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Huangfu P, Pearson F, Abu-Hijleh FM, Wahlich C, Willis K, Awad SF, Abu-Raddad LJ, Critchley JA. Impact of price reductions, subsidies, or financial incentives on healthy food purchases and consumption: a systematic review and meta-analysis. Lancet Planet Health 2024; 8:e197-e212. [PMID: 38453385 DOI: 10.1016/s2542-5196(24)00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
Poor diets are a global concern and are linked with various adverse health outcomes. Healthier foods such as fruit and vegetables are often more expensive than unhealthy options. This study aimed to assess the effect of price reductions for healthy food (including fruit and vegetables) on diet. We performed a systematic review and meta-analysis on studies that looked at the effects of financial incentives on healthy food. Main outcomes were change in purchase and consumption of foods following a targeted price reduction. We searched electronic databases (MEDLINE, EconLit, Embase, Cinahl, Cochrane Library, and Web of Science), citations, and used reference screening to identify relevant studies from Jan 1, 2013, to Dec 20, 2021, without language restrictions. We stratified results by population targeted (low-income populations vs general population), the food group that the reduction was applied to (fruit and vegetables, or other healthier foods), and study design. Percentage price reduction was standardised to assess the effect in meta-analyses. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. 34 studies were eligible; 15 took place in supermarkets and eight took place in workplace canteens in high-income countries, and 21 were targeted at socioeconomically disadvantaged communities. Pooled analyses of 14 studies showed a price reduction of 20% resulted in increases in fruit and vegetable purchases by 16·62% (95% CI 12·32 to 20·91). Few studies had maintained the price reduction for over 6 months. In conclusion, price reductions can lead to increases in purchases of fruit and vegetables, potentially sufficient to generate health benefits, if sustained.
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Affiliation(s)
- Peijue Huangfu
- Population Health Research Institute, St George's, University of London, London, UK
| | - Fiona Pearson
- Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Farah Marwan Abu-Hijleh
- Department of Public Health, College of Health Sciences, QU Health Quality Office, Qatar University, Doha, Qatar
| | - Charlotte Wahlich
- Population Health Research Institute, St George's, University of London, London, UK
| | - Kathryn Willis
- Population Health Research Institute, St George's, University of London, London, UK
| | - Susanne F Awad
- Infectious Diseases Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Laith J Abu-Raddad
- Infectious Diseases Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
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McGrath G. Using a divider nudge in supermarket shopping trolleys to increase fruit and vegetable purchases: A feasibility study using an intervention design. NUTR BULL 2023; 48:513-522. [PMID: 37864781 DOI: 10.1111/nbu.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/23/2023]
Abstract
Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing obesity and chronic diseases: however, only one in 16 Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test the feasibility of covertly modifying shopper purchasing behaviour to purchase more F&Vs using a visual divider nudge message (prompts) covering the entire base of shopping trolleys. Placards provided a visual representation of the recommended proportion of the trolley base that should be allocated to fruits and vegetables (implied social norm). Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting receipts to measure the weight (kg), total spending and F&V specific spending (Australian dollars) for intervention versus control trolleys for one weekend day only. We also conducted a short intercept survey that was administered independently from the research study day on non-trial shoppers. Shoppers who selected trolleys with the divider nudge placards (n = 102) purchased equal weight of F&Vs (Intervention: mean = 6.25 kg, SD = 5.60 kg, 95% CI = 5.14 kg, 7.35 kg, vs. Control: mean 6.03 kg, SD = 5.17 kg, 95% CI = 5.01 kg, 7.04 kg, p = 0.768) and spent equal amounts on F&Vs compared to shoppers in the control group (n = 102) (Intervention: mean = $41.46, SD = $36.68, 95% CI = $34.25, $48.66, vs. Control: mean $39.85, SD = $33.30, 95% CI = $33.34, $46.39, p = 0.744). There was no difference in the total spending between groups (Intervention: mean = $135.99, SD = $90.10, 95% CI = $118.29, $153.68, vs. Control: mean $155.68, SD = $96.46, 95% CI = $136.73, $174.63, p = 0.133). The divider nudge placard did not lead to any difference in shoppers' purchases of F&Vs. However, this study demonstrates the feasibility of testing a cheap, simple and easy supermarket nutrition intervention. Larger studies are required to elucidate and confirm these findings over the longer term.
