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Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood. Nutrients 2021; 13:nu13114176. [PMID: 34836431 PMCID: PMC8624977 DOI: 10.3390/nu13114176] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of 'tracking' of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.
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Mohammadi S, Su TT, Papadaki A, Jalaludin MY, Dahlui M, Mohamed MNA, Jago R, Toumpakari Z, Johnson L, Majid HA. Perceptions of eating practices and physical activity among Malaysian adolescents in secondary schools: a qualitative study with multi-stakeholders. Public Health Nutr 2021; 24:2273-2285. [PMID: 32744217 PMCID: PMC10195509 DOI: 10.1017/s1368980020002293] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/09/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents. DESIGN A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data. SETTING Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia. PARTICIPANTS Focus groups were conducted with seventy-six adolescents aged 13-14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators. RESULTS Stakeholders thought that adolescents' misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers' commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA. CONCLUSIONS These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents.
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Affiliation(s)
- Shooka Mohammadi
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Tin Tin Su
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway47500, Malaysia
| | - Angeliki Papadaki
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Muhammad Yazid Jalaludin
- Department of Paediatrics, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Maznah Dahlui
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Mohd Nahar Azmi Mohamed
- Department of Sports Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
| | - Russell Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Zoi Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BristolBS8 1TZ, UK
| | - Hazreen Abdul Majid
- Centre for Population Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, Malaysia
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Jawa Timur60115, Indonesia
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Lhachimi SK, Pega F, Heise TL, Fenton C, Gartlehner G, Griebler U, Sommer I, Bombana M, Katikireddi SV. Taxation of the fat content of foods for reducing their consumption and preventing obesity or other adverse health outcomes. Cochrane Database Syst Rev 2020; 9:CD012415. [PMID: 32914461 PMCID: PMC9508786 DOI: 10.1002/14651858.cd012415.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Overweight and obesity are increasing worldwide and are considered to be a major public health issue of the 21st century. Introducing taxation of the fat content in foods is considered a potentially powerful policy tool to reduce consumption of foods high in fat or saturated fat, or both. OBJECTIVES To assess the effects of taxation of the fat content in food on consumption of total fat and saturated fat, energy intake, overweight, obesity, and other adverse health outcomes in the general population. SEARCH METHODS We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase, and 15 other databases and trial registers on 12 September 2019. We handsearched the reference lists of all records of included studies, searched websites of international organizations and institutions (14 October 2019), and contacted review advisory group members to identify planned, ongoing, or unpublished studies (26 February 2020). SELECTION CRITERIA In line with Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria, we included the following study types: randomized controlled trials (RCTs), cluster-randomized controlled trials (cRCTs), non-randomized controlled trials (nRCTs), controlled before-after (CBA) studies, and interrupted time series studies. We included studies that evaluated the effects of taxes on the fat content in foods. Such a tax could be expressed as sales, excise, or special value added tax (VAT) on the final product or an intermediary product. Eligible interventions were taxation at any level, with no restriction on the duration or the implementation level (i.e. local, regional, national, or multinational). Eligible study populations were children (zero to 17 years) and adults (18 years or older) from any country and setting. We excluded studies that focused on specific subgroups only (e.g. people receiving pharmaceutical intervention; people undergoing a surgical intervention; ill people who are overweight or obese as a side effect, such as those with thyroiditis and depression; and people with chronic illness). Primary outcomes were total fat consumption, consumption of saturated fat, energy intake through fat, energy intake through saturated fat, total energy intake, and incidence/prevalence of overweight or obesity. We did not exclude studies based on country, setting, comparison, or population. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods for all phases of the review. Risk of bias of the included studies was assessed using the criteria of Cochrane's 'Risk of bias' tool and the EPOC Group's guidance. Results of the review are summarized narratively and the certainty of the evidence was assessed using the GRADE approach. These steps were done by two review authors, independently. MAIN RESULTS We identified 23,281 records from searching electronic databases and 1173 records from other sources, leading to a total of 24,454 records. Two studies met the criteria for inclusion in the review. Both included studies investigated the effect the Danish tax on saturated fat contained in selected food items between 2011 and 2012. Both studies used an interrupted time series design. Neither included study had a parallel control group from another geographic area. The included studies investigated an unbalanced panel of approximately 2000 households in Denmark and the sales data from a specific Danish supermarket chain (1293 stores). Therefore, the included studies did not address individual participants, and no restriction regarding age, sex, and socioeconomic characteristics were defined. We judged the overall risk of bias of the two included studies as unclear. For the outcome total consumption of fat, a reduction of 41.8 grams per week per person in a household (P < 0.001) was estimated. For the consumption of saturated fat, one study reported a reduction of 4.2% from minced beef sales, a reduction of 5.8% from cream sales, and an increase of 0.5% to sour cream sales (no measures of statistical precision were reported for these estimates). These estimates are based on a restricted number of food types and derived from sales data; they do not measure individual intake. Moreover, these estimates do not account for other relevant sources of fat intake (e.g. packaged or processed food) or other food outlets (e.g. restaurants or cafeterias); hence, we judged the evidence on the effect of taxation on total fat consumption or saturated fat consumption to be very uncertain. We did not identify evidence on the effect of the intervention on energy intake or the incidence or prevalence of overweight or obesity. AUTHORS' CONCLUSIONS Given the very low quality of the evidence currently available, we are unable to reliably establish whether a tax on total fat or saturated fat is effective or ineffective in reducing consumption of total fat or saturated fat. There is currently no evidence on the effect of a tax on total fat or saturated fat on total energy intake or energy intake through saturated fat or total fat, or preventing the incidence or reducing the prevalence of overweight or obesity.
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Affiliation(s)
- Stefan K Lhachimi
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Department for Health Services Research, Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Frank Pega
- Public Health, University of Otago, Wellington, New Zealand
| | - Thomas L Heise
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Candida Fenton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gerald Gartlehner
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
- RTI International, Research Triangle Park, North Carolina, USA
| | - Ursula Griebler
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Isolde Sommer
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Manuela Bombana
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Health Promotion, AOK Baden-Württemberg, Stuttgart, Germany
- Department of General Practice and Health Services Research, University Hospital, University of Heidelberg, Heidelberg, Germany
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Grannon KY, Larson N, Pelletier J, O'Connell MJ, Nanney MS. State Agency Support of Weight-Related School Policy Implementation. THE JOURNAL OF SCHOOL HEALTH 2018; 88:685-692. [PMID: 30133777 DOI: 10.1111/josh.12673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 11/01/2017] [Accepted: 02/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In this study, we describe state agency strategies to support weight-related policy implementation in schools, and examine the association among state support, obesity prevalence, and strength of state policies governing school nutrition and physical education. METHODS The 2012 School Health Policies and Practices Study describes prevalence of implementation support state agencies provided to schools/districts. Implementation support items were analyzed by weight-related policy area (eg, advertising, wellness policy) and by type of support (eg, technical assistance). Results were summed to create a total weight-related policy support score. Linear regression was used to examine associations between policy support and state youth obesity prevalence (2011-2012 National Survey for Children's Health), overall and stratified by state policy strength (2012 Classification of Laws Associated with School Students). RESULTS States provided support most commonly for school meals and wellness policies (89% and 81%, respectively) and least often for after-school PE (26%). Most states (80%) provided technical assistance. The total weight-related policy support score had a significant positive association with state-level youth overweight/obesity prevalence (p = .03). CONCLUSION State agencies appear to be responding to their youth obesity prevalence with technical support. Schools and state agencies should work in collaboration to provide a healthy school environment for all students.
