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Booth L, Santos JA, Hoek AC, Webster J, Pettigrew S. Population Subgroups at Risk of Unhealthy Changes in Food and Beverage Consumption During COVID-19 Lockdowns. Int J Behav Med 2024; 31:163-168. [PMID: 36879051 PMCID: PMC9988201 DOI: 10.1007/s12529-023-10165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Understanding health behaviour changes during the COVID-19 pandemic can assist in developing strategies to promote healthy lifestyles at such times. The aim of this exploratory study was to examine whether the frequency of consuming unhealthy foods and beverages changed during lockdown and whether certain population subgroups were more likely to make such changes. METHOD An online survey was administered to a national sample of 4022 Australian adults (51% female, mean age 48 years). Generalised linear models with generalised estimating equations were used to identify whether demographic characteristics (age, gender, education, presence of children in the household, number of people in the household) and beliefs related to COVID-19 were associated with changes in the frequency of consuming alcohol, sweet snacks, salty snacks, and sugary beverages from pre to during lockdown. RESULTS Overall, the frequency of consuming the four assessed unhealthy products did not change during lockdown. However, being male and having children at home were consistently associated with unhealthy changes, whereas believing that alcohol or unhealthy diets would exacerbate COVID-19 severity was linked to a decreased frequency of consuming these products respectively. Age, education, and living with more people were also associated with changes in the frequency of consuming some product categories. CONCLUSION During lockdown, certain population subgroups appeared to be at increased risk of more frequent consumption of unhealthy foods and beverages. Believing certain consumption habits are linked to adverse health impacts of COVID was found to reduce frequency of consumption of related products, presenting a potential focus for future public health actions.
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Affiliation(s)
- Leon Booth
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia.
- UNSW Medicine and Health, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
| | - Annet C Hoek
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, 2042, Australia
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Johnson C, Thout SR, Nidhuram S, Hart A, Hoek AC, Rogers K, Shivashankar R, Ide N, Chatterjee S, Webster J, Praveen D. Protocol for the implementation and evaluation of a community-based behavior change intervention to reduce dietary salt intake in India. J Clin Hypertens (Greenwich) 2023; 25:175-182. [PMID: 36639981 PMCID: PMC9903196 DOI: 10.1111/jch.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
Excess dietary salt intake is well established as a leading cause of high blood pressure and associated cardiovascular disease, yet current salt intake in India is nearly 11 g per day, more than twice World Health Organization maximum recommended intake of 5 g per day. Although dietary survey data from India indicate that the main sources of dietary salt are salt added during cooking at home, and few salt reduction efforts have focused on interventions at the household level. As a result, there is little evidence of the effectiveness of behavior change programs to reduce salt intake at the household level. The study aims to develop and implement a community based behavioral change intervention to reduce salt intake delivered by front line community-based health volunteers; and evaluate the preliminary effectiveness, acceptability, and feasibility of delivering a salt reduction behavior change program and potential to support future scale-up. The study is a pre-post intervention design, and outcomes will be evaluated from a random sample of 1500 participants from 28 villages in two primary health centers in Siddipet, Telangana. Primary outcome is change in salt-related KAB (knowledge, attitude, and behavior) score, and secondary outcomes will be changes in salt intake measured by 24 h urinary sodium excretion and change in scores using the subscales of the COM-B ("capability", "opportunity", "motivation" and "behavior") tool. Findings will be used to inform future public health policies to support implementation of scalable community-based interventions to reduce salt intake and control hypertension, the leading-cause of death in India.