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Affiliation(s)
- Greg McGrath
- La Trobe University, Melbourne, Victoria, Australia
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3
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Winkler LL, Toft U, Glümer C, Bloch P, Buch-Andersen T, Christensen U. Involving supermarkets in health promotion interventions in the Danish Project SoL. A practice-oriented qualitative study on the engagement of supermarket staff and managers. BMC Public Health 2023; 23:706. [PMID: 37072841 PMCID: PMC10111755 DOI: 10.1186/s12889-023-15501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 03/21/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Supermarkets have been suggested as relevant settings for environmental and educational initiatives encouraging healthier shopping and eating decisions, but in the literature, limited attention has been paid to the context, perspectives, and everyday practices of supermarket staff. The aim of this study was to examine the engagement of supermarket staff in a health promotion project from a practice-oriented perspective. METHODS The study was based on qualitative data collected in the supermarket setting of Project SoL; a community-based health promotion project in Denmark. We conducted 26 in-depth interviews with store managers and other key staff members in seven participating supermarkets. In addition, we collected data on planning, implementation, and perceptions of supermarket staff of in-store interventions and other project-related activities. These field data included short telephone interviews, observational notes, photos, and audiotapes of meetings. Data were analysed from the perspective of practice theory. RESULTS Although supermarket staff found community-based health promotion meaningful to engage in, the study observed that their engagement was challenged by a business mindset, practical routines and structural requirements favouring sales promotion over health promotion. Nevertheless, there were also examples of how health promotion activities and ways of thinking were successfully incorporated in everyday staff practices during and after Project SoL. CONCLUSIONS Our findings point to both potentials and challenges for using supermarkets as settings for health promotion. The voluntary engagement of supermarket staff in community-based health projects cannot stand alone but should be supplemented by more long-lasting strategies and policies regulating this and other food environments. Context-sensitive and practice-oriented analyses in local food environments could inform such strategies and policies to make sure they target unwanted elements and practices and not just individual behavior.
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Affiliation(s)
- Lise L Winkler
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark.
| | - Ulla Toft
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Charlotte Glümer
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
- Center for Diabetes, Vesterbrogade 121, 3rd floor, København V, 1620, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, 2730, Denmark
| | - Tine Buch-Andersen
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Nordre Fasanvej 57, Frederiksberg, 2000, Denmark
| | - Ulla Christensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Gothersgade 160, København K, 1123, Denmark
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McGrath GM. Using social norm nudges in supermarket shopping trolleys to increase fruit and vegetable purchases. NUTR BULL 2023; 48:115-123. [PMID: 36842136 DOI: 10.1111/nbu.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/27/2023]
Abstract
Fruit and vegetable (F&V) consumption is associated with a reduced risk of developing obesity and chronic diseases: however, only one in twenty Australian adults consume F&Vs at the recommended two servings of fruit and five servings of vegetables per day. What and how much people eat is influenced by their social and physical environments. Supermarkets are a key setting influencing food purchases, and as such, they can shape consumption patterns of F&Vs. Implementing effective strategies to increase F&V intake is crucial. The objective of this research was to test if shopper purchasing behaviour can be modified to purchase more F&Vs using social norm nudge messages (prompts) placed in shopping trolleys. Placards giving the message that the majority of shoppers purchased F&Vs at each shop were placed in shopping trolleys. Applying an intervention research design, 30 out of ~100 trolleys were fitted with the placards and shopper purchases were measured by collecting receipts to measure the quantity (kg), total and F&V spending (Australian dollars) for intervention versus control trolleys. We also conducted a short intercept survey that was administered independently from the research study day. Shoppers who selected trolleys with the social norm nudge placards (n = 109) purchased 1.25 kg more F&Vs (Intervention: mean = 5.45 kg, SD = 4.23 kg, 95% CI 4.65 kg, 6.26 kg vs. Control: mean 4.19 kg, SD = 3.75 kg, 95% CI 3.48 kg, 4.90 kg, p = 0.020, Cohen's d = 0.32) and spent an extra $9.10 more on F&Vs compared to shoppers in the control group (n = 109; Intervention: mean = $36.20, SD = $26.30, 95% CI = $31.24, $41.26 vs. Control: mean $27.10, SD = $24.00, 95% CI = $22.50, $31.67, p = 0.008, Cohen's d = 0.36). The social norm nudge placard shows promise in modifying shoppers' purchases to buy more F&Vs. Larger studies are required to elucidate and confirm these findings over the longer term.