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Affiliation(s)
- Katherine Y Grannon
- Medical School, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN 55414
| | - Nicole Larson
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN 55454
| | - Jennifer Pelletier
- Minnesota Department of Health, Office of Statewide Health Improvement Initiatives, 85 East 7th Place, Suite 220, St. Paul, MN 55164-0882
| | - Michael J O'Connell
- University of Minnesota, Biostatistical Design and Analysis Center, 717 Delaware Street SE, Minneapolis, Minnesota 55414
| | - Marilyn S Nanney
- School of Medicine, Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Minneapolis, Minnesota 55414
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Orlando A, Cazzaniga E, Giussani M, Palestini P, Genovesi S. Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid. Front Public Health 2018; 6:129. [PMID: 29774210 PMCID: PMC5943632 DOI: 10.3389/fpubh.2018.00129] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
Over the past 60 years there has been a dramatic increase in the prevalence of overweight in children and adolescents, ranging from 4% in 1975 to 18% in 2016. Recent estimates indicate that overweight or obese children and adolescents are more than 340 million. Obesity is often associated with hypertension, which is an important cardiovascular risk factor. Recent studies show that the presence of hypertension is a frequent finding in the pediatric age. Hypertensive children easily become hypertensive adults. This phenomenon contributes to increasing cardiovascular risk in adulthood. Primary hypertension is a growing problem especially in children and adolescents of western countries, largely because of its association with the ongoing obesity epidemic. Recently, it has been hypothesized that a dietary link between obesity and elevated blood pressure (BP) values could be simple carbohydrate consumption, particularly fructose, both in adults and in children. Excessive intake of fructose leads to increased serum uric acid (SUA) and high SUA values are independently associated with the presence of hypertension and weaken the efficacy of lifestyle modifications in children. The present review intends to provide an update of existing data regarding the relationship between BP, simple carbohydrates (particularly fructose), and uric acid in pediatric age. In addition, we analyze the national policies that have been carried out over the last few years, in order to identify the best practices to limit the socio-economic impact of the effects of excessive sugar consumption in children.
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Affiliation(s)
- Antonina Orlando
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Emanuela Cazzaniga
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marco Giussani
- Family Pediatrician, Azienda Sanitaria Locale della Provincia di Milano, Milan, Italy
| | - Paola Palestini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simonetta Genovesi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy
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Patsch AJ, Smith JH, Liebert ML, Behrens TK, Charles T. Improving Healthy Eating and the Bottom Line: Impact of a Price Incentive Program in 2 Hospital Cafeterias. Am J Health Promot 2018; 30:425-32. [PMID: 27445324 DOI: 10.1177/0890117116658237] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the impact of a health-promoting price intervention on food sales and profit. DESIGN Nonrandomized evaluation study. SETTING Two hospital cafeterias. PARTICIPANTS Hospital employees (2800) were the priority population. INTERVENTION During baseline phase, healthy versions of existing unhealthy items were introduced. The intervention phase included marketing and price incentives/disincentives for healthy and unhealthy items, with a 35% price differential. MEASURES Average and proportional change in sales and impact on financial outcomes were assessed. ANALYSIS Two-way factorial analyses of variance and two-proportion Z-score tests were run to assess change in sales. Independent samples t tests were used to test for changes in profit. RESULTS Significant impact was demonstrated on all burger sales in the desired direction during intervention (P < .001). Most notably, the average weekly turkey burger sales at Penrose Hospital (PH) increased 13-fold (10.85-145.59) and became the majority of the market share (51.8%, P < .001). For salads, significant interaction between phase and food type was found at St. Francis Medical Center (SFMC) (P = .002) but not at PH (P = .304). Healthy PH salads were popular at baseline and intervention, comprising the majority of the market share throughout the entire study (68.4%-70.2%, respectively, P = .238). Cafeteria gross sales and burger profit (P < .001) increased at both cafeterias. CONCLUSION Incentivizing consumers through price interventions changed hospital cafeteria food sales in the desired direction while improving the bottom line.
