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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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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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3
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Sundermeir SM, Trujillo A, Mathew D, Harper K, Gunen B, Poirier L, Gittelsohn J. The Impact of a Pricing Manipulation Intervention on Food Sales in a Small Community Grocery Store in Baltimore City. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2039828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Samantha M. Sundermeir
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonio Trujillo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Mathew
- Department of Economics and Department of International Studies, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kaitlyn Harper
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bengucan Gunen
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Maryland, USA
| | - Lisa Poirier
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zhu S, Mitsinikos C, Poirier L, Igusa T, Gittelsohn J. Development of a System Dynamics Model to Guide Retail Food Store Policies in Baltimore City. Nutrients 2021; 13:nu13093055. [PMID: 34578934 PMCID: PMC8465929 DOI: 10.3390/nu13093055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 12/29/2022] Open
Abstract
Policy interventions to improve food access and address the obesity epidemic among disadvantaged populations are becoming more common throughout the United States. In Baltimore MD, corner stores are a frequently used source of food for low-income populations, but these stores often do not provide a range of affordable healthy foods. This research study aimed to assist city policy makers as they considered implementing a Staple Food Ordinance (SFO) that would require small stores to provide a range and depth of stock of healthy foods. A System Dynamics (SD) model was built to simulate the complex Baltimore food environment and produce optimal values for key decision variables in SFO planning. A web-based application was created for users to access this model to optimize future SFOs, and to test out different options. Four versions of potential SFOs were simulated using this application and the advantages and drawbacks of each SFO are discussed based on the simulation results. These simulations show that a well-designed SFO has the potential to reduce staple food costs, increase corner store profits, reduce food waste, and expand the market for heathy staple foods.
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Affiliation(s)
- Siyao Zhu
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA; (C.M.); (T.I.)
- Correspondence: ; Tel.: +1-517-775-9441
| | - Cassandra Mitsinikos
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA; (C.M.); (T.I.)
| | - Lisa Poirier
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (L.P.); (J.G.)
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Takeru Igusa
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA; (C.M.); (T.I.)
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (L.P.); (J.G.)
| | - Joel Gittelsohn
- Global Obesity Prevention Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA; (L.P.); (J.G.)
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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5
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The effects of nudges on purchases, food choice, and energy intake or content of purchases in real-life food purchasing environments: a systematic review and evidence synthesis. Nutr J 2020; 19:103. [PMID: 32943071 PMCID: PMC7500553 DOI: 10.1186/s12937-020-00623-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/08/2020] [Indexed: 01/24/2023] Open
Abstract
Background Adults with a low socioeconomic position (SEP) are more likely to engage in unhealthy diets as compared to adults with high SEP. However, individual-level educational interventions aiming to improve food choices have shown limited effectiveness in adults with low SEP. Environmental-level interventions such as nudging strategies however, may be more likely to benefit low SEP groups. We aimed to review the evidence for the effectiveness of nudges as classified according to interventions in proximal physical micro-environments typology (TIPPME) to promote healthy purchases, food choice, or affecting energy intake or content of purchases, within real-life food purchasing environments. Second, we aimed to investigate the potentially moderating role of SEP. Methods We systematically searched PubMed, EMBASE, and PsycINFO until 31 January 2018. Studies were considered eligible for inclusion when they i) complied with TIPPME intervention definitions; ii) studied actual purchases, food choice, or energy intake or content of purchases, iii) and were situated in real-life food purchasing environments. Risk of bias was assessed using a quality assessment tool and evidence was synthesized using harvest plots. Results From the 9210 references identified, 75 studies were included. Studies were generally of weak to moderate quality. The most frequently studied nudges were information (56%), mixed (24%), and position nudges (13%). Harvest plots showed modest tendencies towards beneficial effects on outcomes for information and position nudges. Less evidence was available for other TIPPME nudging interventions for which the harvest plots did not show compelling patterns. Only six studies evaluated the effects of nudges across levels of SEP (e.g., educational level, food security status, job type). Although there were some indications that nudges were more effective in low SEP groups, the limited amount of evidence and different proxies of SEP used warrant caution in the interpretation of findings. Conclusions Information and position nudges may contribute to improving population dietary behaviours. Evidence investigating the moderating role of SEP was limited, although some studies reported greater effects in low SEP subgroups. We conclude that more high-quality studies obtaining detailed data on participant’s SEP are needed. Registration This systematic review is registered in the PROSPERO database (CRD42018086983).
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Yan S, Caspi C, Trude ACB, Gunen B, Gittelsohn J. How Urban Food Pantries are Stocked and Food Is Distributed: Food Pantry Manager Perspectives from Baltimore. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2020.1729285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sally Yan
- International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Caitlin Caspi
- Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angela C. B. Trude
- Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bengucan Gunen
- Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- International Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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7
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Blake MR, Backholer K, Lancsar E, Boelsen-Robinson T, Mah C, Brimblecombe J, Zorbas C, Billich N, Peeters A. Investigating business outcomes of healthy food retail strategies: A systematic scoping review. Obes Rev 2019; 20:1384-1399. [PMID: 31397087 DOI: 10.1111/obr.12912] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/13/2019] [Accepted: 06/23/2019] [Indexed: 12/17/2022]
Abstract
Large changes to food retail settings are required to improve population diet. However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strategy evaluations. Peer-reviewed and grey literature were searched. We identified qualitative or quantitative real-world food or beverage retail strategies designed to improve the healthiness of the consumer nutrition environment (eg, changes to the "marketing mix" of product, price, promotion, and/or placement). Eligible studies reported store- or chain-level outcomes for measures of commercial viability, retailer perspectives, customer perspectives, and/or community outcomes. 11 682 titles and abstracts were screened with 107 studies included for review from 15 countries. Overall item sales, revenue, store patronage, and customer level of satisfaction with strategy were the most frequently examined outcomes. There was a large heterogeneity in outcome measures reported and in favourability for retailers of outcomes across studies. We recommend more consistent reporting of business outcomes and increased development and use of validated and reliable measurement tools. This may help generate more robust research evidence to aid retailers and policymakers to select feasible and sustainable healthy food retail strategies to benefit population health within and across countries.