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Gomes Cordeiro N, Mendes LL, Jardim MZ, Claro RM, Pessoa MC, Granado FS, Cristina de Souza Andrade A, de Lima Costa BV. Do Food and Nutrition Public Establishments Influence Availability to Healthy Food in Neighborhood? JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2022.2155095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Larissa Loures Mendes
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mariana Zogbi Jardim
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rafael Moreira Claro
- Department of Nutrition, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fernanda Serra Granado
- Public Health Postgraduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Jun Y, Yifan W, Qiongyin W, Shuo Z, Meizhen W, Huajun F, Jun J, Xiaopeng Q, Yanfeng Z, Ting C. Generation of fruit and vegetable wastes in the farmers' market and its influencing factors: A case study from Hangzhou, China. WASTE MANAGEMENT (NEW YORK, N.Y.) 2022; 154:331-339. [PMID: 36326543 DOI: 10.1016/j.wasman.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/17/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
There remains little understanding of fruit and vegetable wastage and the influencing factors within retail. This study aimed to examine the processes contributing to vegetable and fruit wastage in traditional farmers' markets widely existing in China, Thailand, and South Korea, with the farmers' market in Hangzhou, China used as a case study. Questionnaires and follow-up surveys were conducted with the market stakeholders (market managers, retailers, and market cleaners) from April 2021 to January 2022. The results showed that the categories of discarded fruits and vegetables were related to their sales varieties, with leaf vegetables and bananas constituting the categories of vegetables and fruit with the most daily wastage. Wastage of fruits and vegetables mostly occurred in the morning. However, there was seasonal variation in fruit and vegetable wastage, with wastage in summer exceeding that in winter. The quantity of fruit and vegetable wastage was related to the size of the farmers' market. The volume of sales was also shown to be positively correlated to wastage. The analysis showed that the rank of factors influencing fruit and vegetable sales was: market service community size > appearance of fruits and vegetables > weather > market environment > fruit and vegetable price > fruit and vegetable origin. Finally, most stakeholders were motivated to reduce wastage, with their motivations including ethics, legal requirements, and economic reasons. The results of this study can act as an important reference for improving the management fruit and vegetable waste.
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Affiliation(s)
- Yin Jun
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China
| | - Wang Yifan
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China
| | - Wang Qiongyin
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China
| | - Zhang Shuo
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China
| | - Wang Meizhen
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China
| | - Feng Huajun
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China
| | - Jiang Jun
- Hangzhou Chengtou Asset Management Group Co., Ltd, Hangzhou 310020, China
| | - Qiu Xiaopeng
- Huadong Engineering Corporation Limited of Power China, Hangzhou 311122, China
| | - Zhang Yanfeng
- Beijing Environmental Sanitation Engineering Group Limited, Beijing 100000,China
| | - Chen Ting
- School of Environment Science & Engineering, Zhejiang Gongshang University, Hangzhou 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling , Hangzhou 310012, China; Instrumental Analysis Center of Zhejiang Gongshang University, Hangzhou 310018, China.
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7
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Pedersen AK, Toft U, Bloch P. Three-year follow-up of a multi-component community-driven health promotion intervention in Denmark. Health Promot Int 2022:6565355. [PMID: 35394505 DOI: 10.1093/heapro/daac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The article presents a follow-up study of a multi-component community-driven health promotion intervention in Denmark. The study examines the perceptions and actions of professional stakeholders 3 years after completion of a 19 months intervention period addressing healthy living, well-being and social engagement among families with young children living in three rural communities on the Danish island of Bornholm. The intervention was implemented within the framework of Project Health and Local Community, also referred to as Project SoL. Qualitative in-depth interviews were conducted with diverse professional stakeholders of the project. They represented local government, public institutions, private enterprises, civil society organizations and local mass media. The interviews addressed the extent to which the project had sustained its influence on professional stakeholders' perceptions and actions following project completion. Efforts were made to understand if persisting influences were value-based and/or manifested as concrete community-driven actions. The study showed that the project had succeeded in sustaining a positive long-term post-intervention influence among informants regarding the values and principles of the project. Despite their sustained motivation and preparedness to continue implementing coordinated community-driven actions this was severely hampered by lack of coordination after project completion. Instead, some of the stakeholders continued developing and implementing actions based on the values and principles of the project within the framework of their own professional networks. The article discusses the structural factors that are required to sustain complex community-driven interventions and the need to reconsider the nature of external support to community development from being project-based to integrated, strategic and long term.
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Affiliation(s)
| | - Ulla Toft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
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Salvo D, Lemoine P, Janda KM, Ranjit N, Nielsen A, van den Berg A. Exploring the Impact of Policies to Improve Geographic and Economic Access to Vegetables among Low-Income, Predominantly Latino Urban Residents: An Agent-Based Model. Nutrients 2022; 14:646. [PMID: 35277005 PMCID: PMC8839639 DOI: 10.3390/nu14030646] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 02/05/2023] Open
Abstract
Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)−(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.
