Choosing healthier foods in recreational sports settings: a mixed methods investigation of the impact of nudging and an economic incentive

Changing the food environment in secondary school canteens to promote healthy dietary choices: a qualitative study with school caterers

BACKGROUND

Typical adolescent diets do not meet current dietary recommendations. There is a need to address these dietary patterns to reduce the risk of obesity and other diet-related diseases. Schools provide an opportune setting to do so, as students consume a substantial proportion of their daily dietary intake whilst at school. There is a developing evidence base on the use of choice architecture (food choice cues) to promote healthy eating in school contexts. It is necessary to understand the acceptability and feasibility of implementing such interventions. We aimed to explore these factors from the perspectives of secondary school caterers.

METHODS

We conducted qualitative interviews with caterers from secondary schools across the West Midlands, UK and national/regional catering representatives. A semi-structured topic guide and visual aid were used to guide interviews. Interviews were recorded and transcribed. Framework analysis was conducted in NVivo v12.

RESULTS

Twelve participants took part. Seven themes were identified and grouped into three categories: Acceptability (Suitability; Salient cues; Student engagement), Barriers (Catering decision drivers; Limits of influence), and Enablers (Perceived role; Opportunities). Caterers considered healthy food cues to be suited to adolescents as they require minimal reflective motivation. Salient cues included enhancing the placement, presentation and portability of healthy items, improving the dining environment and focusing pricing/incentive strategies on increased quantity. Student engagement was considered important. Some catering decision drivers conflicted with healthy food cues, and many felt that their role in healthy eating was limited due to the overwhelming influence of external food environments, adolescent resistance, and features of the secondary school canteen setting e.g. short duration of lunchtime, lack of space. However, caterers appeared motivated to implement healthy food cues and identified key opportunities for implementation, including integration into whole-school approaches to healthy eating.

CONCLUSIONS

Interventions using healthy food cues appeared acceptable to secondary school caterers, key potential implementers of these strategies. Future interventions could incorporate strategies relating to placement, presentation and pricing to prompt healthy selections, and actions to engage the student body and improve the dining environment. Evaluations should consider potential impacts upon food purchasing, consumption and waste to address caterers' concerns about these issues.

Examining school nutrition policies and their effect on the promotion of low-nutrient foods in the context of sports advertising

OBJECTIVES

Despite recommendations to implement nutrition standards in schools, low-nutrient foods and high-energy drinks are still some of the most important challenges for school management and students' purchasing and consumption behavior. In this regard, the aim of the present study is to examine school nutrition policies and their effect on the promotion of low-nutrient foods in the context of sports advertising.

METHODS

A partial least square technique with SmartPLS 3.0 and bootstrapping with 500 resamples was used to examine the effect of food marketing on school nutrition policies and students' nutritional involvement. Online surveys were done through The Iranian Educational Network of students and measured on a 5-point Likert scale. The survey questionnaire consisted of 3 scales to measure the following: school nutrition policies, advertising of low-nutrient foods, and student nutritional involvement.

RESULTS

Results from a sample of 382 Iranian high school students revealed that low-nutrient food advertising has a significant effect on student consumption, and the greatest overall effect on students' nutritional involvement. School nutrition policies were affected by media, endorsement, and the environmental advertising, whereas school financial capabilities had the greatest direct effect on students' nutritional involvement.

CONCLUSIONS

These findings suggest that advertising through sports media plays a mediating role in school nutrition policies and student nutritional involvement. Policy changes to restrict food marketing for young people must include both television and non-broadcast media.

Nutrition Environment Gaps and Distribution Challenges in Rural Food Pantries During the COVID-19 Pandemic: A Mixed-Methods Study

BACKGROUND

Food insecurity disproportionately affects low-income, racially marginalized, and rural communities. The COVID-19 pandemic led to higher demand for emergency food distribution, potentially impacting food pantry operations and services. Limited research exists assessing consumer nutrition environments of pantries in rural regions.

OBJECTIVES

To assess the consumer nutrition environment of rural food pantries and report challenges and adaptations encountered during the pandemic.

DESIGN

A mixed-methods, cross-sectional survey.

PARTICIPANTS/SETTING

Nineteen food pantry representatives from California's San Joaquin Valley were surveyed between August 2020 and June 2021. Representatives were eligible if their pantry served the general population and was open at least once a week. Nine were church-based pantries, and 10 were from other settings.

MAIN OUTCOME MEASURES

The Nutrition Environment Food Pantry Assessment Tool (NEFPAT) measured the nutrition food environment and scored pantries as bronze (0-15), silver (16-31), or gold (32-47) categories. Eleven items were developed to explore pandemic-related challenges.

STATISTICAL ANALYSES PERFORMED

Independent χ2 tests assessed the relationship between the organization type and NEFPAT scores and food supply sources. Fisher's exact test explored associations between food pantry type, NEFPAT category, and challenges. Nonparametric tests were run on non-normally distributed data. Inductive content analysis was used to examine open-ended pandemic-related questions.

RESULTS

The nutrition environment of most pantries was suboptimal, because no pantry scored in the "gold" category based on total NEFPAT scores (median, 18 of 47). No statistically significant differences were found in the NEFPAT scores by organization type. Most pantries did not provide healthy food nudges or culturally diverse foods. Key COVID-19 challenges encountered consisted of supply- and demand-side issues, including reduced personnel, capacity, and resources, and increased client quantity and demand for food.

CONCLUSIONS

Assessing the nutrition environment of rural food pantries revealed gaps and strategies for improvement, including the use of healthy nudges and increasing the availability of culturally diverse foods.

Using coupons to encourage healthier child snack purchases in corner stores: results from the CHOMPS study

Objectives

To examine youths' (ages 6-15 years) autonomous snack purchases in corner stores and pilot use of coupons to encourage more healthful snack purchases.

Methods

This pilot study involved four corner stores proximal to K-8 schools in Massachusetts. Kids-only coupons of varying discounts were provided in store and paired with simple visual and verbal economic and health messages. Observational data about youths' autonomous snack purchases was recorded pre- and post-intervention. Outcomes of interest were snack item, price, and nutrient content. Comparisons of purchase characteristics and nutritional content across intervention conditions were made using Chi-squared and t-tests.