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Affiliation(s)
- Claire Johnson
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia,The School of Public Health and Community MedicineThe University of New South WalesSydneyAustralia
| | - Sudhir Raj Thout
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia,Indian Institute of Technology HyderabadKandi, SangareddyTelanganaIndia
| | - Spoorthi Nidhuram
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia
| | - Ashleigh Hart
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia
| | - Annet C. Hoek
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia
| | - Kris Rogers
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia,Graduate School of HealthThe University of Technology SydneySydneyAustralia
| | - Roopa Shivashankar
- Resolve to Save LivesAn Initiative of Vital StrategiesNew York CityNew YorkUSA,Indian Council of Medical ResearchNew DelhiIndia
| | - Nicole Ide
- Resolve to Save LivesAn Initiative of Vital StrategiesNew York CityNew YorkUSA
| | - Susmita Chatterjee
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia
| | - Jacqui Webster
- Food Policy DivisionThe George Institute for Global HealthSydneyAustralia
| | - Devarsetty Praveen
- Research and Development DivisionThe George Institute for Global HealthHyderabadIndia,University of New South WalesSydneyNSWAustralia,Prasanna School of Public HealthManipal Academy of Higher EducationManipalIndia
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Rosewarne E, Hoek AC, Palu A, Trieu K, Taylor C, Ha DTP, Sieburg M, Ide N, Buse K, Webster J. Advancing Health Research Impact through a Systemic Multi-Sectoral Approach: A Protocol for Introducing Reduced-Sodium Salts and Salty Condiments in Vietnam. Int J Environ Res Public Health 2022; 19:12937. [PMID: 36232237 PMCID: PMC9565934 DOI: 10.3390/ijerph191912937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Better alignment between health research organisations with the needs (and interests) of key stakeholders in the health policy and research system is critical to improving research impact. The George Institute for Global Health's 'Healthier Societies' program focuses on harnessing the power of governments, markets, and communities to improve population level health equity outcomes and maximise research impact. This protocol outlines a systemic multi-sectoral approach to advance health research impact globally applied to a project to reduce population salt intake in Vietnam by introducing reduced-sodium salts and salty condiments. We defined a systemic multi-sectoral approach to be a strategy that involves engaging with government, market and communities in a deliberate and joined-up way to solve a problem in which they all have a role to play. The project objectives are to: (i) produce reduced-sodium fish sauce products and test consumer acceptability; (ii) investigate the market feasibility of introducing reduced-sodium foods (salt, bot canh and fish sauce) into the Vietnamese market; (iii) estimate the cost-effectiveness of three different government strategies to support the implementation of reduced-sodium products; and (iv) develop an advocacy roadmap to maximise potential research impact. Methods will include standard quality and safety assessments, consumer sensory testing for the locally produced reduced-sodium fish sauces, market feasibility assessment (including collating market data and semi-structured interviews with stakeholders), cost-effectiveness modelling (Markov cohort model), multi-sector stakeholder engagement, and the development of a coordinated advocacy strategy using the Kotter Plus framework. Health research organisations are increasingly seeking ways to achieve greater impact with their research. Through the application of a systemic multi-sectoral approach with governments, markets and communities, this protocol provides an example of how health research projects can achieve such impact.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St., Sydney, NSW 2042, Australia
| | - Annet C. Hoek
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St., Sydney, NSW 2042, Australia
| | - Aliyah Palu
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St., Sydney, NSW 2042, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St., Sydney, NSW 2042, Australia
| | - Colman Taylor
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St., Sydney, NSW 2042, Australia
- Health Technology Analysts, Level 1/370 Norton St., Sydney, NSW 2040, Australia
| | - Do Thi Phuong Ha
- National Institute of Nutrition, Vietnam. 48B Tăng Bạt Hổ Street, Phạm Đình Hổ, Hai Bà Trưng District, Hanoi 11611, Vietnam
| | - Michael Sieburg
- YCP Solidiance, PTE LTD, Suite 704, Satra Dong Khoi Building, 58 Dong Khoi Street, District 1, Ho Chi Minh City 700000, Vietnam
| | - Nicole Ide
- Resolve to Save Lives, 85 Broad Street, Suite 1626, New York, NY 10004, USA
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London SW7 2BX, UK
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Level 5, 1 King St., Sydney, NSW 2042, Australia
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4
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Taylor C, Hoek AC, Deltetto I, Peacock A, Ha DTP, Sieburg M, Hoang D, Trieu K, Cobb LK, Jan S, Webster J. The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam. ACTA ACUST UNITED AC 2021; 79:32. [PMID: 33706807 PMCID: PMC7953693 DOI: 10.1186/s13690-021-00540-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam. Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00540-4.