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Affiliation(s)
- Deborah Salvo
- Prevention Research Center, Brown School, Washington University in Saint Louis, Saint Louis, MO 63130, USA
| | - Pablo Lemoine
- Centro Nacional de Consultoría, Bogotá 110221, Colombia;
| | - Kathryn M. Janda
- UTHealth School of Public Health, Austin, TX 78701, USA; (K.M.J.); (N.R.); (A.N.); (A.v.d.B.)
| | - Nalini Ranjit
- UTHealth School of Public Health, Austin, TX 78701, USA; (K.M.J.); (N.R.); (A.N.); (A.v.d.B.)
| | - Aida Nielsen
- UTHealth School of Public Health, Austin, TX 78701, USA; (K.M.J.); (N.R.); (A.N.); (A.v.d.B.)
| | - Alexandra van den Berg
- UTHealth School of Public Health, Austin, TX 78701, USA; (K.M.J.); (N.R.); (A.N.); (A.v.d.B.)
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9
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Merino Martinez R, Müller H, Negru S, Ormenisan A, Arroyo Mühr LS, Zhang X, Trier Møller F, Clements MS, Kozlakidis Z, Pimenoff VN, Wilkowski B, Boeckhout M, Öhman H, Chong S, Holzinger A, Lehtinen M, van Veen EB, Bała P, Widschwendter M, Dowling J, Törnroos J, Snyder MP, Dillner J. Human exposome assessment platform. Environ Epidemiol 2021; 5:e182. [PMID: 34909561 PMCID: PMC8663864 DOI: 10.1097/ee9.0000000000000182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/14/2021] [Indexed: 11/26/2022] Open
Abstract
The Human Exposome Assessment Platform (HEAP) is a research resource for the integrated and efficient management and analysis of human exposome data. The project will provide the complete workflow for obtaining exposome actionable knowledge from population-based cohorts. HEAP is a state-of-the-science service composed of computational resources from partner institutions, accessed through a software framework that provides the world's fastest Hadoop platform for data warehousing and applied artificial intelligence (AI). The software, will provide a decision support system for researchers and policymakers. All the data managed and processed by HEAP, together with the analysis pipelines, will be available for future research. In addition, the platform enables adding new data and analysis pipelines. HEAP's final product can be deployed in multiple instances to create a network of shareable and reusable knowledge on the impact of exposures on public health.
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Affiliation(s)
| | | | | | | | | | | | - Frederik Trier Møller
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ville N. Pimenoff
- Karolinska Institutet, Stockholm, Sweden
- Faculty of Medicine, University of Oulu, Oulu, Finland
- Tampere University, Tampere, Finland
| | | | | | - Hanna Öhman
- Faculty of Medicine, University of Oulu, Oulu, Finland
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland
| | - Steven Chong
- Danish National Biobank, Statens Serum Institut, Copenhagen, Denmark
| | | | - Matti Lehtinen
- Karolinska Institutet, Stockholm, Sweden
- Tampere University, Tampere, Finland
| | | | | | - Martin Widschwendter
- Research Institute for Biomedical Aging Research, Universität Innsbruck, Innsbruck, Austria
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10
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Jenneson VL, Pontin F, Greenwood DC, Clarke GP, Morris MA. A systematic review of supermarket automated electronic sales data for population dietary surveillance. Nutr Rev 2021; 80:1711-1722. [PMID: 34757399 PMCID: PMC9086796 DOI: 10.1093/nutrit/nuab089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Context Most dietary assessment methods are limited by self-report biases, how long they take for participants to complete, and cost of time for dietitians to extract content. Electronically recorded, supermarket-obtained transactions are an objective measure of food purchases, with reduced bias and improved timeliness and scale. Objective The use, breadth, context, and utility of electronic purchase records for dietary research is assessed and discussed in this systematic review. Data sources Four electronic databases (MEDLINE, EMBASE, PsycINFO, Global Health) were searched. Included studies used electronically recorded supermarket transactions to investigate the diet of healthy, free-living adults. Data extraction Searches identified 3422 articles, of which 145 full texts were retrieved and 72 met inclusion criteria. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data analysis Purchase records were used in observational studies, policy evaluations, and experimental designs. Nutrition outcomes included dietary patterns, nutrients, and food category sales. Transactions were linked to nutrient data from retailers, commercial data sources, and national food composition databases. Conclusion Electronic sales data have the potential to transform dietary assessment and worldwide understanding of dietary behavior. Validation studies are warranted to understand limits to agreement and extrapolation to individual-level diets. Systematic Review Registration PROSPERO registration no. CRD42018103470