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Affiliation(s)
| | | | - Mina L Liebert
- YMCA of the Pikes Peak Region, Colorado Springs, CO, USA
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Psaltopoulou T, Hatzis G, Papageorgiou N, Androulakis E, Briasoulis A, Tousoulis D. Socioeconomic status and risk factors for cardiovascular disease: Impact of dietary mediators. Hellenic J Cardiol 2017; 58:32-42. [DOI: 10.1016/j.hjc.2017.01.022] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 09/29/2016] [Indexed: 11/17/2022] Open
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Hua SV, Ickovics JR. Vending Machines: A Narrative Review of Factors Influencing Items Purchased. J Acad Nutr Diet 2016; 116:1578-1588. [PMID: 27546077 DOI: 10.1016/j.jand.2016.06.378] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
Abstract
Vending machines are a ubiquitous part of our food environments. Unfortunately, items found in vending machines tend to be processed foods and beverages high in salt, sugar, and/or fat. The purpose of this review is to describe intervention and case studies designed to promote healthier vending purchases by consumers and identify which manipulations are most effective. All studies analyzed were intervention or case studies that manipulated vending machines and analyzed sales or revenue data. This literature review is limited to studies conducted in the United States within the past 2 decades (ie, 1994 to 2015), regardless of study population or setting. Ten articles met these criteria based on a search conducted using PubMed. Study manipulations included price changes, increase in healthier items, changes to the advertisements wrapped around vending machines, and promotional signs such as a stoplight system to indicate healthfulness of items and to remind consumers to make healthy choices. Overall, seven studies had manipulations that resulted in statistically significant positive changes in purchasing behavior. Two studies used manipulations that did not influence consumer behavior, and one study was equivocal. Although there was no intervention pattern that ensured changes in purchasing, price reductions were most effective overall. Revenue from vending sales did not change substantially regardless of intervention, which will be important to foster initiation and sustainability of healthier vending. Future research should identify price changes that would balance healthier choices and revenue as well as better marketing to promote purchase of healthier items.
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Racey M, O'Brien C, Douglas S, Marquez O, Hendrie G, Newton G. Systematic Review of School-Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness? THE JOURNAL OF SCHOOL HEALTH 2016; 86:452-63. [PMID: 27122145 DOI: 10.1111/josh.12396] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/03/2015] [Accepted: 01/09/2016] [Indexed: 05/21/2023]
Abstract
BACKGROUND Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness. METHODS Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures. RESULTS Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up. CONCLUSIONS We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.
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Affiliation(s)
- Megan Racey
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Charlene O'Brien
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Sabrina Douglas
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Olivia Marquez
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
| | - Gilly Hendrie
- CSIRO Food and Nutritional Sciences, PO BOX 10041, Adelaide 5000, South Australia.
| | - Genevieve Newton
- University of Guelph, Department of Human Health & Nutritional Science, Guelph, ON N1G 2W1, Canada.
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Jun J, Arendt SW, Kang J. Understanding customers’ healthful food selection at restaurants: Roles of attitude, gender, and past experience. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/15378020.2016.1159895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Temple JL, Ziegler AM, Epstein LH. Influence of Price and Labeling on Energy Drink Purchasing in an Experimental Convenience Store. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:54-59.e1. [PMID: 26404774 DOI: 10.1016/j.jneb.2015.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/03/2015] [Accepted: 08/09/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the impact of energy drink (ED) pricing and labeling on the purchase of EDs. METHODS Participants visited a laboratory-based convenience store 3 times and purchased a beverage under different ED labeling (none, caffeine content, and warning labels) and pricing conditions. The 36 participants (aged 15-30 years) were classified as energy drink consumers (≥ 2 energy drinks/wk) and nonconsumers (< 1 energy drink/mo). Data were log transformed to generate elasticity coefficients. The authors analyzed changes in elasticity as a function of price and labeling using mixed-effects regression models. RESULTS Increasing the price of EDs reduced ED purchases and increased purchasing of other caffeinated beverages among ED consumers. Energy drink labels affected ED sales in adolescents. CONCLUSIONS AND IMPLICATIONS These data suggest that ED pricing and labeling may influence the purchasing of ED, especially in adolescent consumers.