Results

Across all stores, 2,973 purchase observations were recorded totaling approximately $6,000. Researchers estimated that about 55% of shoppers were 10-12 years old. Modest coupon usage (2.2% of purchases) was noted. However, candy purchases decreased, and the percentage of purchase events that included at least one healthier food item more than doubled, regardless of coupon use. Improvements in the nutritional content of snacks were also observed.

Conclusion

Kids-only coupons have the potential to assist with shifting autonomous snack purchase behavior in outside of school settings.

A national nudge study of differently framed messages to increase COVID-19 vaccine uptake in Saudi Arabia: A randomized controlled trial

Background

During the COVID-19 pandemic, Saudi Arabia witnessed hesitancy from a proportion of the population toward taking the vaccine; thus, it was necessary to nudge them to uptake it. This study was conducted to assess the impact of using different types of messages to nudge the public to increase the proportion of vaccinated individuals.

Methods

This study is a multi-arm randomized controlled trial aiming to assess the efficacy of using differently framed messages that appear as pop-notifications in Sehatty application. Of those who preregistered to receive a COVID-19 vaccine but didn't take it according to the Saudi national vaccine registry (n = 1,291,686), 12,000 individuals were randomly recruited and randomly assigned to one of five intervention groups (commitment, loss aversion, salience, social norms, and ego) or a control group. To ensure the exposure occurred in the intervention groups, we included only those who received the notification, which was confirmed by checking the information technology system. We used the Chi-square test to compare each intervention group against the control group separately. Also, we used the same test to investigate whether sex and age influenced the percentage of booked appointments in the intervention groups.

Results

Social norms, ego, salience and loss aversion groups had higher percentages of booked appointments when compared to the control group (21.0%, p = 0.001; 19.1%, p = 0.011; 19.0%, p = 0.013; 18.4%, p = 0.034, respectively). Moreover, when combining the intervention groups, the percentage was higher than the control group (p < 0.001). The percentages of booked appointments made by Young adults (18-35 years old) were higher than that of adults over 35 years old in the social norms (22.6%, p = 0.016) and ego groups (21.0%, p = 0.010). At the same time, sex didn't affect the percentages of booked appointments in any group.

Conclusion

Using different framings of messages to nudge the public to take vaccines can help increase the percentage of immunized individuals in a community. Nudges can boost the public health of a population during an unusual spread of vaccine-preventable diseases. Findings might also inspire governmental responses to other public health situations.

The unhealthy-tasty intuition in dining out situations: the role of health inferences and taste expectations

Introduction

Increasing obesity rates around the globe have challenged policymakers to find strategies to prompt healthier eating habits. While unhealthy eating takes place in many different contexts, dining out is a context where individuals often choose an unhealthy option despite the availability of healthier alternatives. One possible explanation for this behavior is the unhealthy-tasty intuition, which refers to the belief that unhealthy food is tastier than healthy food. Nevertheless, many policymakers and restaurant managers follow the - in this context - counterintuitive approach of using health claims to nudge people towards more healthy eating choices or habits.

Methods

The current research employs an online experiment with 137 participants and investigates how health claims and sensory claims impact on the purchase intention of healthy options for desserts. Furthermore, it explores how health inferences and taste expectations mediate the intention to purchase.

Results and discussion

Findings from the online experiment confirm that health claims prompt positive health inferences, while also stimulating unfavorable taste expectations, resulting in a lower intention to purchase. Surprisingly, we found no effect of a sensory claim on taste expectations. The findings of our experiment contradict the unhealthy-tasty intuition by revealing a significant positive correlation between taste expectations and health inferences. While both health inferences and taste expectations impact positively on purchasing intentions for the health-claim condition, the indirect effect of taste expectations was stronger than the indirect effect of health inferences.

Effect of a relative pricing intervention and active merchandising on snack purchases: interrupted time series analysis of a hospital retailer-led strategy

BACKGROUND

Pricing policies have been shown to be an effective lever for promoting healthier dietary choices in consumer food environments. It is not yet well understood how pricing can be used to encourage healthier substitute purchases. The aim of the study was to assess the effect of a retailer-led relative pricing intervention on weekly purchases of targeted snack foods and beverages.

METHODS

This was an ecological analysis in a real-world large tertiary hospital consumer food environment setting in urban Canada, comprised of four retail outlets: two large cafeterias, one smaller cafeteria, and one grab-and-go café. An interrupted time series analysis was designed to evaluate the effect of Snacking Made Simple, a retailer-led relative pricing intervention applied to 10 popular snack foods and beverages (n = 87 weeks, 66 weeks baseline and 21 weeks intervention, April 2018 to December 2019), on weekly purchase differences between healthier and less healthy targeted items, adjusted for weekly sales volume. Five healthier items were price discounted, alongside a price increase for five less healthy items. The intervention was actively merchandised in keeping with behaviour change theory.

RESULTS

Weekly purchases of targeted snacks became healthier during the intervention period (β = 21.41, p = 0.0024). This followed a baseline period during which weekly purchases of less healthy targeted snacks had outpaced over time those of healthier targeted snacks (β = -11.02, p = 3.68E-14). We estimated that, all else being equal, a hypothetical 9.43 additional weeks of the intervention would be required to transition to net-healthier targeted snack purchases in this environment. The effects of the intervention varied by retail outlet, and the outcome appears driven by specific food items; further, examining merchandising implementation, we posited whether direct versus indirect substitution may have affected purchasing outcomes.

CONCLUSIONS

Relative pricing may be a promising way to incentivize healthier substitute purchasing in the consumer food environment. Added attention to merchandising strategy as well as value-add factors within food categories and their effects on price salience may be an important factor in effective intervention design.

