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Brooker PG, Howlett CA, Brindal E, Hendrie GA. Strategies associated with improved healthiness of consumer purchasing in supermarket interventions: a systematic overview of reviews and evaluation of primary articles. Front Public Health 2024; 12:1334324. [PMID: 38983251 PMCID: PMC11232481 DOI: 10.3389/fpubh.2024.1334324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/03/2024] [Indexed: 07/11/2024] Open
Abstract
Background Growing evidence suggests that it is possible to change the retail food environment to enable healthier choices via in-store interventions. It has been difficult to draw clear conclusions as to which interventions are most effective in positively influencing consumer purchasing behaviour given the significant heterogeneity within the food retail research literature. The aim of this study was to (1) summarise current high-quality systematic, scoping, and/or narrative reviews (Part I: overview of reviews); and (2) synthesise high-quality original research, to understand the range, types and effectiveness of strategies implemented in food retail settings (Part II: evaluation of primary studies). Methods To identify reviews describing the effects of intervention strategies aiming to improve the healthiness of consumer purchasing in supermarkets, a systematic search across seven electronic databases was completed in April 2023. The methodological quality of reviews was assessed using the risk of bias in systematic reviews for systematic and scoping reviews, and the Scale for the Assessment of Narrative Review Articles for narrative reviews. High-quality reviews were further inspected and synthesised narratively (Part I). Next, to understand strategies associated with improved healthiness of consumer purchasing high-quality, primary articles from high-quality reviews identified in Part I were retrieved, and the strategies implemented within these interventions were summarised (Part II). Results Thirty-eight reviews met the inclusion criteria for Part I; two-thirds (n = 25, 66%) were rated as high-quality (66%). These reviews indicated that pricing strategies had the greatest proportion of reported positive or promising effects on outcomes (n = 8 of 11 reviews, 73%). Twenty reviews met the inclusion criteria for Part II and the 771 primary articles from these reviews were screened with 23 high-quality primary articles included in analysis. Findings indicated that promotional strategies in combination with another strategy appeared to be most successful among regular shoppers (the general population), whereas pricing was most successful in low socio-economic status and rural sub-groups. Conclusion Promotion, pricing and prompting were the most commonly tested strategies across the overview of reviews and review of primary articles. Promotion, in combination with other strategies, and pricing appear to be most promising, but the effectiveness of pricing strategies may vary by sub-groups of the population. How pricing and promotion in combination with other strategies can be implemented responsibly and sustainably to change purchase habits towards healthier items should be explored further. Systematic Review registration OSF, https://osf.io/jyg73/.
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Affiliation(s)
- Paige G. Brooker
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
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Rutsaert P, Donovan J, Murphy M, Hoffmann V. Farmer decision making for hybrid maize seed purchases: Effects of brand loyalty, price discounts and product information. AGRICULTURAL SYSTEMS 2024; 218:104002. [PMID: 38911698 PMCID: PMC11188992 DOI: 10.1016/j.agsy.2024.104002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 06/25/2024]
Abstract
CONTEXT Each year public and private sector maize breeding programs in Kenya deliver high-yielding hybrids that are resistant to drought, pests, and diseases. Yet, most Kenyan maize farmers purchase older, well-known hybrids. While the 'varietal turnover' problem is well known, few solutions have emerged. OBJECTIVE The potential for seed companies and retailers to influence farmers' product selection towards new products remains an open question. In-store marketing that induces farmers to experiment with new products may be a scalable and cost-effective way to advance seed systems development. METHODS Our controlled field experiment with 600 farmers in Kenya comprised a mock agrodealer store stocked with locally available hybrids, where half the farmers who participated faced an out-of-stock situation for their preferred product. The influence of price promotions and product performance information on farmers' seed choice were assessed. RESULTS AND CONCLUSIONS When a participant's preferred product was available, performance information and discounts had no effect on decisions. However, when the preferred product was unavailable, the treatments had limited effects on product selection. Prior experience and brand loyalty stood out as the strongest predictors of seed product selection. SIGNIFICANCE Our work explored the potential for two interventions-information and price discounts-to influence farmers' product selection. While these interventions showed limited influence on selection, the study design provides a clear starting point for future related experiments. More public and private investments are required to generate timely, comparable, and reliable information on seed performance. The strong effect of brand loyalty favors larger-sized seed companies with sizable marketing budgets.
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Affiliation(s)
- Pieter Rutsaert
- International Maize and Wheat Improvement Centre (CIMMYT), Nairobi, Kenya
| | - Jason Donovan
- International Maize and Wheat Improvement Centre (CIMMYT), Texcoco, Mexico
| | - Mike Murphy
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - Vivian Hoffmann
- International Food Policy Research Institute (IFPRI), Washington, DC, USA
- Carleton University, Ottawa, ON, Canada
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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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Stuber JM, Mackenbach JD, de Bruijn GJ, Gillebaart M, Hoenink JC, Middel CNH, de Ridder DTD, van der Schouw YT, Smit EG, Velema E, Vos AL, Waterlander WE, Lakerveld J, Beulens JWJ. Real-world nudging, pricing, and mobile physical activity coaching was insufficient to improve lifestyle behaviours and cardiometabolic health: the Supreme Nudge parallel cluster-randomised controlled supermarket trial. BMC Med 2024; 22:52. [PMID: 38303069 PMCID: PMC10835818 DOI: 10.1186/s12916-024-03268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Context-specific interventions may contribute to sustained behaviour change and improved health outcomes. We evaluated the real-world effects of supermarket nudging and pricing strategies and mobile physical activity coaching on diet quality, food-purchasing behaviour, walking behaviour, and cardiometabolic risk markers. METHODS This parallel cluster-randomised controlled trial included supermarkets in socially disadvantaged neighbourhoods across the Netherlands with regular shoppers aged 30-80 years. Supermarkets were randomised to receive co-created nudging and pricing strategies promoting healthier purchasing (N = 6) or not (N = 6). Nudges targeted 9% of supermarket products and pricing strategies 3%. Subsequently, participants were individually randomised to a control (step counter app) or intervention arm (step counter and mobile coaching app) to promote walking. The primary outcome was the average change in diet quality (low (0) to high (150)) over all follow-up time points measured with a validated 40-item food frequency questionnaire at baseline and 3, 6, and 12 months. Secondary outcomes included healthier food purchasing (loyalty card-derived), daily step count (step counter app), cardiometabolic risk markers (lipid profile and HbA1c via finger prick, and waist circumference via measuring tape), and supermarket customer satisfaction (questionnaire-based: very unsatisfied (1) to very satisfied (7)), evaluated using linear mixed-models. Healthy supermarket sales (an exploratory outcome) were analysed via controlled interrupted time series analyses. RESULTS Of 361 participants (162 intervention, 199 control), 73% were female, the average age was 58 (SD 11) years, and 42% were highly educated. Compared to the control arm, the intervention arm showed no statistically significant average changes over time in diet quality (β - 1.1 (95% CI - 3.8 to 1.7)), percentage healthy purchasing (β 0.7 ( - 2.7 to 4.0)), step count (β - 124.0 (- 723.1 to 475.1), or any of the cardiometabolic risk markers. Participants in the intervention arm scored 0.3 points (0.1 to 0.5) higher on customer satisfaction on average over time. Supermarket-level sales were unaffected (β - 0.0 (- 0.0 to 0.0)). CONCLUSIONS Co-created nudging and pricing strategies that predominantly targeted healthy products via nudges were unable to increase healthier food purchases and intake nor improve cardiometabolic health. The mobile coaching intervention did not affect step count. Governmental policy measures are needed to ensure more impactful supermarket modifications that promote healthier purchases. TRIAL REGISTRATION Dutch Trial Register ID NL7064, 30 May 2018, https://www.onderzoekmetmensen.nl/en/trial/20990.
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Affiliation(s)
- Josine M Stuber
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
- Amsterdam Public Health, Amsterdam, the Netherlands.
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Joreintje D Mackenbach
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Gert-Jan de Bruijn
- Department of Communication Science, University of Antwerp, St-Jacobstraat 2, 2000, Antwerp, Belgium
| | - Marleen Gillebaart
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Jody C Hoenink
- Centre for Diet and Activity Research, MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Cédric N H Middel
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Denise T D de Ridder
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, the Netherlands
| | - Edith G Smit
- Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, the Netherlands
| | - Elizabeth Velema
- Netherlands Nutrition Centre (Voedingscentrum), Bezuidenhoutseweg 105, The Hague, The Netherlands
| | - Anne L Vos
- Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam, the Netherlands
| | - Wilma E Waterlander
- Amsterdam Public Health, Amsterdam, the Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jeroen Lakerveld
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam, the Netherlands
- Upstream Team, www.upstreamteam.nl, Amsterdam UMC, De Boelelaan 1117, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, the Netherlands
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Gholar VM, Christian R. Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities. JBI Evid Implement 2023; 21:374-385. [PMID: 37131273 DOI: 10.1097/xeb.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities. INTRODUCTION Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided. METHODS The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels. RESULTS The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance. CONCLUSION Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.
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Affiliation(s)
- Victoria M Gholar
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
- The Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, MS, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Robin Christian
- The Myrlie Evers-Williams Institute for the Elimination of Health Disparities, Jackson, MS, USA
- Mississippi Centre for Evidence-Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
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Nzesi A, Owusu B, Barry J, Sandhu M, Geliebter A. Impact of a randomized controlled trial of discounts on fruits, vegetables, and noncaloric beverages in NYC supermarkets on food intake and health risk factors. PLoS One 2023; 18:e0291770. [PMID: 37992046 PMCID: PMC10664931 DOI: 10.1371/journal.pone.0291770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/05/2023] [Indexed: 11/24/2023] Open
Abstract
The objective of this study was to observe the effects of a multi-level (30%, 15%, and 0%) randomized discount on fruits, vegetables, and non-caloric beverages on changes in dietary intake. This randomized controlled trial (RCT) comprised an 8-week baseline, a 32-week intervention, and a 16-week follow-up. 24-hour dietary recalls were conducted during the baseline period and before the intervention midpoint. In-person clinical measures were analyzed from Week 8 (end of baseline) and 24 (midpoint). This report is from an interim analysis up to the intervention period midpoint at Week 24, as the study is still ongoing. Participants with BMIs of 24.5-50 kg/m2 and ages 18-70 years old who were the primary household shoppers were recruited from several New York City supermarkets, starting in September 2018. Of these, we analyzed 20 in the 30% discount group, 25 in the 15% discount group, and 19 in the 0% discount group. The 30% discount group reported greater intake of vegetables (+98.4 g ± 48.9 SD, P = 0.049) and diet soda (+63.3 g ± 29.3, P = 0.035) relative to the baseline period, compared to the 0% discount group. The clinical measures including body weight remained unchanged. The participants who experienced the COVID-19 pandemic had a marginal increase in body weight of 1.5 kg, P = 0.053. In conclusion, we observed a significant increase in intake of vegetables and diet soda in the 30% discount group relative to the 0% discount group.
