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Hua S, Tucker AC, Santos SR, Thomas AE, Mui Y, Velez-Burgess V, Poirier L, Cheskin LJ, Matsuzaki M, Williamson S, Colon-Ramos U, Gittelsohn J. The Quality of Menu Offerings in Independently Owned Restaurants in Baltimore, Maryland: Results from Mixed-Methods Formative Research for the FRESH Trial. Nutrients 2024; 16:1524. [PMID: 38794762 PMCID: PMC11123881 DOI: 10.3390/nu16101524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: Independently owned restaurants (IORs) are prevalent in under-resourced racial and ethnic minority communities in the US and present a unique setting for public health nutrition interventions. (2) Methods: We conducted 14 in-depth interviews with IOR owners in Baltimore about their perceptions of healthy food, and customers' acceptance of healthier menus and cooking methods and concurrent observations of the availability of healthy options on their menus. Qualitative data were coded and analyzed using ATLAS.ti. Observations were analyzed with statistical analysis performed in R. (3) Results: Owners perceived non-fried options, lean proteins, and plant-based meals as healthy. While open to using healthier cooking fats, they had mixed feelings about reducing salt, adopting non-frying methods for cooking, and adding vegetables and whole grains to the menu, and were reluctant to reduce sugar in recipes and beverages. Only 17.5% of 1019 foods and 27.6% of 174 beverages in these IORs were healthy, with no significant differences in the healthfulness of restaurant offerings within low-healthy-food-access/low-income neighborhoods and those outside. (4) Conclusion: Healthy options are generally scarce in Baltimore's IORs. Insights from owners inform future interventions to tailor healthy menu offerings that are well-received by customers and feasible for implementation.
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Affiliation(s)
- Shuxian Hua
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Anna Claire Tucker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Sydney R. Santos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Audrey E. Thomas
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Yeeli Mui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Veronica Velez-Burgess
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Lisa Poirier
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Lawrence J. Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA 22030, USA;
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Mika Matsuzaki
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Stacey Williamson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
| | - Uriyoan Colon-Ramos
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA;
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA; (A.C.T.); (S.R.S.); (Y.M.); (V.V.-B.); (L.P.); (M.M.); (S.W.); (J.G.)
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García Bulle Bueno B, Horn AL, Bell BM, Bahrami M, Bozkaya B, Pentland A, de la Haye K, Moro E. Effect of mobile food environments on fast food visits. Nat Commun 2024; 15:2291. [PMID: 38480685 PMCID: PMC10937966 DOI: 10.1038/s41467-024-46425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/26/2024] [Indexed: 03/17/2024] Open
Abstract
Poor diets are a leading cause of morbidity and mortality. Exposure to low-quality food environments saturated with fast food outlets is hypothesized to negatively impact diet. However, food environment research has predominantly focused on static food environments around home neighborhoods and generated mixed findings. In this work, we leverage population-scale mobility data in the U.S. to examine 62M people's visits to food outlets and evaluate how food choice is influenced by the food environments people are exposed to as they move through their daily routines. We find that a 10% increase in exposure to fast food outlets in mobile environments increases individuals' odds of visitation by 20%. Using our results, we simulate multiple policy strategies for intervening on food environments to reduce fast-food outlet visits. This analysis suggests that optimal interventions are informed by spatial, temporal, and behavioral features and could have 2x to 4x larger effect than traditional interventions focused on home food environments.
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Affiliation(s)
| | - Abigail L Horn
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 90089, USA
- Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, 90292, USA
| | - Brooke M Bell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, 06510, USA
| | - Mohsen Bahrami
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Burçin Bozkaya
- Sabanci Business School, Sabanci University, 34956, Tuzla, Istanbul, Turkey
| | - Alex Pentland
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kayla de la Haye
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, 90089, USA
| | - Esteban Moro
- Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
- Grupo Interdisciplinar de Sistemas Complejos (GISC), Department of Mathematics and GISC, Universidad Carlos III de Madrid, 28911, Leganés, Spain.
- Network Science Institute, Northeastern University, Boston, MA, 02115, USA.
