang HJ. Association between convenience stores near schools and obesity among school-aged children in Beijing, China. BMC Public Health 2020; 20:150. [PMID: 32005214 PMCID: PMC6995088 DOI: 10.1186/s12889-020-8257-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/21/2020] [Indexed: 12/04/2022] Open
Abstract
Background Food environments have rapidly changed over the past years in China and children have more access to unhealthy food in convenience stores near schools. Since the studies on the association between convenience stores near schools and obesity had inconsistent results and no similar study in China, we conducted a study on the association in Beijing of China, which will provide scientific evidence for the intervention of childhood obesity. Methods The study included 2201 students at grade 4 of 37 primary schools in Dongcheng or Miyun district of Beijing. The food environment data was acquired from AMAP, the free web-based geospatial service provider. The numbers of convenience stores were captured within the 800-m network buffer near schools using Geographic Information System. The weight and height of each student were measured by trained health professionals. Students’ dietary and physical behaviors and other information associated with obesity were collected with questionnaires for students and their parents. The generalized linear mixed model (GLMM) was used to analyze the data. Results The average age of the students was 10.2 years (Standard Deviation (SD) = 0.33). The prevalence of obesity in students was 14.9%. The median number of convenience stores within the 800-m network buffer near schools was 24 in two districts. The number of convenience stores near each school varied from 5 to 67 (median: 25) in Dongcheng district and from 1 to 57 (median: 22) in Miyun district. After adjusting for the confounding factors at the family and individual levels, the association between convenience stores and childhood obesity was statistically significant. Additional ten convenience stores near schools were associated with an increased risk of obesity (Odds Ratio (OR) = 1.13, 95% confidence interval (CI): 1.03,1.24, P = 0.011). Compared with less than 24 convenience stores near schools, the students with more than or equal to 24 convenience stores near schools had an increased risk of obesity (OR = 1.49, 95% CI: 1.09, 2.03, P = 0.013). Conclusion The students with more convenience stores near their schools had an increased risk of obesity. The findings provided evidence for developing public health policy to restrict the number of convenience stores near schools to prevent and control childhood obesity.
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Affiliation(s)
- Shuang Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Rd, Beijing, 100191, China
| | - Yu Cheng
- Department of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Rd, Beijing, 100191, China
| | - Lan Cheng
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Di Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Rd, Beijing, 100191, China
| | - Qin Li
- Reproductive Medicine Center, Peking University Third Hospital Beijing, Beijing, China
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Rd, Beijing, 100191, China
| | - Hai-Jun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, No.38 Xueyuan Rd, Beijing, 100191, China.
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24
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Elbel B, Tamura K, McDermott ZT, Wu E, Schwartz AE. Childhood Obesity and the Food Environment: A Population-Based Sample of Public School Children in New York City. Obesity (Silver Spring) 2020; 28:65-72. [PMID: 31675159 PMCID: PMC6925337 DOI: 10.1002/oby.22663] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 09/06/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to examine the relationship between proximity to healthy and unhealthy food outlets around children's homes and their weight outcomes. METHODS A total of 3,507,542 student-year observations of height and weight data from the 2009-2013 annual FitnessGram assessment of New York City public school students were used. BMI z scores were calculated, student obesity or obesity/overweight was determined using Centers for Disease Control and Prevention growth charts, and these data were combined with the locations of four food outlet types (fast-food restaurants, wait-service restaurants, corner stores, and supermarkets) to calculate distance to the nearest outlet. Associations between weight status outcomes and distance to these food outlet types were examined using neighborhood (census tract) fixed effects. RESULTS Living farther than 0.025 mile (about half of a city block) from the nearest fast-food restaurant was associated with lower obesity and obesity/overweight risk and lower BMI z scores. Results ranged from 2.5% to 4.4% decreased obesity. Beyond this distance, there were generally no impacts of the food environment and little to no impact of other food outlet types. CONCLUSIONS Proximity to fast-food restaurants was inversely related to childhood obesity, but no relationships beyond that were seen. These findings can help better inform policies focused on food access, which could, in turn, reduce childhood obesity.
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Affiliation(s)
- Brian Elbel
- Department of Population Health, School of Medicine, New York University, New York, New York, USA
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Kosuke Tamura
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zachary T McDermott
- Wagner Graduate School of Public Service, New York University, New York, New York, USA
| | - Erilia Wu
- Department of Population Health, School of Medicine, New York University, New York, New York, USA
| | - Amy Ellen Schwartz
- Center for Policy Research, Maxwell School for Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA
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25
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Removing competitive foods v. nudging and marketing school meals: a pilot study in high-school cafeterias. Public Health Nutr 2019; 23:366-373. [DOI: 10.1017/s136898001900329x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To compare federally reimbursable school meals served when competitive foods are removed and when marketing and nudging strategies are used in school cafeterias operating the National School Lunch Program (NSLP). The second objective was to determine how marketing and nudging strategies influence competitive food sales.Design:In the Healthy Choices School, all competitive foods were removed; the Healthy Nudging School retained competitive foods and promoted the school meal programme using marketing and nudging strategies; a third school made no changes. Cafeteria register data were collected from the beginning of the 2013–2014 school year through the four-week intervention. Outcome measures included daily entrées served; share of entrées served with vegetables, fruit and milk; and total competitive food sales. Difference-in-difference models were used to examine outcome measure changes.Setting:Three high schools in a diverse, Northeast US urban district with universally free meals.Participants:High-school students participating in the NSLP.Results:During the intervention weeks, the average number of entrées served daily was significantly higher in the Healthy Choices School (82·1 (se 33·9)) and the Healthy Nudging School (107·4 (se 28·2)) compared with the control school. The only significant change in meal component selection was a 6 % (se 0·02) higher rate of vegetable servings in the Healthy Choices School compared with the control school. Healthy Nudging School competitive food sales did not change.Conclusions:Both strategies – removing competitive foods and marketing and nudging – may increase school meal participation. There was no evidence that promoting school meals decreased competitive food sales.