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Affiliation(s)
- Victoria L Jenneson
- V.L. Jenneson, F. Pontin, D.C. Greenwood, and M.A. Morris are with the Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom. V.L. Jenneson, F. Pontin, and G.P. Clarke are with the School of Geography, Faculty of Environment, University of Leeds, Leeds, United Kingdom. D.C. Greenwood and M.A. Morris are with the School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Francesca Pontin
- V.L. Jenneson, F. Pontin, D.C. Greenwood, and M.A. Morris are with the Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom. V.L. Jenneson, F. Pontin, and G.P. Clarke are with the School of Geography, Faculty of Environment, University of Leeds, Leeds, United Kingdom. D.C. Greenwood and M.A. Morris are with the School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Darren C Greenwood
- V.L. Jenneson, F. Pontin, D.C. Greenwood, and M.A. Morris are with the Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom. V.L. Jenneson, F. Pontin, and G.P. Clarke are with the School of Geography, Faculty of Environment, University of Leeds, Leeds, United Kingdom. D.C. Greenwood and M.A. Morris are with the School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Graham P Clarke
- V.L. Jenneson, F. Pontin, D.C. Greenwood, and M.A. Morris are with the Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom. V.L. Jenneson, F. Pontin, and G.P. Clarke are with the School of Geography, Faculty of Environment, University of Leeds, Leeds, United Kingdom. D.C. Greenwood and M.A. Morris are with the School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Michelle A Morris
- V.L. Jenneson, F. Pontin, D.C. Greenwood, and M.A. Morris are with the Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom. V.L. Jenneson, F. Pontin, and G.P. Clarke are with the School of Geography, Faculty of Environment, University of Leeds, Leeds, United Kingdom. D.C. Greenwood and M.A. Morris are with the School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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11
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Vogel C, Crozier S, Penn-Newman D, Ball K, Moon G, Lord J, Cooper C, Baird J. Altering product placement to create a healthier layout in supermarkets: Outcomes on store sales, customer purchasing, and diet in a prospective matched controlled cluster study. PLoS Med 2021; 18:e1003729. [PMID: 34491999 PMCID: PMC8423266 DOI: 10.1371/journal.pmed.1003729] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous product placement trials in supermarkets are limited in scope and outcome data collected. This study assessed the effects on store-level sales, household-level purchasing, and dietary behaviours of a healthier supermarket layout. METHODS AND FINDINGS This is a prospective matched controlled cluster trial with 2 intervention components: (i) new fresh fruit and vegetable sections near store entrances (replacing smaller displays at the back) and frozen vegetables repositioned to the entrance aisle, plus (ii) the removal of confectionery from checkouts and aisle ends opposite. In this pilot study, the intervention was implemented for 6 months in 3 discount supermarkets in England. Three control stores were matched on store sales and customer profiles and neighbourhood deprivation. Women customers aged 18 to 45 years, with loyalty cards, were assigned to the intervention (n = 62) or control group (n = 88) of their primary store. The trial registration number is NCT03518151. Interrupted time series analysis showed that increases in store-level sales of fruits and vegetables were greater in intervention stores than predicted at 3 (1.71 standard deviations (SDs) (95% CI 0.45, 2.96), P = 0.01) and 6 months follow-up (2.42 SDs (0.22, 4.62), P = 0.03), equivalent to approximately 6,170 and approximately 9,820 extra portions per store, per week, respectively. The proportion of purchasing fruits and vegetables per week rose among intervention participants at 3 and 6 months compared to control participants (0.2% versus -3.0%, P = 0.22; 1.7% versus -3.5%, P = 0.05, respectively). Store sales of confectionery were lower in intervention stores than predicted at 3 (-1.05 SDs (-1.98, -0.12), P = 0.03) and 6 months (-1.37 SDs (-2.95, 0.22), P = 0.09), equivalent to approximately 1,359 and approximately 1,575 fewer portions per store, per week, respectively; no differences were observed for confectionery purchasing. Changes in dietary variables were predominantly in the expected direction for health benefit. Intervention implementation was not within control of the research team, and stores could not be randomised. It is a pilot study, and, therefore, not powered to detect an effect. CONCLUSIONS Healthier supermarket layouts can improve the nutrition profile of store sales and likely improve household purchasing and dietary quality. Placing fruits and vegetables near store entrances should be considered alongside policies to limit prominent placement of unhealthy foods. TRIAL REGISTRATION ClinicalTrials.gov NCT03518151 (pre-results).