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Affiliation(s)
- Aniema Nzesi
- Department of Psychiatry, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Benedicta Owusu
- Department of Psychiatry, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Jillian Barry
- Department of Psychiatry, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Manveer Sandhu
- Department of Psychiatry, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Allan Geliebter
- Department of Psychiatry, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
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Vogel C, Dijkstra C, Huitink M, Dhuria P, Poelman MP, Mackenbach JD, Crozier S, Seidell J, Baird J, Ball K. Real-life experiments in supermarkets to encourage healthy dietary-related behaviours: opportunities, challenges and lessons learned. Int J Behav Nutr Phys Act 2023; 20:73. [PMID: 37340326 DOI: 10.1186/s12966-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Supermarkets are the primary source of food for many people yet their full potential as a setting to encourage healthy dietary-related behaviours remains underutilised. Sharing the experiences from research groups who have worked with supermarket chains to evaluate strategies that promote healthy eating could improve the efficiency of building such relationships and enhance the design quality of future research studies. METHODS A collective case study approach was used to synthesise experiences of engaging and sustaining research collaborations with national supermarket chains to test the effectiveness of health-focused in-store interventions. The collective narrative covers studies conducted in three high-income countries: Australia, the Netherlands and the United Kingdom. RESULTS We have distilled our experiences and lessons learned into six recommendations for conducting high quality public health research with commercial supermarket chains. These include: (i) using personal contacts, knowledge of supermarket activities and engaging executive management to establish a partnership and allowing time to build trust; (ii) using scientifically robust study designs with appropriate sample size calculations; (iii) formalising data exchange arrangements and allocating adequate resource for data extraction and re-categorisation; (iv) assessing effects at individual/households level where possible; (v) designing a mixed-methods process evaluation to measure intervention fidelity, dose and unintended consequences; and (vi) ensuring scientific independence through formal contract agreements. CONCLUSIONS Our collective experiences of working in non-financial partnerships with national supermarket chains could be useful for other research groups looking to develop and implement supermarket studies in an efficient manner. Further evidence from real-life supermarket interventions is necessary to identify sustainable strategies that can improve population diet and maintain necessary commercial outcomes.
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Affiliation(s)
- Christina Vogel
- Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Marlijn Huitink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Wageningen, 6700 EW, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute, De Boelelaan 1089a, 1081HV, Amsterdam, the Netherlands
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Jacob Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Impact of a farmers' market healthy food subsidy on the diet quality of adults with low incomes in British Columbia, Canada: a pragmatic randomized controlled trial. Am J Clin Nutr 2023; 117:766-776. [PMID: 36804420 DOI: 10.1016/j.ajcnut.2023.01.017] [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: 08/22/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Adults with low incomes have lower diet quality than their higher income counterparts. In Canada, the British Columbia Farmers' Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods in farmers' markets. OBJECTIVE The objective of this study was to examine the impact of the FMNCP on the diet quality of adults with low incomes. METHOD In a pragmatic randomized controlled trial conducted in 2019, adults with low incomes (≥18 y) were randomly assigned either to an FMNCP intervention (n = 143) or a no-intervention control group (n = 142). The FMNCP group received 16 coupon sheets valued at $21 per sheet over 10-15 wk to purchase healthy foods from farmers' markets. Participants completed a questionnaire and 2 24-h dietary recalls at baseline (0 wk), immediately post-intervention (10-15 wk), and 16-wk post-intervention (26-31 wk). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Linear mixed-effects regression assessed differences in HEI-2015 total (primary outcome) and component scores (secondary outcomes) between the FMNCP and control groups at post-intervention and 16-wk post-intervention. Subgroup analyses examined program impacts by sex and age group (18-59 y, ≥60 y). RESULTS There were no significant differences in HEI-2015 total scores between the FMNCP and control groups at post-intervention (-0.07; 95% CI: -4.07, 3.93) or 16-wk post-intervention (1.22; 95% CI: -3.00, 5.44) overall or between subgroups. There were no significant between-group differences in HEI-2015 component scores at post-intervention, although there were significant differences in component scores for dairy and fatty acids at 16-wk post-intervention. CONCLUSION The FMNCP did not significantly improve diet quality among adults with low incomes over the study period. Further research is needed to explore whether higher subsidy amounts or a longer intervention period is needed to meaningfully improve diet quality among adults with low incomes. This trial was registered at [clinicaltrials.gov] as [NCT03952338].
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Matthews M, Belisle J, Stanley C, Scholfield B. Relational Verbal Behavior and Eco-Friendly Purchasing: A Preliminary Translational Analysis and Implications. BEHAVIOR AND SOCIAL ISSUES 2022; 31:418-436. [PMID: 38013769 PMCID: PMC9579595 DOI: 10.1007/s42822-022-00106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Consumer behavior is impacting Earth's climate, and solving the climate change crisis will necessarily involve influencing the anthropogenic causes of behavior. The present study evaluated relational frames involving comparative climate relations on consumer choices in a simulated purchasing task. In baseline, participants selected among common household commodities that differed along three dimensions: color, an unfamiliar symbol (Y and Z), and price. Price was sequentially increased for the product with the Z symbol. All participants showed maximum sensitivity to price in baseline, where any increase for Z led to selection of Y across commodities. Relational training involved selecting among climate related stimuli in the presence of the symbols Y and Z, where correct responding occurred when participants selected the more harmful stimulus in the presence of Y and the less harmful stimulus in the presence on Z. A generalization test showed that correct responding transferred to novel stimulus arrangements based on climate impact. In the post-training purchasing phase, six of the seven participants showed reduced sensitivity to increases in price, where price and symbol appeared to interact to influence purchasing. These results have implications for a science of consumer behavior related to climate change from an RFT account.
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Affiliation(s)
| | - Jordan Belisle
- Missouri State University, 901 S. National Ave, Springfield, MO USA
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Slapø H, Bugge AB, Sandaker I, Lekhal S. Can in-store interventions reduce the socioeconomic gap in fruit and vegetable purchases in grocery stores? A descriptive study of volume sales from 2012 to 2020 in Norway's largest grocery store chain. Appetite 2022; 176:106100. [PMID: 35660077 DOI: 10.1016/j.appet.2022.106100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
Fruits and vegetable (FVs) consumption is an essential determinant of health, and intake is strongly patterned by socioeconomic status (SES). Inside grocery store interventions have increasingly been explored to promote healthier diets, especially for people with lower SES. This study describes how the supermarket chain Kiwi used a combination of in-store interventions to increase annual sales of FVs between 2012 and 2020. In particular, this study examined how sales developed in counties with different demographic characteristics (e.g., education, income, overweight and obesity, and self-reported FVs consumption level) in order to evaluate whether the effect differs between different populations. The primary outcome measurement was annual volume sales, adjusted for new stores opening and closing during the study period, also called like-for-like sales. The study has used a descriptive study design. The chain used interventions such as better placement, promoting healthy foods, giving out discounts, and placing "on the go" FVs and cups with portioned FVs at the cash registry. Results show that like-for-like volume sales of FVs grew by 34.1% during the study period. The increase was especially strong for vegetables, which increased by 41.8%, compared to fruits and berries, which increased by 25%. Sales increased for all eleven counties in Norway. Using the Spearman correlation, a moderately positive association was found between the number of overweight or obese people in counties and the development in FVs sales. To conclude, in-store interventions positively impacted FVs sales. More research in an experimental context is needed to determine if interventions may reduce the socioeconomic gap in FVs consumption.
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Affiliation(s)
- Helena Slapø
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs Plass, N-0130, Oslo, Norway.
| | - Annechen Bahr Bugge
- Consumption Research Norway, Oslo Metropolitan University, P.O. BOX 4 St., Olavs Plass, N-0130, Oslo, Norway.
| | - Ingunn Sandaker
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs Plass, N-0130, Oslo, Norway.
| | - Samira Lekhal
- Morbid Obesity Centre, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, 3116, Tønsberg, Norway.
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11
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Atanasova P, Kusuma D, Pineda E, Frost G, Sassi F, Miraldo M. The impact of the consumer and neighbourhood food environment on dietary intake and obesity-related outcomes: A systematic review of causal impact studies. Soc Sci Med 2022; 299:114879. [PMID: 35290815 PMCID: PMC8987734 DOI: 10.1016/j.socscimed.2022.114879] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 02/19/2022] [Accepted: 03/04/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The food environment has been found to impact population dietary behaviour. Our study aimed to systematically review the impact of different elements of the food environment on dietary intake and obesity. METHODS We searched MEDLINE, Embase, PsychInfo, EconLit databases to identify literature that assessed the relationship between the built food environments (intervention) and dietary intake and obesity (outcomes), published between database inception to March 26, 2020. All human studies were eligible except for those on clinical sub-groups. Only studies with causal inference methods were assessed. Studies focusing on the food environment inside homes, workplaces and schools were excluded. A risk of bias assessment was conducted using the CASP appraisal checklist. Findings were summarized using a narrative synthesis approach. FINDINGS 58 papers were included, 55 of which were conducted in high-income countries. 70% of papers focused on the consumer food environments and found that in-kind/financial incentives, healthy food saliency, and health primes, but not calorie menu labelling significantly improved dietary quality of children and adults, while BMI results were null. 30% of the papers focused on the neighbourhood food environments and found that the number of and distance to unhealthy food outlets increased the likelihood of fast-food consumption and higher BMI for children of any SES; among adults only selected groups were impacted - females, black, and Hispanics living in low and medium density areas. The availability and distance to healthy food outlets significantly improved children's dietary intake and BMI but null results were found for adults. INTERPRETATION Evidence suggests certain elements of the consumer and neighbourhood food environments could improve populations dietary intake, while effect on BMI was observed among children and selected adult populations. Underprivileged groups are most likely to experience and impact on BMI. Future research should investigate whether findings translate in other countries.