Nudging low-medium income mothers towards healthy child options in an online restaurant scenario

Helping mothers make the healthiest choices for their children when eating out can contribute to preventing the prevalence of childhood overweight and obesity, particularly in economically disadvantaged classes. Herein, we tested whether two different nudges (a default option and a social norm prompt) could guide low- and middle-income mothers towards healthier children's menu choices in a fictive restaurant setting and investigated the drivers of healthy child menu selection. A cross-sectional online survey was performed among 809 Italian mothers with children aged between 3 and 12 years, and a between-subjects design (control, nudge 1, and nudge 2) was applied. The findings revealed that both nudges had no significant effect on the number of healthy menu selections compared with the healthy choices made in the control condition. Furthermore, considering the entire sample, the results show that certain characteristics of a mother (e.g., authoritative parenting style) and child (younger age) duo increase the likelihood of the former selecting a healthy children's menu. Similarly, a positive correlation between the likelihood of choosing a healthy children's menu and the mother's involvement in the child's nutrition (meal preparation and weekly diet) was observed.

Children's Access to Non-School Destinations by Active or Independent Travel: A Scoping Review

BACKGROUND

Children's access to non-school destinations is important for their well-being, but this has been overlooked in transport planning. Research on children's access to non-school destinations is growing, and there is a need for a comprehensive overview, examining both quantitative and qualitative studies, of the existing evidence on places that children access by active or independent travel.

OBJECTIVES

Identify and summarize quantitative and qualitative research on the topic of active or independent travel to non-school destinations for elementary aged children (6 to 13 years old).

METHODS

Papers published in English between 1980 and July 2021 were sourced from: (i) Web of Science Core Collection; (ii) PubMed; and (iii) APA PsycInfo. Three relevant journals related to children and transport were hand searched: (i) Children's Geographies; (ii) Journal of Transport & Health; and (iii) Journal of Transport Geography. The search was limited to peer-reviewed articles published in English between 1980 and July 2021. Covidence, an online software platform for systematic reviews, was used to organize articles during the title and abstract screening stage. PRISMA-Scr is applied for reporting.

RESULTS

27 papers were retained from an initial 1293 identified peer-reviewed articles. The results reveal that children in different geographies travel unsupervised or by active modes to places that support different domains of their well-being such as a friend or relative's home, local parks or green spaces, recreational facilities, and different retail locations (e.g., restaurants). There is evidence that children's ability to reach certain places is constrained, likely due to safety concerns or environmental barriers.

CONCLUSIONS

Research on children's diverse destinations is relatively limited as compared to trips to school. Various methodologies have been applied and can be combined to completement each other such as objective GPS tracking and subjective surveys on places children would go if they were available. Future research should clearly report and discuss the non-school destinations that children access to better inform transport planning and policy for all aspects of children's lives.

Implementation and sales impact of a capacity building intervention in Australian sporting facility food outlets: a longitudinal observational study

Background

Few studies have explored behavioural and financial impacts of retail initiatives after 2 years to address the unhealthy food environments common in local government sporting settings.

Aims

To evaluate the impact of a 2-year local government capacity building intervention in sporting facility food outlets on (1) the healthiness of refrigerated drink choices available and visible to customers, (2) healthiness of refrigerated drinks sold and (3) refrigerated drink revenue.

Methods

52 sporting facilities within 8 local governments from Victoria, Australia, participated in an intervention between March 2018 and February 2020 by limiting 'red' (least healthy) drinks to ≤20% of refrigerator display and increasing 'green' (healthiest) drinks to ≥50% of display. Mixed models assessed changes in mean percentage of 'red', 'amber' and 'green' drinks displayed over time, compared with baseline.Facilities provided electronic weekly itemised sales data (December 2015 to February 2020). Weekly volume of 'red' or 'green' drinks sold as a proportion of total drinks sold, and total refrigerated drinks revenue were compared preimplementation and postimplementation using mixed models (seasonal facilities), and mixed-effect interrupted time series models (non-seasonal facilities).

Results

Display of 'red' drinks decreased by mean -17.1 percentage points (pp) (95% CI -23.9 to -10.3) and 'green' drinks increased 16.1 pp (95% CI 9.30, 22.9) between baseline and 18-month audits.At nine seasonal facilities, compared with the summer preimplementation, the mean volume of 'red' drinks sold decreased by -19.0 pp (95% CI -28.6, to -9.51) and refrigerated drink revenue decreased by-AU$81.8 (95% CI -AU$123 to -AU$40.8) per week. At 15 non-seasonal facilities, by February 2020, the volume of 'red' drinks sold decreased on average by -11.0 pp (95% CI -21.6 to -0.41) with no change in drink revenue.

Conclusion

Reducing the display of unhealthy drinks can be an effective public health policy to improve the healthiness of customer purchases, provided there is consideration of potential impacts on revenue.

A need for multi-sector and multi-pronged solutions to address the many barriers inhibiting change from unhealthy food environments in publicly funded recreation facilities: a mixed-method study

Public recreation facilities are preferred gathering places for families to participate in physical, social, intellectual, and creative pursuits, and the importance of food environments in these facilities is gaining recognition. Evidence from other Canadian jurisdictions describes such food environments as unsupportive of health, which contradicts national recreation priorities to have healthy choices as the easy choices. This study aimed to characterize food environments in a convenient sample of Saskatchewan public recreation facilities. A convergent/parallel mixed methods study design used quantitative methods to determine the healthfulness of concession stands and vending machines and qualitative methods to examine barriers and facilitators to healthy eating at facilitates. Results found that 5% of concession main dishes were defined as healthy and packaged foods/beverages in concession stands and vending machines were defined as Offer Most Often 6% and 8% of the time, respectively, according to Saskatchewan Nutrition Standards. Reported barriers to healthy eating were more than twice as prevalent as facilitators. To align with population health recommendations in Saskatchewan, food environments in public recreation facilities require immediate attention. Results and recommendations can be used to build collective action to address the problem and as a benchmark to measure change. Novelty Bullets • Only 5% of concession main dishes were defined as healthy. • Only 6% of packaged foods and beverages in concessions, and 8% in vending, were defined as Offer Most Often. • Reported barriers to healthy eating were more than twice as prevalent as facilitators, resulting in a current state that is difficult to change.