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Daniel Penn-Newman
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, Wessex Institute, University of Southampton, Southampton, United Kingdom
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
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12
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Eustachio Colombo P, Milner J, Scheelbeek PFD, Taylor A, Parlesak A, Kastner T, Nicholas O, Elinder LS, Dangour AD, Green R. Pathways to "5-a-day": modeling the health impacts and environmental footprints of meeting the target for fruit and vegetable intake in the United Kingdom. Am J Clin Nutr 2021; 114:530-539. [PMID: 33871601 PMCID: PMC8326030 DOI: 10.1093/ajcn/nqab076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/25/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fruit and vegetable consumption in the United Kingdom is currently well below recommended levels, with a significant associated public health burden. The United Kingdom has committed to reducing its carbon emissions to net zero by 2050, and this transition will require shifts towards plant-based diets. OBJECTIVE The aim was to quantify the health effects, environmental footprints, and cost associated with 4 different pathways to meeting the United Kingdom's "5-a-day" recommendation for fruit and vegetable consumption. METHODS Dietary data based on 18,006 food diaries from 4528 individuals participating in the UK National Diet and Nutrition Survey (2012/13-2016/17) constituted the baseline diet. Linear programming was used to model the hypothetical adoption of the 5-a-day (400 g) recommendation, which was assessed according to 4 pathways differing in their prioritization of fruits versus vegetables and UK-produced versus imported varieties. Increases in fruit and vegetable consumption were substituted for consumption of sweet snacks and meat, respectively. Changes in life expectancy were assessed using the IOMLIFET life table model. Greenhouse gas emissions (GHGEs), blue water footprint (WF), and total diet cost were quantified for each 5-a-day diet. RESULTS Achieving the 5-a-day target in the United Kingdom could increase average life expectancy at birth by 7-8 mo and reduce diet-related GHGEs by 6.1 to 12.2 Mt carbon dioxide equivalents/y; blue WFs would change by -0.14 to +0.07 km3/y. Greater reductions in GHGEs were achieved by prioritizing increased vegetable consumption over fruit, whereas the greatest reduction in WF was obtained by prioritizing vegetable varieties produced in the United Kingdom. All consumption pathways increased diet cost (£0.34-£0.46/d). CONCLUSIONS Benefits to both population and environmental health could be expected from consumption pathways that meet the United Kingdom's 5-a-day target for fruit and vegetables. Our analysis identifies cross-sectoral trade-offs and opportunities for national policy to promote fruit and vegetable consumption in the United Kingdom.
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Affiliation(s)
| | - James Milner
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pauline F D Scheelbeek
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Alexandr Parlesak
- Global Nutrition and Health, University College Copenhagen, Copenhagen, Denmark
| | - Thomas Kastner
- Senckenberg Biodiversity and Climate Research Centre, Frankfurt, Germany
| | - Owen Nicholas
- Department of Statistical Science, University College London, London, United Kingdom
| | - Liselotte S Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Alan D Dangour
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rosemary Green
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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13
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Shaw SC, Ntani G, Baird J, Vogel CA. A systematic review of the influences of food store product placement on dietary-related outcomes. Nutr Rev 2021; 78:1030-1045. [PMID: 32483615 PMCID: PMC7666915 DOI: 10.1093/nutrit/nuaa024] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Context Product placement strategies have been used to influence customers’ food purchases in food stores for some time; however, assessment of the evidence that these techniques can limit unhealthy, and promote healthy, food choices has not been completed. Objective This systematic review aimed to determine how product placement strategies, availability, and positioning, in physical retail food stores located in high-income countries, influence dietary-related behaviors. Data Sources From a search of 9 databases, 38 articles, 17 observational studies, and 22 intervention studies met the study inclusion criteria. Data Extraction Two reviewers independently extracted data relating to study design, study population, exposures, outcomes, and key results. Each study was also assessed for risk of bias in relation to the research question. Data Analysis Meta-analysis was not possible owing to heterogeneous study designs and outcomes. As recommended by Cochrane, results were synthesized in effect direction plots using a vote-counting technique which recorded the direction of effect and significance level according to the expected relationship for health improvement. Conclusions The majority of studies showed that greater availability and more prominent positioning of healthy foods, or reduced availability and less prominent positioning of unhealthy foods, related to better dietary-related behaviors. A large number of results, however, were nonsignificant, which likely reflects the methodological difficulties inherent in this research field. Adequately powered intervention studies that test both the independent and additive effects of availability and positioning strategies are needed. Systematic Review Registration PROSPERO registration no. 42016048826