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Affiliation(s)
- Petya Atanasova
- Centre for Health Economics & Policy Innovation, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK.
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK
| | - Elisa Pineda
- Centre for Health Economics & Policy Innovation, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK; School of Public Health, Imperial College London, Medical School Building, St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
| | - Gary Frost
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, Faculty Building South Kensington Campus, London, SW7 2AZ, UK
| | - Franco Sassi
- Centre for Health Economics & Policy Innovation, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK; Department of Economics and Public Policy, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK
| | - Marisa Miraldo
- Centre for Health Economics & Policy Innovation, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK; Department of Economics and Public Policy, Imperial College Business School, South Kensington Campus, Exhibition Rd, London, SW7 2AZ, UK
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12
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Bracci EL, Milte R, Keogh JB, Murphy KJ. Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles. BMC Public Health 2022; 22:23. [PMID: 34991538 PMCID: PMC8734134 DOI: 10.1186/s12889-021-12447-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans. Methods Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs. Results Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week). Conclusions The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.
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Affiliation(s)
- Ella L Bracci
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia
| | - Jennifer B Keogh
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Karen J Murphy
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia.
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13
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Jung SE, Shin YH, Cave L, Rockett J, Hermann J. Understanding Whole Grain Consumption among Low-Income Older Adults Using the Theory of Planned Behavior. J Nutr Gerontol Geriatr 2022; 41:46-64. [PMID: 34983322 DOI: 10.1080/21551197.2021.2024477] [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: 10/19/2022]
Abstract
Older adults have low whole grain (WG) intake. This qualitative study used the Theory of Planned Behavior (TPB) to identify low-income older adults' WG beliefs. A convenience sample of 25 low-income adults 60 years and older were interviewed using questions developed based on TPB constructs: behavioral, normative, and control beliefs. Interviews were audio-recorded, transcribed verbatim, cross-checked for consistency, and analyzed using content analysis. Study results revealed that regarding behavioral beliefs, health benefits, taste, and nutrition were WG advantages and sensory qualities, higher cost, and longer cooking time were disadvantages. Regarding normative beliefs, healthcare professionals and family members approved WG intake and those less informed about WGs disapproved. Regarding control beliefs, availability/accessibility, knowledge of WG benefits, and WG cooking skills facilitated WG intake and age-related changes, WG cost, decreased motivation to cook, and low knowledge (label reading) were barriers. Results provide insights for developing programs to increase older adults' WG intake.
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Affiliation(s)
- Seung Eun Jung
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Yeon Ho Shin
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Lauren Cave
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Julianne Rockett
- Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Janice Hermann
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
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14
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The relative importance of primary food choice factors among different consumer groups: A latent profile analysis. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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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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16
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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: 13] [Impact Index Per Article: 4.3] [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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17
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Tsai M, Cash SB, Anzman-Frasca S, Goldberg JP, Johnson SK, Oslund J, Folta SC. Helping parents provide vegetable snacks: Investigating price and taste as barriers. Appetite 2021; 166:105481. [PMID: 34175360 DOI: 10.1016/j.appet.2021.105481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
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Affiliation(s)
- Marisa Tsai
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA; Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin Street, Tenth Floor, Oakland, CA 94607, USA.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences and Center for Ingestive Behavior Research, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, USA.
| | - Jeanne P Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sarah K Johnson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Jennifer Oslund
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
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18
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Slapø H, Schjøll A, Strømgren B, Sandaker I, Lekhal S. Efficiency of In-Store Interventions to Impact Customers to Purchase Healthier Food and Beverage Products in Real-Life Grocery Stores: A Systematic Review and Meta-Analysis. Foods 2021; 10:922. [PMID: 33922185 PMCID: PMC8146080 DOI: 10.3390/foods10050922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Grocery stores are important settings to promote healthier food and beverage choices. The present paper aims at reviewing the effectiveness of different types of in-store interventions and how they impact sales of different product category in real grocery stores. Systematic search was conducted in six databases. In-store interventions were categorized according to the framework by Kraak et al. (2017) into one or more of eight interventions (e.g., place, profile, portion, pricing, promotion, healthy default picks, prompting and proximity). This systematic theme-based review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) data screening and selection. Thirty-six studies were included in the qualitative synthesis and 30 studies were included in the meta-analysis, representing 72 combinations of in-store interventions. The analysis demonstrates that interventions overall had small significant effect size (ES) using Cohen's d on food purchase behavior (d = 0.17, 95% CI [0.04, 0.09]), with largest ES for pricing (d = 0.21) and targeting fruits and vegetables (d = 0.28). Analysis of ES of in-store interventions show that pricing, and pricing combined with promotion and prompting, effectively impacted purchase behavior. Interventions significantly impacted both sales of healthy and unhealthy products and significantly increased sales of fruits and vegetables, healthy beverage and total volume of healthy products. Results should however be interpreted with some caution, given the relatively low quality of overall evidence and low number of studies and observations for some types of intervention. Further research exploring impact on different in-store interventions and targeting especially unhealthy products are needed.
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Affiliation(s)
- Helena Slapø
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway; (B.S.); (I.S.)
- GreeNudge, Tordenskioldsgate 2, N-0160 Oslo, Norway;
| | - Alexander Schjøll
- Consumption Research Norway, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway;
| | - Børge Strømgren
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway; (B.S.); (I.S.)
| | - Ingunn Sandaker
- Department of Behavioral Sciences, Oslo Metropolitan University, P.O. BOX 4 St., Olavs plass, N-0130 Oslo, Norway; (B.S.); (I.S.)
| | - Samira Lekhal
- GreeNudge, Tordenskioldsgate 2, N-0160 Oslo, Norway;
- Morbid Obesity Centre, Vestfold Hospital Trust, Halfdan Wilhelmsens allé 17, 3116 Tønsberg, Norway
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Hoseini A, Dehdari T, Solhi M, Rahideh ST, Janani L. Qualitative exploration of the factors influencing the use of dietary supplements in Iranian women: introduction to areas of focus for developing interventions. Heliyon 2021; 7:e06672. [PMID: 33889781 PMCID: PMC8049998 DOI: 10.1016/j.heliyon.2021.e06672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Literature shows that the consumption of Dietary Supplements (DS) is more common in Iran. This study aimed to explore the experiences of a sample of Iranian women regarding the factors influencing the use of DS. METHODS This qualitative content analysis study was conducted in Qods city, Tehran province, Iran from January to March 2020. Forty-two semi-structured in-depth interviews were performed with women. The participants were asked about their experiences about the determinants of the consumption of DS. After the first round of the interviews was done, we performed content analysis of the data and continued up to data saturation. RESULTS Two main themes including personal factors (with 5 subthemes including sociodemographic characteristics, perceived benefits of DS, history of illness, physiological conditions, and lifestyle factors) and socio-economic factors (with 3 subthemes including subjective norms, the price of food and commercial considerations of the sectors involved in the production and sale of DS) emerged as the experiences of the participants as to the intake of DS. CONCLUSIONS These variables may suggest areas which need to be focused on for performing more effective interventions to affect appropriate consumption of DS in Iran.
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Affiliation(s)
- Akramsadat Hoseini
- Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Dehdari
- Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Solhi
- Department of Health Education and Health Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Tayebeh Rahideh
- Department of Nutrition, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Janani
- Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
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Blake MR, Sacks G, Zorbas C, Marshall J, Orellana L, Brown AK, Moodie M, Ni Mhurchu C, Ananthapavan J, Etilé F, Cameron AJ. The 'Eat Well @ IGA' healthy supermarket randomised controlled trial: process evaluation. Int J Behav Nutr Phys Act 2021; 18:36. [PMID: 33712022 PMCID: PMC7953771 DOI: 10.1186/s12966-021-01104-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Successful implementation and long-term maintenance of healthy supermarkets initiatives are crucial to achieving potential population health benefits. Understanding barriers and enablers of implementation of real-world trials will enhance wide-scale implementation. This process evaluation of a healthy supermarket intervention sought to describe (i) customer, retailer and stakeholder perspectives on the intervention; (ii) intervention implementation; and (iii) implementation barriers and enablers. Methods Eat Well @ IGA was a 12-month randomised controlled trial conducted in 11 Independent Grocers of Australia (IGA) chain supermarkets in regional Victoria, Australia (5 intervention and 6 wait-listed control stores). Intervention components included trolley and basket signage, local area and in-store promotion, and shelf tags highlighting the healthiest packaged foods. A sequential mixed-methods process evaluation was undertaken. Customer exit surveys investigated demographics, and intervention recall and perceptions. Logistic mixed-models estimated associations between customer responses and demographics, with store as random effect. Supermarket staff surveys investigated staff demographics, interactions with customers, and intervention component feedback. Semi-structured stakeholder interviews with local government, retail and academic partners explored intervention perceptions, and factors which enabled or inhibited implementation, maintenance and scalability. Interviews were inductively coded to identify key themes. Results Of 500 customers surveyed, 33%[95%CI:23,44] recalled the Eat Well @ IGA brand and 97%[95%CI:93,99] agreed that IGA should continue its efforts to encourage healthy eating. The 82 staff surveyed demonstrated very favourable intervention perceptions. Themes from 19 interviews included that business models favour sales of unhealthy foods, and that stakeholder collaboration was crucial to intervention design and implementation. Staff surveys and interviews highlighted the need to minimise staff time for project maintenance and to regularly refresh intervention materials to increase and maintain salience among customers. Conclusions This process evaluation found that interventions to promote healthy diets in supermarkets can be perceived as beneficial by retailers, customers, and government partners provided that barriers including staff time and intervention salience are addressed. Collaborative partnerships in intervention design and implementation, including retailers, governments, and academics, show potential for encouraging long-term sustainability of interventions. Trial registration ISRCTN, ISRCTN37395231 Registered 4 May 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01104-z.
