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Naughton SS, Al Subhi M, Boelsen-Robinson T, Blake MR, Ananthapavan J, Peeters A. The change in food service costs associated with increasing the healthiness of ready-to-eat food provision: A systematic scoping review. Obes Rev 2024:e13830. [PMID: 39256927 DOI: 10.1111/obr.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 08/15/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024]
Abstract
Increasing the healthiness of food retail environments is an identified mechanism to help halt rising rates of diet-related non-communicable diseases. Previous studies on healthy food environment adoption report that retailers' perceptions of loss of profitability and higher food costs are often barriers to change. Despite this, actual changes to profitability and food costs have not been fully explored. This study aimed to systematically scope the evidence relating to changes to food costs or profitability when changes are made to increase the healthiness of food and drinks sold by food service retailers. Nine databases were searched, with studies included from settings that sold ready-to-consume items, with interventions to increase the healthiness of menus, and reporting food environment/nutrition outcomes, and cost/profit outcomes. Of the 12 studies included, the majority were conducted in the United States and in school settings. Most studies indicated that increasing the healthiness of food service retail environments resulted in neutral or favorable financial outcomes. Food costs and/or profit changes were most often monitored via simple accounting measures. While further research is needed to strengthen the evidence on financial outcomes of healthier food provision, this review indicates that some perceived barriers to change may not be warranted.
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Affiliation(s)
- Shaan S Naughton
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Moosa Al Subhi
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Tara Boelsen-Robinson
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Miranda R Blake
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Jaithri Ananthapavan
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
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Dancey J, Reeve B, Jones A, Ferguson M, van Burgel E, Brimblecombe J. The use of private regulatory measures to create healthy food retail environments: a scoping review. Public Health Nutr 2024; 27:e88. [PMID: 38465376 PMCID: PMC11010160 DOI: 10.1017/s136898002400065x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/16/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Different forms of public and private regulation have been used to improve the healthiness of food retail environments. The aim of this scoping review was to systematically examine the types of private regulatory measures used to create healthy food retail environments, the reporting of the processes of implementation, monitoring, review and enforcement and the barriers to and enablers of these. DESIGN Scoping review using the Johanna Briggs Institute guidelines. Ovid MEDLINE, PsycINFO, Embase, CINAHL Plus, Business Source Complete and Scopus databases were searched in October 2020 and again in September 2023 using terms for 'food retail', 'regulation' and 'nutrition'. Regulatory measure type was described by domain and mechanism. Deductive thematic analysis was used to identify reported barriers and enablers to effective regulatory governance processes using a public health law framework. SETTING Food retail. PARTICIPANTS Food retail settings using private regulatory measures to create healthier food retail environments. RESULTS In total, 17 694 articles were screened and thirty-five included for review from six countries, with all articles published since 2011. Articles reporting on twenty-six unique private regulatory measures cited a mix of voluntary (n 16), mandatory (n 6) measures, both (n 2) or did not disclose (n 2). Articles frequently reported on implementation (34/35), with less reporting on the other regulatory governance processes of monitoring (15/35), review (6/35) and enforcement (2/35). CONCLUSIONS We recommend more attention be paid to reporting on the monitoring, review and enforcement processes used in private regulation to promote further progress in improving the healthiness of food retail environments.