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Affiliation(s)
- Miranda R Blake
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.,Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Tara Boelsen-Robinson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Catherine Mah
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Christina Zorbas
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Natassja Billich
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Anna Peeters
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
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8
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Reznar MM, Brennecke K, Eathorne J, Gittelsohn J. A cross-sectional description of mobile food vendors and the foods they serve: potential partners in delivering healthier food-away-from-home choices. BMC Public Health 2019; 19:744. [PMID: 31196159 PMCID: PMC6567609 DOI: 10.1186/s12889-019-7075-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
Background Food away from home (FAFH) in the US is associated with adverse health outcomes, and food dollars spent on FAFH continues to increase. FAFH studies have typically focused on restaurants and carryout establishments, but mobile food vendors – popularly known in the US as food trucks – have become more numerous and are an understudied segment of FAFH. The objective of this study was to assess mobile food vendors, their attitudes toward health and nutrition, and the foods they serve. Methods This was a cross-sectional study of 41 mobile food vendors in Michigan, US. The survey contained questions about food and nutrition attitudes, such as barriers to putting healthy items on menus and perceived agreement with healthy food preparation practices. Participants were classified into a healthy and a less healthy attitude group based on whether they believed healthy menu items could be successful or not. In addition, participant menus were collected and analyzed according to whether menu items were healthy, moderately healthy, or unhealthy. Descriptive, univariate, and bivariate analyses were conducted. Results Two-thirds of the participants felt that healthy menu items could be successful, and yet taste and value were the most important menu item success factors, each rated as important by 100% of the participants. Low consumer demand was the biggest barrier to putting healthy items on the menu (76%) whereas lack of chef interest (29%) and need for special training (24%) were the smallest. 72% of the vendors offered at least one healthy menu item, but only 20% of all reviewed menu items were healthy overall. There was no difference in the proportion of menu items that were healthy when comparing those with healthy attitudes (23% of menu items healthy) to those less healthy attitudes (17% of menu items healthy, p = 0.349). Conclusions Mobile food vendors had positive views about putting healthy items on menus. However, a low proportion of menu items were classified as healthy. This suggests that mobile food vendors are promising potential public health partners in improving the health profile of FAFH, but that education of vendors is needed to ensure the success of healthier items. Electronic supplementary material The online version of this article (10.1186/s12889-019-7075-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melissa M Reznar
- Oakland University School of Health Sciences, 433 Meadow Brook Road, 3102 Human Health Building, Rochester, MI, 48309, USA.
| | - Katherine Brennecke
- Oakland University School of Health Sciences, 433 Meadow Brook Road, 3102 Human Health Building, Rochester, MI, 48309, USA
| | - Jamie Eathorne
- Oakland University School of Health Sciences, 433 Meadow Brook Road, 3102 Human Health Building, Rochester, MI, 48309, USA
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W2041, Baltimore, MD, 21205, USA
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9
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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10
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Shangguan S, Afshin A, Shulkin M, Ma W, Marsden D, Smith J, Saheb-Kashaf M, Shi P, Micha R, Imamura F, Mozaffarian D. A Meta-Analysis of Food Labeling Effects on Consumer Diet Behaviors and Industry Practices. Am J Prev Med 2019; 56:300-314. [PMID: 30573335 PMCID: PMC6340779 DOI: 10.1016/j.amepre.2018.09.024] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 01/03/2023]
Abstract
CONTEXT The influence of food and beverage labeling (food labeling) on consumer behaviors, industry responses, and health outcomes is not well established. EVIDENCE ACQUISITION PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Ten databases were searched in 2014 for studies published after 1990 evaluating food labeling and consumer purchases/orders, intakes, metabolic risk factors, and industry responses. Data extractions were performed independently and in duplicate. Studies were pooled using inverse-variance random effects meta-analysis. Heterogeneity was explored with I2, stratified analyses, and meta-regression; and publication bias was assessed with funnel plots, Begg's tests, and Egger's tests. Analyses were completed in 2017. EVIDENCE SYNTHESIS From 6,232 articles, a total of 60 studies were identified, including 2 million observations across 111 intervention arms in 11 countries. Food labeling decreased consumer intakes of energy by 6.6% (95% CI= -8.8%, -4.4%, n=31), total fat by 10.6% (95% CI= -17.7%, -3.5%, n=13), and other unhealthy dietary options by 13.0% (95% CI= -25.7%, -0.2%, n=16), while increasing vegetable consumption by 13.5% (95% CI=2.4%, 24.6%, n=5). Evaluating industry responses, labeling decreased product contents of sodium by 8.9% (95% CI= -17.3%, -0.6%, n=4) and artificial trans fat by 64.3% (95% CI= -91.1%, -37.5%, n=3). No significant heterogeneity was identified by label placement or type, duration, labeled product, region, population, voluntary or legislative approaches, combined intervention components, study design, or quality. Evidence for publication bias was not identified. CONCLUSIONS From reviewing 60 intervention studies, food labeling reduces consumer dietary intake of selected nutrients and influences industry practices to reduce product contents of sodium and artificial trans fat.