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ALjaraedah TY, Takruri HR, Tayyem RF. Dietary practices and nutrient intake among adolescents: A general review. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.obmed.2019.100145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bejarano CM, Cushing CC. Dietary Motivation and Hedonic Hunger Predict Palatable Food Consumption: An Intensive Longitudinal Study of Adolescents. Ann Behav Med 2019; 52:773-786. [PMID: 30124763 DOI: 10.1093/abm/kax051] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Understanding interactions between stable characteristics and fluctuating states underlying youth's food choices may inform methods for promoting more healthful food intake. Purpose This study examined dietary motivation and hedonic hunger as interacting predictors of adolescents' consumption of palatable foods. Methods Intensive longitudinal data were collected from 50 adolescents (aged 13-18) over 20 days. Participants completed a measure of dietary motivation at baseline and reported on hedonic hunger and palatable food consumption via a smartphone app at the end of each day. Results Results indicated that 66.7% of the variability in hedonic hunger was between-person (BP) and 33.3% was within-person (WP). BP hedonic hunger was positively associated with fatty food consumption (β = 0.28, p < .05), and WP hedonic hunger was positively associated with starchy food consumption (β = 0.38, p < .0001). Autonomous motivation was negatively associated with consumption of fast foods (β = -0.14, p < .05). Significant cross-level interactions were found: WP hedonic hunger and controlled motivation were positively associated with starchy food consumption, and WP hedonic hunger and autonomous motivation were negatively associated with fast food consumption. Conclusions Findings indicated that hedonic hunger has the potential to fluctuate, and conceptualization of the variable as both trait and state may be most appropriate. Adolescents with controlled dietary motivation may be vulnerable to the influence of hedonic hunger and prone to eating higher quantities of starchy foods. Adolescents with autonomous dietary motivation may be less vulnerable to hedonic hunger and less likely to consume fast food.
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Affiliation(s)
- Carolina M Bejarano
- Clinical Child Psychology Program, Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
| | - Christopher C Cushing
- Clinical Child Psychology Program, Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS, USA
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Youth Willingness to Purchase Whole Grain Snack Packs from New York City Corner Stores Participating in a Healthy Retail Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183233. [PMID: 31487809 PMCID: PMC6765790 DOI: 10.3390/ijerph16183233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 12/31/2022]
Abstract
Corners stores in low-income communities are a promising setting to intervene in youth whole grain intake. One strategy that may encourage whole grain intake is if corner stores were to pair and sell whole grain snacks in combination with either a liked fruit or vegetable and an optional condiment (i.e., a whole grain snack pack). This study examined youth in terms of their (1) liking of fruits, vegetables, and whole grain snacks; (2) perceptions about which fruits and vegetables pair best with whole grain snacks; and (3) willingness to pay for a whole grain snack pack. One-time intercept surveys were conducted with 10-18-year-olds (n = 402) who visited a New York City (NYC) corner store (n = 34) participating in the City Harvest Healthy Retail Program. On average, youth were willing to spend $2.38 (SD $4.32) on a whole grain snack pack. Higher overall liking scores for vegetables and whole grain snacks were associated with willingness to spend 24.4% (95% confidence interval (CI): 11.5-38.7%) and 21.6% (95%CI: 5.2-40.6%) more on whole grain snack packs, respectively. In conclusion, youth are receptive to purchasing whole grain snack packs from NYC corner stores participating in a healthy retail program.
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Sanchez-Vaznaugh EV, Weverka A, Matsuzaki M, Sánchez BN. Changes in Fast Food Outlet Availability Near Schools: Unequal Patterns by Income, Race/Ethnicity, and Urbanicity. Am J Prev Med 2019; 57:338-345. [PMID: 31377084 PMCID: PMC6816308 DOI: 10.1016/j.amepre.2019.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Previous research has observed income or racial/ethnic inequalities in fast food restaurant availability near schools. The purpose of this study was to investigate changes in fast food restaurant availability near schools between 2000 and 2010 by school neighborhood income, race/ethnicity, and urbanicity. METHODS Using data from 7,466 California public schools, negative binomial regression models estimated the relative ratios to evaluate the income gradient in fast food restaurant availability, examine differences in the income gradient in fast food restaurant availability between 2000 and 2010, and investigate if fast food restaurant availability changed in 2010 versus 2000, stratified by race/ethnicity and urbanicity. The analyses were conducted in 2018 and early 2019. RESULTS In urban areas, there was a negative school neighborhood income gradient in fast food restaurant availability in both 2000 and 2010, and across all race/ethnic groups, except majority African American schools. The income gradient in fast food restaurant availability was steeper in 2010 relative to 2000 among Latino majority urban schools. Fast food restaurant availability increased in 2010 relative to 2000 among majority African American, majority Latino, and majority Asian schools in the least affluent neighborhoods. Among majority white schools in similar neighborhoods the availability of fast food restaurants did not change but declined in the most affluent school neighborhoods. In nonurban areas, the income patterns in fast food restaurant availability were less clear, and fast food restaurant availability increased among majority white and Latino schools within the middle neighborhood income tertile. CONCLUSIONS These findings suggest the need for future interventions to target schools in low-income urban neighborhoods. Additionally, reducing child health disparities and improving health for all children requires monitoring changes in the food environment near schools.
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Affiliation(s)
- Emma V Sanchez-Vaznaugh
- Department of Health Education, San Francisco State University, San Francisco, California; Center for Health Equity, University of California, San Francisco, San Francisco, California.
| | - Aiko Weverka
- Department of Health Education, San Francisco State University, San Francisco, California
| | - Mika Matsuzaki
- Department of Health Education, San Francisco State University, San Francisco, California
| | - Brisa N Sánchez
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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McKerchar C, Smith M, Stanley J, Barr M, Chambers T, Abel G, Lacey C, Gage R, Ni Mhurchu C, Signal L. Food store environment examination - FoodSee: a new method to study the food store environment using wearable cameras. Glob Health Promot 2019; 27:73-81. [PMID: 31451082 DOI: 10.1177/1757975919859575] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Food environments shape food behaviours and are implicated in rising rates of obesity worldwide. Measurement of people's interactions with food stores is important to advance understanding of the associations between the food environment and in-store behaviour. This paper describes a new method, Food Store Environment Examination (FoodSee) to measure people's interaction with the food store environment in a feasibility study focused on convenience stores and children. METHODS One hundred and sixty-eight randomly selected children (aged 11-13 years) recruited from 16 randomly selected schools in Wellington, New Zealand, used wearable cameras for 4 days that recorded images every 7 s. The study was conducted from July 2014 to June 2015. All images of convenience stores and service stations, and a sample of images from supermarkets, were evaluated to determine the feasibility of assessing food availability and marketing. The outcomes of interest assessed were: food product availability, placement, packaging, branding, price promotion, purchases and consumption. RESULTS Thirty-seven children (22%) visited a convenience store or service station at least once during the study period. In total, there were 65 visits to 34 different stores. Seven hundred and nineteen images revealed the in-store environment. Of those, 86.1% were usable and able to be analysed for the outcomes of interest. CONCLUSIONS The FoodSee methodology provides a promising new method to study people's interaction with the in-store food environment. The evidence generated will be valuable in understanding and improving the food store environment within which people shop, and will contribute to efforts to address obesity globally.