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Affiliation(s)
- Jane Dancey
- Department of Nutrition, Dietetics and Food, Monash
University, Clayton, VIC,
Australia
| | - Belinda Reeve
- The University of Sydney Law School, Sydney,
NSW, Australia
| | - Alexandra Jones
- The George Institute for Global Health, University of New
South Wales, UNSW, Sydney, NSW,
Australia
| | - Megan Ferguson
- School of Public Health, The University of
Queensland, Herston, QLD,
Australia
| | - Emma van Burgel
- Department of Nutrition, Dietetics and Food, Monash
University, Clayton, VIC,
Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash
University, Clayton, VIC,
Australia
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3
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Day G, Collins J, Twohig C, De Silva K, Brimblecombe J. Towards healthy food retail: An assessment of public health nutrition workforce capacity to work with stores. Aust N Z J Public Health 2023; 47:100056. [PMID: 37182502 DOI: 10.1016/j.anzjph.2023.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE This article aims to investigate the capacity of nutrition professionals to engage in food retail practice change to improve population diet. METHODS Convergent mixed method design was used that includes pre-interview surveys, in-depth interviews, and retrospective mapping of service provision. The study was conducted in organisations that provide a nutrition professional service to food retail stores in remote Australia. The study participants include 11 nutrition professionals and eight organisation representatives, including managers, organisation directors and policy officers. Systems-mapping and thematic analysis of the in-depth interviews were conducted using a capacity development framework. Descriptive analysis was applied to pre-interview survey and mapping data. RESULTS A gap between the aspirational work and current capacity of nutrition professionals to engage effectively with stores was identified. Engagement with stores to improve population health was valued by organisations. Dominance of the medical health model limited organisation strategic support for store work and created barriers. Key barriers included the limited access to training, decision-support tools, information, financial resources and organisational structures that directed store work. CONCLUSIONS Provision of adequate store-specific training, resources and organisational support may empower the nutrition professional workforce to be powerful leaders in co-design for healthy food retail. IMPLICATIONS FOR PUBLIC HEALTH Building capacity for this critical workforce to engage in food retail practice change must consider the influence of the broader health system and employer organisations and need for access to evidence-based decision-support tools.
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Affiliation(s)
- Georgia Day
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Cliona Twohig
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation (ALPA), 70 O'Sullivan Circuit, East Arm, Northern Territory, 0822, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Victoria, 3168, Australia; Menzies School of Health Research, John Mathews Building (58), Royal Darwin Hospital Campus, 58 Rocklands Dr, Tiwi, NT, 0810, Australia.
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Brimblecombe J, Miles B, Chappell E, De Silva K, Ferguson M, Mah C, Miles E, Gunther A, Wycherley T, Peeters A, Minaker L, McMahon E. Implementation of a food retail intervention to reduce purchase of unhealthy food and beverages in remote Australia: mixed-method evaluation using the consolidated framework for implementation research. Int J Behav Nutr Phys Act 2023; 20:20. [PMID: 36803988 PMCID: PMC9938595 DOI: 10.1186/s12966-022-01377-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/08/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Adoption of health-enabling food retail interventions in food retail will require effective implementation strategies. To inform this, we applied an implementation framework to a novel real-world food retail intervention, the Healthy Stores 2020 strategy, to identify factors salient to intervention implementation from the perspective of the food retailer. METHODS A convergent mixed-method design was used and data were interpreted using the Consolidated Framework for Implementation Research (CFIR). The study was conducted alongside a randomised controlled trial in partnership with the Arnhem Land Progress Aboriginal Corporation (ALPA). Adherence data were collected for the 20 consenting Healthy Stores 2020 study stores (ten intervention /ten control) in 19 communities in remote Northern Australia using photographic material and an adherence checklist. Retailer implementation experience data were collected through interviews with the primary Store Manager for each of the ten intervention stores at baseline, mid- and end-strategy. Deductive thematic analysis of interview data was conducted and informed by the CFIR. Intervention adherence scores derived for each store assisted interview data interpretation. RESULTS Healthy Stores 2020 strategy was, for the most part, adhered to. Analysis of the 30 interviews revealed that implementation climate of the ALPA organisation, its readiness for implementation including a strong sense of social purpose, and the networks and communication between the Store Managers and other parts of ALPA, were CFIR inner and outer domains most frequently referred to as positive to strategy implementation. Store Managers were a 'make-or-break' touchstone of implementation success. The co-designed intervention and strategy characteristics and its perceived cost-benefit, combined with the inner and outer setting factors, galvanised the individual characteristics of Store Managers (e.g., optimism, adaptability and retail competency) to champion implementation. Where there was less perceived cost-benefit, Store Managers seemed less enthusiastic for the strategy. CONCLUSIONS Factors critical to implementation (a strong sense of social purpose; structures and processes within and external to the food retail organisation and their alignment with intervention characteristics (low complexity, cost advantage); and Store Manager characteristics) can inform the design of implementation strategies for the adoption of this health-enabling food retail initiative in the remote setting. This research can help inform a shift in research focus to identify, develop and test implementation strategies for the wide adoption of health-enabling food retail initiatives into practice. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN 12,618,001,588,280.