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Affiliation(s)
- Siyi Shangguan
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ashkan Afshin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Masha Shulkin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; University of Michigan Medical School, Ann Arbor, Michigan
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Marsden
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Jessica Smith
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; Bell Institute of Health and Nutrition, General Mills Inc., Minneapolis, Minnesota
| | - Michael Saheb-Kashaf
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts; School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.
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11
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Gittelsohn J, Novotny R, Trude ACB, Butel J, Mikkelsen BE. Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010030. [PMID: 30586845 PMCID: PMC6339209 DOI: 10.3390/ijerph16010030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Rachel Novotny
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Jean Butel
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Bent Egberg Mikkelsen
- Department of Learning & Philosophy, Aalborg University, A.C. Meyers Vænge 15, DK-2450 Copenhagen SV, Denmark.
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12
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Jalali MS, Rahmandad H, Bullock SL, Lee-Kwan SH, Gittelsohn J, Ammerman A. Dynamics of intervention adoption, implementation, and maintenance inside organizations: The case of an obesity prevention initiative. Soc Sci Med 2018; 224:67-76. [PMID: 30763824 DOI: 10.1016/j.socscimed.2018.12.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/22/2018] [Accepted: 12/15/2018] [Indexed: 12/11/2022]
Abstract
Overall impact of public health prevention interventions relies not only on the average efficacy of an intervention, but also on the successful adoption, implementation, and maintenance (AIM) of that intervention. In this study, we aim to understand the dynamics that regulate AIM of organizational level intervention programs. We focus on two well-documented obesity prevention interventions, implemented in food carry-outs and stores in low-income urban areas of Baltimore, Maryland, which aimed to improve dietary behaviour for adults by providing access to healthier foods and point-of-purchase promotions. Building on data from field observations, in-depth interviews, and data discussed in previous publications, as well as the strategy and organizational behaviour literature, we developed a system dynamics model of the key processes of AIM. With simulation analysis, we show several reinforcing mechanisms that span stakeholder motivation, communications, and implementation quality and costs can turn small changes in the process of AIM into big difference in the overall impact of the intervention. Specifically, small changes in the allocation of resources to communication with stakeholders of intervention could have a nonlinear long-term impact if those additional resources can turn stakeholders into allies of the intervention, reducing the erosion rates and enhancing sustainability. We present how the dynamics surrounding communication, motivation, and erosion can create significant heterogeneity in the overall impact of otherwise similar interventions. Therefore, careful monitoring of how those dynamics unfold, and timely adjustments to keep the intervention on track are critical for successful implementation and maintenance.
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Affiliation(s)
- Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA; Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Hazhir Rahmandad
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Sally Lawrence Bullock
- Department of Nutrition, Gillings School of Global Public Health, UNC Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), University of North Carolina at Chapel Hill, NC, USA.
| | - Seung Hee Lee-Kwan
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Joel Gittelsohn
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alice Ammerman
- Department of Nutrition, Gillings School of Global Public Health, UNC Center for Health Promotion and Disease Prevention (a CDC Prevention Research Center), University of North Carolina at Chapel Hill, NC, USA.
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13
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Ross A, Krishnan N, Panchal J, Brooks JK, Lloyd E, Lee THJ, Gittelsohn J. Formative Research for an Innovative Smartphone Application to Improve Distribution of Healthy Foods to Corner Stores in Baltimore City. Ecol Food Nutr 2018; 58:3-22. [PMID: 30522356 DOI: 10.1080/03670244.2018.1553778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We sought to collect information about the operations of wholesalers and store owner perceptions of smartphones to plan for and create a smartphone application that will facilitate the distribution of healthy foods to corner stores. In-depth interviews were conducted with wholesalers, corner store owners, distributors, and food environment experts in Baltimore City, Maryland, which included providing feedback for a mockup of the app. Store owners that were comfortable with smartphones liked the idea of the app because it was economically practical, culturally suitable, simple and easy to use, and provided a large variety of items at a fair or low price. We found that barriers to uptake among corner store owners would be high delivery costs, no foreign language capability, and a complicated user interface. This work will inform future projects that will utilize mHealth technology to improve distribution of healthier foods in food deserts.
