Comparison of Geographic Information System and Subjective Assessments of Momentary Food Environments as Predictors of Food Intake: An Ecological Momentary Assessment Study

Why we don't eat as intended: Moderators of the short-term intention-behaviour relation in food intake

OBJECTIVES

A healthy diet is essential for preventing chronic disease and promoting overall health. Translating one's intention to eat healthy into actual behaviour has, however, proven difficult with a range of internal and contextual factors identified as driving eating behaviour.

DESIGN

We leverage Temporal Self-Regulation Theory to examine these momentary determinants' direct and moderating effects on the intention-behaviour relation with Ecological Momentary Assessment (EMA).

METHODS

Eighty-seven healthy participants (mage = 24.1 years; 59 women, 28 men) reported, 5 times daily for 10 weekdays, their intentions to stick to a self-set dietary restriction goal for the next 3 hr, the goal congruency of their eating behaviour in the past 3 hr, and a range of factors potentially influencing food intake, such as stress, emotions and environmental eating cues.

RESULTS

Two-part multilevel modelling revealed that craving, availability of goal-incongruent foods, social eating cues, giving in to other temptations and weaker momentary intentions directly increased the risk and severity of goal-incongruent intake within the next 3 hr. Social cues, stress and craving further influence behaviour through altering intention implementation.

CONCLUSIONS

Results imply that people regularly fail to implement intentions for 3-hr periods and that a range of factors influences this, both directly and by disrupting intentional processes. While for some barriers, fostering strong intentions throughout the day could be beneficial, others require different strategies for dietary adherence.

University Food Environment Assessment Methods and Their Implications: Protocol for a Systematic Review

BACKGROUND

While the retail food environment has been well studied, research surrounding the university food environment is still emerging. Existing research suggests that university food environments can influence behavioral outcomes such as students' dietary choices, which may be maintained long-term. Despite a growing interest in assessing university food environments, there is no standardized tool for completing this task. How researchers define "healthy" when assessing university food environments needs to be clarified. This paper describes the protocol for systematically reviewing literature involving university food environment assessments.

OBJECTIVE

This paper aimed to describe the protocol for a systematic review of the assessments of university food environments. The review will summarize previously used tools or methods and their implications.

METHODS

Electronic databases, including PubMed (NLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycINFO (EBSCO), CINAHL (Cumulative Index to Nursing & Allied Health) Complete (EBSCO), ProQuest Nursing and Allied Health, and Google Scholar were searched for papers published between 2012 and 2022 using combinations of related medical subject headings terms and keywords. The electronic databases were supplemented by reviewing the reference list for all included papers and systematic reviews returned with our search results. The review will include all study types, including randomized controlled trials, observational studies, and other pre-post designs. Papers that examine at least 1 aspect of the university food environment, such as cafeterias, campus convenience stores, and vending machines, were considered for inclusion. A total of 2 reviewers will independently screen titles and abstracts, complete a full-text review, extract data, and perform a quality assessment of included papers, with a third reviewer resolving any conflicts. The Quality Assessment for Diverse Studies (QuADS) tool was used to determine the methodological quality of selected studies. A narrative and tabular summary of the findings were presented. There will not be a meta-analysis due to the methodological heterogeneity of the included papers.

RESULTS

The initial queries of 4502 records have been executed, and papers have been screened for inclusion. Data extractions were completed in December 2023. The results of the review were accepted for publication in May 2024. The systematic review generated from this protocol will offer evidence for using different assessment tools to examine the campus food environment.

CONCLUSIONS

This systematic review will summarize the tools and methods used to assess university food environments where many emerging adults spend a significant part of their young adult lives. The findings will highlight variations in practice and how "healthy" has been defined globally. This review will provide an understanding of this unique organizational food environment with implications for practice and policy.

TRIAL REGISTRATION

PROSPERO CRD42023398073; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=398073.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54955.

The integration of geographic methods and ecological momentary assessment in public health research: A systematic review of methods and applications

With the widespread prevalence of mobile devices, ecological momentary assessment (EMA) can be combined with geospatial data acquired through geographic techniques like global positioning system (GPS) and geographic information system. This technique enables the consideration of individuals' health and behavior outcomes of momentary exposures in spatial contexts, mostly referred to as "geographic ecological momentary assessment" or "geographically explicit EMA" (GEMA). However, the definition, scope, methods, and applications of GEMA remain unclear and unconsolidated. To fill this research gap, we conducted a systematic review to synthesize the methodological insights, identify common research interests and applications, and furnish recommendations for future GEMA studies. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to systematically search peer-reviewed studies from six electronic databases in 2022. Screening and eligibility were conducted following inclusion criteria. The risk of bias assessment was performed, and narrative synthesis was presented for all studies. From the initial search of 957 publications, we identified 47 articles included in the review. In public health, GEMA was utilized to measure various outcomes, such as psychological health, physical and physiological health, substance use, social behavior, and physical activity. GEMA serves multiple research purposes: 1) enabling location-based EMA sampling, 2) quantifying participants' mobility patterns, 3) deriving exposure variables, 4) describing spatial patterns of outcome variables, and 5) performing data linkage or triangulation. GEMA has advanced traditional EMA sampling strategies and enabled location-based sampling by detecting location changes and specified geofences. Furthermore, advances in mobile technology have prompted considerations of additional sensor-based data in GEMA. Our results highlight the efficacy and feasibility of GEMA in public health research. Finally, we discuss sampling strategy, data privacy and confidentiality, measurement validity, mobile applications and technologies, and GPS accuracy and missing data in the context of current and future public health research that uses GEMA.