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Affiliation(s)
- Julie Brimblecombe
- Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia. .,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT, 0810, Australia. .,School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD, 4006, Australia.
| | - Bethany Miles
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia
| | - Emma Chappell
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia ,grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD 4006 Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation, 70 O’Sullivan Cct, East Arm, NT 0828 Australia
| | - Megan Ferguson
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia ,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia ,grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD 4006 Australia
| | - Catherine Mah
- grid.55602.340000 0004 1936 8200Dalhousie University, 5850 College Street, Second Floor, PO Box 15000, Halifax, NS B3H 4R2 Canada ,grid.17063.330000 0001 2157 2938University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Eddie Miles
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
| | - Anthony Gunther
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
| | - Thomas Wycherley
- grid.1026.50000 0000 8994 5086Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, North Terrace, Adelaide, South Australia 5000 Australia
| | - Anna Peeters
- grid.1021.20000 0001 0526 7079Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Leia Minaker
- grid.46078.3d0000 0000 8644 1405School of Planning, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Emma McMahon
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia ,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
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Middel CN, Schuitmaker-Warnaar TJ, Mackenbach JD, Broerse JE. Designing a Healthy Food-Store Intervention; A Co-Creative Process Between Interventionists and Supermarket Actors. Int J Health Policy Manag 2022; 11:2175-2188. [PMID: 34634882 PMCID: PMC9808264 DOI: 10.34172/ijhpm.2021.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/17/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Without consideration for the food system in which healthy food-store interventions (HFIs) are implemented, their effects are likely to be unsustainable. Co-creation of HFIs by interventionists and food-store actors may improve contextual fit and therefore the effectiveness and sustainability of interventions, but there are few case studies on the topic. This study aims to provide insights into the integration of knowledge from contextual actors into HFI designs, through a co-creative process, to illustrate potential challenges, advantages, and outcomes. METHODS We describe the co-creative design of an HFI in a Dutch supermarket chain, conducted through three increasingly in-depth design phases. Each phase consisted of a cycle of theorizing (gather insights from literature, feedback, and pilot studies), building (develop intervention designs), and evaluating (interviews or workshops with supermarket actors, to explore barriers and facilitators for sustainable implementation), feeding back into the next phase (drafting adapted intervention designs, based on feedback, and research input). Interview transcripts underwent a qualitative content analysis. RESULTS We co-creatively designed four types of interventions to promote healthier food choices in supermarkets: (1) price strategies, (2) product presentation and positioning, (3) signage, and (4) interactive messaging. Interventions were aligned with the culture, structures and practices of the supermarket chain, while simultaneously challenging these system characteristics. For example, the idea of price promotions on healthy foods was well-received and encountered only practical barriers, which were easily resolved. However, the specification of tax-like price increases on unhealthy foods led to substantial resistance on cultural and commercial grounds, which were resolved through support from a key supermarket actor. CONCLUSION Our results illustrate the potential benefits of co-creation approaches in HFI design. We reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes.