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Affiliation(s)
- Christina McKerchar
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Moira Smith
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Michelle Barr
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tim Chambers
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Gillian Abel
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Cameron Lacey
- Māori and Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Ryan Gage
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Louise Signal
- Health Promotion and Policy Research Unit, Department of Public Health, University of Otago, Wellington, New Zealand
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Elbel B, Tamura K, McDermott ZT, Duncan DT, Athens JK, Wu E, Mijanovich T, Schwartz AE. Disparities in food access around homes and schools for New York City children. PLoS One 2019; 14:e0217341. [PMID: 31188866 PMCID: PMC6561543 DOI: 10.1371/journal.pone.0217341] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/10/2019] [Indexed: 11/19/2022] Open
Abstract
Demographic and income disparities may impact food accessibility. Research has not yet well documented the precise location of healthy and unhealthy food resources around children's homes and schools. The objective of this study was to examine the food environment around homes and schools for all public school children, stratified by race/ethnicity and poverty status. This cross-sectional study linked data on the exact home and school addresses of a population-based sample of public school children in New York City from 2013 to all corner stores, supermarkets, fast-food restaurants, and wait-service restaurants. Two measures were created around these addresses for all children: 1) distance to the nearest outlet, and 2) count of outlets within 0.25 miles. The total analytic sample included 789,520 K-12 graders. The average age was 11.78 years (SD ± 4.0 years). Black, Hispanic, and Asian students live and attend schools closer to nearly all food outlet types than White students, regardless of poverty status. Among not low-income students, Black, Hispanic, and Asian students were closer from home and school to corner stores and supermarkets, and had more supermarkets around school than White students. The context in which children live matters, and more nuanced data is important for development of appropriate solutions for childhood obesity. Future research should examine disparities in the food environment in other geographies and by other demographic characteristics, and then link these differences to health outcomes like body mass index. These findings can be used to better understand disparities in food access and to help design policies intended to promote healthy eating among children.
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Affiliation(s)
- Brian Elbel
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- Wagner Graduate School of Public Service, New York University, New York, NY, United States of America
- * E-mail:
| | - Kosuke Tamura
- Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Zachary T. McDermott
- Wagner Graduate School of Public Service, New York University, New York, NY, United States of America
| | - Dustin T. Duncan
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
- College of Global Public Health, New York University, New York, NY, United States of America
| | - Jessica K. Athens
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Erilia Wu
- Department of Population Health, New York University School of Medicine, New York, NY, United States of America
| | - Tod Mijanovich
- Department of Humanities and Social Sciences, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, United States of America
| | - Amy Ellen Schwartz
- Center for Policy Research, Maxwell School, Syracuse University, Syracuse, NY, United States of America
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Lawman HG, Lofton X, Grossman S, Root M, Perez M, Tasian G, Patel A. A randomized trial of a multi-level intervention to increase water access and appeal in community recreation centers. Contemp Clin Trials 2019; 79:14-20. [PMID: 30771559 PMCID: PMC6499604 DOI: 10.1016/j.cct.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Improving children's tap water intake and reducing sugar-sweetened beverage (SSB) consumption is beneficial for health and health equity, particularly in low-income communities and communities of color. Existing community level interventions to improve the intake of tap water have predominantly occurred in schools and have focused on promoting water consumption in cafeterias during lunch or snack periods. METHODS The "Hydrate Philly" intervention was developed to target multiple environmental and social factors to improve tap water consumption in community recreation centers in low-income communities: replacing old and unappealing water fountains with appealing water-bottle-filling "hydration stations", conducting water safety testing and publicizing results, disseminating reusable water bottles, promoting tap water, and discouraging SSB consumption. Efficacy of the intervention will be tested through a group-randomized controlled trial (n = 28 centers) of the intervention's impact on center-level water fountain/station use as measured by flow meters during a youth summer camp program primarily for children aged 6-12 years. Intervention impact on the primary outcome (use of drinking water sources) will be examined with a difference-in-differences approach using an ordinary least squares regression model for analysis at the center level. Secondary outcomes include SSBs brought to summer camp, reusable and single-use bottled water use, program trash, and recreation center staff SSB consumption. DISCUSSION Multilevel approaches are needed to increase tap water intake and decrease SSB consumption among low-income and minority youth beyond school and meal settings. The current study describes the Hydrate Philly intervention, the study design, and baseline characteristics of recreation centers participating in the study. ClinicalTrials.gov Registration: #NCT03637465.
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Affiliation(s)
- Hannah G Lawman
- Philadelphia Department of Public Health, Philadelphia, PA, USA.