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Affiliation(s)
- Colman Taylor
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia. .,Health Technology Analysts Pty Ltd, Surry Hills, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Irene Deltetto
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | - Adrian Peacock
- Health Technology Analysts Pty Ltd, Surry Hills, Australia
| | | | | | | | - Kathy Trieu
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Laura K Cobb
- Resolve to Save Lives, An Initiative of Vital Strategies, New York, NY, USA
| | - Stephen Jan
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Jacqui Webster
- The George Institute for Global Health, Australia University of NSW, PO Box M201, Missenden Rd, Camperdown, NSW, 2050, Australia
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Boulet M, Hoek AC, Raven R. Towards a multi-level framework of household food waste and consumer behaviour: Untangling spaghetti soup. Appetite 2020; 156:104856. [PMID: 32905821 PMCID: PMC7474811 DOI: 10.1016/j.appet.2020.104856] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 08/03/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
Changing the everyday food-related behaviours of consumers is a critical part of tackling the global food waste challenge. Comprehensive frameworks of household food waste and consumer behavior are needed to guide the development of targeted interventions and future research agendas. This study systematically reviews food waste and behaviour studies from developed nations to provide an overview of the current research field. It uses a multi-level perspective to organise the various factors influencing food-related behaviour and proposes a new, multi-level, framework of consumer behaviour and household food waste. A novel addition to the field, the framework gathers factors at micro (individual), meso (household), and macro (external to the household) levels and argues that behaviour and food waste emerge from their interactions. Our review also reveals a research domain with disciplinary and methodological ‘bald spots’ and an over-emphasis on individual level factors. A multi-level research agenda focusing on under-explored factors and interactions between factors across levels is presented, and consideration given to multi-level interventions that support consumer behaviour change to reduce household food waste.
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Affiliation(s)
- Mark Boulet
- BehaviourWorks Australia, Monash University, 8 Scenic Drive, Clayton Vic, 3800, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, PO Box M201, Missenden Rd, NSW, 2050, Australia.
| | - Rob Raven
- Monash Sustainable Development Institute, Monash University, 8 Scenic Drive, Clayton Vic, 3800, Australia.
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6
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Tekle DY, Santos JA, Trieu K, Thout SR, Ndanuko R, Charlton K, Hoek AC, Huffman MD, Jan S, Webster J. Monitoring and implementation of salt reduction initiatives in Africa: A systematic review. J Clin Hypertens (Greenwich) 2020; 22:1355-1370. [PMID: 32770701 PMCID: PMC7496579 DOI: 10.1111/jch.13937] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
This systematic review aims to document salt consumption patterns and the implementation status and potential impact of salt reduction initiatives in Africa, from studies published between January 2009 and November 2019. Studies were sourced using MEDLINE, Embase, Cochrane Library electronic databases, and gray literature. Of the 887 records retrieved, 38 studies conducted in 18 African countries were included. Twelve studies measured population salt intake, 11 examined salt level in foods, 11 assessed consumer knowledge, attitudes, and behaviors, 1 study evaluated a behavior change intervention, and 3 studies modeled potential health gains and cost savings of salt reduction interventions. The population salt intake studies determined by 24‐hour urine collections showed that the mean (SD) salt intake in African adults ranged from 6.8 (2.2) g to 11.3 (5.4) g/d. Salt levels in foods were generally high, and consumer knowledge was fairly high but did not seem to translate into salt lowering behaviors. Modeling studies showed that interventions for reducing dietary sodium would generate large health gains and cost savings for the health system. Despite this evidence, adoption of population salt reduction strategies in Africa has been slow, and dietary consumption of sodium remains high. Only South Africa adopted legislation in 2016 to reduce population salt intake, but success of this intervention has not yet been fully evaluated. Thus, rigorous evaluation of the salt reduction legislation in South Africa and initiation of salt reduction programs in other African countries will be vital to achieving the targeted 30% reduction in salt intake by 2025.