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Affiliation(s)
- Cédric N.H. Middel
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Joreintje D. Mackenbach
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Upstream Team, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jacqueline E.W. Broerse
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Validation of the Thumbs food classification system as a tool to accurately identify the healthiness of foods. Br J Nutr 2022; 129:2001-2010. [PMID: 36038139 PMCID: PMC10167659 DOI: 10.1017/s0007114522002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess: (1) the Thumbs system’s alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying ‘unhealthy’ (contributing to discretionary energy and added sugars) and ‘healthy’ products against HSR and NTSCG; (3) areas for optimisation. Food and beverage products sold between 05/2018 and 05/2019 in fifty-one remote stores were classified in each system. System alignment was assessed by cross-tabulating percentages of products, discretionary energy and added sugars sold assigned to the same healthiness levels across the systems. The system/s capturing the highest percentage of discretionary energy and added sugars sold in ‘unhealthy’ products and the lowest levels in ‘healthy’ products were considered the best performing. Cohen’s κ was used to assess agreement between the Thumbs system and the NTSCG for classifying products as healthy. The Thumbs system classified product healthiness in line with the HSR and NTSCG, with Cohen’s κ showing moderate agreement between the Thumbs system and the NTSCG (κ = 0·60). The Thumbs system captured the most discretionary energy sold (92·2 %) and added sugar sold (90·6 %) in unhealthy products and the least discretionary energy sold (0 %) in healthy products. Modifications to optimise the Thumbs system include aligning several food categories to the NTSCG criteria and addressing core/discretionary classification discrepancies of fruit juice/drinks. The Thumbs system offers a classification algorithm that could strengthen the HSR system.
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7
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Jaenke R, van den Boogaard C, McMahon E, Brimblecombe J. Development and pilot of a tool to measure the healthiness of the in-store food environment. Public Health Nutr 2021; 24:243-252. [PMID: 32787988 PMCID: PMC7808860 DOI: 10.1017/s1368980020002025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/23/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To rigorously develop a tool which enables rapid yet comprehensive appraisal of the consumer food retail environment and provision of real-time feedback to store managers and owners, based on the '4Ps' principles of marketing. DESIGN Multi-stage iterative approach including (1) Systematic literature review; (2) Stakeholder consultation; (3) Assessment of existing tools against identified needs; (4) Tool development; (5) Pilot testing and (6) Transition of tool to mobile application (the Store Scout app). SETTING Northern Territory, Australia. PARTICIPANTS Nine remote Aboriginal community food stores; public health nutritionists, retailers, store board directors, Aboriginal community members, government representatives. RESULTS Forty-seven existing tools and thirty-four stakeholder interviews informed the development of the current instrument, which comprised: (1) seven product categories (Fruit & Vegetables, Drinks, Snack Foods, Meals & Convenience Foods, Meat & Seafood, Dairy & Eggs, Breads & Cereals) across the '4Ps' (Product, Placement, Price, Promotion); (2) Store manager questions about context and perceived importance of key principles about the store environment and (3) a scoring and feedback component. The tool was considered feasible and acceptable by all testers. CONCLUSIONS The developed tool addresses an unmet need to measure the consumer food retail environment across all 4Ps whilst also incorporating manager perspectives and immediate feedback. Our objectives of developing a comprehensive, feasible and acceptable instrument were achieved during pilot testing. The tool will support implementation of best practice within stores to encourage healthy food choices and has potential for broad application in retail settings locally and internationally, as well as for research purposes.