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Pepper T, Hart KH, Hodgkins CE. Tackling (Childhood) Obesity through a Voluntary Food Reformulation Policy: A Repeated Cross-Sectional Study Investigating Nutritional Changes in the Out-of-Home Sector. Nutrients 2023; 15:3149. [PMID: 37513567 PMCID: PMC10384819 DOI: 10.3390/nu15143149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The Childhood Obesity Plan aimed to reduce sugar and energy in foods through a voluntary sugar-reduction programme. Our primary objective was to determine whether this implementation strategy had been successful, focusing on the out-of-home sector. We used a repeated cross-sectional design to evaluate nutritional changes in desserts served by leading chain restaurants. We extracted nutrition information from online menus in autumn/winter 2020, for comparison with baseline (2017) and interim (2018) values extracted from third-party datasets. We assessed compliance with the 20% sugar-reduction target and category-specific energy targets by product category and for pooled desserts. Overall, sugar/portion and energy/portion decreased by 11% and 4%, respectively. Policy targets were achieved in one of five categories (ice-cream: -38% sugar, p < 0.001; -30% energy, p < 0.001). Secondary outcomes were analysed for subgroups with the necessary data. Few chains significantly reduced sugar and/or energy across their dessert range. Energy/portion was positively associated with portion weight and sugar/portion but not with sugar/100 g. More than half of adults' desserts contained excessive sugar and/or saturated fat compared with dietary guidelines. Children's desserts less frequently exceeded guidelines. These results demonstrate that voluntary measures can drive substantial change when technical, commercial, and operational barriers can be overcome.
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Affiliation(s)
- Tammy Pepper
- Department of Nutritional Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Kathryn H Hart
- Department of Nutritional Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Charo E Hodgkins
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford GU2 7XH, UK
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Fuster M, Dimond E, Handley MA, Rose D, Stoecker C, Knapp M, Elbel B, Conaboy C, Huang TTK. Evaluating the outcomes and implementation determinants of interventions co-developed using human-centered design to promote healthy eating in restaurants: an application of the consolidated framework for implementation research. Front Public Health 2023; 11:1150790. [PMID: 37275479 PMCID: PMC10233011 DOI: 10.3389/fpubh.2023.1150790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Background Restaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fidelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research. Methods This study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staff (n = 19) and customers (n = 31)], social media monitoring, and post-implementation key informant interviews with owners and staff. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR. Results The HCD-tailored interventions had different outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no significant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staff, but fidelity and sustainability differed by restaurant (high in R1, low in R2). Barriers and facilitators for implementation were found across all CFIR constructs, varying by restaurant and intervention. Most relevant constructs were found in the inner setting (restaurant structure, implementation climate), individual characteristics, and process (HCD application). The influence of outer setting constructs (policy, peer pressure) was limited due to lack of awareness. Conclusion Our findings provide insights for interventions developed in challenging and constantly changing settings, as in the case of restaurants. This research expands the application of CFIR to complex and dynamic community-based settings and interventions developed using HCD. This is a significant innovation for the field of public health nutrition and informs future interventions in similarly dynamic and understudied settings.
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Affiliation(s)
- Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Emily Dimond
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Margaret A. Handley
- Partnership for Research in Implementation Science for Equity (PRIDE) Center and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, United States
| | - Donald Rose
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Charles Stoecker
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
- Department of Health Policy and Management, New Orleans, LA, United States
| | - Megan Knapp
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, United States
| | - Brian Elbel
- Department of Medicine, New York University Grossman School of Medicine,New York, NY, United States
- Wagner Graduate School of Public Service, New York University,New York, NY, United States
| | - Cara Conaboy
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Terry T. K. Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, City University of New York Graduate School of Public Health and Health Policy, New York, NY, United States
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Du W, Zhang P, Zhang J, Li Y, He FJ, Zhang X, Su C, Jia X, Li L, Song J, Zhang B, Wang H. Sodium Reduction in Restaurant Food: A Randomized Controlled Trial in China. Nutrients 2022; 14:nu14245313. [PMID: 36558472 PMCID: PMC9781955 DOI: 10.3390/nu14245313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Restaurant food is one of the important sources of sodium intake in China. We aimed to determine whether a restaurant-based comprehensive intervention program may induce lower sodium content in restaurant food. A randomized controlled trial was implemented between 2019 and 2020 in 192 restaurants in China. After baseline assessment, the restaurants were randomly assigned to either an intervention or a control group (1:1). Comprehensive activities designed for intervention restaurants were conducted for one year. The primary outcome was the difference in change of sodium content estimated by the mean values of five best-selling dishes for each restaurant, from baseline to the end of the trial between groups. In total, 66 control restaurants and 80 intervention restaurants completed the follow-up assessment. The average sodium content of dishes at baseline was 540.9 ± 176.8 mg/100 g in control and 551.9 ± 149.0 mg/100 g in intervention restaurants. The mean effect of intervention after adjusting for confounding factors was -43.63 mg/100 g (95% CI: from -92.94 to 5.66, p = 0.08), representing an 8% reduction in sodium content. The restaurant-based intervention led to a modest but not significant reduction in the sodium content of restaurant food. There is great urgency for implementing effective and sustainable salt reduction programs, due to the rapid increase in the consumption of restaurant food in China.