An Educational Intervention for Improving the Snacks and Beverages Brought to Youth Sports in the USA

OBJECTIVES

The purpose of this study was to test a small-scale intervention and its ability to decrease total sugar intake and number of calories offered at youth sports games.

METHODS

This study was a pre/post-test quasi-experimental design. A flier was developed and distributed to parents. The flier aimed to decrease the sugar-sweetened beverages and increase the nutritional quality of food brought to games. Baseline data were collected in 2018 (n = 61). The flier was distributed prior to the start of the league, once during the league, and posted online in 2019. Postintervention data were collected in the intervention group (n = 122) and a comparison group (n = 74). Nutritional information was collected through direct observation.

RESULTS

The average amount of total sugar provided per game per child was 25.5 g at baseline when snacks/beverages were provided at games. After the intervention, the average amount of total sugar provided significantly decreased (16.7 g/game/child, p < 0.001).

CONCLUSIONS

The intervention reduced total sugar offered and the number of sugar-sweetened beverages brought to games. It was low-cost and could be easily implemented by public health practitioners and/or parks and recreation administrators. Further, considerations could be made to implement policies relative to snacks and beverages at youth sports games.

Impact of a Capacity-Building Intervention on Food Marketing Features in Recreation Facilities

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.

Implementing a healthy food retail policy: a mixed-methods investigation of change in stakeholders' perspectives over time

OBJECTIVES

To investigate (i) changes in stakeholder commitment and (ii) perceptions of the purpose, challenges and benefits of healthy food and beverage provision in community sports settings during the stepwise implementation of a healthy beverage policy.

DESIGN

Convergent, parallel, mixed-methods design complemented (i) repeat semi-structured interviews with council stakeholders (n 17 interviews, n 6 interviewees), with (ii) repeat quantitative stakeholder surveys measuring Commitment to Organisational Change; (iii) weekly sales data examining health behaviour and revenue effects (15 months pre-intervention; 14 months post-intervention); (iv) customer exit surveys (n 458); and (v) periodic photographic audits of beverage availability. Interviews were analysed inductively. Stakeholder surveys, sales data, customer surveys and audits were analysed descriptively.

SETTING

Four local government-owned sports and recreation centres in Melbourne, Australia, completed a 3-month trial to increase the availability of healthy beverages and decrease the availability of unhealthy beverages in food outlets.

PARTICIPANTS

Interviews were conducted with council managers and those involved in implementation (September 2016-October 2017). Customers were surveyed (September-October 2017).

RESULTS

Interviews and surveys indicated that stakeholders' commitment to policies varied such that, over time, optimism that changing beverage availability could increase the healthiness of customers' purchases became more widespread among interviewees. Stakeholder focus generally progressed from anticipatory concern to solutions-focused discussions. Sales, audit and customer survey data supported interview findings.

CONCLUSIONS

We found a general increase in optimism regarding policy outcomes over time during the implementation of a healthy beverage policy. Stepwise trials should be further explored as an engagement tool within community retail settings.

Examining taste testing and point-of-purchase prompting as strategies to promote healthier food selection from food trucks

OBJECTIVE

To examine the feasibility of taste testing and point-of-purchase prompting to promote healthier food choices at a food truck event.

DESIGN

A pre-/post-study was conducted where food trucks provided samples of healthy food items to patrons and implemented point-of-purchase prompting (promotional signage; verbal cues). Implementation fidelity, acceptability and initial effectiveness were assessed via observation, patron surveys and sales data. A linear mixed model with a random effect for subject (food truck) and fixed effect for time point (baseline, intervention and post-intervention) was used to assess changes in relative sales of promoted healthy items as a percentage of food items sold.

SETTING

Weekly food truck event in Buffalo, New York.

PARTICIPANTS

Seven food trucks; 179 patrons.

RESULTS

Implementation fidelity data illustrated that all food trucks complied with manualised procedures. Approximately one-third of surveyed patrons accepted a healthy sample, with the majority rating the sample positively. There was no main effect of time when examining changes in relative sales of promoted healthy items across all periods (P = 0·32); however, effect sizes representing changes between individual time points are consistent with an increase from baseline to intervention (d = 0·51), which was maintained through post-intervention (d = 0·03). The change from baseline to post-intervention corresponded to a medium effect size (d = 0·55).

CONCLUSIONS

Findings generally support the feasibility of implementing taste testing and point-of-purchase prompting to increase the selection of healthy food items from food trucks; implications for future research in this novel setting are discussed.

Improving Cardiovascular Health through Nudging Healthier Food Choices: A Systematic Review

Obesity and metabolic syndrome are considered major public health problems, and their negative impact on cardiovascular disease (CVD) and diabetes mellitus type 2 (DM2) is profound. Targeting modifiable risk factors such as dietary habits is therefore of great importance. Many of today’s health challenges with overweight and obesity may have behavioral roots, and traditional methods such as regulations and campaigns are often insufficient to improve dietary choices. Nudging or choice architecture might be a viable tool to influence people’s everyday choices and behaviors to better outcomes. This paper reviews the current state of the rapidly expanding number of experimental field studies that investigate the effects/associations of nudging on healthy food choices. A systematic literature search was conducted in PubMed, where 142 citations were identified. Based on selection criteria, six randomized controlled trials and 15 non-randomized controlled trials were ultimately included. The results of this systematic review show that many of the studies included traffic-light labeling, which may be a promising strategy. The reviewed findings, however, also highlight the challenges that confront experimental studies examining the impact of nudging on diet.