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Affiliation(s)
- Rachael Jaenke
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Christel van den Boogaard
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Emma McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
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Brimblecombe J, McMahon E, Ferguson M, De Silva K, Peeters A, Miles E, Wycherley T, Minaker L, Greenacre L, Gunther A, Chappell E, Chatfield MD, Mah CL. Effect of restricted retail merchandising of discretionary food and beverages on population diet: a pragmatic randomised controlled trial. Lancet Planet Health 2020; 4:e463-e473. [PMID: 33038320 DOI: 10.1016/s2542-5196(20)30202-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The effectiveness of healthy food promotion on food and beverage sales in real-world food retail settings has been shown in randomised trials. The effectiveness of restrictions on the promotion of unhealthy food is, however, less clear. We aimed to assess the effect of restricted unhealthy food promotion, specifically those items contributing most to free sugar sales, on food and beverage sales. METHODS In this community-level pragmatic, partially randomised, parallel group trial, stores were randomly assigned by a statistician using a single sequence of random assignments to the intervention group, in which a co-designed strategy restricted merchandising of unhealthy food, or to a control group of usual retail practice. The trial was done in partnership with an organisation operating 25 stores in remote Australia. The primary analysis was based on difference in weekly sales with the strategy compared with no strategy in free sugar from all foods and beverages (g/total MJ; primary outcome), targeted food or beverages (weight and free sugars; g/total MJ), and gross profit (AU$) using mixed models. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001588280. FINDINGS Between June 13 and Aug 15, 2018, 20 stores were recruited; ten stores were randomly assigned to the intervention group and ten stores to the control group. The trial was done between Sept 2 and Dec 2, 2018. The Healthy Stores 2020 strategy resulted in a reduction in sales of free sugar of 2·8% (95% CI -4·9 to -0·7). Targeted beverages were reduced by 8·4% (-12·3 to -4·3) and associated free sugar by 6·8% (-10·9 to -2·6), sugar-sweetened soft drinks by 13·2% (-18·5 to -7·6), and associated free sugar by 13·4% (-18·7 to -7·7). Reductions in sales of free sugar from confectionery of 7·5% (-14·3 to -0·2) and in weight sold (-4·6%, -11·1 to 2·3) resulted; however, the reduction in weight was not statistically significant. No differences in sales of table sugar and sweet biscuits were observed. Gross profit was not impacted adversely; a small increase resulted (5·3%, 0·3 to 10·5). INTERPRETATION Restricted merchandising of unhealthy foods and beverages, while allowing for complementary merchandising of healthier foods and beverages in a real-world store setting and co-designed with retailers, can achieve both public health and business relevant gains. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia; Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia.
| | - Emma McMahon
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Edward Miles
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Thomas Wycherley
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, SA, Australia
| | - Leia Minaker
- School of Planning, University of Waterloo, Waterloo, ON, Canada
| | - Luke Greenacre
- Business School, Monash University, Melbourne, VIC, Australia
| | - Anthony Gunther
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia
| | - Emma Chappell
- Arnhem Land Progress Aboriginal Corporation, Darwin, NT, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Catherine L Mah
- Faculty of Health, Dalhousie University, Halifax, NS, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Browne J, Lock M, Walker T, Egan M, Backholer K. Effects of food policy actions on Indigenous Peoples' nutrition-related outcomes: a systematic review. BMJ Glob Health 2020; 5:e002442. [PMID: 32816952 PMCID: PMC7437701 DOI: 10.1136/bmjgh-2020-002442] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Indigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap. METHODS Eight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework. RESULTS We identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples' diets, health or well-being. CONCLUSION Both targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.
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Affiliation(s)
- Jennifer Browne
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mark Lock
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Troy Walker
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
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McMahon EJ, Jaenke R, Brimblecombe J. A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study. JMIR Mhealth Uhealth 2020; 8:e16971. [PMID: 32706683 PMCID: PMC7407248 DOI: 10.2196/16971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/20/2020] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. OBJECTIVE This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. METHODS The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. RESULTS The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8%) or good (n=81/196, 41.3%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). CONCLUSIONS These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments.
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Affiliation(s)
- Emma Joy McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Rachael Jaenke
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Mah CL, Luongo G, Hasdell R, Taylor NGA, Lo BK. A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies. Curr Nutr Rep 2019; 8:411-428. [PMID: 31797233 PMCID: PMC6904419 DOI: 10.1007/s13668-019-00295-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks. RECENT FINDINGS Of 86 articles (1974-2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the "4Ps" of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.
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Affiliation(s)
- Catherine L. Mah
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, PO Box 15000, Halifax, NS B3H 4R2 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON M5T 3M7 Canada
| | - Gabriella Luongo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON M5T 3M7 Canada
| | - Rebecca Hasdell
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Nathan G. A. Taylor
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, PO Box 15000, Halifax, NS B3H 4R2 Canada
| | - Brian K. Lo
- Division of Nutritional Sciences, Cornell University, 417 Savage Hall, Ithaca, NY 14850 USA
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