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Kirk SFL, Olstad DL, McIsaac JLD, Prowse RJL, Caswell S, Hanning R, Raine KD, Mâsse LC, Naylor PJ. Appetite for change? Facilitators and barriers to nutrition guideline implementation in Canadian recreational facilities. Health Promot Int 2021; 36:1672-1682. [PMID: 33615376 DOI: 10.1093/heapro/daab017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/12/2022] Open
Abstract
As providers of community-based physical activity programs, recreation and sports facilities serve as an important resource for health promotion. Unfortunately, the food environments within these settings often do not reflect healthy eating guidelines. This study sought to describe facilitators and barriers to implementing provincial nutrition guidelines in recreation and sports facilities in three Canadian provinces with nutrition guidelines. Semi-structured interviews were analysed thematically to identify facilitators and barriers to implementing provincial nutrition guidelines. Facilitators and barriers were then categorised using a modified "inside out" socio-ecological model that places health-related and other social environments at the centre. A total of 32 semi-structured interviews were conducted at two time-points across the three guideline provinces. Interview participants included recreation staff managers, facility committee or board members and recreation volunteers. Eight facilitators and barriers were identified across five levels of the inside out socio-ecological model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Findings reinforce the importance of top down (clear expectations regarding guideline implementation at the time of approval) and bottom up (need for buy-in from multiple stakeholders) approaches to ensure successful implementation of nutrition guidelines. The application of a modified socio-ecological model allowed for a more nuanced understanding of leverage points to support successful guideline implementation. Lay summary Healthy eating is an important behaviour for preventing chronic diseases. Supporting people to access healthy foods in places where they live, learn, work or play is a public health priority. Recreation and sports facilities are a setting where people can be physically active. Unfortunately, the food environment in these settings may not reflect nutrition guidelines. In this study, we interviewed key stakeholders from recreation and sports facilities in three Canadian provinces who had put guidelines for healthy eating in place. We used a specific framework to do this called the inside out socio-ecological model. Eight facilitators and barriers were identified using this model. Facilitators included provincial or municipal expectations of guideline implementation, clear communication to staff around guideline directives and the presence of a champion within the community or facility who supported guideline implementation. Barriers included unhealthy food culture within community, competition from other food providers and issues within food service contracts that undermined healthy food provision. Our findings can help people working in recreation and sports facilities to identify issues that may help or hinder healthy food provision in these settings.
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Affiliation(s)
- Sara F L Kirk
- Healthy Populations Institute
- School of Health and Human Performance, Faculty of Health, Dalhousie University, PO Box 150000, Halifax, NS, Canada B3H 4R2
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada T2N 4Z6
| | - Jessie-Lee D McIsaac
- Healthy Populations Institute
- Faculty of Education and Department of Child and Youth Study, Mount Saint Vincent University, Halifax, NS, Canada B3M 2J6
| | - Rachel J L Prowse
- School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada T6G 1C9
| | - Susan Caswell
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada N2L 3G1
| | - Rhona Hanning
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada N2L 3G1
| | - Kim D Raine
- School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada T6G 1C9
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4
| | - P J Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3015, Stn CSC, Victoria, BC, Canada V8W 3P1
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Prowse RJL, Naylor PJ, Olstad DL, Storey K, Carson V, Mâsse LC, Kirk SFL, Raine KD. Impact of a Capacity-Building Intervention on Food Marketing Features in Recreation Facilities. J Nutr Educ Behav 2020; 52:935-943. [PMID: 32417119 DOI: 10.1016/j.jneb.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/10/2019] [Revised: 03/26/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the impact of a capacity-building intervention (CBI) to support implementing provincial nutrition guidelines on food marketing in recreation facilities (RFs). DESIGN Randomized controlled trial within a natural experiment: food marketing in RFs from 3 guideline provinces randomly assigned to intervention (GL+CBI) or comparison (GL-ONLY) was compared with facilities in 1 province without guidelines (NO-GL). Food marketing was assessed by the Food and Beverage Marketing Assessment Tool for Settings. SETTING Canadian provinces with/without voluntary nutrition guidelines for RFs. PARTICIPANTS 51 RFs. INTERVENTION 18-month CBI. MAIN OUTCOME MEASURES Change in Food and Beverage Marketing Assessment Tool for Settings scores and marketing features between baseline and follow-up across groups. ANALYSIS Kruskal-Wallis with post hoc Mann-Whitney U tests. RESULTS No significant differences in food marketing features between baseline and follow-up across groups except for a change in food marketing frequency (P = 0.045). The increase in frequency in NO-GL (median, 6.0; interquartile range, -2.0 to 8.5) was significantly greater than changes in the GL+CBI (P = 0.033) and GL-ONLY sites (P = 0.049). CONCLUSIONS AND IMPLICATIONS Capacity-building was not associated with improved food marketing features potentially because of nonmandated nutrition guidelines, low priority for change, and vague or narrow facility goals and guidelines. Nutrition guidelines with specific unhealthy food marketing restrictions should be mandated and supported.