| | - Xavier Lofton
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Sara Grossman
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Mica Root
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - Meka Perez
- Philadelphia Department of Public Health, Philadelphia, PA, USA; Philadelphia Parks and Recreation Department, Philadelphia, PA, USA
| | - Gregory Tasian
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anisha Patel
- School of Medicine, Stanford University, Stanford, CA, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Polonsky HM, Bauer KW, Fisher JO, Davey A, Sherman S, Abel ML, Hanlon A, Ruth KJ, Dale LC, Foster GD. Effect of a Breakfast in the Classroom Initiative on Obesity in Urban School-aged Children: A Cluster Randomized Clinical Trial. JAMA Pediatr 2019; 173:326-333. [PMID: 30801612 PMCID: PMC6450266 DOI: 10.1001/jamapediatrics.2018.5531] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Serving breakfast in the classroom is promoted to increase participation in the federal School Breakfast Program. However, little is known about the effect of breakfast in the classroom on children's weight status. OBJECTIVE To evaluate the effect of a breakfast in the classroom initiative, which combined breakfast in the classroom with breakfast-specific nutrition education, on overweight and obesity among urban children in low-income communities. DESIGN, SETTING, AND PARTICIPANTS A cluster-randomized clinical trial among 1362 fourth- through sixth-grade students from low-income urban communities across 2.5 years. Sixteen kindergarten through eighth grade Philadelphia public schools with universal breakfast participated. Participants were recruited in September 2013, and the intervention began in January 2014. Data analysis took place from April 1, 2018, to August 30, 2018. INTERVENTIONS Intervention schools received a program that included breakfast in the classroom and breakfast-specific nutrition education. Control schools continued breakfast before school in the cafeteria and standard nutrition education. MAIN OUTCOMES AND MEASURES The primary outcome was the combined incidence of overweight and obesity. Secondary outcomes included the combined prevalence of overweight and obesity, incidence and prevalence of obesity, changes in body mass index (BMI) z score, and School Breakfast Program participation. RESULTS Among the 1362 students, mean (SD) age was 10.8 (0.96) years and 700 (51.4%) were female; 907 (66.6%) were black, 233 (17.1%) were Hispanic, 100 (7.3%) were white, 83 (6.1%) were Asian, and 39 were of multiple or other race/ethnicity. After 2.5 years, students in intervention schools had participated in the School Breakfast Program 53.8% of days, compared with 24.9% of days among students in control schools (β = 0.33; 95% CI, 0.22-0.42). There was no difference between intervention and control schools in the combined incidence of overweight and obesity after 2.5 years (11.7% vs 9.3%; odds ratio [OR] 1.31; 95% CI, 0.85-2.02; P = .22). However, the incidence (11.6% vs 4.4%; OR, 2.43; 95% CI, 1.47-4.00) and prevalence (28.0% vs 21.2%; OR, 1.46; 95% CI, 1.11-1.92) of obesity were higher in intervention schools than in control schools after 2.5 years. CONCLUSIONS AND RELEVANCE A breakfast in the classroom initiative increased participation in the School Breakfast Program and did not affect the combined incidence of overweight and obesity. However, the initiative had an unintended consequence of increasing incident and prevalent obesity. Further research is needed to identify approaches to increase participation in the School Breakfast Program that do not increase obesity among students. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01924130.
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Affiliation(s)
- Heather M. Polonsky
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Katherine W. Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor
| | - Jennifer O. Fisher
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania,Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania,Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Adam Davey
- College of Health Sciences and Department of Behavioral Health and Nutrition, University of Delaware, Newark
| | | | | | - Alexandra Hanlon
- Department of Statistics, Virginia Polytechnic Institute and State University, Roanoake
| | - Karen J. Ruth
- Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | | | - Gary D. Foster
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania,WW (formerly Weight Watchers), New York, New York,Center for Weight and Eating Disorders, University of Pennsylvania, Philadelphia
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Ross A, Krishnan N, Panchal J, Brooks JK, Lloyd E, Lee THJ, Gittelsohn J. Formative Research for an Innovative Smartphone Application to Improve Distribution of Healthy Foods to Corner Stores in Baltimore City. Ecol Food Nutr 2018; 58:3-22. [PMID: 30522356 DOI: 10.1080/03670244.2018.1553778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We sought to collect information about the operations of wholesalers and store owner perceptions of smartphones to plan for and create a smartphone application that will facilitate the distribution of healthy foods to corner stores. In-depth interviews were conducted with wholesalers, corner store owners, distributors, and food environment experts in Baltimore City, Maryland, which included providing feedback for a mockup of the app. Store owners that were comfortable with smartphones liked the idea of the app because it was economically practical, culturally suitable, simple and easy to use, and provided a large variety of items at a fair or low price. We found that barriers to uptake among corner store owners would be high delivery costs, no foreign language capability, and a complicated user interface. This work will inform future projects that will utilize mHealth technology to improve distribution of healthier foods in food deserts.
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Affiliation(s)
- Alexandra Ross
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Nandita Krishnan
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Janaki Panchal
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jennifer K Brooks
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Emily Lloyd
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ting-Hsuan Joyce Lee
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Joel Gittelsohn
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Ruggiero CF, Poirier L, Trude ACB, Yang T, Schwendler T, Gunen B, Loh IH, Perepezko K, Nam CS, Sato P, Gittelsohn J. Implementation of B'More Healthy Communities for Kids: process evaluation of a multi-level, multi-component obesity prevention intervention. HEALTH EDUCATION RESEARCH 2018; 33:458-472. [PMID: 30202959 PMCID: PMC6293311 DOI: 10.1093/her/cyy031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 05/10/2023]
Abstract
B'More Healthy Communities for Kids was a multi-level, multi-component obesity prevention intervention to improve access, demand and consumption of healthier foods and beverages in 28 low-income neighborhoods in Baltimore City, MD. Process evaluation assesses the implementation of an intervention and monitor progress. To the best of our knowledge, little detailed process data from multi-level obesity prevention trials have been published. Implementation of each intervention component (wholesaler, recreation center, carryout restaurant, corner store, policy and social media/text messaging) was classified as high, medium or low according to set standards. The wholesaler component achieved high implementation for reach, dose delivered and fidelity. Recreation center and carryout restaurant components achieved medium reach, dose delivered and fidelity. Corner stores achieved medium reach and dose delivered and high fidelity. The policy component achieved high reach and medium dose delivered and fidelity. Social media/text messaging achieved medium reach and high dose delivered and fidelity. Overall, study reach and dose delivered achieved a high implementation level, whereas fidelity achieved a medium level. Varying levels of implementation may have balanced the performance of an intervention component for each process evaluation construct. This detailed process evaluation of the B'More Healthy Communities for Kids allowed the assessment of implementation successes, failures and challenges of each intervention component.
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Affiliation(s)
- C F Ruggiero
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Poirier
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A C B Trude
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Yang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - T Schwendler
- Peace Corps, Serekunda, The Gambia, Washington, DC, USA
| | - B Gunen
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I H Loh
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Perepezko
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C S Nam
- Joint Learning Initiative on Faith and Local Communities, Washington, DC, USA
| | - P Sato
- University of S�o Paulo, S�o Paulo, SP, Brazil
| | - J Gittelsohn
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Carmo ASD, Assis MMD, Cunha CDF, Oliveira TRPRD, Mendes LL. The food environment of Brazilian public and private schools. CAD SAUDE PUBLICA 2018; 34:e00014918. [PMID: 30517312 DOI: 10.1590/0102-311x00014918] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 08/15/2018] [Indexed: 11/22/2022] Open
Abstract
This study's aim was to characterize the food environment of Brazilian public and private schools. This was a national school-based cross-sectional study with 1,247 schools - among which 81.09% were public and 18.91% were private - in 124 Brazilian municipalities. The data originated from the Questionnaire on Aspects of the School Environment, used in the Study of Cardiovascular Risk in Adolescents (ERICA) in 2013 and 2014. Data analysis was conducted in 2017. The chi-square test was used to compare proportions. A greater proportion of public schools offered school meals (98.15%) in comparison to private schools (8.07%) (p < 0.001). The internal sale of food and beverages was more prevalent in private schools (97.75% vs. 45.06%, p < 0.001). Also, sale and advertisement of processed and ultra-processed foods (sodas, cookies, savory snacks, sandwiches and pizza), as well as the presence of vending machines for industrialized products (18.02% vs. 4%) (p < 0.001) were more common in private schools. Street vendors at the school gate or surroundings were identified in 41.32% of the public schools and 47.75% of the private schools (p > 0.05). These findings reveal the predominance of obesogenic environments mainly in private schools, and can contribute to the design of Brazilian public policies to promote a healthy school food environment.