Investigating business outcomes of healthy food retail strategies: A systematic scoping review

Large changes to food retail settings are required to improve population diet. However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strategy evaluations. Peer-reviewed and grey literature were searched. We identified qualitative or quantitative real-world food or beverage retail strategies designed to improve the healthiness of the consumer nutrition environment (eg, changes to the "marketing mix" of product, price, promotion, and/or placement). Eligible studies reported store- or chain-level outcomes for measures of commercial viability, retailer perspectives, customer perspectives, and/or community outcomes. 11 682 titles and abstracts were screened with 107 studies included for review from 15 countries. Overall item sales, revenue, store patronage, and customer level of satisfaction with strategy were the most frequently examined outcomes. There was a large heterogeneity in outcome measures reported and in favourability for retailers of outcomes across studies. We recommend more consistent reporting of business outcomes and increased development and use of validated and reliable measurement tools. This may help generate more robust research evidence to aid retailers and policymakers to select feasible and sustainable healthy food retail strategies to benefit population health within and across countries.

The effect of nudges aligned with the renewed Flemish Food Triangle on the purchase of fresh fruits: An on-campus restaurant experiment

OBJECTIVE

This study examined the effect of nudges, inspired by the recently renewed Flemish Food Triangle, on fruit sales in a Belgian on-campus university restaurant.

METHODS

In this mixed-method real-life experiment, nudges were added weekly over a period of four consecutive weeks: placement of (1) Food Triangle posters in the restaurant, (2) 'green heart' icons above the fruit stands, and (3) substitution and (4) social norm messages at the fruit stands. During baseline (no intervention) and all intervention weeks, dessert sales were registered. Short interviews were used to ask customers about their perceptions regarding the intervention. Follow-up measurements (7 and 30 weeks later) evaluated the longer-term effectiveness, while all nudges remained in place. Dessert sales were analyzed separately for both sexes, students and staff categories (based on academic degree).

RESULTS

Compared to baseline, the combination of the Food Triangle and the green heart intervention materials in week 2 resulted in significant increases in fruit consumption across almost all subgroups. The other intervention materials used in the current study had rather limited effects in the short term. After 7 weeks of follow-up, significant fruit sale increases were established for all subgroups compared to baseline. At 30 weeks follow-up, the effect for staff B (Bachelor's degree) disappeared. The majority of the respondents (66.4%) had noticed at least one of the nudges, while only 3.4% indicated to have adjusted their dessert choice as a result of the nudges.

CONCLUSIONS

The combination of nudges was effective in the long term and increased fruit purchase in nearly all subgroups. Short interviews show that a more active approach may be needed to increase effect sizes.

Recreational Centres' Facilities and Activities to Support Healthy Ageing in Singapore

Objective: This study examined the physical and social environment (facilities and activities) of Singapore’s Recreational Centres (RCs) and female patrons’ (>50 years) perception of the RC facilities and activities. Materials and Methods: A total of 100 RCs were audited, and 22 face-to-face interviews were undertaken. Results: Physical activity classes were the main activity offered (mean = eight classes per month), with walking (29.8%) and aerobics sessions (17.5%) being the most frequent. Nutrition classes and social activities were offered less often (mean = one class per month). The activities were well received by patrons, offering opportunities to interact while participating in physical activity and nutrition classes. However, the need for staff training, consideration of patron’s abilities and the desire to engage in alternative activities were expressed. Conclusion: Overall, RCs’ facilities and activities were well liked by the patrons but opportunities for improvements were identified. Regular reviews of facilities and activities through consultation with the RC patrons and managers are needed to ensure that the facilities and activities remain relevant and practical to the patrons. This will help to support active lifestyles and healthy eating practices among older adults residing within the community.

Nudging to get our food choices on a sustainable track

Food production is one of the major contributors to environmental damage. Adaptations in our food choices are needed to preserve resources for the needs of future generations. More sustainable consumption patterns have been encouraged by economic incentives, laws, education and communication campaigns. Nonetheless, consumers still find difficulties in trying to change their current food habits. This review takes a behavioural approach in encouraging sustainable food choices among consumers. From a nudging perspective, many behavioural changes can be encouraged in a non-obtrusive way by adapting the complex food environment in which consumers are operating. These interventions do not restrict consumers' choices but rather adapt the choice architecture wherein food decisions are made. Drawing on the literature from diverse theoretical perspectives, we provide an overview of the application of nudging for more sustainable food choices and highlight where more research is needed. More specifically, we discuss research that used nudging to engender cognitive impact (i.e. the use of labels or visibility enhancements), affective responses (i.e. sensorial and social influence cues) and behavioural effects (i.e. adjustments in convenience and product size). We conclude that this review only shows the tip of the iceberg of the research on nudging and sustainable consumption that is likely forthcoming in the next few years, following the successes of nudging applications in other domains. Nonetheless, each individual nudging intervention requires careful examination. Personal predispositions towards the environment should be considered when designing interventions, demonstrating the complementarity of nudging with education on sustainable consumption.

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

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.

A cross-sectional description of mobile food vendors and the foods they serve: potential partners in delivering healthier food-away-from-home choices

Background

Food away from home (FAFH) in the US is associated with adverse health outcomes, and food dollars spent on FAFH continues to increase. FAFH studies have typically focused on restaurants and carryout establishments, but mobile food vendors – popularly known in the US as food trucks – have become more numerous and are an understudied segment of FAFH. The objective of this study was to assess mobile food vendors, their attitudes toward health and nutrition, and the foods they serve.

Methods

This was a cross-sectional study of 41 mobile food vendors in Michigan, US. The survey contained questions about food and nutrition attitudes, such as barriers to putting healthy items on menus and perceived agreement with healthy food preparation practices. Participants were classified into a healthy and a less healthy attitude group based on whether they believed healthy menu items could be successful or not. In addition, participant menus were collected and analyzed according to whether menu items were healthy, moderately healthy, or unhealthy. Descriptive, univariate, and bivariate analyses were conducted.

Results

Two-thirds of the participants felt that healthy menu items could be successful, and yet taste and value were the most important menu item success factors, each rated as important by 100% of the participants. Low consumer demand was the biggest barrier to putting healthy items on the menu (76%) whereas lack of chef interest (29%) and need for special training (24%) were the smallest. 72% of the vendors offered at least one healthy menu item, but only 20% of all reviewed menu items were healthy overall. There was no difference in the proportion of menu items that were healthy when comparing those with healthy attitudes (23% of menu items healthy) to those less healthy attitudes (17% of menu items healthy, p = 0.349).