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Affiliation(s)
- Dejen Yemane Tekle
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Rhoda Ndanuko
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Karen Charlton
- Faculty of Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Annet C Hoek
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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7
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Rosewarne E, Hoek AC, Sacks G, Wolfenden L, Wu J, Reimers J, Corben K, Moore M, Ni Mhurchu C, Webster J. A comprehensive overview and qualitative analysis of government-led nutrition policies in Australian institutions. BMC Public Health 2020; 20:1038. [PMID: 32605547 PMCID: PMC7325668 DOI: 10.1186/s12889-020-09160-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 06/22/2020] [Indexed: 11/20/2022] Open
Abstract
Background Institutions are a recommended setting for dietary interventions and nutrition policies as these provide an opportunity to improve health by creating healthy food environments. In Australia, state and territory governments encourage or mandate institutions in their jurisdiction to adopt nutrition policies. However, no work has analysed the policy design across settings and jurisdictions. This study aimed to compare the design and components of government-led institutional nutrition policies between Australian states and territories, determine gaps in existing policies, and assess the potential for developing stronger, more comprehensive policies. Methods Government-led institutional nutrition policies, in schools, workplaces, health facilities and other public settings, were identified by searching health and education department websites for each Australian state and territory government. This was supplemented by data from other relevant stakeholder websites and from the Food Policy Index Australia website. A framework for monitoring and evaluating nutrition policies in publicly-funded institutions was used to extract data and a qualitative analysis of the design and content of institutional nutrition policies was performed. Comparative analyses between the jurisdictions and institution types were conducted, and policies were assessed for comprehensiveness. Results Twenty-seven institutional nutrition policies were identified across eight states and territories in Australia. Most policies in health facilities and public schools were mandatory, though most workplace policies were voluntary. Twenty-four included nutrient criteria, and 22 included guidelines for catering/fundraising/advertising. While most included implementation guides or tools and additional supporting resources, less than half included tools/timelines for monitoring and evaluation. The policy design, components and nutrient criteria varied between jurisdictions and institution types, though all were based on the Australian Dietary Guidelines. Conclusions Nutrition policies in institutions present an opportunity to create healthy eating environments and improve population health in Australia. However, the design of these policies, including lack of key components such as accountability mechanisms, and jurisdictional differences, may be a barrier to implementation and prevent the policies having their intended impact.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gary Sacks
- Deakin University, Melbourne, Victoria, 3125, Australia
| | - Luke Wolfenden
- University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Jason Wu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation, 15-31 Pelham Street, Melbourne, Victoria, 3053, Australia
| | - Kirstan Corben
- Victorian Health Promotion Foundation, 15-31 Pelham Street, Melbourne, Victoria, 3053, Australia
| | - Michael Moore
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Cliona Ni Mhurchu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia.,The University of Auckland, Auckland, 1142, New Zealand
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2052, Australia
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8
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Jorgensen BS, Boulet M, Hoek AC. A level-of-analysis issue in resource consumption and environmental behavior research: A theoretical and empirical contradiction. J Environ Manage 2020; 260:110154. [PMID: 32090844 DOI: 10.1016/j.jenvman.2020.110154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/09/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
Behavioral theories have much to offer researchers and policy makers who seek sustainable resource management within households. However, much research on household resource consumption applies theories of the individual to understand the behavioral patterns of what are very often groups of people cohabiting in a particular dwelling. This misalignment of levels of analysis leads to erroneous empirical results and conclusions, and thereby less effective policy and management actions. We address this issue by first detailing the nature of the problem; illustrating its pervasiveness in research on resource consumption behaviors; offering some ways forward by drawing on research on group dynamics; and exploring new ways of thinking about some existing concepts in resource consumption and conservation with the goal of developing insights from a household-level perspective. We suggest that researchers seek a multi-level understanding of consumption and conservation in future research, as this could lead to theories and evidence to support group-level interventions that target behaviors in a household setting, which is likely to be more effective than existing individualistic approaches.