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Affiliation(s)
- Miranda R Blake
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia.
| | - Gary Sacks
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia
| | - Christina Zorbas
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia
| | - Josephine Marshall
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia
| | - Liliana Orellana
- Biostatistics Unit, Deakin University, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Amy K Brown
- City of Greater Bendigo, PO Box 733, Bendigo, Victoria, 3552, Australia
| | - Marj Moodie
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia.,Deakin Health Economics, Institute for Health Transformation, Faculty of Health Deakin University, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Jaithri Ananthapavan
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia.,Deakin Health Economics, Institute for Health Transformation, Faculty of Health Deakin University, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Fabrice Etilé
- Paris School of Economics and INRA, 48, Boulevard Jourdan, 75014, Paris, France
| | - Adrian J Cameron
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Locked Bag 20000, Victoria, 3220, Geelong, Australia
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Carins J, Pang B, Willmott T, Knox K, Storr R, Robertson D, Rundle-Thiele S, Pettigrew S. Creating supportive eating places: a systematic review of food service initiatives. Health Promot Int 2021; 36:1368-1392. [PMID: 33538304 DOI: 10.1093/heapro/daaa155] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Obesity and diet-related health problems are complex, multi-factorial issues. Individual food choices are shaped by the wider context, and food environment level change is needed to support individual behaviour change. The food service sector can play an integral role, changing aspects of the food environment and contributing to improved consumer health. This systematic review aimed to analyse food service schemes that aimed to improve consumer health. Ten electronic databases were systematically searched to identify articles, supplemented with checking of reference lists from similar reviews and forward and backward searches to identify articles describing food service sector schemes. Sixteen schemes were identified, documented in 36 articles/reports. The schemes aimed to improve consumer health through one of three approaches-informing, enabling or engineering. In this order, these approaches involved increasing levels of effort from food services, corresponding with decreasing levels of effort for consumers. Half the schemes were informing, relying on an informed consumer to make a healthy choice. Most informing schemes had been evaluated to determine their impact on consumer choice and/or health, the evidence showed these schemes were generally ineffective. The effect of the enabling or engineering schemes on consumer choice and health had not been measured. Instead, evaluations focussed on process or business engagement rather than behavioural change assessments. This review indicates the food sector has the potential to contribute to consumer health through enabling and engineering; however, detailed outcome assessments are needed to draw definitive conclusions.
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Affiliation(s)
- Julia Carins
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Bo Pang
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Taylor Willmott
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Kathy Knox
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Ryan Storr
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Dianne Robertson
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Department of Marketing, Griffith University, 170 Kessels Road, Nathan, Brisbane, Queensland 4111, Australia
| | - Simone Pettigrew
- Food Policy Division, George Institute for Global Health, 1 King St, Newtown, Sydney, New South Wales 2042, Australia
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Yoder AD, Proaño GV, Handu D. Retail Nutrition Programs and Outcomes: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 121:1866-1880.e4. [PMID: 33229206 DOI: 10.1016/j.jand.2020.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/05/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.
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Huitink M, Poelman MP, Seidell JC, Kuijper LDJ, Hoekstsra T, Dijkstra C. Can Healthy Checkout Counters Improve Food Purchases? Two Real-Life Experiments in Dutch Supermarkets. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228611. [PMID: 33228189 PMCID: PMC7699573 DOI: 10.3390/ijerph17228611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022]
Abstract
Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9-2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3-3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0-3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7-1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1-1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.
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Affiliation(s)
- Marlijn Huitink
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (L.D.J.K.); (T.H.); (C.D.)
- Correspondence:
| | - Maartje P. Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, 6706 KN Wageningen, The Netherlands;
| | - Jacob C. Seidell
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (L.D.J.K.); (T.H.); (C.D.)
| | - Lothar D. J. Kuijper
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (L.D.J.K.); (T.H.); (C.D.)
| | - Trynke Hoekstsra
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (L.D.J.K.); (T.H.); (C.D.)
| | - Coosje Dijkstra
- Department of Health Science, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands; (J.C.S.); (L.D.J.K.); (T.H.); (C.D.)
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The drivers, trends and dietary impacts of non-nutritive sweeteners in the food supply: a narrative review. Nutr Res Rev 2020; 34:185-208. [PMID: 33148371 DOI: 10.1017/s0954422420000268] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diets, including excess added sugar consumption, contribute to the global burden of disease. Subsequently, many nutrition policies have been implemented to reduce added sugar intake and improve population health, including taxes, education, labelling and environmental interventions. A potential consequence of these policy actions is the substitution of added sugars with non-nutritive sweeteners (NNS) in a variety of foods and beverages. NNS are used to reduce the energy and sugar content of foods and beverages while maintaining their palatability. Evidence of the toxicological risks of NNS is inconsistent, though concerns have been raised over the potential substitution effects of ultra-processed foods containing NNS for whole foods. This review aimed to provide an overview of current NNS food supply and consumption patterns, assess added sugar-reduction policies and their impact on NNS, and determine the impact of NNS on food choice, energy intake and diet quality. NNS are widely available in a variety of products, though most commonly in carbonated beverages, dairy products, confectionery, table-top sweeteners and fruit drinks. However, the longitudinal trends of different product categories, and differences between geographies and economy-income levels, require further study. Few studies have examined NNS consumption trends globally, though an increase in NNS consumption in beverages has been observed in some regions. Research examining how the increased availability of low-sugar, NNS-containing products affects global dietary patterns is limited, particularly in terms of their potential substitution effects.
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Piernas C, Aveyard P, Lee C, Tsiountsioura M, Noreik M, Astbury NM, Oke J, Madigan C, Jebb SA. Evaluation of an intervention to provide brief support and personalized feedback on food shopping to reduce saturated fat intake (PC-SHOP): A randomized controlled trial. PLoS Med 2020; 17:e1003385. [PMID: 33151934 PMCID: PMC7643942 DOI: 10.1371/journal.pmed.1003385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/18/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Guidelines recommend reducing saturated fat (SFA) intake to decrease cardiovascular disease (CVD) risk, but there is limited evidence on scalable and effective approaches to change dietary intake, given the large proportion of the population exceeding SFA recommendations. We aimed to develop a system to provide monthly personalized feedback and healthier swaps based on nutritional analysis of loyalty card data from the largest United Kingdom grocery store together with brief advice and support from a healthcare professional (HCP) in the primary care practice. Following a hybrid effectiveness-feasibility design, we tested the effects of the intervention on SFA intake and low-density lipoprotein (LDL) cholesterol as well as the feasibility and acceptability of providing nutritional advice using loyalty card data. METHODS AND FINDINGS The Primary Care Shopping Intervention for Cardiovascular Disease Prevention (PC-SHOP) study is a parallel randomized controlled trial with a 3 month follow-up conducted between 21 March 2018 to 16 January2019. Adults ≥18 years with LDL cholesterol >3 mmol/L (n = 113) were recruited from general practitioner (GP) practices in Oxfordshire and randomly allocated to "Brief Support" (BS, n = 48), "Brief Support + Shopping Feedback" (SF, n = 48) or "Control" (n = 17). BS consisted of a 10-minute consultation with an HCP to motivate participants to reduce their SFA intake. Shopping feedback comprised a personalized report on the SFA content of grocery purchases and suggestions for lower SFA swaps. The primary outcome was the between-group difference in change in SFA intake (% total energy intake) at 3 months adjusted for baseline SFA and GP practice using intention-to-treat analysis. Secondary outcomes included %SFA in purchases, LDL cholesterol, and feasibility outcomes. The trial was powered to detect an absolute reduction in SFA of 3% (SD3). Neither participants nor the study team were blinded to group allocation. A total of 106 (94%) participants completed the study: 68% women, 95% white ethnicity, average age 62.4 years (SD 10.8), body mass index (BMI) 27.1 kg/m2 (SD 4.7). There were small decreases in SFA intake at 3 months: control = -0.1% (95% CI -1.8 to 1.7), BS = -0.7% (95% CI -1.8 to 0.3), SF = -0.9% (95% CI -2.0 to 0.2); but no evidence of a significant effect of either intervention compared with control (difference adjusted for GP practice and baseline: BS versus control = -0.33% [95% CI -2.11 to 1.44], p = 0.709; SF versus control = -0.11% [95% CI -1.92 to 1.69], p = 0.901). There were similar trends in %SFA based on supermarket purchases: control = -0.5% (95% CI -2.3 to 1.2), BS = -1.3% (95% CI -2.3 to -0.3), SF = -1.5% (95% CI -2.5 to -0.5) from baseline to follow-up, but these were not significantly different: BS versus control p = 0.379; SF versus control p = 0.411. There were small reductions in LDL from baseline to follow-up (control = -0.14 mmol/L [95% CI -0.48, 0.19), BS: -0.39 mmol/L [95% CI -0.59, -0.19], SF: -0.14 mmol/L [95% CI -0.34, 0.07]), but these were not significantly different: BS versus control p = 0.338; SF versus control p = 0.790. Limitations of this study include the small sample of participants recruited, which limits the power to detect smaller differences, and the low response rate (3%), which may limit the generalisability of these findings. CONCLUSIONS In this study, we have shown it is feasible to deliver brief advice in primary care to encourage reductions in SFA intake and to provide personalized advice to encourage healthier choices using supermarket loyalty card data. There was no evidence of large reductions in SFA, but we are unable to exclude more modest benefits. The feasibility, acceptability, and scalability of these interventions suggest they have potential to encourage small changes in diet, which could be beneficial at the population level. TRIAL REGISTRATION ISRCTN14279335.