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Affiliation(s)
- Wenwen Du
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Puhong Zhang
- George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China
- Faculty of Medicine, University of New South Wales, Sydney, NSW 1466, Australia
| | - Jiguo Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Yuan Li
- George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China
- Faculty of Medicine, University of New South Wales, Sydney, NSW 1466, Australia
| | - Feng J. He
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Xiaofan Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Xiaofang Jia
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Li Li
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Jing Song
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 4NS, UK
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
- Key Laboratory of Trace Element Nutrition, National Health Commission, Beijing 100050, China
- Correspondence: ; Tel.: +86-10-66237089
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Frank T, Rodriguez Pouget E, Fuster M. Food Environments in Times of Crises: Examining Menu Changes in Response to COVID-19 Among Hispanic Caribbean Restaurants in New York City. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2118563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Tara Frank
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, NY, USA
| | - Enrique Rodriguez Pouget
- Department of Health and Nutrition Sciences, Brooklyn College, City University of New York, Brooklyn, NY, USA
| | - Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Fuster M, Kodali H, Ray K, Elbel B, Handley MA, Huang TTK, Johnson G. Area Characteristics and Consumer Nutrition Environments in Restaurants: an Examination of Hispanic Caribbean Restaurants in New York City. J Racial Ethn Health Disparities 2022; 9:1454-1463. [PMID: 34152587 PMCID: PMC8216094 DOI: 10.1007/s40615-021-01083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/29/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
Hispanics in the USA, particularly those of Caribbean descent, experience high levels of diet-related diseases and dietary risk factors. Restaurants are an increasingly important yet understudied source of food and may present opportunities to positively influence urban food environments. We sought to explore food environments further, by examining the association between neighborhood characteristics and restaurant consumer nutrition environments within New York City's Hispanic Caribbean (HC) restaurant environments. We applied an adapted version of the Nutrition Environment Measurements Survey for Restaurants (NEMS-R) to evaluate a random sample of HC restaurants (n=89). NEMS-HCR scores (continuous and categorized as low, medium, and high based on data distribution) were examined against area sociodemographic characteristics using bivariate and logistic regression analysis. HC restaurants located in Hispanic geographic enclaves had a higher proportion of fried menu items (p<0.01) but presented fewer environmental barriers to healthy eating, compared with those in areas with lower Hispanic concentrations. No significant differences in NEMS-R scores were found by other neighborhood characteristics. Size was the only significant factor predicting high NEMS-HCR scores, where small restaurants were less likely to have scores in the high category (NEMS-HCR score>6), compared with their medium (aOR: 6.6, 95% CI: 1.8-24.6) and large counterparts (aOR: 5.6, 95% CI: 1.5-21.4). This research is the first to examine the association between restaurant location and consumer nutrition environments, providing information to contribute to future interventions and policies seeking to improve urban food environments in communities disproportionately affected by diet-related conditions, as in the case of HC communities in New York City.
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Affiliation(s)
- Melissa Fuster
- Department of Health and Nutrition Science, Brooklyn College, City University of New York, Brooklyn, NY, USA.