Conclusions

Mobile food vendors had positive views about putting healthy items on menus. However, a low proportion of menu items were classified as healthy. This suggests that mobile food vendors are promising potential public health partners in improving the health profile of FAFH, but that education of vendors is needed to ensure the success of healthier items.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7075-8) contains supplementary material, which is available to authorized users.

Australia's sugar tale

OBJECTIVE

To establish high intake of free sugars and its related disease burden as a significant public health challenge in Australia.

DESIGN

We discuss five key actions to reduce intake of free sugars tailored to the Australian context. These strategies are informed by reviewing the global scientific evidence on the effectiveness of a range of policy responses to reduce intake of free sugars at the population level.

SETTING

Australia.

PARTICIPANTS

Australian population.

RESULTS

The five key actions to reduce population levels for intake of free sugars tailored to the Australian context include prioritising health in trade agreements and policy; introducing a fiscal policy supporting health and promoting food reformulation; regulating advertising and improving labelling; strengthening the current dietary guidelines; and encouraging healthy choices.

CONCLUSIONS

The adoption and implementation of the strategies discussed in the current commentary would aid in tackling the rising health burden from the intake of free sugars in Australia.

Default-name and tasting nudges increase salsify soup choice without increasing overall soup choice

Nudging is a popular behavior change technique but the conditions for its effectiveness have not been researched extensively. The current study aimed to test whether the effectiveness of nudging is limited to certain characteristics of the nudged product by focusing on a specific product (salsify soup) within a broader category (soups). Two parallel studies were conducted in two sandwich restaurants in a university setting at which a default-name nudge ("suggestion of the chef") and a tasting nudge were implemented aimed at increasing the choice for salsify soup using a non-randomized study design during 10 and 12 measurement days. The beta-regression model showed that the default-name nudge increased the proportion of customers that choose the salsify soup during intervention days compared to non-intervention days, p < .001, OR: 1.70. The tasting nudge also increased the proportion of customers that choose the salsify soup from baseline to intervention, p < .001, OR: 6.17 and from baseline to post-intervention, p < .01, OR: 1.87, and decreased from intervention to post-intervention, p < .001, OR: 0.30. Both nudges did not increase the choice for the overall category of soups. The results show that certain types of nudges are able to increase specific products of a category without increasing overall choice of a category in contrast to previous findings.

Parents Report Competing Priorities Influence Snack Choice in Youth Sports

OBJECTIVE

To describe parental perceptions of team snacks, factors that motivate snack choice, and perceptions of healthy snacking guidelines in youth sports.

METHODS

Six in-depth group interviews were conducted among parents (n = 22) of children aged 4-12 years in 2 Los Angeles County Baseball Little Leagues. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Parents perceived fruit as the ideal snack; this ideal was balanced with competing priorities, including children's preferences, cost, time, and social norms regarding snacks as rewards and team bonding. Although parents were supportive of promoting healthy snacks, they believed that snacking guidelines should not be mandated.

CONCLUSIONS AND IMPLICATIONS

Developing messages that align with parents' motivations when choosing snacks could promote healthier snacking in youth sports. Future studies are warranted to explore drivers of snacking with a broader sample and to examine how to promote healthy snacks effectively.

The effects of bowl size and portion size on food intake and fullness ratings in a sample of Japanese men

OBJECTIVE

Portion sizes and bowl sizes may be related to food intake and perceived fullness. The objective of the present study was to investigate the effects of portion size and bowl size and possible interactions between these variables on food intake and fullness in a sample of Japanese men.

DESIGN

Participants ate four different experimental meals across four weeks and completed questionnaires about their fullness using a visual analogue scale administered before and after meals. The four meal patterns included consistent portions of several foods commonly eaten together in typical Japanese meals, along with 150 g of rice served in a small rice bowl (diameter of 11·5 cm), 150 g of rice served in a large rice bowl (diameter of 13·5 cm), 250 g of rice served in a small rice bowl or 250 g of rice served in a large rice bowl.

SETTING

Tokyo.SubjectTwenty-one adult men participated in the study.

RESULTS

Portion size had a significant main effect on rice intake (F (1,20)=83, P<0·001) and fullness (F (1,20)=8·0, P=0·010), but no significant effects of bowl size on the outcome variables were found. The interactions between portion size and bowl size on intake and fullness were not significant.

CONCLUSIONS

The sample of Japanese men showed an influence of portion size on food intake. Further research is needed to clarify the combined effects of bowl size and portion size on intake and fullness.

A systematic review and meta-analysis of the effectiveness of nudging to increase fruit and vegetable choice

Background

Nudging refers to interventions that organize the choice architecture in order to alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. As a strategy to encourage healthy behaviour, nudging can serve as a complement to health education. However, the empirical evidence regarding the effectiveness of nudging as a way to influence food choice remains contradictory. To address this issue, a systematic review and meta-analysis was conducted to test the effects of nudging to encourage people to select more fruit and vegetables.

Methods

A systematic literature search was performed on PubMed, Medline, PsycInfo, Cochrane library, Scopus and Google Scholar. After quality assessment, 20 articles (23 studies) were retained for narrative synthesis. Twelve articles (14 studies) contained enough information to calculate effect-sizes for meta-analysis using Comprehensive Meta-analysis software.

Results

The meta-analysis shows that nudging interventions that aim to increase fruit and/or vegetable choice/sales/servings have a moderately significant effect (d = 0.30), with the largest effect for altering placement (d = 0.39) and combined nudges (d = 0.28).

Conclusion

The results of this review provide an indication of the effectiveness of nudging on fruit and vegetable choice in terms of actual effect-sizes, while also highlighting the problems that must be addressed before more definitive conclusions can be drawn.

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)

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.