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Barnes TL, Lenk K, Caspi CE, Erickson DJ, Laska MN. Perceptions of a healthier neighborhood food environment linked to greater fruit and vegetable purchases at small and non-traditional food stores. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018; 14:741-761. [PMID: 31798762 DOI: 10.1080/19320248.2018.1549518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this study was to examine associations between perceived neighborhood food environments and food purchasing at small and non-traditional food stores. Intercept interviews of 661 customers were conducted in 105 small and non-traditional food stores. We captured (1) customer perceptions of the neighborhood food environment, (2) associations between customer perceptions and store-level characteristics, and (3) customers' perceptions and shopping behaviors. Findings suggest that customers with more favorable perceptions of the neighborhood food environment were more likely to purchase fruits and vegetables, despite no significant association between perceptions of the neighborhood and objectively measured store characteristics.
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Affiliation(s)
- Timothy L Barnes
- Children's Minnesota Research Institute, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Ave. S, Minneapolis, MN 55404.,University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
| | - Kathleen Lenk
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
| | - Caitlin E Caspi
- University of Minnesota, Department of Family Medicine and Community Health, Program in Health Disparities Research, 717 Delaware St. SE, Minneapolis, MN 55414
| | - Darin J Erickson
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
| | - Melissa N Laska
- University of Minnesota, Division of Epidemiology and Community Health, Suite 300, 1300 South 2nd St., Minneapolis, MN 55454
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Trude ACB, Surkan PJ, Cheskin LJ, Gittelsohn J. A multilevel, multicomponent childhood obesity prevention group-randomized controlled trial improves healthier food purchasing and reduces sweet-snack consumption among low-income African-American youth. Nutr J 2018; 17:96. [PMID: 30373597 PMCID: PMC6206663 DOI: 10.1186/s12937-018-0406-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Consumption of foods and beverages rich in sugar remains high across all races and ages in the United States. Interventions to address childhood obesity and decrease sugar intake are needed, particularly in low-income settings. METHODS B'more Healthy Communities for Kids (BHCK) was a group-randomized, controlled trial implemented among 9-15-year olds in 30 low-income areas of Baltimore. We increased access to low-sugar foods and beverages at wholesalers and small food stores. Concurrently, we encouraged their purchase and consumption by children through youth-led nutrition education in recreation centers, in-store promotions, text messaging and a social media program directed at caregivers. Sugar consumption (sugar sweetened beverage (SSB), sweets) in youth was assessed pre- (n = 534) and post-intervention (n = 401) using the Block Kids Food Frequency Questionnaire. Purchasing of 38 healthier and 28 less healthier food/beverage varieties in the previous 7 days was assessed via self-report. Multilevel models at the community and individual levels were used. Analyses were stratified by age (younger: 9-12-year olds (n = 339) vs older: 13-15 (n = 170)). Models were controlled for child's sex, race, total daily caloric intake, and caregiver's age and sex. RESULTS Overall baseline mean healthier food purchasing was 2.5 (+ 3.6; min. 0, max. 34 items per week), and unhealthier food purchasing 4.6 (+ 3.7; 0-19 items per week). Mean intake at baseline for kcal from SSB was 176 (+ 189.1) and 153 (+ 142.5), and % of calories from sweets (i.e. cookies, cakes, pies, donuts, candy, ice cream, sweetened cereals, and chocolate beverages) was 15.9 (+ 9.7) and 15.9 (+ 7.7) in comparison and intervention youth, respectively. Intervention youth increased healthier foods and beverages purchases by 1.4 more items per week than comparison youth (β = 1.4; 95% CI: 0.1; 2.8). After the intervention, there was a 3.5% decrease in kcal from sweets for older intervention youth, compared to the control group (β = - 3.5; 95% CI: -7.76; - 0.05). No impact was seen on SSB consumption. CONCLUSION BHCK successfully increased healthier food purchasing variety in youth, and decreased % calories from sweet snacks in older youth. Multilevel, multicomponent environmental childhood obesity programs are a promising strategy to improve eating behaviors among low-income urban youth. TRIAL REGISTRATION NCT02181010 (July 2, 2014, retrospectively registered).
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Affiliation(s)
- Angela C. B. Trude
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Pamela J. Surkan
- Department of International Health, Social and Behavioral Interventions Program, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Lawrence J. Cheskin
- Department of Health Behavior and Society, and the Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 550 N. Broadway, Baltimore, MD 21205 USA
| | - Joel Gittelsohn
- Department of International Health, Global Obesity Prevention Center, and Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Shikany JM, Carson TL, Hardy CM, Li Y, Sterling S, Hardy S, Walker CM, Baskin ML. Assessment of the nutrition environment in rural counties in the Deep South. J Nutr Sci 2018; 7:e27. [PMID: 30402218 PMCID: PMC6218927 DOI: 10.1017/jns.2018.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/31/2018] [Accepted: 09/21/2018] [Indexed: 11/23/2022] Open
Abstract
The nutrition environment, including food store type, may influence dietary choices, which in turn can affect risk of obesity and related chronic diseases such as CHD, diabetes and cancer. The objective of the present study was to elucidate the extent to which healthy foods are available and affordable in various rural food outlets. A subset of the nutrition environment was assessed using the Nutrition Environment Measures Survey in Stores (NEMS-S). The NEMS-S instrument assessed the availability and price of healthy foods (e.g. low-fat/non-fat milk, lean meats and reduced-fat dinner entrées) compared with less healthy counterparts (e.g. whole milk, non-lean meats and regular dinner entrées). The NEMS-S also assessed the quality of fresh fruits and vegetables. Availability, prices and quality of healthy foods were compared between grocery stores (n 24) and convenience stores (n 67) in nine rural counties in Alabama. Mean availability subscale score (possible range 0 to 30; higher score indicates a greater number of healthier foods were available) for grocery stores was 22·6 (sd 8·1), compared with 6·6 (sd 5·2) in convenience stores (P < 0·0001); and mean price subscale score (possible range -9 to 18; higher score indicates that healthier options were less expensive than the less healthy options) for grocery stores was 2·4 (sd 2·7), compared with 0·7 (sd 1·2) in convenience stores (P = 0·0080). Mean total NEMS-S score (possible range -9 to 54) in grocery stores was 29·8 (sd 10·9) compared with 7·3 (sd 7·1) in convenience stores (P < 0·0001). Both grocery and convenience stores could be strategic points of intervention to improve the nutrition environment in the counties that were surveyed.