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Affiliation(s)
- Sarah C Shaw
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Georgia Ntani
- UK Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Christina A Vogel
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.,NIHR Southampton Biomedical Research Centre, Faculty of Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Nutrition Interventions in Low-Income Rural and Urban Retail Environments: A Systematic Review. J Acad Nutr Diet 2021; 121:1087-1114. [PMID: 33589382 DOI: 10.1016/j.jand.2020.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/24/2020] [Accepted: 12/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutrition interventions promoting healthy food choices aim to address health challenges of residents in low-income environments. Research about the effectiveness of nutrition interventions in low-income populations is limited, particularly for those in rural areas. Behavioral economics (BE) strategies demonstrate effectiveness for improving eating behaviors in some settings. However, the efficacy of BE interventions in retail food stores serving low-income populations residing in rural and urban geographies is nascent. OBJECTIVE This systematic literature review aims to identify and compare nutrition interventions implemented in rural and urban low-income retail food stores, including BE strategies when applied. METHODS This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviewers searched five databases for peer-reviewed publications from October 2010 to October 2019. Included studies implemented a nutrition intervention in low-income retail food stores and provided a quantitative outcome evaluation with results separated by rural and urban geography. BE interventions were analyzed based on the MINDSPACE framework for behavior change. RESULTS Forty-six separate publications (n = 20 rural, n = 26 urban) in the United States, Canada, Europe, New Zealand, and Australia were included. Researchers independently rated publications as low risk of bias (n = 4), moderate (n = 18), or high risk of bias (n = 24) using the Quality Assessment Tool for Quantitative Studies. Studies (n = 18) demonstrated positive outcomes for customer purchases, store sales, or participant intake of targeted healthy foods. Overall, most effective interventions included point-of-purchase signage (n = 16) and product placement strategies (n = 4 urban). Rural studies included financial incentives combined with participant education (n = 2) and incorporated culturally appropriate messengers and/or symbols (n = 5) to improve healthy food purchases and intake. CONCLUSIONS Improved research quality and tailored evidence-based interventions, including BE strategies, are necessary in retail food environments to promote healthy eating behaviors in low-income populations.
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Mah CL, Luongo G, Hasdell R, Taylor NGA, Lo BK. A Systematic Review of the Effect of Retail Food Environment Interventions on Diet and Health with a Focus on the Enabling Role of Public Policies. Curr Nutr Rep 2020; 8:411-428. [PMID: 31797233 PMCID: PMC6904419 DOI: 10.1007/s13668-019-00295-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose of Review Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks. Recent Findings Of 86 articles (1974–2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the “4Ps” of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. Summary The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.
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Affiliation(s)
- Catherine L Mah
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, PO Box 15000, Halifax, NS, B3H 4R2, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada.
| | - Gabriella Luongo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Toronto, ON, M5T 3M7, Canada
| | - Rebecca Hasdell
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Nathan G A Taylor
- School of Health Administration, Dalhousie University, Sir Charles Tupper Medical Building, 5850 College Street, 2nd Floor, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Brian K Lo
- Division of Nutritional Sciences, Cornell University, 417 Savage Hall, Ithaca, NY, 14850, USA
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Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010065. [PMID: 31861788 PMCID: PMC6981808 DOI: 10.3390/ijerph17010065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.