The effect of a portion size intervention on French fries consumption, plate waste, satiety and compensatory caloric intake: an on-campus restaurant experiment

Background

One of the driving factors of dietary overconsumption throughout the last decennia is the increase of food portion sizes. Larger portions induce higher daily energy intake, so reducing portion size may reduce intake of excess calories. However, real-life studies about the effects of portion size reduction are lacking. Therefore, this study examined the effect of a French fries portion size reduction on French fries consumption, French fries plate waste, satiety and caloric intake during the subsequent afternoon among university students and employees in a Belgian on-campus restaurant setting. Moreover, this study evaluated consumers’ perception about the portion size reduction.

Methods

The study took place over a two-time (i.e. baseline and intervention week) 4-day period (Tuesday–Friday) in the on-campus restaurant where ±1200 meals are served every day. French fries’ portions were reduced by 20% by replacing the usual porcelain bowl served during the baseline week (±200 g) with smaller volume paper bags during the intervention week (±159 g) in a pre-post real-life experiment. French fries consumption and plate waste were measured in 2056 consumers at baseline and 2175 consumers at intervention. Additionally, interviews were conducted directly after lunch and again between 4 and 6 p.m. on the same day to assess satiety and caloric intake at pre and post in a small subsample of both French fries consumers (n = 19) and non-French fries consumers (n = 14). Post-intervention, the same subsample was interviewed about their perception of the portion size reduction (n = 28).

Results

Total French fries intake decreased by 9.1%, and total plate waste decreased by 66.4%. No differences were found in satiety or caloric intake between baseline and intervention week among the French fries’ consumers. The majority (n = 24, 86%) of French fries consumers noticed the reduction in portion size during the intervention. Although most participants (n = 19, 68%) perceived the reduced portion size as sufficient, only a minority of participants (n = 9, 32%) indicated post-intervention that they would agree with a permanent implementation.

Conclusions

Reducing portion size may lead to reduced caloric intake, without changing perceived levels of satiety.

At-a-glance - "A tough sell": findings from a qualitative analysis on the provision of healthy foods in recreation and sports settings

Recreation and sport settings (RSS) typically promote health in the form of physical activity, but the healthfulness of their food environment is often neglected. We explored stakeholder perspectives on barriers to healthy food provision in RSS through telephone interviews with ten representatives from RSS across Nova Scotia. Three key barriers were identified: 1) cultural norms associated with food in RSS and the broader environment, 2) the persisting notion of personal choice and responsibility, and 3) financial implications of healthy food provision. These barriers challenge healthy food provision in RSS and require multi-faceted strategies to overcome social norms that undermine health behaviours.

Pricing Strategies to Encourage Availability, Purchase, and Consumption of Healthy Foods and Beverages: A Systematic Review

Introduction

Food pricing policies to promote healthy diets, such as taxes, price manipulations, and food subsidies, have been tested in different settings. However, little consensus exists about the effect of these policies on the availability of healthy and unhealthy foods, on what foods consumers buy, or on the impact of food purchases on consumer health outcomes. We conducted a systematic review of studies of the effect of food-pricing interventions on retail sales and on consumer purchasing and consumption of healthy foods and beverages.

Methods

We used MEDLINE, Embase, PsycINFO, Web of Science, ClinicalTrials.gov, and the Cochrane Library to conduct a systematic search for peer-reviewed articles related to studies of food pricing policies. We selected articles that were published in English from January 2000 through December 2016 on the following types of studies: 1) real-world experimental studies (randomized controlled trials, quasi-experimental studies, and natural experiments); 2) population studies of people or retail stores in middle-income and high-income countries; 3) pricing interventions alone or in combination with other strategies (price promotions, coupons, taxes, or cash-back rebates), excluding studies of vending-machine or online sales; and 4) outcomes studies at the retail (stocking, sales) and consumer (purchasing, consumption) levels. We selected 65 articles representing 30 studies for review.

Results

Sixteen pricing intervention studies that sought to improve access to healthy food and beverage options reported increased stocking and sales of promoted food items. Most studies (n = 23) reported improvement in the purchasing and consumption of healthy foods or beverages or decreased purchasing and consumption of unhealthy foods or beverages. Most studies assessed promotions of fresh fruits and vegetables (n = 20); however, these foods may be hard to source, have high perishability, and raise concerns about safety and handling. Few of the pricing studies we reviewed discouraged purchasing and consumption of unhealthy foods (n = 6). Many studies we reviewed had limitations, including lack of formative research, process evaluation, or psychosocial and health assessments of the intervention’s impact; short intervention duration; or no assessment of food substitutions or the effects of pricing interventions on food purchasing and diets.

Conclusion

Pricing interventions generally increased stocking, sales, purchasing, and consumption of promoted foods and beverages. Additional studies are needed to differentiate the potential impact of selected pricing strategies and policies over others.

Differences in Mothers' and Children's Dietary Intake during Physical and Sedentary Activities: An Ecological Momentary Assessment Study

BACKGROUND

Physical activity and diet are major modifiable health behaviors contributing to obesity risk. Although patterns of these behaviors tend to cluster within individuals and within family units, it is unknown to what extent healthy and unhealthy dietary intake might differentially accompany sedentary and physical activities in mothers compared with their children.

OBJECTIVE

Our goal was to examine differences in co-occurrence of activities and dietary intake between mothers and children, as measured in real time using ecological momentary assessment.

PARTICIPANTS/SETTING

This study examined cross-sectional data from 175 mothers and their children aged 8 to 12 years.

MAIN OUTCOME MEASURES

Participants completed 8 days of ecological momentary assessment surveys, reporting on whether the following activities had occurred during the past 2 hours: sedentary screen activity, physical activity, and intake of healthy (ie, fruits and vegetables) and unhealthy (ie, fast food, chips/fries, pastries/sweets, and soda/energy drinks) foods.

STATISTICAL ANALYSES PERFORMED

Multilevel logistic regression models estimated the adjusted odds of consuming healthy and unhealthy dietary intake for mothers and children during time periods reporting physical activity (vs no physical activity) or sedentary screen activity (vs no sedentary screen activity). Post hoc tests compared estimates for mothers vs children.