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Affiliation(s)
- Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Melina Tsiountsioura
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Michaela Noreik
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nerys M. Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Claire Madigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess EA. Environmental Interventions to Reduce the Consumption of Sugar-Sweetened Beverages: Abridged Cochrane Systematic Review. Obes Facts 2020; 13:397-417. [PMID: 32784303 PMCID: PMC7590771 DOI: 10.1159/000508843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Regular consumption of sugar-sweetened beverages (SSB) can increase the risk for obesity, type 2 diabetes, cardiovascular disease, and dental caries. Interventions that alter the physical or social environment in which individuals make beverage choices have been proposed to reduce the consumption of SSB. METHODS We included randomised controlled, non-randomised controlled, and interrupted time series studies on environmental interventions, with or without behavioural co-interventions, implemented in real-world settings, lasting at least 12 weeks, and including at least 40 individuals. Studies on the taxation of SSB were not included, as these are subject of a separate Cochrane review. We used standard Cochrane methods for data extraction, risk of bias assessment, and evidence grading and synthesis. Searches were updated to January 24, 2018. RESULTS We identified 14,488 unique records and assessed 1,030 full texts for eligibility. We included 58 studies comprising a total of 1,180,096 participants and a median length of follow-up of 10 months. We found moderate-certainty evidence for consistent associations with decreases in SSB consumption or sales for the following interventions: traffic light labelling, price increases on SSB, in-store promotion of healthier beverages in supermarkets, government food benefit programs with incentives for purchasing fruits and vegetables and restrictions on SSB purchases, multi-component community campaigns focused on SSB, and interventions improving the availability of low-calorie beverages in the home environment. For the remaining interventions we found low- to very-low-certainty evidence for associations showing varying degrees of consistency. CONCLUSIONS With observed benefits outweighing observed harms, we suggest that environmental interventions to reduce the consumption of SSB be considered as part of a wider set of measures to improve population-level nutrition. Implementation should be accompanied by evaluations using appropriate methods. Future studies should examine population-level effects of interventions suitable for large-scale implementation, and interventions and settings not yet studied thoroughly.
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Affiliation(s)
- Peter von Philipsborn
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany,
- Pettenkofer School of Public Health, Munich, Germany,
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Laura K Busert
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Stephanie Polus
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Backholer K, Sacks G, Cameron AJ. Food and Beverage Price Promotions: an Untapped Policy Target for Improving Population Diets and Health. Curr Nutr Rep 2020; 8:250-255. [PMID: 31300982 DOI: 10.1007/s13668-019-00287-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW The price of foods and beverages is a critical driver of food choice, particularly among families and households with limited food budgets. Policies targeting unhealthy food and beverage price promotions represent an untapped policy target for improving population diets and health. Here we review policy options for reducing the frequency and influence of price promotions on unhealthy foods and beverages (high in one or more of salt, sugar and saturated fat), and demonstrate their potential to complement other food policies and improve population diets. RECENT FINDINGS Price promotions on unhealthy foods and beverages are ubiquitous in many settings globally and appear to be more common than price promotions for healthy food. Shoppers appear to be more responsive to price promotions on unhealthy foods and beverages compared to price promotions for healthier items, with evidence that discounts lead to impulse purchases, stockpiling and overconsumption. A range of policy options exist to reduce the influence of price promotions on unhealthy foods and beverages, but none have been tested in the real world, meaning the industry and consumer responses to such policies are unclear. Policies that reduce the prevalence and influence of unhealthy food and beverage price promotions should be considered as part of a comprehensive approach to improving population diets.
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Affiliation(s)
- Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia.
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
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Food Co-Operatives: A Potential Community-Based Strategy to Improve Fruit and Vegetable Intake in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114154. [PMID: 32532100 PMCID: PMC7312496 DOI: 10.3390/ijerph17114154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/22/2022]
Abstract
Only 5% of Australian children and adults eat enough fruit and vegetables. Two common barriers are high cost and limited access. Food co-operatives (‘co-ops’) may have the potential to reduce these barriers. We conducted a scoping analysis of food co-ops in the Sydney region to describe their characteristics and objectives. We also conducted a survey of members and non-members of co-ops to assess their fruit and vegetable intake using validated questions. Fifteen food co-ops were identified in the Sydney region and the most common objective was to provide cheap affordable produce. Most co-ops (61%) were in areas of high socio-economic status (SES). Members of food co-ops had a higher vegetable intake than non-members [mean difference (MD) = 0.54 serves/daily; 95% confidence interval (CI) of 0.15 to 0.93] and were also more likely to meet the recommendations for fruit and vegetable intake [odds ratio (OR) = 4.77 (95% CI = 1.15, 19.86)]. Implications of this study are that if food co-ops can be implemented on a wider scale, they hold potential for improving fruit and vegetable intakes.
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Dibay Moghadam S, Krieger JW, Louden DKN. A systematic review of the effectiveness of promoting water intake to reduce sugar-sweetened beverage consumption. Obes Sci Pract 2020; 6:229-246. [PMID: 32523712 PMCID: PMC7278905 DOI: 10.1002/osp4.397] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To examine whether the promotion of water intake could reduce sugar-sweetened beverage (SSB) consumption or purchases independent of interventions that target SSBs. METHODS Seven databases were systematically searched. Included studies used water promotion as the primary intervention; used a controlled trial, single group pre-post, or prospective cohort study design; included a measure of SSB consumption or purchase; enrolled human participants of any age who lived in high-income or middle-income countries; contained original data; and appeared in a peer-reviewed English-language article published from 1 January 2000 to January 4, 2019. The search yielded 7068 publications, from which 108 were chosen for full-text review. Seventeen were included in this review. RESULTS Nine of the 17 studies were randomized controlled trials, six were nonrandomized controlled trials, and 2 were single-group pre-post studies. Participants were primarily children and adolescents. Interventions included water provision, education or promotion activities. Ten of 17 studies were at low or some/moderate risk of bias. Seven studies showed a statistically significant decrease in SSB consumption of which only 2 were at low or some/moderate risk of bias. CONCLUSIONS This review found limited evidence that interventions aimed solely at increasing water consumption reduce SSB intake. Further research is needed to investigate whether interventions that combine water promotion and SSB reduction strategies could be synergistic for reducing SSB intake.
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Affiliation(s)
- Sepideh Dibay Moghadam
- Department of EpidemiologyUniversity of WashingtonWashingtonUnited States of America
- Fred Hutchinson Cancer Research CenterCancer Prevention ProgramWashingtonUnited States of America
| | - James W. Krieger
- Department of Health ServicesUniversity of WashingtonWashingtonUnited States of America
- Healthy Food AmericaWashingtonUnited States of America
| | - Diana K. N. Louden
- University LibrariesUniversity of WashingtonWashingtonUnited States of America
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Stuber JM, Mackenbach JD, de Boer FE, de Bruijn GJ, Gillebaart M, Harbers MC, Hoenink JC, Klein MCA, Middel CNH, van der Schouw YT, Schuitmaker-Warnaar TJ, Velema E, Vos AL, Waterlander WE, Lakerveld J, Beulens JWJ. Reducing cardiometabolic risk in adults with a low socioeconomic position: protocol of the Supreme Nudge parallel cluster-randomised controlled supermarket trial. Nutr J 2020; 19:46. [PMID: 32429917 PMCID: PMC7236937 DOI: 10.1186/s12937-020-00562-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
Abstract
Background Unhealthy lifestyle behaviours such as unhealthy dietary intake and insufficient physical activity (PA) tend to cluster in adults with a low socioeconomic position (SEP), putting them at high cardiometabolic disease risk. Educational approaches aiming to improve lifestyle behaviours show limited effect in this population. Using environmental and context-specific interventions may create opportunities for sustainable behaviour change. In this study protocol, we describe the design of a real-life supermarket trial combining nudging, pricing and a mobile PA app with the aim to improve lifestyle behaviours and lower cardiometabolic disease risk in adults with a low SEP. Methods The Supreme Nudge trial includes nudging and pricing strategies cluster-randomised on the supermarket level, with: i) control group receiving no intervention; ii) group 1 receiving healthy food nudges (e.g., product placement or promotion); iii) group 2 receiving nudges and pricing strategies (taxing of unhealthy foods and subsidizing healthy foods). In collaboration with a Dutch supermarket chain we will select nine stores located in low SEP neighbourhoods, with the nearest competitor store at > 1 km distance and managed by a committed store manager. Across the clusters, a personalized mobile coaching app targeting walking behaviour will be randomised at the individual level, with: i) control group; ii) a group receiving the mobile PA app. All participants (target n = 1485) should be Dutch-speaking, aged 45–75 years with a low SEP and purchase more than half of their household grocery shopping at the selected supermarkets. Participants will be recruited via advertisements and mail-invitations followed by community-outreach methods. Primary outcomes are changes in systolic blood pressure, LDL-cholesterol, HbA1c and dietary intake after 12 months follow-up. Secondary outcomes are changes in diastolic blood pressure, blood lipid markers, waist circumference, steps per day, and behavioural factors including healthy food purchasing, food decision style, social cognitive factors related to nudges and to walking behaviours and customer satisfaction after 12 months follow-up. The trial will be reflexively monitored to support current and future implementation. Discussion The findings can guide future research and public health policies on reducing lifestyle-related health inequalities, and contribute to a supermarket-based health promotion intervention implementation roadmap. Trial registration Dutch Trial Register ID NL7064, 30th of May, 2018
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Affiliation(s)
- Josine M Stuber
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands. .,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Joreintje D Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Femke E de Boer
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Gert-Jan de Bruijn
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Marleen Gillebaart
- Department of Social, Health and Organizational Psychology, Utrecht University, Utrecht, the Netherlands
| | - Marjolein C Harbers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jody C Hoenink
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands
| | - Michel C A Klein
- Social AI group, department of Computer Science, VU University Amsterdam, Amsterdam, the Netherlands
| | - Cédric N H Middel
- Athena Institute, Faculty of Science, VU University, Amsterdam, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Elizabeth Velema
- Netherlands Nutrition Centre (Voedingscentrum), The Hague, The Netherlands
| | - Anne L Vos
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilma E Waterlander
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, VU University Amsterdam, Amsterdam, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Examining Shopping Patterns, Use of Food-Related Resources, and Proposed Solutions to Improve Healthy Food Access Among Food Insecure and Food Secure Eastern North Carolina Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103361. [PMID: 32408632 PMCID: PMC7277759 DOI: 10.3390/ijerph17103361] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022]
Abstract
In the Southern United States (U.S.), food insecurity rates are higher in rural (20.8%) versus urban communities (15%). Food insecurity can exacerbate diet-related disease. Thus, the purpose of this study was to examine differences in the use of food-related community resources and potential solutions proposed among food insecure versus food secure residents. A community survey (n = 370) was conducted in rural eastern North Carolina, with questions pertaining to food security status and food-related resources. The IBM SPSS Statistics software and SAS software were used to examine differences in food-related resources, and qualitative data analysis was used to examine differences in solutions offered between food insecure and food secure participants. Of the 370 respondents, forty-eight-point-six percent were classified as food insecure. Food insecure participants were more likely to report shopping for groceries at a convenience/discount store, less likely to use their own vehicle for transportation, and less likely to purchase food from local producers. Food insecure participants were more likely to suggest solutions related to reducing the cost of healthy food, while food secure participants were more likely to suggest educational or convenience-related interventions.