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Affiliation(s)
- James M. Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Tiffany L. Carson
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Claudia M. Hardy
- Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-3300, USA
| | - Yufeng Li
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Samara Sterling
- Department of Nutrition Sciences, School of Health Professions, University of Alabama at Birmingham, 1675 University Boulevard, Birmingham, AL 35294-3360, USA
| | - Sharonda Hardy
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
| | - Cordie M. Walker
- Comprehensive Cancer Center, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-3300, USA
| | - Monica L. Baskin
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-4410, USA
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Tibbits M, Wang H, Soliman G, Schram S, Balluff M, Grimm BL, Siahpush M. Demographic differences in healthy food purchases in a corner store intervention. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2017.1403405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | - Hongmei Wang
- Department of Health Services Research & Administration, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | - Ghada Soliman
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | - Sarah Schram
- Division of Community Health and Nutrition Services, Douglas County Health Department, Omaha, NE
| | - Mary Balluff
- Division of Community Health and Nutrition Services, Omaha, NE, USA
| | - Brandon L. Grimm
- Office of Public Health Practice, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | - Mohammad Siahpush
- College of Public Health, Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, NE, USA
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Examining the Feasibility of Healthy Minimum Stocking Standards for Small Food Stores. J Acad Nutr Diet 2018; 118:1655-1663. [PMID: 29650459 DOI: 10.1016/j.jand.2017.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 12/14/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In response to recent national efforts to increase the availability of healthy food in small stores, we sought to understand the extent to which small food stores could implement the newly published Healthy Small Store Minimum Stocking Recommendations and reflect on the new US Department of Agriculture Food and Nutrition Service's final rule for stocking of staple foods for Supplemental Nutrition Assistance Program-approved retailers. DESIGN We collected qualitative and quantitative data from 57 small stores in four states (Arizona, Delaware, Minnesota, and North Carolina) that accepted Supplemental Nutrition Assistance Program but not Special Supplemental Nutrition Assistance Program for Women, Infants, and Children benefits. Data from semistructured, in-depth interviews with managers/owners were transcribed, coded, and analyzed. We collected quantitative store inventory data onsite and later performed descriptive analyses. RESULTS Store interviews revealed a reluctant willingness to stock healthy food and meet new recommendations. No stores met recommended fruit and vegetable stocking, although 79% carried at least one qualifying fruit and 74% carried at least one qualifying vegetable. Few stores met requirements for other food categories (ie, whole grains and low-fat dairy) with the exception of lean proteins, where stores carrying nuts or nut butter were more likely to meet the protein recommendation. Water and 100% juice were widely available and 68% met basic healthy beverage criteria. CONCLUSIONS In contrast to the inventory observed, most owners believed store stock met basic recommendations. Further, findings indicate that small stores are capable of stocking healthy products; however, technical and infrastructure support, as well as incentives, would facilitate shifts from staple to healthier staple foods. Retailers may need support to understand healthier product criteria and to drive consumer demand for new products.
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Polonsky HM, Davey A, Bauer KW, Foster GD, Sherman S, Abel ML, Dale LC, Fisher JO. Breakfast Quality Varies by Location among Low-Income Ethnically Diverse Children in Public Urban Schools. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:190-197.e1. [PMID: 29107474 PMCID: PMC7340127 DOI: 10.1016/j.jneb.2017.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate breakfast location and children's food choices. METHODS Cross-sectional analysis of 1,371 fourth- through sixth-grade students in 2013. Foods and beverages in 17 categories characterized breakfast choices: (1) ≥ 1 fruits or vegetables, (2) ≥ 1 foods high in saturated fats and added sugars (SFAS), and (3) meeting School Breakfast Program (SBP) requirements. RESULTS Among breakfast eaters (n = 1,133; 82.6%), 46.0% ate at home, 13.1% ate at school, 41.0% ate at multiple locations; and 21.8% ate at a corner store. Those eating at school were more likely to consume ≥1 fruit or vegetable (odds ratio [OR] = 1.90; 95% confidence interval [CI], 1.26-2.87), less likely to eat ≥1 SFAS food (OR = 0.46; 95% CI, 0.22-0.94), and more likely to meet SBP requirements (OR = 2.47; 95% CI, 1.42-4.29). Those eating at corner stores (n = 247) were more likely to consume high-SFAS foods (63.9% vs 9.2%; P < .001). CONCLUSIONS AND IMPLICATIONS Eating school breakfast increased the odds of consuming fruit, choosing lower SFAS, and meeting nutritional requirements of the SBP relative to other locations.
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Affiliation(s)
- Heather M Polonsky
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA
| | - Adam Davey
- Department of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware, Newark, DE
| | - Katherine W Bauer
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Gary D Foster
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI; Weight Watchers International, New York, NY
| | | | | | | | - Jennifer O Fisher
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA; Department of Social and Behavioral Sciences, College of Public Health, Philadelphia, PA.
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Lenk KM, Caspi CE, Harnack L, Laska MN. Customer Characteristics and Shopping Patterns Associated with Healthy and Unhealthy Purchases at Small and Non-traditional Food Stores. J Community Health 2018; 43:70-78. [PMID: 28616707 PMCID: PMC5730500 DOI: 10.1007/s10900-017-0389-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Small and non-traditional food stores (e.g., corner stores) are often the most accessible source of food for residents of lower income urban neighborhoods in the U.S. Although healthy options are often limited at these stores, little is known about customers who purchase healthy, versus less healthy, foods/beverages in these venues. We conducted 661 customer intercept interviews at 105 stores (corner stores, gas marts, pharmacies, dollar stores) in Minneapolis/St. Paul, Minnesota, assessing all food and beverage items purchased. We defined three categories of "healthy" and four categories of "unhealthy" purchases. Interviews assessed customer characteristics [e.g., demographics, body-mass index (BMI)]. We examined associations between healthy versus unhealthy purchases categories and customer characteristics. Overall, 11% of customers purchased ≥1 serving of healthy foods/beverages in one or more of the three categories: 8% purchased fruits/vegetables, 2% whole grains, and 1% non-/low-fat dairy. Seventy-one percent of customers purchased ≥1 serving of unhealthy foods/beverages in one or more of four categories: 46% purchased sugar-sweetened beverages, 17% savory snacks, 15% candy, and 13% sweet baked goods. Male (vs. female) customers, those with a lower education levels, and those who reported shopping at the store for convenience (vs. other reasons) were less likely to purchase fruits/vegetables. Unhealthy purchases were more common among customers with a BMI ≥30 kg/m2 (vs. lower BMI). Results suggest intervention opportunities to increase healthy purchases at small and non-traditional food stores, particularly interventions aimed at male residents, those with lower education levels and residents living close to the store.