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Affiliation(s)
- Alexandra Ross
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,b Department of Health, Behavior, and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Nandita Krishnan
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Janaki Panchal
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Jennifer K Brooks
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Emily Lloyd
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ting-Hsuan Joyce Lee
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Joel Gittelsohn
- a Center for Human Nutrition , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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14
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Ruggiero CF, Poirier L, Trude ACB, Yang T, Schwendler T, Gunen B, Loh IH, Perepezko K, Nam CS, Sato P, Gittelsohn J. Implementation of B'More Healthy Communities for Kids: process evaluation of a multi-level, multi-component obesity prevention intervention. HEALTH EDUCATION RESEARCH 2018; 33:458-472. [PMID: 30202959 PMCID: PMC6293311 DOI: 10.1093/her/cyy031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 05/10/2023]
Abstract
B'More Healthy Communities for Kids was a multi-level, multi-component obesity prevention intervention to improve access, demand and consumption of healthier foods and beverages in 28 low-income neighborhoods in Baltimore City, MD. Process evaluation assesses the implementation of an intervention and monitor progress. To the best of our knowledge, little detailed process data from multi-level obesity prevention trials have been published. Implementation of each intervention component (wholesaler, recreation center, carryout restaurant, corner store, policy and social media/text messaging) was classified as high, medium or low according to set standards. The wholesaler component achieved high implementation for reach, dose delivered and fidelity. Recreation center and carryout restaurant components achieved medium reach, dose delivered and fidelity. Corner stores achieved medium reach and dose delivered and high fidelity. The policy component achieved high reach and medium dose delivered and fidelity. Social media/text messaging achieved medium reach and high dose delivered and fidelity. Overall, study reach and dose delivered achieved a high implementation level, whereas fidelity achieved a medium level. Varying levels of implementation may have balanced the performance of an intervention component for each process evaluation construct. This detailed process evaluation of the B'More Healthy Communities for Kids allowed the assessment of implementation successes, failures and challenges of each intervention component.
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Affiliation(s)
- C F Ruggiero
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Poirier
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A C B Trude
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Yang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - T Schwendler
- Peace Corps, Serekunda, The Gambia, Washington, DC, USA
| | - B Gunen
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I H Loh
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Perepezko
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C S Nam
- Joint Learning Initiative on Faith and Local Communities, Washington, DC, USA
| | - P Sato
- University of S�o Paulo, S�o Paulo, SP, Brazil
| | - J Gittelsohn
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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15
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Understanding Out-of-Home Food Environment, Family Restaurant Choices, and Childhood Obesity with an Agent-Based Huff Model. SUSTAINABILITY 2018. [DOI: 10.3390/su10051575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Carter P, Bignardi G, Hollands GJ, Marteau TM. Information-based cues at point of choice to change selection and consumption of food, alcohol and tobacco products: a systematic review. BMC Public Health 2018; 18:418. [PMID: 29587686 PMCID: PMC5872569 DOI: 10.1186/s12889-018-5280-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Reducing harmful consumption of food, alcohol, and tobacco products would prevent many cancers, diabetes and cardiovascular disease. Placing information-based cues in the environments in which we select and consume these products has the potential to contribute to changing these behaviours. METHODS In this review, information-based cues are defined as those which comprise any combination of words, symbols, numbers or pictures that convey information about a product or its use. We specifically exclude cues which are located on the products themselves. We conducted a systematic review of randomised, cluster- randomised, and non-randomised controlled trials to assess the impact of such cues on selection and consumption. Thirteen studies met the inclusion criteria, of which 12 targeted food (most commonly fruit and vegetables), one targeted alcohol sales, and none targeted tobacco products. RESULTS Ten studies reported statistically significant effects on some or all of the targeted products, although studies were insufficiently homogenous to justify meta-analysis. Existing evidence suggests information-based cues can influence selection and consumption of food and alcohol products, although significant uncertainty remains. CONCLUSIONS The current evidence base is limited both in quality and quantity, with relatively few, heterogeneous studies at unclear or high risk of bias. Additional, more rigorously conducted studies are warranted to better estimate the potential for these interventions to change selection and consumption of food, alcohol and tobacco products. TRIAL REGISTRATION PROSPERO. 2016; CRD42016051884 .
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Affiliation(s)
- Patrice Carter
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Giacomo Bignardi
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | | | - Theresa M. Marteau
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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17
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The Impact of a Multi-Level Multi-Component Childhood Obesity Prevention Intervention on Healthy Food Availability, Sales, and Purchasing in a Low-Income Urban Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111371. [PMID: 29125558 PMCID: PMC5708010 DOI: 10.3390/ijerph14111371] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/18/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
Abstract
The multifactorial causes of obesity require multilevel and multicomponent solutions, but such combined strategies have not been tested to improve the community food environment. We evaluated the impact of a multilevel (operating at different levels of the food environment) multicomponent (interventions occurring at the same level) community intervention. The B’more Healthy Communities for Kids (BHCK) intervention worked at the wholesaler (n = 3), corner store (n = 50), carryout (n = 30), recreation center (n = 28), household (n = 365) levels to improve availability, purchasing, and consumption of healthier foods and beverages (low-sugar, low-fat) in low-income food desert predominantly African American zones in the city of Baltimore (MD, USA), ultimately intending to lead to decreased weight gain in children (not reported in this manuscript). For this paper, we focus on more proximal impacts on the food environment, and measure change in stocking, sales and purchase of promoted foods at the different levels of the food system in 14 intervention neighborhoods, as compared to 14 comparison neighborhoods. Sales of promoted products increased in wholesalers. Stocking of these products improved in corner stores, but not in carryouts, and we did not find any change in total sales. Children more exposed to the intervention increased their frequency of purchase of promoted products, although improvement was not seen for adult caregivers. A multilevel food environment intervention in a low-income urban setting improved aspects of the food system, leading to increased healthy food purchasing behavior in children.