STROBE-GEMA: a STROBE extension for reporting of geographically explicit ecological momentary assessment studies

CONTEXT

While a growing body of research has been demonstrating how exposure to social and built environments relate to various health outcomes, specific pathways generally remain poorly understood. But recent technological advancements have enabled new study designs through continuous monitoring using mobile sensors and repeated questionnaires. Such geographically explicit momentary assessments (GEMA) make it possible to link momentary subjective states, behaviors, and physiological parameters to momentary environmental conditions, and can help uncover the pathways linking place to health. Despite its potential, there is currently no review of GEMA studies detailing how location data is used to measure environmental exposure, and how this in turn is linked to momentary outcomes of interest. Moreover, a lack of standard reporting of such studies hampers comparability and reproducibility.

AIMS

The objectives of this research were twofold: 1) conduct a systematic review of GEMA studies that link momentary measurement with environmental data obtained from geolocation data, and 2) develop a STROBE extension guideline for GEMA studies.

METHOD

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria consisted of a combination of repeated momentary measurements of a health state or behavior with GPS coordinate collection, and use of these location data to derive momentary environmental exposures. To develop the guideline, the variables extracted for the systematic review were compared to elements of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and CREMAS (CRedibility of Evidence from Multiple Analyses of the Same data) checklists, to provide a new guideline for GEMA studies. An international panel of experts participated in a consultation procedure to collectively develop the proposed checklist items. RESULTS AND DEVELOPED TOOLS: A total of 20 original GEMA studies were included in the review. Overall, several key pieces of information regarding the GEMA methods were either missing or reported heterogeneously. Our guideline provides a total of 27 categories (plus 4 subcategories), combining a total of 70 items. The 22 categories and 32 items from the original STROBE guideline have been integrated in our GEMA guideline. Eight categories and 6 items from the CREMAS guideline have been included to our guideline. We created one new category (namely "Consent") and added 32 new items specific to GEMA studies.

CONCLUSIONS AND RECOMMENDATIONS

This study offers a systematic review and a STROBE extension guideline for the reporting of GEMA studies. The latter will serve to standardize the reporting of GEMA studies, as well as facilitate the interpretation of results and their generalizability. In short, this work will help researchers and public health professionals to make the most of this method to advance our understanding of how environments influence health.

GIS-Based Assessments of Neighborhood Food Environments and Chronic Conditions: An Overview of Methodologies

The industrial revolution and urbanization fundamentally restructured populations' living circumstances, often with poor impacts on health. As an example, unhealthy food establishments may concentrate in some neighborhoods and, mediated by social and commercial drivers, increase local health risks. To understand the connections between neighborhood food environments and public health, researchers often use geographic information systems (GIS) and spatial statistics to analyze place-based evidence, but such tools require careful application and interpretation. In this article, we summarize the factors shaping neighborhood health in relation to local food environments and outline the use of GIS methodologies to assess associations between the two. We provide an overview of available data sources, analytical approaches, and their strengths and weaknesses. We postulate next steps in GIS integration with forecasting, prediction, and simulation measures to frame implications for local health policies.

Socio-Spatial Segregation of Unhealthy Food Environments across Public Schools in Santiago, Chile

Santiago, Chile is a very segregated city, with higher childhood obesity rates observed in vulnerable areas. We compared the counts and proximity of unhealthy food outlets (UFOs) around a 400 m buffer of 443 public schools (municipal and subsidized) located in socioeconomically diverse neighborhoods in 14 municipalities of Santiago. This was a cross-sectional study in which the socioeconomic status (SES) of the population living inside the buffer was classified as middle-high, middle, and low. We used the Kruskal-Wallis test for comparisons of density and proximity between type of school, SES, and population density. We used a negative binomial model (unadjusted and adjusted by population density) to determine the expected change in counts of UFOs by SES, which was compared to the reference (middle-high). Low SES neighborhoods had significantly more counts of UFOs, and these were located much closer to schools. Low and middle SES neighborhoods had an 88% and 48% higher relative risk of having UFOs compared to middle-high SES areas; (IRR = 1.88; 95% CI 1.59-2.23) and (IRR = 1.48; 95% CI 1.20-1.82), respectively. A socio-spatial segregation of UFOs associated with childhood obesity across public schools was observed in Santiago.