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Affiliation(s)
| | - Mark Boulet
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Australia.
| | - Annet C Hoek
- The George Institute for Global Health, Australia.
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9
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Hermans RCJ, de Bruin H, Larsen JK, Mensink F, Hoek AC. Adolescents' Responses to a School-Based Prevention Program Promoting Healthy Eating at School. Front Public Health 2017; 5:309. [PMID: 29218306 PMCID: PMC5704644 DOI: 10.3389/fpubh.2017.00309] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/03/2017] [Indexed: 11/13/2022] Open
Abstract
Background To improve the effectiveness of school-based programs that aim to promote adolescents' healthy food choices, it is essential to understand the views and behaviors of the target group. This study aimed to get a better understanding of adolescents' food and health perceptions and their willingness to be involved in a specific school-based prevention program, i.e., the Dutch "Healthy School Canteen Program." Methods This study used a mixed-methods research design. First, seven semi-structured focus groups were conducted using a selective sample of 42 Dutch adolescents (25 girls, 17 boys, aged 13-16 years). Second, an online survey among 133 adolescent respondents (72 girls, 61 boys, aged 12-19 years) using snowball sampling was conducted. Content analysis was performed to make inferences about the focus group discussions, whereas statistical analyses were conducted to analyze the survey data. Results Findings from the group discussions indicated that healthy eating was only an issue of importance when adolescents perceived negative physical changes (e.g., with regard to looks or physical performance). Adolescents also indicated that they clearly wanted to make their own food and beverage choices at school. The quantitative data indicated that taste, price, and variety were seen as the most important aspects of a healthy food assortment (mean scores 8.1, 7.8, and 7.7 on a 10-point scale, respectively). In general, a majority of the adolescents (64%) expressed that students should be involved in the organization of a healthy food environment in schools. At the same time, however, adolescents were not willing to participate themselves. This was mostly because they were skeptical about their ideas being heard and put into action by their schools. Conclusion School-based prevention programs, such as the Healthy School Program, should take into account that adolescents have a low risk perception of unhealthy eating and are seeking food choice autonomy. In addition, schools should not lose sight of product price, taste, and variety to make their food assortment attractive to students. If schools aim to involve adolescents in prevention programs that promote healthy eating, it is essential that they have a formal student involvement process that ensures that adolescents' suggestions are valued.