RESULTS

Children were significantly more likely than their mothers to consume unhealthy foods during 2-hour windows that included physical activity (odds ratio [children] 1.85, 95% CI 1.47 to 2.31; odds ratio [mothers] 0.83, 95% CI 0.58 to 1.20; P_diff <0.05), but not sedentary screen activity (P_diff=0.067). In addition, children and their mothers did not differ in their likelihood of consuming healthy foods during 2-hour windows with sedentary screen activity (P_diff =0.497) or physical activity (P_diff =0.170).

CONCLUSIONS

Results indicate that the consumption of unhealthy foods may be more likely to co-occur within a 2-hour window including physical activity in children as compared to their mothers. Future research should examine reasons for this difference, and potential areas for intervention.

Healthy Concessions: High School Students' Responses to Healthy Concession Stand Changes

BACKGROUND

A previous sales data analysis demonstrated success in selling healthier items at a concession stand. Questions remained regarding student satisfaction and whether the intervention reached non-health-conscious students.

METHODS

Cross-sectional anonymous samples of students at a large midwestern high school were surveyed before and after an intervention improved the number of healthier items available at the concession stand.

RESULTS

The survey was completed by 301 students preintervention and 314 students postintervention. Satisfaction remained good (3.7 preintervention and 3.6 postintervention). Satisfaction with the variety and taste of foods increased. We compared students who felt having healthy items were important at the concessions to those who did not. Overall satisfaction with concessions did not differ between groups. The latter group (healthy items not important) reported improved satisfaction with food variety (2.8 to 3.1, p = .02) and the former reported improved satisfaction with healthy foods (2.5 to 2.9, p = .03) and overall taste (3.2 to 3.4, p = .02). Of the healthy items not important students 76% reported purchasing at least 1 new healthier food.

CONCLUSIONS

Adding healthier foods to school concession stands has positive effects on student satisfaction, sales, and reaches all students whether or not they care about having healthy items available.

Lack of efficacy of a salience nudge for substituting selection of lower-calorie for higher-calorie milk in the work place

Obesity is a major burden on healthcare systems. Simple, cost effective interventions that encourage healthier behaviours are required. The present study evaluated the efficacy of a salience nudge for promoting a change in milk selection from full-cream to low-fat (lower-calorie) in the kitchen of a university-based research institute that provided full-cream and low-fat milk free of charge. Milk selection was recorded for 12 weeks (baseline). A sign with the message “Pick me! I am low calorie” was then placed on the low-fat milk and selection was recorded for a further 12 weeks. During baseline, selection of low-fat milk was greater than selection of full-cream milk (p = 0.001) with no significant milk-type × time interaction (p = 0.12). During the intervention period overall milk selection was not different from baseline (p = 0.22), with low-fat milk selection remaining greater than full-cream milk selection (p < 0.001) and no significant milk-type × time interaction (p = 0.41). However, sub-analysis of the first two weeks of the intervention period indicated an increase in selection of both milk types (p = 0.03), but with a greater increase in low-fat milk selection (p = 0.01, milk-type × time interaction). However, milk selection then returned towards baseline during the rest of the intervention period. Thus, in the present setting, salience nudging promoted a transient increase in low-fat milk selection, but also increased selection of full-cream milk, indicating that nudging was not effective in promoting healthier milk choices.

If we offer it, will children buy it? Sales of healthy foods mirrored their availability in a community sport, commercial setting in Alberta, Canada

BACKGROUND

Community sports settings are often sources of unhealthy foods for children. Many managers in these settings are reluctant to increase availability of healthy food options because they perceive that healthy foods are not profitable. This study assessed the independent contribution of increased availability of healthy foods to their sales in a community sport, commercial context. Change in revenues per patron was also examined.

METHODS

The availability of healthy items was increased from 9.1% at baseline (35 days) to 25.0% during the intervention period (40 days), returning to 9.1% postintervention (6 days). Purchases of all patrons who bought foods/beverages (n=17,262 items sold) from two concessions at an outdoor community pool were assessed from baseline to postintervention. Chi-square analyses assessed differences in the proportion of healthy and unhealthy items sold, as well as in the proportion of total revenues per patron across periods. A trained observer also recorded qualitative observations pertaining to a subset of patrons' (n=221) dietary behaviors and activities.

RESULTS

Healthy items represented 7.7%, 22.7%, and 9.8% of sales during the preintervention, intervention, and postintervention periods, respectively (p<0.01). Sales of healthy beverages exceeded sales of all other product types. The proportion of total revenues per patron did not differ by period.

CONCLUSIONS

Food availability was an important environmental determinant of food purchasing behaviors in this community commercial context, given that sales of healthy foods closely mirrored their availability. Increased availability of healthy foods in community and commercial settings is important because concurrent changes within multiple environments will be required to improve children's dietary behaviors.

The Impact of Emotional Intelligence on Conditions of Trust among Leaders at the Kentucky Department for Public Health

There has been limited leadership research on emotional intelligence and trust in governmental public health settings. The purpose of this study was to identify and seek to understand the relationship between trust and elements of emotional intelligence, including stress management, at the Kentucky Department for Public Health (KDPH). The KDPH serves as Kentucky's state governmental health department. KDPH is led by a Commissioner and composed of seven primary divisions and 25 branches within those divisions. The study was a non-randomized cross-sectional study utilizing electronic surveys that evaluated conditions of trust among staff members and emotional intelligence among supervisors. Pearson correlation coefficients and corresponding p-values are presented to provide the association between emotional intelligence scales and the conditions of trust. Significant positive correlations were observed between supervisors' stress management and the staff members' trust or perception of supervisors' loyalty (r = 0.6, p = 0.01), integrity (r = 0.5, p = 0.03), receptivity (r = 0.6, p = 0.02), promise fulfillment (r = 0.6, p = 0.02), and availability (r = 0.5, p = 0.07). This research lays the foundation for emotional intelligence and trust research and leadership training in other governmental public health settings, such as local, other state, national, or international organizations. This original research provides metrics to assess the public health workforce with attention to organizational management and leadership constructs. The survey tools could be used in other governmental public health settings in order to develop tailored training opportunities related to emotional intelligence and trust organizations.