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Affiliation(s)
- Kathleen M Lenk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second St. Suite 300, Minneapolis, MN, 55454, USA.
| | - Caitlin E Caspi
- Department of Family Medicine and Community Health, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lisa Harnack
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second St. Suite 300, Minneapolis, MN, 55454, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. Second St. Suite 300, Minneapolis, MN, 55454, USA
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Nau C, Kumanyika S, Gittelsohn J, Adam A, Wong MS, Mui Y, Lee BY. Identifying Financially Sustainable Pricing Interventions to Promote Healthier Beverage Purchases in Small Neighborhood Stores. Prev Chronic Dis 2018; 15:E12. [PMID: 29369758 PMCID: PMC5798217 DOI: 10.5888/pcd15.160611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Residents of low-income communities often purchase sugar-sweetened beverages (SSBs) at small, neighborhood “corner” stores. Lowering water prices and increasing SSB prices are potentially complementary public health strategies to promote more healthful beverage purchasing patterns in these stores. Sustainability, however, depends on financial feasibility. Because in-store pricing experiments are complex and require retailers to take business risks, we used a simulation approach to identify profitable pricing combinations for corner stores. Methods The analytic approach was based on inventory models, which are suitable for modeling business operations. We used discrete-event simulation to build inventory models that use data representing beverage inventory, wholesale costs, changes in retail prices, and consumer demand for 2 corner stores in Baltimore, Maryland. Model outputs yielded ranges for water and SSB prices that increased water demand without loss of profit from combined water and SSB sales. Results A 20% SSB price increase allowed lowering water prices by up to 20% while maintaining profit and increased water demand by 9% and 14%, for stores selling SSBs in 12-oz cans and 16- to 20-oz bottles, respectively. Without changing water prices, profits could increase by 4% and 6%, respectively. Sensitivity analysis showed that stores with a higher volume of SSB sales could reduce water prices the most without loss of profit. Conclusion Various combinations of SSB and water prices could encourage water consumption while maintaining or increasing store owners’ profits. This model is a first step in designing and implementing profitable pricing strategies in collaboration with store owners.
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Affiliation(s)
- Claudia Nau
- Kaiser Permanente Southern California, Southern California Permanente Medical Group, Department for Research and Evaluation, Office 041R02, 100 S Los Robles, Pasadena CA 91101.
| | - Shiriki Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Global Obesity Prevention Center, Johns Hopkins University, Baltimore, Maryland
| | - Joel Gittelsohn
- Global Obesity Prevention Center, Johns Hopkins University, Baltimore, Maryland.,Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Atif Adam
- Global Obesity Prevention Center, Johns Hopkins University, Baltimore, Maryland.,Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle S Wong
- Global Obesity Prevention Center, Johns Hopkins University, Baltimore, Maryland.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yeeli Mui
- Food Systems Planning and Healthy Communities Lab, University at Buffalo, State University of New York, Buffalo, New York
| | - Bruce Y Lee
- Global Obesity Prevention Center, Johns Hopkins University, Baltimore, Maryland.,Carey Business School, Johns Hopkins University, Baltimore, Maryland
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45
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Gittelsohn J, Ayala GX, D’angelo H, Kharmats A, Ribisl KM, Schmidt Sindberg L, Liverman SP, Laska MN. Formal and informal agreements between small food stores and food and beverage suppliers: Store owner perspectives from four cities. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018. [DOI: 10.1080/19320248.2017.1403406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, Baltimore, MD, USA
| | - Guadalupe X. Ayala
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Heather D’angelo
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna Kharmats
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, Baltimore, MD, USA
| | - Kurt M. Ribisl
- Department of Health Behavior and Health Education, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lesley Schmidt Sindberg
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Susan P. Liverman
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N. Laska
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Ross A, Krishnan N, Ruggiero C, Kerrigan D, Gittelsohn J. A mixed methods assessment of the barriers and readiness for meeting the SNAP depth of stock requirements in Baltimore's small food stores. Ecol Food Nutr 2017; 57:94-108. [PMID: 29283673 DOI: 10.1080/03670244.2017.1416362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We sought to understand Baltimore corner store owners' awareness of and readiness for the then-approved Supplemental Nutrition Assistance Program depth of stock requirements and assess potential barriers and solutions. In-depth interviews and stocking observations were conducted in 17 corner stores in low-income food deserts of Baltimore City. Corner store owners conveyed little to no awareness of the pending depth of stock changes. Only two stores were currently ready for the requirements. Low customer demand, high amounts of potential spoilage, and unfair pricing at the wholesaler were identified by store owners as barriers to stocking required foods.
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Affiliation(s)
- Alexandra Ross
- a Global Obesity Prevention Center , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD, USA.,b Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD, USA
| | - Nandita Krishnan
- a Global Obesity Prevention Center , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD, USA
| | - Cara Ruggiero
- a Global Obesity Prevention Center , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD, USA
| | - Deanna Kerrigan
- b Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD, USA
| | - Joel Gittelsohn
- a Global Obesity Prevention Center , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD, USA
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Patterns of food and physical activity environments related to children's food and activity behaviors: A latent class analysis. Health Place 2017; 49:19-29. [PMID: 29156415 DOI: 10.1016/j.healthplace.2017.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 10/09/2017] [Accepted: 11/02/2017] [Indexed: 11/20/2022]
Abstract
Relationships between food and physical activity (PA) environments and children's related behaviors are complex. Latent class analyses derived patterns from proximity to healthy and unhealthy food outlets, PA facilities and parks, and counts of residential dwellings and intersections. Regression analyses examined whether derived classes were related to food consumption, PA, and overweight among 404 low-income children. Compared to children living in Low PA-Low Food environments, children in High Intersection&Parks-Moderate Density&Food, and High Density-Low Parks-High Food environments, had significantly greater sugar-sweetened beverage consumption (ps<0.01) and overweight/obesity (ps<0.001). Children in the High Density-Low Parks-High Food environments were more likely to walk to destinations (p = 0.01) Recognizing and leveraging beneficial aspects of neighborhood patterns may be more effective at positively influencing children's eating and PA behaviors compared to isolating individual aspects of the built environment.