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Blakely T, Nghiem N, Genc M, Mizdrak A, Cobiac L, Mhurchu CN, Swinburn B, Scarborough P, Cleghorn C. Modelling the health impact of food taxes and subsidies with price elasticities: The case for additional scaling of food consumption using the total food expenditure elasticity. PLoS One 2020; 15:e0230506. [PMID: 32214329 PMCID: PMC7098589 DOI: 10.1371/journal.pone.0230506] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/03/2020] [Indexed: 11/24/2022] Open
Abstract
Background Food taxes and subsidies are one intervention to address poor diets. Price elasticity (PE) matrices are commonly used to model the change in food purchasing. Usually a PE matrix is generated in one setting then applied to another setting with differing starting consumptions and prices of foods. This violates econometric assumptions resulting in likely mis-estimation of total food consumption. In this paper we demonstrate this problem, canvass possible options for rescaling all consumption after applying a PE matrix, and illustrate the use of a total food expenditure elasticity (TFEe; the expenditure elasticity for all food combined given the policy-induced change in the total price of food). We use case studies of: NZ$2 per 100g saturated fat (SAFA) tax, NZ$0.4 per 100g sugar tax, and a 20% fruit and vegetable (F&V) subsidy. Methods We estimated changes in food purchasing using a NZ PE matrix applied conventionally, and then with TFEe adjustment. Impacts were quantified for pre- to post-policy changes in total food expenditure and health adjusted life years (HALYs) for the total NZ population alive in 2011 over the rest of their lifetime using a multistate lifetable model. Results Two NZ studies gave TFEe’s of 0.68 and 0.83, with international estimates ranging from 0.46 to 0.90 (except a UK outlier of 0.04). Without TFEe adjustment, total food expenditure decreased with the tax policies and increased with the F&V subsidy–implausible directions of shift given economic theory and the external TFEe estimates. After TFEe adjustment, HALY gains reduced by a third to a half for the two taxes and reversed from an apparent health loss to a health gain for the F&V subsidy. With TFEe adjustment, HALY gains (in 1000’s) were: 1,805 (95% uncertainty interval 1,337 to 2,340) for the SAFA tax; 1,671 (1,220 to 2,269) for the sugar tax; and 953 (453 to 1,308) for the F&V subsidy. Conclusions If PE matrices are applied in settings beyond where they were derived, additional scaling is likely required. We suggest that the TFEe is a useful scalar, but we also encourage other researchers to examine this issue and propose alternative options.
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Affiliation(s)
- Tony Blakely
- Population Interventions Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Murat Genc
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Linda Cobiac
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Cliona Ni Mhurchu
- National Institute of Health Innovation, University of Auckland, Auckland, New Zealand
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Christine Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
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Vadiveloo MK, Guan X, Parker HW, Perraud E, Buchanan A, Atlas S, Thorndike AN. Evaluating the effect of individually-targeted food incentives on grocery purchases: The smart cart study protocol for a randomized controlled cross-over trial. Contemp Clin Trials 2020; 91:105966. [PMID: 32092439 DOI: 10.1016/j.cct.2020.105966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIMS Health stakeholders are interested in the promise of healthy food incentives to improve dietary quality. The Smart Cart Study tested whether targeting healthful food incentives based on customer preferences and purchase history was effective for improving grocery purchase quality. DESIGN Randomized controlled crossover design of 224 adults who shopped at an independent supermarket for ≥50% of their groceries, participated in the store's loyalty program, and completed validated diet and sociodemographic/behavioral questionnaires. Participants were randomized using 1:1 blocked randomization; all participants received a 5% discount on their purchases with their loyalty card. For the first 13-weeks, the intervention group received individually-targeted weekly coupons (valued up to $10) with brief nutrition education to improve grocery purchase quality. The study team developed healthy food coupons, and the study algorithm allocated targeted coupons to participants' loyalty cards using purchase history, dietary preferences/allergies, and baseline diet quality. Control participants received weekly untargeted nutrition education and occasional generic coupons. Following a 2-4 week washout period, the two groups crossed over. The primary study outcomes were purchases of targeted products and grocery purchase quality measured using the validated Grocery Purchase Quality Index-2016; the study was powered to detect a minimum 3% difference in purchase quality. CONCLUSIONS The Smart Cart Study tested a novel application of automated individually-targeted marketing using customer purchase history, dietary quality, and preferences to identify and deliver targeted incentives to improve grocery purchase quality. Future research could scale this program through collaboration between multiple stakeholders, including supermarkets, workplace wellness initiatives and insurance companies.
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Affiliation(s)
- Maya K Vadiveloo
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, United States of America.
| | - Xintong Guan
- Marketing Area, College of Business Administration, University of Rhode Island, Kingston, RI, United States of America
| | - Haley W Parker
- Department of Nutrition and Food Sciences, College of Health Sciences, University of Rhode Island, Kingston, RI, United States of America
| | - Elie Perraud
- AgroParis Tech., 75231 Paris, Ile-de-France, France
| | - Ashley Buchanan
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, United States of America
| | - Stephen Atlas
- Marketing Area, College of Business Administration, University of Rhode Island, Kingston, RI, United States of America
| | - Anne N Thorndike
- General Internal Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Vogel C, Crozier S, Dhuria P, Shand C, Lawrence W, Cade J, Moon G, Lord J, Ball K, Cooper C, Baird J. Protocol of a natural experiment to evaluate a supermarket intervention to improve food purchasing and dietary behaviours of women (WRAPPED study) in England: a prospective matched controlled cluster design. BMJ Open 2020; 10:e036758. [PMID: 32047023 PMCID: PMC7044911 DOI: 10.1136/bmjopen-2020-036758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Poor diet is a leading risk factor for non-communicable diseases and costs the National Health Service £5.8 billion annually. Product placement strategies used extensively in food outlets, like supermarkets, can influence customers' preferences. Policy-makers, including the UK Government, are considering legislation to ensure placement strategies promote healthier food purchasing and dietary habits. High-quality scientific evidence is needed to inform future policy action. This study will assess whether healthier placement strategies in supermarkets improve household purchasing patterns and the diets of more than one household member. METHODS AND ANALYSES This natural experiment, with a prospective matched controlled cluster design, is set in discount supermarkets across England. The primary objective is to investigate whether enhanced placement of fresh fruit and vegetables improves household-level purchasing of these products after 6 months. Secondary objectives will examine: (1) differences in intervention effects on purchasing by level of educational attainment, (2) intervention effects on the dietary quality of women and their young children, (3) intervention effects on store-level sales of fruit and vegetables and (4) cost-effectiveness of the intervention from individual, retailer and societal perspectives. Up to 810 intervention and 810 control participants will be recruited from 18 intervention and 18 matched control stores. Eligible participants will be women aged 18-45 years, who hold a loyalty card and shop in a study store. Each control store will be matched to an intervention store on: (1) sales profile, (2) neighbourhood deprivation and (3) customer profile. A detailed process evaluation will assess intervention implementation, mechanisms of impact and, social and environmental contexts. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Southampton, Faculty of Medicine Ethics Committee (ID 20986.A5). Primary, secondary and process evaluation results will be submitted for publication in peer-reviewed scientific journals and shared with policy-makers. TRIAL REGISTRATION NUMBER NCT03573973; Pre-results.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Calum Shand
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janet Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham Moon
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Zorbas C, Grigsby-Duffy L, Backholer K. Getting the Price Right: How Nutrition and Obesity Prevention Strategies Address Food and Beverage Pricing Within High-Income Countries. Curr Nutr Rep 2020; 9:42-53. [PMID: 31953676 DOI: 10.1007/s13668-020-00300-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Food and beverage prices are major influences on dietary intakes. International health bodies recommend leveraging food prices to create healthier food environments. A policy review was conducted to understand the extent to which national nutrition and obesity prevention policy strategies within high-income countries (i) consider food price as a determinant of health and (ii) propose and implement policies to rebalance food pricing towards healthier options. RECENT FINDINGS Policy strategies were inconsistent and fragmented in their inclusion of food prices as determinants of diet-related health. The equity benefits of pricing policies were often indicated. Fiscal measures and food subsidies in schools were the most commonly proposed and implemented pricing policies, predominantly used in Europe. Price is a pertinent but underutilized policy lever in nutrition policy. Comprehensive food and beverage pricing strategies need to be identified, adopted and implemented to improve population diets for everyone.
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Affiliation(s)
- Christina Zorbas
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Lily Grigsby-Duffy
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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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 2019; 8:411-428. [PMID: 31797233 PMCID: PMC6904419 DOI: 10.1007/s13668-019-00295-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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. 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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Taufik D, Verain MC, Bouwman EP, Reinders MJ. Determinants of real-life behavioural interventions to stimulate more plant-based and less animal-based diets: A systematic review. Trends Food Sci Technol 2019. [DOI: 10.1016/j.tifs.2019.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Weight loss is traditionally viewed as straightforward counting of calories in and calories out, with little regard to the role of the adipocytes tasked with storing said calories. However, the body executes a complex compensatory response to any intervention that depletes its energy stores. Here, the authors discuss the methods used to attain weight loss, the body's response to this weight loss, and the difficulties in maintaining weight loss. Furthermore, the authors provide an overview of the literature on the physiological effects of liposuction. OBJECTIVE To describe the role of adipose tissue in energy homeostasis, methods of weight loss, weight regain, and the effect of liposuction on endocrine signaling. METHODS The authors conducted a narrative review of representative studies. CONCLUSION A variety of strategies for weight loss exist, and optimizing one's weight status may in turn optimize the aesthetic outcomes of liposuction. This is most apparent in the preferential reaccumulation of fat in certain areas after liposuction and the ability to avoid this with a negative energy balance.