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Affiliation(s)
- Rachel J L Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Dana L Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Olstad DL, Raine KD, Prowse RJL, Tomlin D, Kirk SF, McIsaac JLD, Mâsse LC, Caswell MS, Hanning RM, Milford T, Naylor PJ. Eat, play, live: a randomized controlled trial within a natural experiment examining the role of nutrition policy and capacity building in improving food environments in recreation and sport facilities. Int J Behav Nutr Phys Act 2019; 16:51. [PMID: 31238919 PMCID: PMC6593504 DOI: 10.1186/s12966-019-0811-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/22/2018] [Accepted: 06/05/2019] [Indexed: 11/18/2022] Open
Abstract
Background Recreation and sport facilities often have unhealthy food environments that may promote unhealthy dietary patterns among children. In response, some Canadian provinces have released voluntary nutrition guidelines for recreation and sport facilities, however implementation has been limited. Organizational capacity building may overcome barriers to implementing guidelines. Eat, Play, Live was a randomized controlled trial embedded within a natural experiment that tested the impact of an 18 month capacity building intervention (CBI) in enhancing implementation of provincial nutrition guidelines, and whether nutrition guidelines were associated with positive changes. Primary outcomes were facility capacity, policy development and food environment quality. Methods Recreation and sport facilities in three guideline provinces were randomized into a guideline + CBI (GL + CBI; n = 17) or a guideline only comparison condition (GL-ONLY; n = 15). Facilities in a province without guidelines constituted a second comparison condition (NO-GL; n = 17). Facility capacity, policy development, and food environment quality (vending and concession) were measured and compared at baseline and follow-up across conditions using repeated measures ANOVA and Chi-square statistics. Healthfulness of vending and concession items was rated as Do Not Sell (least nutritious), Sell Sometimes or Sell Most (most nutritious). Results There were significant time by condition effects, with significant increases in facility capacity (mean ± SD: 30.8 ± 15.6% to 62.3 ± 22.0%; p < 0.01), nutrition policy development (17.6% developed new policies; p = 0.049), overall quality of the concession food environment (14.7 ± 8.4 to 17.5 ± 7.2; p < 0.001), and in the proportion of Sell Most (3.7 ± 4.4% to 11.0 ± 9.0%; p = 0.002) and Sell Sometimes vending snacks (22.4 ± 14.4% to 43.8 ± 15.8%; p < 0.001) in GL + CBI facilities, with a significant decline in Do Not Sell vending snacks (74.0 ± 16.6% to 45.2 ± 20.1%; p < 0.001). Conclusions Significant improvements in facility capacity, policy development and food environment quality occurred in recreation and sport facilities that were exposed to nutrition guidelines and participated in a CBI. Outcomes did not improve in facilities that were only passively or not at all exposed to guidelines. Ongoing capacity building may enhance implementation of voluntary nutrition guidelines, however food environments remained overwhelmingly unhealthy, suggesting additional scope to enhance implementation. Trials registration Clinical trials registration (retrospectively registered): ISRCTN14669997 Jul 3, 2018. Electronic supplementary material The online version of this article (10.1186/s12966-019-0811-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Rachel J L Prowse
- School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, T6G 1C9, Canada
| | - Dona Tomlin
- School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3015 Stn CSC, Victoria, BC, V8W 3P1, Canada
| | - Sara F Kirk
- Healthy Populations Institute, Dalhousie University, Stairs House, PO Box 15000, 6230, South Street, Halifax, NS, B3H 4R2, Canada
| | - Jessie-Lee D McIsaac
- Faculty of Education and Department of Child and Youth Study, Mount Saint Vincent University, 166 Bedford Hwy, Halifax, NS, B3M 2J6, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - M Susan Caswell
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Rhona M Hanning
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Todd Milford
- Department of Curriculum and Instruction, Faculty of Education, University of Victoria, PO Box 1700, STN CSC, Victoria, BC, V8W 2YW, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 3015 Stn CSC, Victoria, BC, V8W 3P1, Canada.