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18
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Gittelsohn J, Trude ACB, Kim H. Pricing Strategies to Encourage Availability, Purchase, and Consumption of Healthy Foods and Beverages: A Systematic Review. Prev Chronic Dis 2017; 14:E107. [PMID: 29101767 PMCID: PMC5672888 DOI: 10.5888/pcd14.170213] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Food pricing policies to promote healthy diets, such as taxes, price manipulations, and food subsidies, have been tested in different settings. However, little consensus exists about the effect of these policies on the availability of healthy and unhealthy foods, on what foods consumers buy, or on the impact of food purchases on consumer health outcomes. We conducted a systematic review of studies of the effect of food-pricing interventions on retail sales and on consumer purchasing and consumption of healthy foods and beverages. Methods We used MEDLINE, Embase, PsycINFO, Web of Science, ClinicalTrials.gov, and the Cochrane Library to conduct a systematic search for peer-reviewed articles related to studies of food pricing policies. We selected articles that were published in English from January 2000 through December 2016 on the following types of studies: 1) real-world experimental studies (randomized controlled trials, quasi-experimental studies, and natural experiments); 2) population studies of people or retail stores in middle-income and high-income countries; 3) pricing interventions alone or in combination with other strategies (price promotions, coupons, taxes, or cash-back rebates), excluding studies of vending-machine or online sales; and 4) outcomes studies at the retail (stocking, sales) and consumer (purchasing, consumption) levels. We selected 65 articles representing 30 studies for review. Results Sixteen pricing intervention studies that sought to improve access to healthy food and beverage options reported increased stocking and sales of promoted food items. Most studies (n = 23) reported improvement in the purchasing and consumption of healthy foods or beverages or decreased purchasing and consumption of unhealthy foods or beverages. Most studies assessed promotions of fresh fruits and vegetables (n = 20); however, these foods may be hard to source, have high perishability, and raise concerns about safety and handling. Few of the pricing studies we reviewed discouraged purchasing and consumption of unhealthy foods (n = 6). Many studies we reviewed had limitations, including lack of formative research, process evaluation, or psychosocial and health assessments of the intervention’s impact; short intervention duration; or no assessment of food substitutions or the effects of pricing interventions on food purchasing and diets. Conclusion Pricing interventions generally increased stocking, sales, purchasing, and consumption of promoted foods and beverages. Additional studies are needed to differentiate the potential impact of selected pricing strategies and policies over others.
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Affiliation(s)
- Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center and Center for Human Nutrition, 615 N Wolfe St, Baltimore, MD, 21205.
| | - Angela Cristina Bizzotto Trude
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center and Center for Human Nutrition, Baltimore, Maryland
| | - Hyunju Kim
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Global Obesity Prevention Center and Center for Human Nutrition, Baltimore, Maryland
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19
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Lopez NV, Folta SC, Glenn ME, Lynskey VM, Patel AA, Anzman-Frasca S. Promoting healthier children's meals at quick-service and full-service restaurants: Results from a pilot and feasibility study. Appetite 2017; 117:91-97. [PMID: 28625854 PMCID: PMC5555846 DOI: 10.1016/j.appet.2017.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/21/2017] [Accepted: 06/14/2017] [Indexed: 11/15/2022]
Abstract
High-calorie restaurant foods contribute to childhood overweight. Increased consumer demand for healthier kids' meals may motivate the restaurant industry to provide additional healthy options. This study pilot-tested a combination of four strategies (toy incentive, placemats, server prompts, signage) designed to increase demand for healthier kids' meals, which were defined as those eligible for the National Restaurant Association's Kids LiveWell program. Relative sales of healthier kids' meals were examined before (n = 3473 total kids' meal orders) and during Month 1 (n = 3546 total kids' meal orders) and Month 2 of implementation (n = 3645 total kids' meal orders) of an 8-week intervention in two locations each of a quick-service (QSR) and full-service (FSR) restaurant chain. Convenience samples of children (n = 27) and their parents (n = 28) were surveyed regarding parent and child perceptions of intervention components. Findings regarding the effectiveness and feasibility of the intervention were mixed. At the FSRs, the relative percentage of monthly sales from healthier kids' meals increased from 5.0% of kids' meal orders at baseline to 8.3% during Month 1, ending at 6.4% during Month 2. At the QSRs, the relative percentage of monthly sales from healthier kids' entrees decreased from 27.5% at baseline to 25.2% during Month 1, ending at 25.9% during Month 2. Implementation quality tracking showed that consistent implementation of intervention components was a challenge; parent- and child-reported awareness of intervention components supported this finding. Future directions are discussed, aiming to build upon these findings and maximize the feasibility, effectiveness, and sustainability of efforts to promote healthier eating in restaurants.