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Affiliation(s)
- William Davis
- Cooper Medical School of Rowan University, Marlton, New Jersey
| | - Naomi Lawrence
- Cooper Medical School of Rowan University, Marlton, New Jersey.,Section of Procedural Dermatology, Cooper University Hospital, Marlton, New Jersey
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Yii V, Palermo C, Kleve S. Population-based interventions addressing food insecurity in Australia: A systematic scoping review. Nutr Diet 2019; 77:6-18. [PMID: 31593624 DOI: 10.1111/1747-0080.12580] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 01/07/2023]
Abstract
AIM Food insecurity (FI) is a critical public health issue in Australia. Population-based interventions aiming to address the socio-ecological determinants of FI are critical for relieving and preventing it. This review aimed to map and summarise the characteristics of population-based interventions addressing household and/or community FI in Australia. METHODS A systematic scoping review was undertaken. Five databases, selected for range and relevance to FI in Australia ("CINAHL plus", "Ovid MEDLINE", "Sociological Abstracts", "Australian Public Affairs Information Service", and "Rural and Remote Health") were searched in May 2018 using the terms and relevant synonyms "FI" and "interventions". In addition a systematic grey literature search using multiple Google searches was undertaken. Data synthesis included categorisation and counting intervention type. Interventions were defined and charted by influence of at least one dimension of food security and impact on the socioeconomic, cultural and environmental conditions. RESULTS A total of 3565 published and grey literature records were identified, with the final 60 records describing 98 interventions. Few national interventions were identified, with approaches predominantly in Victoria, Northern Territory and Tasmania. Determinants related to living and working environments, food availability and food utilisation were most frequently addressed. Interventions addressing the key determinant of FI economic access were limited. A number of interventions did not appear to be associated with rigorous evaluation. CONCLUSIONS While there is evidence of population responses to FI in Australia, the effectiveness of these remains limited. Importantly there is a lack of coordinated and coherent national responses that address the range of FI determinants.
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Affiliation(s)
- Vivien Yii
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, Victoria, Australia
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Blake MR, Backholer K, Lancsar E, Boelsen-Robinson T, Mah C, Brimblecombe J, Zorbas C, Billich N, Peeters A. Investigating business outcomes of healthy food retail strategies: A systematic scoping review. Obes Rev 2019; 20:1384-1399. [PMID: 31397087 DOI: 10.1111/obr.12912] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/13/2019] [Accepted: 06/23/2019] [Indexed: 12/17/2022]
Abstract
Large changes to food retail settings are required to improve population diet. However, limited research has comprehensively considered the business implications of healthy food retail strategies for food retailers. We performed a systematic scoping review to identify types of business outcomes that have been reported in healthy food retail strategy evaluations. Peer-reviewed and grey literature were searched. We identified qualitative or quantitative real-world food or beverage retail strategies designed to improve the healthiness of the consumer nutrition environment (eg, changes to the "marketing mix" of product, price, promotion, and/or placement). Eligible studies reported store- or chain-level outcomes for measures of commercial viability, retailer perspectives, customer perspectives, and/or community outcomes. 11 682 titles and abstracts were screened with 107 studies included for review from 15 countries. Overall item sales, revenue, store patronage, and customer level of satisfaction with strategy were the most frequently examined outcomes. There was a large heterogeneity in outcome measures reported and in favourability for retailers of outcomes across studies. We recommend more consistent reporting of business outcomes and increased development and use of validated and reliable measurement tools. This may help generate more robust research evidence to aid retailers and policymakers to select feasible and sustainable healthy food retail strategies to benefit population health within and across countries.
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Affiliation(s)
- Miranda R Blake
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia.,Centre for Health Economics, Monash University, Clayton, Victoria, Australia
| | - Tara Boelsen-Robinson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Catherine Mah
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Christina Zorbas
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
| | - Natassja Billich
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia
| | - Anna Peeters
- Deakin University, Geelong, Global Obesity Centre, Institute for Health Transformation, Victoria, Australia
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Monetary Cost of the MyPlate Diet in Young Adults: Higher Expenses Associated with Increased Fruit and Vegetable Consumption. J Nutr Metab 2019; 2019:2790963. [PMID: 31192007 PMCID: PMC6525887 DOI: 10.1155/2019/2790963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/16/2018] [Accepted: 03/17/2019] [Indexed: 01/04/2023] Open
Abstract
Background Cost is a commonly reported barrier to healthy eating. This is a secondary research analysis designed to examine the food expenditures of young adults on a university campus following the United States Department of Agriculture (USDA) MyPlate guidelines for fruits and vegetables. Methods Meal receipts and dietary intake were recorded weekly. Anthropometrics and clinical assessments were recorded before intervention. Researchers rated compliance based on the participant's dietary food log, receipt matching, food pictures, and reports during weekly 1-hour consultations. Results Fifty-three young adults (18–30 years old) at-risk of, or diagnosed with, metabolic syndrome (MetS) were enrolled in the study, with 10 excluded (n = 43) from analyses due to enrollment in a fixed cost university campus dining meal plan. A two sample t-test assessed differences in food costs and regression analysis determined associations between food cost and diet compliance while controlling for confounding factors of age, sex, and body mass index (BMI). Diet compliant subjects (n = 38) had higher weekly food cost at $95.73 compared to noncompliant subjects (n = 5) who spent $66.24 (p=0.01). A regression analysis controlling for age, sex, BMI, and geographical region also indicated cost differences based on diet compliance (p < 0.0001). Conclusion Results indicate an ∼$29.00 per week increase in food cost when eating the recommended amount of fruit and vegetables. These findings can contribute to research incentive design, program planning cost, and determining effective interventions to improve diet in this population.
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Nutrition literacy predicts adherence to healthy/unhealthy diet patterns in adults with a nutrition-related chronic condition. Public Health Nutr 2019; 22:2157-2169. [PMID: 31146797 DOI: 10.1017/s1368980019001289] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the relationship between adherence to distinct dietary patterns and nutrition literacy. DESIGN We identified distinct dietary patterns using principal covariates regression (PCovR) and principal components analysis (PCA) from the Diet History Questionnaire II. Nutrition literacy was assessed using the Nutrition Literacy Assessment Instrument (NLit). Cross-sectional relationships between dietary pattern adherence and global and domain-specific NLit scores were tested by multiple linear regression. Mean differences in diet pattern adherence among three predefined nutrition literacy performance categories were tested by ANOVA. SETTING Metropolitan Kansas City, USA. PARTICIPANTS Adults (n 386) with at least one of four diet-related diseases. RESULTS Three diet patterns of interest were derived: a PCovR prudent pattern and PCA-derived Western and Mediterranean patterns. After controlling for age, sex, BMI, race, household income, education level and diabetes status, PCovR prudent pattern adherence positively related to global NLit score (P < 0·001, β = 0·36), indicating more intake of prudent diet foods with improved nutrition literacy. Validating the PCovR findings, PCA Western pattern adherence inversely related to global NLit (P = 0·003, β = -0·13) while PCA Mediterranean pattern positively related to global NLit (P = 0·02, β = 0·12). Using predefined cut points, those with poor nutrition literacy consumed more foods associated with the Western diet (fried foods, sugar-sweetened beverages, red meat, processed foods) while those with good nutrition literacy consumed more foods associated with prudent and Mediterranean diets (vegetables, olive oil, nuts). CONCLUSIONS Nutrition literacy predicted adherence to healthy/unhealthy diet patterns. These findings warrant future research to determine if improving nutrition literacy effectively improves eating patterns.
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Harrington RA, Scarborough P, Hodgkins C, Raats MM, Cowburn G, Dean M, Doherty A, Foster C, Juszczak E, Ni Mhurchu C, Winstone N, Shepherd R, Timotijevic L, Rayner M. A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study. JMIR Form Res 2019; 3:e9910. [PMID: 30958277 PMCID: PMC6482590 DOI: 10.2196/formative.9910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 12/05/2018] [Accepted: 12/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. OBJECTIVE The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. METHODS The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). RESULTS We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). CONCLUSIONS Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. TRIAL REGISTRATION ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s40814-015-0015-1.
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Affiliation(s)
- Richard A Harrington
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Monique M Raats
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Gill Cowburn
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Moira Dean
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Aiden Doherty
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Naomi Winstone
- Department of Higher Education, University of Surrey, Guildford, United Kingdom
| | - Richard Shepherd
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Lada Timotijevic
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mike Rayner
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Vogel C, Abbott G, Ntani G, Barker M, Cooper C, Moon G, Ball K, Baird J. Examination of how food environment and psychological factors interact in their relationship with dietary behaviours: test of a cross-sectional model. Int J Behav Nutr Phys Act 2019; 16:12. [PMID: 30700323 PMCID: PMC6354411 DOI: 10.1186/s12966-019-0772-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To improve population diet environmental strategies have been hailed the panacea because they require little agency or investment of personal resources; this contrasts with conventional strategies that rely on individuals to engage high levels of agency and make deliberate choices. There is an immediate need to improve understanding of the synergy between the psychological and environmental determinants of diet in order to optimise allocation of precious public health resources. This study examined the synergistic and relative association between a number of food environment and psychological factors and the dietary behaviours of a population sample of women with young children. METHODS Women in Hampshire were recruited from children's centres and asked about their demographic characteristics, psychological resources, dietary behaviours (food frequency questionnaire) and perceptions of healthy food access and affordability. Three local food environment factors were objectively assessed: i) spatial access to food outlets using activity spaces; ii) healthfulness of the supermarket where women did their main food shop, (based on nine in-store factors including price, placement and promotion on seven healthy and five less healthy foods); iii) nutrition environment of children's centres visited frequently by the women, assessed via staff-administered questionnaire. A theoretical model linking environmental factors to dietary behaviours, both directly and indirectly through three factors representing individual agency (psychological resources, perceived food affordability, perceived food accessibility), was tested using Structural Equation Modelling. RESULTS Complete data were available for 753 women. The environment of women's main supermarket was indirectly related to their dietary behaviours through psychological resources and perceived food affordability. Shopping at supermarkets classified as having a healthier in-store environment was associated with having greater psychological resources associated with healthy eating (standardised regression weight β = 0.14SD, p = 0.03) and fewer food affordability concerns (β = - 0.14SD, p = 0.01), which in turn related to healthier dietary behaviours (β = 0.55SD, < 0.001 and β = - 0.15, p = 0.01 respectively). The three food environment factors were not directly associated with dietary behaviour (p > 0.3). The overall model fit was good (CFI = 0.91, RMSEA = 0.05 [0.05, 0.06]). CONCLUSIONS This pathway analysis identified three focal points for intervention and suggests that high-agency interventions targeting individual psychological resources when combined with low-agency supermarket environment interventions may confer greater benefits on dietary behaviours than either intervention alone.