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Prowse RJL, Tomlin DL, Naylor PJ, Raine KD. Exploring Nutrition Labelling of Food and Beverages in Vending Machines in Canadian Recreational Sport Settings. CAN J DIET PRACT RES 2019; 80:55-62. [PMID: 30430860 DOI: 10.3148/cjdpr-2018-039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: To evaluate whether interpretive "health" labels placed in vending machines in recreation centres represented products' nutrient content when compared with provincial nutrition guidelines. Methods: A cross-sectional audit (November 2015 - April 2016) of 139 vending machines in recreation facilities found 525 foods and beverages in 17 machines labelled by vendors according to healthfulness. Product nutrient content was compared with provincial nutrition guideline criteria. Cross-tabulation and weighted Cohen's kappa evaluated agreement between vendor interpretive labels and guideline ranks. Descriptive statistics evaluated how mislabelled products deviated from recommended nutrient content. Mann-Whitney tests compared nutrient content of "healthy" and "unhealthy" labelled products. Results: Almost one-third of all products were mislabelled by vendors with 72% of those labelled healthier than their actual guideline rank. Energy, total fat, sugar, and sodium contents exceeded recommended levels in one-third to one-half of mislabelled products. Overall, products labelled healthy by vendors were significantly lower in energy, sodium, and fat compared with those labelled unhealthy; however, not for all food types (e.g., bars, fruit snacks, nuts). Conclusions: For certain product categories, vendor interpretive nutrition labels poorly represented products' nutrient content according to provincial nutrition guidelines. Dietitians may be a valuable resource to help implement nutrition guidelines to create credible interpretive product labelling systems.
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Affiliation(s)
| | - Dona L Tomlin
- b School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC
| | - Patti-Jean Naylor
- b School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC
| | - Kim D Raine
- a School of Public Health, University of Alberta, Edmonton, AB
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Prowse RJL, Naylor PJ, Olstad DL, Carson V, Storey K, Mâsse LC, Kirk SFL, Raine KD. Food marketing in recreational sport settings in Canada: a cross-sectional audit in different policy environments using the Food and beverage Marketing Assessment Tool for Settings (FoodMATS). Int J Behav Nutr Phys Act 2018; 15:39. [PMID: 29848329 PMCID: PMC5977555 DOI: 10.1186/s12966-018-0673-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children's recreational sport settings typically sell energy dense, low nutrient products; however, it is unknown whether the same types of food and beverages are also marketed in these settings. Understanding food marketing in sports settings is important because the food industry often uses the promotion of physical activity to justify their products. This study aimed to document the 'exposure' and 'power' of food marketing present in public recreation facilities in Canada and assess differences between provinces with and without voluntary provincial nutrition guidelines for recreation facilities. METHODS Food marketing was measured in 51 sites using the Food and beverage Marketing Assessment Tool for Settings (FoodMATS). The frequency and repetition ('exposure') of food marketing and the presence of select marketing techniques, including child-targeted, sports-related, size, and healthfulness ('power'), were assessed. Differences in 'exposure' and 'power' characteristics between sites in three guideline provinces (n = 34) and a non-guideline province (n = 17) were assessed using Pearson's Chi squared tests of homogeneity and Mann-Whitney U tests. RESULTS Ninety-eight percent of sites had food marketing present. The frequency of food marketing per site did not differ between guideline and non-guideline provinces (median = 29; p = 0.576). Sites from guideline provinces had a significantly lower proportion of food marketing occasions that were "Least Healthy" (47.9%) than sites from the non-guideline province (73.5%; p < 0.001). Use of child-targeted and sports-related food marketing techniques was significantly higher in sites from guideline provinces (9.5% and 10.9%, respectively), than in the non-guideline province (1.9% and 4.5% respectively; p values < 0.001). It was more common in the non-guideline province to use child-targeted and sports-related techniques to promote "Least Healthy" items (100.0% and 68.4%, respectively), compared to the guideline provinces (59.3% and 52.0%, respectively). CONCLUSIONS Recreation facilities are a source of children's exposure to unhealthy food marketing. Having voluntary provincial nutrition guidelines that recommend provision of healthier foods was not related to the frequency of food marketing in recreation facilities but was associated with less frequent marketing of unhealthy foods. Policy makers should provide explicit food marketing regulations that complement provincial nutrition guidelines to fulfill their ethical responsibility to protect children and the settings where children spend time.