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Affiliation(s)
- Roel C J Hermans
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.,The Netherlands Nutrition Centre, The Hague, Netherlands
| | | | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Annet C Hoek
- BehaviourWorks Australia, Monash Sustainability Institute, Monash University, Melbourne, VIC, Australia
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Danner L, Ristic R, Johnson TE, Meiselman HL, Hoek AC, Jeffery DW, Bastian SE. Context and wine quality effects on consumers' mood, emotions, liking and willingness to pay for Australian Shiraz wines. Food Res Int 2016; 89:254-265. [DOI: 10.1016/j.foodres.2016.08.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/29/2016] [Accepted: 08/07/2016] [Indexed: 11/30/2022]
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11
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Hoek AC, Pearson D, James SW, Lawrence MA, Friel S. Shrinking the food-print: A qualitative study into consumer perceptions, experiences and attitudes towards healthy and environmentally friendly food behaviours. Appetite 2016; 108:117-131. [PMID: 27686818 DOI: 10.1016/j.appet.2016.09.030] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 08/03/2016] [Accepted: 09/25/2016] [Indexed: 02/07/2023]
Abstract
Internationally, there is increasing recognition of the importance of multilevel policies and actions that address healthy and environmentally friendly food behaviours. However it is not yet clear which actions are most suitable to support consumers to adopt both behaviours concurrently. To this end, we undertook a qualitative study to assess consumer perceptions, experiences and attitudes towards healthy and environmentally friendly foods and four target behaviours: reducing overconsumption of food beyond energy needs, reducing consumption of low-nutrient energy dense foods, eating less animal- and more plant-derived foods, and reducing food waste. Online in-depth interviews were held with 29 Australian food shoppers representing different levels of involvement with health and environment in daily food choices. The results indicate that compared to health, the relationship between food and the environment is rarely considered by consumers. The four target food behaviours were primarily associated and motivated by an impact on health, except for not wasting foods. Participants had the most positive attitude and highest motivation for eating less processed and packaged foods, mostly to avoid excessive packaging and 'chemicals' in foods. This was followed by the behaviours reducing food waste and overconsumption. Conversely, there was a predominantly negative attitude towards, and low motivation for, eating less animal-derived products and more plant based foods. Overall, consumers found a joined concept of healthy and environmentally friendly foods an acceptable idea. We recommend that health should remain the overarching principle for policies and actions concerned with shifting consumer behaviours, as this personal benefit appears to have a greater potential to support behaviour change. Future consumer focused work could pay attention to framing behavioural messages, providing intermediate behavioural goals, and a multiple target approach to change habitual behaviours.
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Affiliation(s)
- A C Hoek
- University of Canberra, Australia.
| | | | - S W James
- Australian National University, School of Regulation and Global Governance (RegNet), Coombs Extension Building 8, Canberra, ACT 2601, Australia.
| | - M A Lawrence
- Deakin University, Institute for Physical Activity and Nutrition, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | - S Friel
- Australian National University, School of Regulation and Global Governance (RegNet), Coombs Extension Building 8, Canberra, ACT 2601, Australia.
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Ristic R, Johnson TE, Meiselman HL, Hoek AC, Bastian SE. Towards development of a Wine Neophobia Scale (WNS): Measuring consumer wine neophobia using an adaptation of The Food Neophobia Scale (FNS). Food Qual Prefer 2016. [DOI: 10.1016/j.foodqual.2015.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hoek AC, Elzerman JE, Hageman R, Kok FJ, Luning PA, Graaf CD. Are meat substitutes liked better over time? A repeated in-home use test with meat substitutes or meat in meals. Food Qual Prefer 2013. [DOI: 10.1016/j.foodqual.2012.07.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hoek AC, van Boekel MA, Voordouw J, Luning PA. Identification of new food alternatives: How do consumers categorize meat and meat substitutes? Food Qual Prefer 2011. [DOI: 10.1016/j.foodqual.2011.01.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hoek AC, Luning PA, Weijzen P, Engels W, Kok FJ, de Graaf C. Replacement of meat by meat substitutes. A survey on person- and product-related factors in consumer acceptance. Appetite 2011; 56:662-73. [DOI: 10.1016/j.appet.2011.02.001] [Citation(s) in RCA: 263] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2009] [Revised: 12/16/2010] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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Hoek AC, Luning PA, Stafleu A, de Graaf C. Food-related lifestyle and health attitudes of Dutch vegetarians, non-vegetarian consumers of meat substitutes, and meat consumers. Appetite 2004; 42:265-72. [PMID: 15183917 DOI: 10.1016/j.appet.2003.12.003] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Revised: 11/11/2003] [Accepted: 12/11/2003] [Indexed: 11/25/2022]
Abstract
The aim was to investigate socio-demographic characteristics, and attitudes to food and health of vegetarians, non-vegetarian consumers of meat substitutes, and meat consumers in The Netherlands. The sample used for this study (participants > or =18 years) was taken from the Dutch National Food Consumption Survey, 1997/1998. Vegetarians (n = 63) and consumers of meat substitutes (n = 39) had similar socio-demographic profiles: higher education levels, higher social economic status, smaller households, and more urbanised residential areas, compared to meat consumers (n = 4313). Attitudes to food were assessed by the food-related lifestyle instrument. We found that vegetarians (n = 32) had more positive attitudes towards importance of product information, speciality shops, health, novelty, ecological products, social event, and social relationships than meat consumers (n = 1638). The health consciousness scale, which was used to assess attitudes to health, supported earlier findings that vegetarians are more occupied by health. Food-related lifestyle and health attitudes of meat substitute consumers (n = 17) were predominantly in-between those from vegetarians and meat consumers. The outcome of this study suggests that in strategies to promote meat substitutes for non-vegetarian consumers, the focus should not only be on health and ecological aspects of foods.