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Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Georgia Ntani
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - Graham Moon
- School of Geography and Environmental Science, University of Southampton, University Road, Southampton, SO17 1BJ UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125 Australia
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
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Brown C, Laws C, Leonard D, Campbell S, Merone L, Hammond M, Thompson K, Canuto K, Brimblecombe J. Healthy Choice Rewards: A Feasibility Trial of Incentives to Influence Consumer Food Choices in a Remote Australian Aboriginal Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010112. [PMID: 30609836 PMCID: PMC6339254 DOI: 10.3390/ijerph16010112] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/21/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022]
Abstract
Poor diet including inadequate fruit and vegetable consumption is a major contributor to the global burden of disease. Aboriginal and Torres Strait Islander Australians experience a disproportionate level of preventable chronic disease and successful strategies to support Aboriginal and Torres Strait Islander people living in remote areas to consume more fruit and vegetables can help address health disadvantage. Healthy Choice Rewards was a mixed methods study to investigate the feasibility of a monetary incentive: store vouchers, to promote fruit and vegetable purchasing in a remote Australian Aboriginal community. Multiple challenges were identified in implementation, including limited nutrition workforce. Challenges related to the community store included frequent store closures and amended trading times, staffing issues and poor infrastructure to support fruit and vegetable promotion. No statistically significant increases in fruit or vegetable purchases were observed in the short time frame of this study. Despite this, community members reported high acceptability of the program, especially for women with children. Optimal implementation including, sufficient time and funding resources, with consideration of the most vulnerable could go some way to addressing inequities in food affordability for remote community residents.
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Affiliation(s)
- Clare Brown
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Cara Laws
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health Medical and Veterinary Sciences, James Cook University, 4870 Cairns, Australia.
| | - Sandy Campbell
- Centre for Indigenous Health Equity Research, Central Queensland University, 4870 Cairns, Australia.
| | - Lea Merone
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | | | - Kani Thompson
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
| | - Karla Canuto
- Apunipima Cape York Health Council, 4870 Cairns, Australia.
- Wardliparingga Aboriginal Health, South Australian Health and Medical Research Institute, 5001 Adelaide, Australia.
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Monash University, 3168 Melbourne, Australia.
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Ferguson M, O'Dea K, Altman J, Moodie M, Brimblecombe J. Health-Promoting Food Pricing Policies and Decision-Making in Very Remote Aboriginal and Torres Strait Islander Community Stores in Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122908. [PMID: 30572601 PMCID: PMC6313585 DOI: 10.3390/ijerph15122908] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/10/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022]
Abstract
Aboriginal and Torres Strait Islander people living in remote communities in Australia experience a disproportionate burden of diet-related chronic disease. This occurs in an environment where the cost of store-purchased food is high and cash incomes are low, factors that affect both food insecurity and health outcomes. Aboriginal and Torres Strait Islander storeowners and the retailers who work with them implement local policies with the aim of improving food affordability and health outcomes. This paper describes health-promoting food pricing policies, their alignment with evidence, and the decision-making processes entailed in their development in community stores across very remote Australia. Semi-structured interviews were conducted with a purposive sample of retailers and health professionals identified through the snowball method, September 2015 to October 2016. Data were complemented through review of documents describing food pricing policies. A content analysis of the types and design of policies was undertaken, while the decision-making process was considered through a deductive, thematic analysis. Fifteen retailers and 32 health professionals providing services to stores participated. Subsidies and subsidy/price increase combinations dominated. Magnitude of price changes ranged from 5% to 25% on fruit, vegetables, bottled water, artificially sweetened and sugar sweetened carbonated beverages, and broadly used 'healthy/essential' and 'unhealthy' food classifications. Feasibility and sustainability were considered during policy development. Greater consideration of acceptability, importance, effectiveness and unintended consequences of policies guided by evidence were deemed important, as were increased involvement of Aboriginal and Torres Strait Islander storeowners and nutritionists in policy development. A range of locally developed health-promoting food pricing policies exist and partially align with research-evidence. The decision-making processes identified offer an opportunity to incorporate evidence, based on consideration of the local context.
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Affiliation(s)
- Megan Ferguson
- School of Public Health, The University of Queensland, Brisbane 4072, Australia.
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Darwin 0811, Australia.
| | - Kerin O'Dea
- Division of Health Sciences, University of South Australia, Adelaide 5001, Australia. Kerin.O'
| | - Jon Altman
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood 3125, Australia.
| | - Marjory Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong 3220, Australia.
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Darwin 0811, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia.
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It Is Time to Make Policy for Healthier Food Environments in Australian Universities. Nutrients 2018; 10:nu10121909. [PMID: 30518049 PMCID: PMC6316519 DOI: 10.3390/nu10121909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 11/16/2022] Open
Abstract
The obesogenic food environment is likely driving excessive weight gain in young adults. Our study aimed to investigate the nutritional quality of current food and drink offerings in an Australian university. This cross-sectional study included baseline environmental audits of 30 food outlets and 62 vending machines across campus. A recent food and drink benchmark for health facilities by state government was used to classify the food and beverage offerings. It recommended food outlets and vending machines to offer at least 75% 'Everyday' (healthy) and less than 25% 'Occasional' (less healthy) foods and drinks. Sugary drinks and options with large portion sizes and unhealthy ingredients should be removed from sale. Only two beverage vending machines and none of the food outlets met the full recommendations. The overall proportions of Everyday and Occasional foods in food outlets were 35% and 22%, respectively with 43% falling into the category that should not be sold. Sugary drinks occupied a third of beverage varieties in outlets and 38% of beverage slots in vending machines. The current university food environment was poorly compliant with the existing benchmark. Specific food policy in the university setting may be needed to make healthier choices more accessible to young adults.
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Magnus A, Cobiac L, Brimblecombe J, Chatfield M, Gunther A, Ferguson M, Moodie M. The cost-effectiveness of a 20% price discount on fruit, vegetables, diet drinks and water, trialled in remote Australia to improve Indigenous health. PLoS One 2018; 13:e0204005. [PMID: 30260984 PMCID: PMC6160015 DOI: 10.1371/journal.pone.0204005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/01/2018] [Indexed: 11/21/2022] Open
Abstract
This paper estimates the cost-effectiveness of a 20% price discount on healthy food and beverages with and without consumer nutrition education, as trialled in remote Northern Australia. Changes in actual store sales, from the pre-discount baseline period, were analysed for population impact on consumption of fruit and vegetables, water and artificially sweetened soft drinks, in addition with total dietary weight (grams), energy (Mega Joules), and sodium (milligrams). Disability Adjusted Life Years (DALYs), arising from changes in dietary risk factor prevalence in the population, were estimated as the primary health outcome in a multi health-state Markov model. The costs of the strategies were sourced from paid invoices and time estimates of staff providing store-based discount promotion and consumer education. The incremental cost-effectiveness ratio adopted a partial societal perspective, (including health and retail sector costs), as cost per DALY averted and was presented in 2011 Australian dollars. The price discount, helped address a gap in food price equity for residents of remote communities. However, the discount strategy, with or without consumer education led to a net loss of population health –36 95%CI (-47,-25) or -21(-28, -15) DALYs respectively, at increased cost to the retail and health sectors, of AUD860000 95%CI (710000, 1million) or AUD500000 (410000, 590000). The strategies trialled were thereby categorised as dominated by current practice while acknowledging considerable uncertainty surrounding the health outcome estimates. The 20% discount on limited targeted products appeared to need to be considered in conjunction with other marketing strategies to support healthy food choices, if remote Australian Indigenous population health is to be improved.
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Affiliation(s)
- Anne Magnus
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Linda Cobiac
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
| | - Mark Chatfield
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
| | - Anthony Gunther
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
| | - Megan Ferguson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Brisbane, Queensland, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Global Obesity Centre, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Pulker CE, Thornton LE, Trapp GSA. What is known about consumer nutrition environments in Australia? A scoping review of the literature. Obes Sci Pract 2018; 4:318-337. [PMID: 30151227 PMCID: PMC6105710 DOI: 10.1002/osp4.275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/22/2018] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Food environments can influence food selection and hold the potential to reduce obesity, non-communicable diseases and their inequalities. 'Consumer nutrition environments' describe what consumers encounter within a food retail outlet, including products, price, promotion and placement. This study aimed to summarize the attributes that have been examined in existing peer-reviewed studies of Australian consumer nutrition environments, identify knowledge gaps and provide recommendations for future research. METHODS A systematic search of peer-reviewed literature was conducted. Sixty-six studies that assessed an aspect of within-store consumer nutrition environments were included. RESULTS Most studies were published from 2011 onwards and were conducted in capital cities and in supermarkets. Studies assessed the domains of product (40/66), price (26/66), promotion (16/66) and placement (6/66). The most common research themes identified were assessment of the impact of area socioeconomic status (13/66), remoteness (9/66) and food outlet type (7/66) on healthy food prices; change in price of healthy foods (6/66); variety of healthy foods (5/66); and prevalence of unhealthy child-orientated products (5/66). CONCLUSIONS This scoping review identified a large number of knowledge gaps. Recommended priorities for researchers are as follows: (1) develop consistent observational methodology, (2) consider consumer nutrition environments in rural and remote communities, (3) develop an understanding of food service outlets, (4) build on existing evidence in all four domains of product, price, placement and promotion and (5) determine effective policy and store-based interventions to increase healthy food selection.
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Affiliation(s)
- C. E. Pulker
- School of Public HealthCurtin UniversityPerthWAAustralia
- Telethon Kids InstituteThe University of Western AustraliaPerthWAAustralia
| | - L. E. Thornton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityMelbourneVICAustralia
| | - G. S. A. Trapp
- Telethon Kids InstituteThe University of Western AustraliaPerthWAAustralia
- School of Population and Global HealthThe University of Western AustraliaCrawleyWAAustralia
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