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Affiliation(s)
- Nanette V Lopez
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | | | | | - Anjali A Patel
- Department of Research, Accents on Health, Inc. (dba Healthy Dining), United States
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Asada Y, Lieberman LD, Neubauer LC, Hanneke R, Fagen MC. Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress. HEALTH EDUCATION & BEHAVIOR 2017; 45:153-166. [DOI: 10.1177/1090198117721611] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Structural change approaches—also known as policy and environmental changes—are becoming increasingly common in health promotion, yet our understanding of how to evaluate them is still limited. An exploratory scoping review of the literature was conducted to understand approaches and methods used to evaluate structural change interventions in health promotion and public health literature. Two analysts—along with health sciences librarian consultation—searched PubMed, Web of Science, and EMBASE for peer-reviewed U.S.-based, English language studies published between 2005 and 2016. Data were extracted on the use of evaluation frameworks, study designs, duration of evaluations, measurement levels, and measurement types. Forty-five articles were included for the review. Notably, the majority (73%) of studies did not report application of a specific evaluation framework. Studies used a wide range of designs, including process evaluations, quasi- or nonexperimental designs, and purely descriptive approaches. In addition, 15.6% of studies only measured outcomes at the individual level. Last, 60% of studies combined more than one measurement type (e.g., site observation + focus groups) to evaluate interventions. Future directions for evaluating structural change approaches to health promotion include more widespread use and reporting of evaluation frameworks, developing validated tools that measure structural change, and shifting the focus to health-directed approaches, including an expanded consideration for evaluation designs that address health inequities.
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Affiliation(s)
- Yuka Asada
- University of Illinois at Chicago, IL, USA
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21
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Gittelsohn J, Trude A. Diabetes and obesity prevention: changing the food environment in low-income settings. Nutr Rev 2017; 75:62-69. [PMID: 28049750 PMCID: PMC5207007 DOI: 10.1093/nutrit/nuw038] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Innovative approaches are needed to impact obesity and other diet-related chronic diseases, including interventions at the environmental and policy levels. Such interventions are promising due to their wide reach. This article reports on 10 multilevel community trials that the present authors either led (n = 8) or played a substantial role in developing (n = 2) in low-income minority settings in the United States and other countries that test interventions to improve the food environment, support policy, and reduce the risk for developing obesity and other diet-related chronic diseases. All studies examined change from pre- to postintervention and included a comparison group. The results show the trials had consistent positive effects on consumer psychosocial factors, food purchasing, food preparation, and diet, and, in some instances, obesity. Recently, a multilevel, multicomponent intervention was implemented in the city of Baltimore that promises to impact obesity in children, and, potentially, diabetes and related chronic diseases among adults. Based on the results of these trials, this article offers a series of recommendations to contribute to the prevention of chronic disease in Mexico. Further work is needed to disseminate, expand, and sustain these initiatives at the city, state, and federal levels.
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Affiliation(s)
- Joel Gittelsohn
- J. Gittelsohn and A. Trude are with the Department of International Health, Center for Human Nutrition, Global Obesity Prevention Center at Johns Hopkins, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Angela Trude
- J. Gittelsohn and A. Trude are with the Department of International Health, Center for Human Nutrition, Global Obesity Prevention Center at Johns Hopkins, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Thayer LM, Pimentel DC, Smith JC, Garcia BA, Lee Sylvester L, Kelly T, Johnston LF, Ammerman AS, Keyserling TC. Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items. AMERICAN JOURNAL OF HEALTH EDUCATION 2016; 48:11-21. [PMID: 28947925 PMCID: PMC5609464 DOI: 10.1080/19325037.2016.1250688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND As Americans commonly consume restaurant foods with poor dietary quality, effective interventions are needed to improve food choices at restaurants. PURPOSE To design and evaluate a restaurant-based intervention to help customers select and restaurants promote heart healthy menu items with healthful fats and high quality carbohydrates. METHODS The intervention included table tents outlining 10 heart healthy eating tips, coupons promoting healthy menu items, an information brochure, and link to study website. Pre and post intervention surveys were completed by restaurant managers and customers completed a brief "intercept" survey. RESULTS Managers (n = 10) reported the table tents and coupons were well received, and several noted improved personal nutrition knowledge. Overall, 4214 coupons were distributed with 1244 (30%) redeemed. Of 300 customers surveyed, 126 (42%) noticed the table tents and of these, 115 (91%) considered the nutrition information helpful, 42 (33%) indicated the information influenced menu items purchased, and 91 (72%) reported the information will influence what they order in the future. DISCUSSION The intervention was well-received by restaurant managers and positively influenced menu item selection by many customers. TRANSLATION TO HEALTH EDUCATION PRACTICE Further research is needed to assess effective strategies for scaling up and sustaining this intervention approach.