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Exploring perceptions of the Mexican sugar-sweetened beverage tax among adolescents in north-west Mexico: a qualitative study. Public Health Nutr 2017; 21:618-626. [DOI: 10.1017/s1368980017002695] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo explore awareness and perceptions of the sugar-sweetened beverage (SSB) tax implemented in Mexico in 2014 among a sample of Mexican adolescents, and to investigate how the tax has affected their purchases and intake of SSB.DesignQualitative.SettingSemi-structured interviews were conducted in April–May 2016. The data were analysed using thematic analysis.SubjectsAdolescents residing in north-west Mexico (n29, 55·2 % females), aged 15–19 years.ResultsFour main themes emerged: awareness of taxation; perceptions of how the tax has affected SSB intake; reasons why the tax was not perceived to have affected SSB intake; and preferences for substitution of the taxed SSB. Participants were mostly unaware of the tax and perceived that it would not cause reductions in their intake of SSB; they felt that the price increase was low and insufficient to affect intake. Taste preferences and ‘addiction’ to SSB were highlighted as the main reasons why participants perceived taxation would not affect intake. If SSB prices were to increase further via a higher tax, participants would consider substituting SSB with other beverages, namely home-made drinks (e.g. 100 % fruit juices), non-caloric, instant-flavoured drinks and water.ConclusionsThese findings provide important insights into the views of this sample of Mexican adolescents regarding the taxation of SSB, by pointing out several possible limitations of the tax policy in Mexico. These results could inform the design of future interventions directed at Mexican youth that would complement and strengthen the current SSB taxation.
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Caspi CE, Wang Q, Shanafelt A, Larson N, Wei S, Hearst MO, Nanney MS. School Breakfast Program Participation and Rural Adolescents' Purchasing Behaviors in Food Stores and Restaurants. THE JOURNAL OF SCHOOL HEALTH 2017; 87:723-731. [PMID: 28876476 PMCID: PMC5679072 DOI: 10.1111/josh.12546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/21/2016] [Accepted: 06/15/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Little is known about adolescents' food purchasing behaviors in rural areas. This study examined whether purchasing food at stores/restaurants around schools was related to adolescents' participation in school breakfast programs and overall diet in rural Minnesota. METHODS Breakfast-skippers enrolled in a group-randomized intervention in 2014 to 2015 (N = 404 from 8 schools) completed 24-hour dietary recalls and pre/post surveys assessing food establishment purchase frequency. Healthy Eating Index Scores (HEI-2010) were calculated for each student. Student-level school breakfast participation (SBP) was obtained from school food service records. Mixed-effects regression models estimated: (1) whether SBP was associated with store/restaurant use at baseline, (2) whether an increase in SBP was associated with a decrease in store/restaurant use, and (3) whether stores/restaurant use was associated with HEI-2010 scores at baseline. RESULTS Students with increased SBP were more likely to decrease fast-food restaurant purchases on the way home from school (OR 1.017, 95% CI 1.005, 1.029), but were less likely to decrease purchases at food stores for breakfast (OR 0.979, 95% CI 0.959, 0.999). Food establishment use was associated with lower HEI-2010 dairy component scores (p = .017). CONCLUSIONS Increasing participation in school breakfast may result in modest changes in purchases at food establishments.
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Affiliation(s)
- Caitlin Eicher Caspi
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414
| | - Qi Wang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55414
| | - Amy Shanafelt
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414
| | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota, Suite 300, 1300 South 2nd Street, Minneapolis, MN 55454
| | - Susan Wei
- Division of Biostatistics, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455
| | - Mary O Hearst
- Henriette Schmoll School of Health, St. Catherine University, 2004 Randolph Ave., St. Paul, MN 55105
| | - Marilyn S Nanney
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. SE, Minneapolis, MN 55414
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Hartmann M, Cash SB, Yeh CH, Landwehr SC, McAlister AR. Children's purchase behavior in the snack market: Can branding or lower prices motivate healthier choices? Appetite 2017. [PMID: 28625855 DOI: 10.1016/j.appet.2017.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Children's dietary-related diseases and their associated costs have expanded dramatically in many countries, making children's food choice a policy issue of increasing relevance. As children spend a considerable amount of money on energy-dense, nutrient-poor (EDNP) products, a better understanding of the main drivers of children's independent food purchase decisions is crucial to move this behavior toward healthier options. OBJECTIVE The objective of the study is to investigate the role of branding and price in motivating children to choose healthier snack options. METHODS The study investigates snack choices of children ages 8 to 11, using a survey and a purchase experiment. The research took place in after-school programs of selected schools in the Boston area. Participants included 116 children. Products in the choice experiment differed on three factors: product type, brand, and price. Data were analyzed using aggregated and mixed logit models. RESULTS Children's purchase decisions are primarily determined by product type (Importance Value (IV) 56.6%), while brand (IV 22.8%) and price (IV 20.6%) prove to be of less relevance. Only those children who state that they like the familiar brand reveal a preference for the branded product in their purchase decision. Price is a significant predictor of choice when controlling for whether or not children obtain an allowance. CONCLUSION It is not simple brand awareness but a child's liking of the brand that determines whether a brand is successful in motivating a child to choose a product. The extent of children's experience with money influences their price responsiveness. To the extent that children who receive an allowance are primarily the ones buying food snacks, higher prices for EDNP snacks could be successful in motivating children to choose a healthier option.
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Affiliation(s)
- Monika Hartmann
- Institute for Food and Resource Economics, University of Bonn, Nussallee 21, D-53115 Bonn, Germany.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA.
| | - Ching-Hua Yeh
- Institute for Food and Resource Economics, University of Bonn, Nussallee 21, D-53115 Bonn, Germany.
| | - Stefanie C Landwehr
- Institute for Food and Resource Economics, University of Bonn, Nussallee 21, D-53115 Bonn, Germany.
| | - Anna R McAlister
- Curtis L. Gerrish School of Business, Endicott College, 376 Hale Street, Beverly, MA 01915, USA.
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