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Affiliation(s)
- Annet C Hoek
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, Bode 62, 6700 EV Wageningen, The Netherlands.
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Abstract
A new and independent method for the quantification of alpha-acids in hops and hop products has been developed. NMR was used as a qualitative method for the complete assignment of all 1H- and 13C-NMR signals of the three main alpha-acids, cohumulone (1), humulone (2) and adhumulone (3). In a 13C two-dimensional INADEQUATE experiment, the 13C-NMR spectrum of 1 was unambiguously assigned via the carbon-carbon connectivities. Use of NMR as a quantitative method allowed quantification of the pure and individual alpha-acids 1 and 2, and the determination of the absolute concentration of solutions of these compounds. Quantification of alpha-acids by NMR is less complicated and more reliable than the methods used until now.
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Affiliation(s)
- A C Hoek
- Department of Pharmacognosy, Leiden/Amsterdam Center for Drug Research, Gorlaeus Laboratories, PO Box 9502, 2300 RA Leiden, The Netherlands.
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Hoek AC, Vleugels LF, Groeneveld C. Improved powder mix quality with Twinsweet. World Rev Nutr Diet 2000; 85:133-9. [PMID: 10647345 DOI: 10.1159/000059717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- A C Hoek
- Holland Sweetener Company, Geleen, The Netherlands
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van Hoogstraten HJ, Wolfhagen FH, van de Meeberg PC, Kuiper H, Nix GA, Becx MC, Hoek AC, van Houte DP, Rijk MC, Salemans JM, Scherpenisse J, Schrijver M, Smit AM, Spoelstra P, Stadhouders PH, Tan TG, Hop WC, ten Kate FJ, vanBerge-Henegouwen GP, Schalm SW, van Buuren HR. Ursodeoxycholic acid therapy for primary sclerosing cholangitis: results of a 2-year randomized controlled trial to evaluate single versus multiple daily doses. J Hepatol 1998; 29:417-23. [PMID: 9764988 DOI: 10.1016/s0168-8278(98)80059-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND/AIMS Ursodeoxycholic acid has been reported to be of potential benefit for primary sclerosing cholangitis but little is known about the long-term biochemical, histological and radiological efficacy or the optimum frequency of ursodeoxycholic acid administration. METHODS A 2-year multicentre randomised controlled trial was initiated to assess the effects of ursodeoxycholic acid (10 mg kg(-1).d(-1), given in either single or multiple daily doses, on symptoms, serum liver tests, cholangiographic and histological findings and the occurrence of treatment failure. Liver biopsies were taken and endoscopic retrograde cholangiography was performed at entry and after 2 years; follow-up examinations were at 3-month intervals. Treatment failure was defined as death, liver transplantation, 4-fold increase in serum bilirubin, variceal bleeding, de novo ascites or cholangitis. Actuarial survival was compared with predicted survival using the revised Mayo natural history model for primary sclerosing cholangitis. RESULTS Forty-eight patients were enrolled. In one case, ursodeoxycholic acid had to be discontinued because of gastro-intestinal complaints. No other side-effects were observed. After 2 years of follow-up, treatment was not associated with a beneficial effect on either symptoms or liver histology. Serum liver tests (alkaline phosphatase, y-glutamyl transferase, aspartate aminotransferase) improved significantly in both groups, while serum bilirubin (which was near normal at entry) and IgG remained stable. No major changes in radiographic bile duct appearance seemed to be present. After 2 years, actuarial survival was 91% (95 CI 83%-99%), which is comparable to the predicted 97% survival rate. Treatment failure occurred in 15% of cases. No significant differences in any of the study endpoints (symptoms, serum liver tests, cholangiographic findings, histology, disease progression) were found between the two groups. CONCLUSIONS Ursodeoxycholic acid is well tolerated in primary sclerosing cholangitis. Significant effects on biochemical parameters were found and symptoms, bilirubin and histology did not deteriorate. No advantage of a multiple daily dose over a single dose was observed.