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Affiliation(s)
- Linden M. Thayer
- Duke University – Center for Advanced Hindsight; 334 Blackwell Street, Suite 320, Durham, NC 27701-3971
| | - Daniela C. Pimentel
- University of North Carolina – Chapel Hill, Department of Nutrition; 135 Dauer Drive 2200 McGavran-Greenberg Hall, CB #7461, Chapel Hill, NC 27599-7461
| | - Janice C. Smith
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Beverly A. Garcia
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Laura Lee Sylvester
- Lenoir County Cooperative Extension; 1791 NC Highway 11 55, Kinston, NC 28504
| | - Tammy Kelly
- Kinston-Lenoir Chamber of Commerce; 301 N. Queen St, Kinston, NC 28501
| | - Larry F. Johnston
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Alice S. Ammerman
- University of North Carolina – Chapel Hill, Department of Nutrition; 135 Dauer Drive 2200 McGavran-Greenberg Hall, CB #7461, Chapel Hill, NC 27599-7461
- University of North Carolina – Chapel Hill Center for Health Promotion and Disease Prevention; 1700 Martin Luther King Jr. Blvd., CB#7426, Chapel Hill NC 27599-7426
| | - Thomas C. Keyserling
- University of North Carolina – Chapel Hill, Department of Medicine; 125 MacNider Hall, CB #7005 Chapel Hill NC 27599-7005
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Ayala GX, Castro IA, Pickrel JL, Williams CB, Lin SF, Madanat H, Jun HJ, Zive M. A restaurant-based intervention to promote sales of healthy children's menu items: the Kids' Choice Restaurant Program cluster randomized trial. BMC Public Health 2016; 16:250. [PMID: 26965639 PMCID: PMC4785671 DOI: 10.1186/s12889-016-2892-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Away-from-home eating is an important dietary behavior with implications on diet quality. Thus, it is an important behavior to target to prevent and control childhood obesity and other chronic health conditions. Numerous studies have been conducted to improve children's dietary intake at home, in early care and education, and in schools; however, few studies have sought to modify the restaurant food environment for children. This study adds to this body of research by describing the development and launch of an innovative intervention to promote sales of healthy children's menu items in independent restaurants in Southern California, United States. METHODS This is a cluster randomized trial with eight pair-matched restaurants in San Diego, California. Restaurants were randomized to a menu-only versus menu-plus intervention condition. The menu-only intervention condition involves manager/owner collaboration on the addition of pre-determined healthy children's menu items and kitchen manager/owner collaboration to prepare and plate these items and train kitchen staff. The menu-plus intervention condition involves more extensive manager/owner collaboration and kitchen staff training to select, prepare, and plate new healthy children's menu items, and a healthy children's menu campaign that includes marketing materials and server training to promote the items. The primary outcome is sales of healthy children's menu items over an 18-week period. In addition, dining parties consisting of adults with children under 18 years of age are being observed unobtrusively while ordering and then interviewed throughout the 18-week study period to determine the impact of the intervention on ordering behaviors. Manager/owner interviews and restaurant audits provide additional evidence of impact on customers, employees, and the restaurant environment. Our process evaluation assesses dose delivered, dose received, and intervention fidelity. DISCUSSION Successful recruitment of the restaurants has been completed, providing evidence that the restaurant industry is open to working on the public health challenge of childhood obesity. Determining whether a restaurant intervention can promote sales of healthy children's menu items will provide evidence for how to create environments that support the healthy choices needed to prevent and control obesity. Despite these strengths, collection of sales data that will allow comprehensive analysis of intervention effects remains a challenge. TRIAL REGISTRATION NCT02511938.
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Affiliation(s)
- Guadalupe X Ayala
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA. .,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA.
| | - Iana A Castro
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Julie L Pickrel
- Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Christine B Williams
- Department of Pediatrics, Center for Community Health, University of California at San Diego, 9500 Gilman Drive, #0927, La Jolla, CA, 92093, USA
| | - Shih-Fan Lin
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Hala Madanat
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Hee-Jin Jun
- San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.,Institute for Behavioral and Community Health, 9245 Sky Park Court, Suite 221, San Diego, CA, 92123, USA
| | - Michelle Zive
- Department of Pediatrics, Center for Community Health, University of California at San Diego, 9500 Gilman Drive, #0927, La Jolla, CA, 92093, USA
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Sanchez-Flack JC, Baquero B, Linnan LA, Gittelsohn J, Pickrel JL, Ayala GX. What influences Latino grocery shopping behavior? Perspectives on the small food store environment from managers and employees in San Diego, California. Ecol Food Nutr 2016; 55:163-81. [PMID: 26800243 DOI: 10.1080/03670244.2015.1112282] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
To inform the design of a multilevel in-store intervention, this qualitative study utilized in-depth semistructured interviews with 28 managers and 10 employees of small-to-medium-sized Latino food stores (tiendas) in San Diego, California, to identify factors within the tienda that may influence Latino customers' grocery-shopping experiences and behaviors. Qualitative data analysis, guided by grounded theory, was performed using open coding. Results suggest that future interventions should focus on the physical (i.e., built structures) and social (i.e., economic and sociocultural) dimensions of store environments, including areas where the two dimensions interact, to promote the purchase of healthy food among customers.