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Affiliation(s)
- Rachel J L Prowse
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
- Centre for Health and Nutrition, University of Alberta, Edmonton, Alberta, Canada.
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Prowse RJL, Naylor PJ, Olstad DL, Carson V, Mâsse LC, Storey K, Kirk SFL, Raine KD. Reliability and validity of a novel tool to comprehensively assess food and beverage marketing in recreational sport settings. Int J Behav Nutr Phys Act 2018; 15:38. [PMID: 29848321 PMCID: PMC5977740 DOI: 10.1186/s12966-018-0667-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/24/2017] [Accepted: 03/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Current methods for evaluating food marketing to children often study a single marketing channel or approach. As the World Health Organization urges the removal of unhealthy food marketing in children’s settings, methods that comprehensively explore the exposure and power of food marketing within a setting from multiple marketing channels and approaches are needed. The purpose of this study was to test the inter-rater reliability and the validity of a novel settings-based food marketing audit tool. Methods The Food and beverage Marketing Assessment Tool for Settings (FoodMATS) was developed and its psychometric properties evaluated in five public recreation and sport facilities (sites) and subsequently used in 51 sites across Canada for a cross-sectional analysis of food marketing. Raters recorded the count of food marketing occasions, presence of child-targeted and sports-related marketing techniques, and the physical size of marketing occasions. Marketing occasions were classified by healthfulness. Inter-rater reliability was tested using Cohen’s kappa (κ) and intra-class correlations (ICC). FoodMATS scores for each site were calculated using an algorithm that represented the theoretical impact of the marketing environment on food preferences, purchases, and consumption. Higher FoodMATS scores represented sites with higher exposure to, and more powerful (unhealthy, child-targeted, sports-related, large) food marketing. Validity of the scoring algorithm was tested through (1) Pearson’s correlations between FoodMATS scores and facility sponsorship dollars, and (2) sequential multiple regression for predicting “Least Healthy” food sales from FoodMATS scores. Results Inter-rater reliability was very good to excellent (κ = 0.88–1.00, p < 0.001; ICC = 0.97, p < 0.001). There was a strong positive correlation between FoodMATS scores and food sponsorship dollars, after controlling for facility size (r = 0.86, p < 0.001). The FoodMATS score explained 14% of the variability in “Least Healthy” concession sales (p = 0.012) and 24% of the variability total concession and vending “Least Healthy” food sales (p = 0.003). Conclusions FoodMATS has high inter-rater reliability and good validity. As the first validated tool to evaluate the exposure and power of food marketing in recreation facilities, the FoodMATS provides a novel means to comprehensively track changes in food marketing environments that can assist in developing and monitoring the impact of policies and interventions. Electronic supplementary material The online version of this article (10.1186/s12966-018-0667-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel J L Prowse
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, AB, Canada. .,Centre for Health & Nutrition, University of Alberta, Edmonton, AB, Canada.
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