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Beynen AC, Lemmens AG, Fielmich-Bouman AM, Hoek AC, Mars YW. Lack of effect of dietary minerals on liver cholesterol concentrations in rats. Z Ernahrungswiss 1989; 28:316-8. [PMID: 2618107 DOI: 10.1007/bf02019394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Female rats were fed cholesterol-free, purified diets with different concentrations of calcium (0.13-0.75%, w/w), magnesium (0.02 or 0.04%) or phosphorus (0.2-0.8%) as the only dietary variable. After 28 days, no effects of the minerals were found on liver cholesterol concentrations and rates of fecal excretion of bile acids.
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Affiliation(s)
- A C Beynen
- Department of Laboratory Animal Science, State University, Utrecht, The Netherlands
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Hoek AC, Lemmens AG, Mullink JW, Beynen AC. Influence of dietary calcium:phosphorus ratio on mineral excretion and nephrocalcinosis in female rats. J Nutr 1988; 118:1210-6. [PMID: 3183767 DOI: 10.1093/jn/118.10.1210] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The effects of dietary calcium (Ca) concentration and calcium: phosphorus (Ca:P) ratio on mineral balance and nephrocalcinosis were studied in female rats. In the first experiment there were two dietary Ca concentrations (0.25 and 0.50%, wt/wt) at two different Ca:P ratios (0.6 and 1.3). In the second experiment the diets were formulated to contain 0.40% P and either 0.13, 0.25, 0.50 or 0.75% Ca. The diets contained 0.03% magnesium (Mg). The fecal outputs of Ca, P and Mg were lower (P less than 0.01) after feeding low Ca diets than after feeding high Ca diets. Urinary excretion of P decreased with increasing dietary Ca and increased with increasing P intake. In rats fed the 0.25% Ca diets whole-body retentions of Ca and P were lower than in the rats fed 0.50% Ca. Both increases in dietary Ca from 0.13 to 0.50% and P from 0.20 to 0.40% elevated Ca and P content of kidneys as well as the degree of nephrocalcinosis. However, after feeding the highest Ca concentration (0.75%) nephrocalcinosis was essentially absent while kidney concentrations of Ca and P were relatively low. When compared with 0.50% Ca in the diet, 0.75% Ca increased group mean whole-body retention of Ca but lowered that of P. In individual rats the degree of nephrocalcinosis and the concentrations of minerals in kidney were positively correlated.
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Affiliation(s)
- A C Hoek
- Department of Laboratory Animal Science, State University, Utrecht, The Netherlands
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Abstract
Heterotopic gastric mucosa in the duodenal bulb is sometimes seen as elevated lesions. Radiological and endoscopic findings in 22 patients are reported, and the characteristic appearance on each study is described. Glucagon-induced hypotonia of the duodenal bulb facilitates the diagnosis.
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