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17
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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18
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Ejlerskov KT, Sharp SJ, Stead M, Adamson AJ, White M, Adams J. Supermarket policies on less-healthy food at checkouts: Natural experimental evaluation using interrupted time series analyses of purchases. PLoS Med 2018; 15:e1002712. [PMID: 30562349 PMCID: PMC6298641 DOI: 10.1371/journal.pmed.1002712] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In response to public concerns and campaigns, some United Kingdom supermarkets have implemented policies to reduce less-healthy food at checkouts. We explored the effects of these policies on purchases of less-healthy foods commonly displayed at checkouts. METHODS AND FINDINGS We used a natural experimental design and two data sources providing complementary and unique information. We analysed data on purchases of small packages of common, less-healthy, checkout foods (sugary confectionary, chocolate, and potato crisps) from 2013 to 2017 from nine UK supermarkets (Aldi, Asda, Co-op, Lidl, M&S, Morrisons, Sainsbury's, Tesco, and Waitrose). Six supermarkets implemented a checkout food policy between 2013 and 2017 and were considered intervention stores; the remainder were comparators. Firstly, we studied the longitudinal association between implementation of checkout policies and purchases taken home. We used data from a large (n ≈ 30,000) household purchase panel of food brought home to conduct controlled interrupted time series analyses of purchases of less-healthy common checkout foods from 12 months before to 12 months after implementation. We conducted separate analyses for each intervention supermarket, using others as comparators. We synthesised results across supermarkets using random effects meta-analyses. Implementation of a checkout food policy was associated with an immediate reduction in four-weekly purchases of common checkout foods of 157,000 (72,700-242,800) packages per percentage market share-equivalent to a 17.3% reduction. This decrease was sustained at 1 year with 185,100 (121,700-248,500) fewer packages purchased per 4 weeks per percentage market share-equivalent to a 15.5% reduction. The immediate, but not sustained, effect was robust to sensitivity analysis. Secondly, we studied the cross-sectional association between checkout food policies and purchases eaten without being taken home. We used data from a smaller (n ≈ 7,500) individual purchase panel of food bought and eaten 'on the go'. We conducted cross-sectional analyses comparing purchases of common checkout foods in 2016-2017 from supermarkets with and without checkout food policies. There were 76.4% (95% confidence interval 48.6%-89.1%) fewer annual purchases of less-healthy common checkout foods from supermarkets with versus without checkout food policies. The main limitations of the study are that we do not know where in the store purchases were selected and cannot determine the effect of changes in purchases on consumption. Other interventions may also have been responsible for the results seen. CONCLUSIONS There is a potential impact of checkout food polices on purchases. Voluntary supermarket-led activities may have public health benefits.
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Affiliation(s)
- Katrine T. Ejlerskov
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Stephen J. Sharp
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Martine Stead
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
| | - Ashley J. Adamson
- Institute of Health & Society and the Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Martin White
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Jean Adams
- Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Mikkelsen BE, Bloch P, Reinbach HC, Buch-Andersen T, Lawaetz Winkler L, Toft U, Glümer C, Jensen BB, Aagaard-Hansen J. Project SoL-A Community-Based, Multi-Component Health Promotion Intervention to Improve Healthy Eating and Physical Activity Practices among Danish Families with Young Children Part 2: Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1513. [PMID: 30021938 PMCID: PMC6069463 DOI: 10.3390/ijerph15071513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/30/2018] [Accepted: 07/03/2018] [Indexed: 12/15/2022]
Abstract
Project SoL is implemented over a period of four years with the aim to promote healthy eating and physical activity among children aged 3⁻8 years by targeting the families in a Danish municipality based on the multi-component, supersetting strategy. Interventions are implemented in childcare centres, schools and supermarkets in three local communities as well as in local mass media and social media during a 19 months period in the Municipality of Bornholm. The matching Municipality of Odsherred serves as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper gives an account of the design used for the summative and formative evaluation based on a realistic evaluation and a mixed methods approach combining qualitative and quantitative methods. Summative studies are conducted on changes of health behaviours among the involved families and within the municipalities in general, changes in community awareness of the project, changes in purchase patterns, changes in overweight and obesity among the targeted children and changes in knowledge and preferences among children due to sensory education workshops. The formative research comprises studies on children's perceptions of health, perceptions of staff at supermarkets and media professionals on their roles in supporting the health promotion agenda, and motivations and barriers of community stakeholders to engage in health promotion at community level. The paper discusses operational issues and lessons learnt related to studying complex community interventions, cross-disciplinarily, interfaces between practice and research and research capacity strengthening; and suggests areas for future research. The development and implementation of the intervention and its theoretical foundation is described in a separate paper.
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Affiliation(s)
- Bent Egberg Mikkelsen
- Department of Learning and Philosophy, Aalborg University, Copenhagen DK-2450, Denmark.
| | - Paul Bloch
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.
| | | | - Tine Buch-Andersen
- Department of Development and Planning, Aalborg University, Copenhagen DK-2450, Denmark.
| | - Lise Lawaetz Winkler
- Research Centre for Prevention and Health, Capital Region, Glostrup DK-2600, Denmark.
| | - Ulla Toft
- Research Centre for Prevention and Health, Capital Region, Glostrup DK-2600, Denmark.
| | - Charlotte Glümer
- Research Centre for Prevention and Health, Capital Region, Glostrup DK-2600, Denmark.
| | - Bjarne Bruun Jensen
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.
| | - Jens Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Health Promotion, Niels Steensens Vej 6, DK-2820 Gentofte, Denmark.
- MRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg ZA-2000, South Africa.
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