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Affiliation(s)
- Jennifer C Sanchez-Flack
- a San Diego State University-University of California at San Diego Joint Doctoral Program in Health Behavior , San Diego , California , USA.,b Institute for Behavioral and Community Health , San Diego , California , USA
| | - Barbara Baquero
- c University of Iowa , College of Public Health, Community & Behavioral Health , Iowa City , Iowa , USA
| | - Laura A Linnan
- d University of North Carolina at Chapel Hill , Gillings School of Global Public Health, Department of Health Behavior , Chapel Hill , North Carolina , USA
| | - Joel Gittelsohn
- e Center for Human Nutrition and Global Obesity Prevention Center, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA
| | - Julie L Pickrel
- b Institute for Behavioral and Community Health , San Diego , California , USA
| | - Guadalupe X Ayala
- b Institute for Behavioral and Community Health , San Diego , California , USA.,f San Diego State University , College of Health & Human Services , San Diego , California , USA
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25
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Lee-Kwan SH, Yong R, Bleich SN, Kwan NH, Park JH, Lawrence R, Gittelsohn J. Carry-out Restaurant Intervention Increases Purchases of Healthy Food. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2015. [DOI: 10.1080/19320248.2015.1045673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gittelsohn J, Mui Y, Adam A, Lin S, Kharmats A, Igusa T, Lee BY. Incorporating Systems Science Principles into the Development of Obesity Prevention Interventions: Principles, Benefits, and Challenges. Curr Obes Rep 2015; 4:174-81. [PMID: 26069864 PMCID: PMC4452216 DOI: 10.1007/s13679-015-0147-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systems modeling represents an innovative approach for addressing the obesity epidemic at the community level. We developed an agent-based model of the Baltimore City food environment that permits us to assess the relative impact of different programs and policies, alone and in combination, and potential unexpected consequences. Based on this experience, and a review of literature, we have identified a set of principles, potential benefits, and challenges. Some of the key principles include the importance of early and multilevel engagement with the community prior to initiating model development and continued engagement and testing with community stakeholders. Important benefits include improving community stakeholder understanding of the system, testing of interventions before implementation, and identification of unexpected consequences. Challenges in these models include deciding on the most important, yet parsimonious factors to consider, how to model food source and food selection behavior in a realistic yet transferable manner, and identifying the appropriate outcomes and limitations of the model.
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Affiliation(s)
- Joel Gittelsohn
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
| | - Yeeli Mui
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
| | - Atif Adam
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
| | - Sen Lin
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
| | - Anna Kharmats
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
| | - Takeru Igusa
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
| | - Bruce Y. Lee
- Global Obesity Prevention Center (GOPC), Johns Hopkins University, Room 2041A, 615 North Wolfe St, Baltimore, MD 21205-2179 USA
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Anderson Steeves E, Martins PA, Gittelsohn J. Changing the Food Environment for Obesity Prevention: Key Gaps and Future Directions. Curr Obes Rep 2014; 3:451-8. [PMID: 25574452 PMCID: PMC4283210 DOI: 10.1007/s13679-014-0120-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The food environment has a great impact on the nutritional health of the population. Food environment interventions have become a popular strategy to address the obesity epidemic. However, there are still significant gaps in our understanding of the most effective strategies to modify the food environment to improve health. In this review, we examine key gaps in the food environment intervention literature, including the need for: developing appropriate formative research plans when addressing the food environment; methods for selecting intervention domains and components; incorporating food producers and distributors in intervention strategies; strengthening evaluation of environmental interventions; building the evidence base for food environment interventions in diverse settings; engaging policy makers in the process of modifying the food environment; and creating systems science models to examine the costs and benefits of a potential program or policy on the food environment prior to implementation. In addition, we outline the need for strategies for addressing these issues including conducting additional pilot interventions, developing additional methodologies, and embracing the use of simulation models.
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Affiliation(s)
- Elizabeth Anderson Steeves
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Global Center
on Childhood Obesity and Center for Human Nutrition, 615 North Wolfe Street, Baltimore
MD 21044, Phone: 937-901-7137, Fax: 410-955-0196
| | - Paula Andrea Martins
- Universidade Federal de São Paulo, Departamento de Ciências
do Movimento Humano., Av. Ana Costa, 95, Vila Matias, 11060001 - Santos, SP –
Brasil, Phone: (13) 38773700, Fax: (13) 38773700
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Global Center
on Childhood Obesity and Center for Human Nutrition, 615 North Wolfe Street, Baltimore
MD 21044, Phone: 410-955-3927, Fax: 410-955-0196
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Gittelsohn J, Anderson Steeves E, Mui Y, Kharmats AY, Hopkins LC, Dennis D. B'More Healthy Communities for Kids: design of a multi-level intervention for obesity prevention for low-income African American children. BMC Public Health 2014; 14:942. [PMID: 25209072 PMCID: PMC4168194 DOI: 10.1186/1471-2458-14-942] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/03/2014] [Indexed: 11/17/2022] Open
Abstract
Background Childhood obesity rates in the U.S. have reached epidemic proportions, and an urgent need remains to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component interventions are needed due to the multi-factorial nature of obesity, and its proven links to both the social and built environment. However, there are huge gaps in the literature related to doing these kinds of interventions among low-income, urban, minority groups. Methods The B’More Healthy Communities for Kids (BHCK) intervention is a multi-level, multi-component intervention, targeting low-income African American youth ages 10–14 and their families in Baltimore, Maryland. This intervention prevents childhood obesity by working at multiple levels of the food and social environments to increase access to, demand for, and consumption of healthier foods. BHCK works to create systems-level change by partnering with city policy-makers, multiple levels of the food environment (wholesalers, corner stores, carryout restaurants), and the social environment (peers and families). In addition, extensive evaluation will be conducted at each level of the intervention to assess intervention effectiveness via both process and impact measures. Discussion This project is novel in multiple ways, including: the inclusion of stakeholders at multiple levels (policy, institutional, and at multiple levels of the food system); that it uses novel computational modeling methodologies to engage policy makers and guide informed decisions of intervention effectiveness; it emphasizes both the built environment (intervening with food sources) and the social environment (intervening with families and peers). The design of the intervention and the evaluation plan of the BHCK project are documented here. Trial registration NCT02181010 (July 2, 2014).
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Affiliation(s)
- Joel Gittelsohn
- Johns Hopkins Global Obesity Prevention Center, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Baltimore, MD 21205-2179, USA.
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