Unpacking Habit With Bayesian Mixed Models: Dynamic Approach to Health Behaviors With Interchangeable Elements, Illustrated Through Multiple Sun Protection Behaviors

Analytics for behavioral habit typically model one behavior at a time, despite the fact that habit often involves multiple cooccurring behaviors, such as food choices and physical activities, where interrelated behaviors are often equally recommended. We propose a novel Mixed-Effects Dynamic hAbit model (MEDA) to simultaneously model multiple related, habitual behaviors. As an illustrative example, MEDA was applied to real-time assessments of sun protection (sunscreen, shade, hat, and protective clothing) reported twice daily by first-degree relatives of melanoma patients who are themselves at an elevated risk of skin cancer. MEDA aims to explicate habits in sun protection under varying environmental cues (e.g., sunny and hot weather). We found consistent between-group differences (e.g., men responding to weather cues more consistently than women) and interactions between cooccurring behaviors (e.g., being in shade discourages sunscreen wearing, more so in men than women). Moreover, MEDA transcends conventional methods to address longstanding challenges-how cue to action and volitional choices differ by groups or even by individual persons. Such nuances in interrelated habitual behaviors are relevant in numerous other applications, such as recommended dietary or physical activity behaviors. These methods best inform personalized behavioral interventions targeting individual preferences for precision behavioral intervention.

Characteristics of smartphone-based dietary assessment tools: a systematic review

Smartphones have become popular in assessing eating behaviour in real-life and real-time. This systematic review provides a comprehensive overview of smartphone-based dietary assessment tools, focusing on how dietary data is assessed and its completeness ensured. Seven databases from behavioural, social and computer science were searched in March 2020. All observational, experimental or intervention studies and study protocols using a smartphone-based assessment tool for dietary intake were included if they reported data collected by adults and were published in English. Out of 21,722 records initially screened, 117 publications using 129 tools were included. Five core assessment features were identified: photo-based assessment (48.8% of tools), assessed serving/ portion sizes (48.8%), free-text descriptions of food intake (42.6%), food databases (30.2%), and classification systems (27.9%). On average, a tool used two features. The majority of studies did not implement any features to improve completeness of the records. This review provides a comprehensive overview and framework of smartphone-based dietary assessment tools to help researchers identify suitable assessment tools for their studies. Future research needs to address the potential impact of specific dietary assessment methods on data quality and participants' willingness to record their behaviour to ultimately improve the quality of smartphone-based dietary assessment for health research.

Ecological Momentary Assessment: A Systematic Review of Validity Research

Ecological momentary assessment (EMA) is a self-report method that involves intensive longitudinal assessment of behavior and environmental conditions during everyday activities. EMA has been used extensively in health and clinical psychology to investigate a variety of health behaviors, including substance use, eating, medication adherence, sleep, and physical activity. However, it has not been widely implemented in behavior analytic research. This is likely an example of the empirically based skepticism with which behavioral scientists view self-report measures. We reviewed studies comparing electronic, mobile EMA (mEMA) to more objective measures of health behavior to explore the validity of mEMA as a measurement tool, and to identify procedures and factors that may promote the accuracy of mEMA. We identified 32 studies that compared mEMA to more objective measures of health behavior or environmental events (e.g., biochemical measures or automated devices such as accelerometers). Results showed that the correspondence rates varied considerably across individuals, behavior, and studies (agreement rates ranged from 1.8%-100%), and no unifying variables could be identified across the studies that found high correspondence. The findings suggest that mEMA can be an accurate measurement tool, but further research should be conducted to identify procedures and variables that promote accurate responding.

Comfort eating: An observational study of affect in the hours immediately before, and after, snacking

OBJECTIVE

'Comfort eating' has been used to explain real-world food choices, suggesting that individuals are drawn to energy-dense ('unhealthy') snacks when experiencing negative affect. However, this concept has rarely been studied, particularly in real-world settings. Similarly, the effects of snacking on subsequent affect are also poorly understood. The present study aimed to examine the association between affect and snacking in daily life.

METHODS

One hundred and forty-one adults recorded their food intake in real time for ~14 days using a study issued mobile phone. Participants also responded to randomly timed assessments. During both types of assessments, participants indicated their current level of affect. By anchoring off snacking events, the trajectory of affect in the hours leading up to - and following - snacking was explored.

RESULTS

In the three hours leading up to a healthy snack, affect was stable. In contrast, affect fell during the hours leading up to an unhealthy snack. The interaction between snack type and time was significant. A similar, but opposite, pattern was seen following snacking: where affect decreased after unhealthy snacking, affect increased following healthy snack intake.

CONCLUSION

The findings are consistent with the hypothesis of comfort eating, with unhealthy snacking being preceded by worsening affect. Unhealthy snacking did not, however, lead to affect improvements afterwards, which questions the 'effectiveness' of comfort eating. The intake of healthy snacks however was associated with positive affective experiences. These findings could function as a component of interventions aiming at improving dietary behaviours.