| | - Hanish Kodali
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Krishnendu Ray
- Department of Nutrition and Food Studies, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Brian Elbel
- Department of Population Health, Grossman School of Medicine, and Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Terry T-K Huang
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, City University of New York, New York, NY, USA
| | - Glen Johnson
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
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8
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Fuster M, Abreu-Runkle R, Handley MA, Rose D, Rodriguez MA, Dimond EG, Elbel B, Huang TTK. Promoting healthy eating in Latin American restaurants: a qualitative survey of views held by owners and staff. BMC Public Health 2022; 22:843. [PMID: 35477376 PMCID: PMC9043880 DOI: 10.1186/s12889-022-13294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Restaurants, particularly independently-owned ones that serve immigrant communities, are important community institutions in the promotion of dietary health. Yet, these restaurants remain under-researched, preventing meaningful collaborations with the public health sector for healthier community food environments. This research aimed to examine levels of acceptability of healthy eating promotion strategies (HEPS) in independently-owned Latin American restaurants (LARs) and identify resource needs for implementing HEPS in LARs. Methods We completed semi-structured, online discussions with LAR owners and staff (n = 20), predominantly from New York City (NYC), to examine current engagement, acceptability, potential barriers, and resource needs for the implementation of HEPS. Verbatim transcripts were analyzed independently by two coders using Dedoose, applying sentiment weighting to denote levels of acceptability for identified HEPS (1 = low, 2 = medium/neutral, 3 = high). Content analysis was used to examine factors associated with HEPS levels of acceptability and resource needs, including the influence of the Coronavirus pandemic (COVID-19). Results The most acceptable HEPS was menu highlights of healthier items (mean rating = 2.8), followed by promotion of healthier items (mean rating = 2.7), increasing healthy offerings (mean rating = 2.6), nutrition information on the menu (mean rating = 2.3), and reduced portions (mean rating = 1.7). Acceptability was associated with factors related to perceived demand, revenue, and logistical constraints. COVID-19 had a mixed influence on HEPS engagement and acceptability. Identified resource needs to engage in HEPS included nutrition knowledge, additional expertise (e.g., design, social media, culinary skills), and assistance with food suppliers and other restaurant operational logistics. Respondents also identified potential policy incentives. Conclusions LARs can positively influence eating behaviors but doing so requires balancing public health goals and business profitability. LARs also faced various constraints that require different levels of assistance and resources, underscoring the need for innovative engagement approaches, including incentives, to promote these changes.
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Affiliation(s)
- Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Rosa Abreu-Runkle
- Department of Hospitality Management, School of Professional Studies, New York City College of Technology, City University of New York, New York, NY, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
| | - Donald Rose
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Michelle A Rodriguez
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Emily G Dimond
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.,Wagner Graduate School of Public Service, New York University, New York, NY, USA
| | - Terry T K Huang
- Department of Community Health and Social Sciences and Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
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Mandracchia F, Llauradó E, Valls RM, Tarro L, Solà R. Evaluating Mediterranean Diet-Adherent, Healthy and Allergen-Free Meals Offered in Tarragona Province Restaurants (Catalonia, Spain): A Cross-Sectional Study. Nutrients 2021; 13:nu13072464. [PMID: 34371970 PMCID: PMC8308532 DOI: 10.3390/nu13072464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Abstract
Restaurant meal consumption has increased substantially, but the ability of restaurants to adhere to guidelines for the Mediterranean diet, healthiness and food allergen management is a challenge. This cross-sectional study aims to assess the Mediterranean diet adherence, healthiness, nutritional quality and food allergen management of meals at restaurants in the Tarragona province (Catalonia, Spain). Primary outcomes included adherence to criteria for the Mediterranean diet (AMed) and gluten management (SMAP), nutritional quality of dishes indicated by a green traffic light rating, meal nutrient content and allergen-free options. Secondary outcomes included restaurant staff knowledge about the Mediterranean diet and food allergens. Forty-four restaurants and 297 dishes were analysed. The restaurants fulfilled an average (mean ± SD) of 5.1 ± 1.6 of 9 compulsory AMed criteria and 12.9 ± 2.8 of 18 SMAP criteria. Dishes were mainly rated green for sugar (n = 178/297; 59.9%) but not for energy (n = 23/297; 7.7%) or total fat (n = 18/297; 6.1%). Waiters and cooks received passing scores for food allergen knowledge (5.8 ± 1.7 and 5.5 ± 1.5 out of 10 points, respectively). Restaurants partially met the AMed and SMAP criteria. Increasing fibre and decreasing saturated fat content are necessary to improve consumers’ adherence to healthy diets. For restaurant staff, training courses should be considered to improve their food allergen management.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Rosa Maria Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Correspondence: ; Tel.: +34-977-758-920
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, 43201 Reus, Spain; (F.M.); (E.L.); (R.M.V.); (R.S.)
- Institut d’Investigació Sanitària Pere Virgili (IISPV), 43204 Reus, Spain
- Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
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