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Affiliation(s)
- Jennifer L Temple
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY; Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; School of Public Health and Health Professions, University at Buffalo, Buffalo, NY.
| | - Amanda M Ziegler
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Leonard H Epstein
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, NY; Department of Pediatrics, University at Buffalo, Buffalo, NY; School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
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Wellard L, Havill M, Hughes C, Watson WL, Chapman K. Energy-dense fast food products cost less: an observational study of the energy density and energy cost of Australian fast foods. Aust N Z J Public Health 2015; 39:544-5. [PMID: 26260073 DOI: 10.1111/1753-6405.12430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 03/01/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the association between energy cost and energy density of fast food products. METHODS Twenty Sydney outlets of the five largest fast food chains were surveyed four times. Price and kilojoule data were collected for all limited-time-only menu items (n=54) and a sample of standard items (n=67). Energy cost ($/kilojoule) and energy density (kilojoules/gram) of menu items were calculated. RESULTS There was a significant inverse relationship between menu item energy density and energy cost (p<0.001). Salads had the highest energy cost, while value items, meals that included a dessert and family meals had the lowest. CONCLUSIONS Fast food chains could provide a wider range of affordable, lower-energy foods, use proportional pricing of larger serve sizes, or change defaults in meals to healthier options. More research is required to determine the most effective strategy to reduce the negative impact of fast food on the population's diet. IMPLICATIONS Current pricing in the fast food environment may encourage unhealthier purchases.
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An R. Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments. Public Health Nutr 2013; 16:1215-28. [PMID: 23122423 PMCID: PMC3898771 DOI: 10.1017/s1368980012004715] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/19/2012] [Accepted: 09/13/2012] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption. DESIGN Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria. SETTING Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants. SUBJECTS Interventions enrolled various population subgroups such as school/ university students, metropolitan transit workers and low-income women. RESULTS All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment. CONCLUSIONS Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.
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Affiliation(s)
- Ruopeng An
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407, USA.
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Liebert ML, Patsch AJ, Smith JH, Behrens TK, Charles T, Bailey TR. Planning and Development of the Better Bites Program. Health Promot Pract 2012. [DOI: 10.1177/1524839912461792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Better Bites program, a hospital cafeteria nutrition intervention strategy, was developed by combining evidence-based practices with hospital-specific formative research, including key informant interviews, the Nutrition Environment Measures Study in Restaurants, hospital employee surveys, and nutrition services staff surveys. The primary program components are pricing manipulation and marketing to promote delicious, affordable, and healthy foods to hospital employees and other cafeteria patrons. The pricing manipulation component includes decreasing the price of the healthy items and increasing the price of the unhealthy items using a 35% price differential. Point-of-purchase marketing highlights taste, cost, and health benefits of the healthy items. The program aims to increase purchases of healthy foods and decrease purchases of unhealthy foods, while maintaining revenue neutrality. This article addresses the formative research, planning, and development that informed the Better Bites program.
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Affiliation(s)
| | - Amy J. Patsch
- Public Health Partners, LLC, Colorado Springs, CO, USA
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Abstract
This paper reviews some of the evidence that dietary behaviours are, in large part, the consequence of automatic responses to contextual food cues, many of which lead to increased caloric consumption and poor dietary choices. We describe studies that illustrate how these automatic mechanisms underlie eating behaviours, as well as evidence that individuals are subject to inherent cognitive limitations, and mostly lack the capacity to consistently recognize, ignore or resist contextual cues that encourage eating. Restaurants and grocery stores are the primary settings from which people obtain food. These settings are often designed to maximize sales of food by strategically placing and promoting items to encourage impulse purchases. Although a great deal of marketing research is proprietary, this paper describes some of the published studies that indicate that changes in superficial characteristics of food products, including packaging and portion sizes, design, salience, health claims and labelling, strongly influence food choices and consumption in ways for which people generally lack insight. We discuss whether contextual influences might be considered environmental risk factors from which individuals may need the kinds of protections that fall under the mission of public health.
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Affiliation(s)
- D A Cohen
- RAND Corporation, Santa Monica Center for Health Policy Research, 1776 Main St., SantaMonica, CA 90407,
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Olstad DL, Raine KD, McCargar LJ. Adopting and implementing nutrition guidelines in recreational facilities: public and private sector roles. A multiple case study. BMC Public Health 2012; 12:376. [PMID: 22632384 PMCID: PMC3490726 DOI: 10.1186/1471-2458-12-376] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/02/2012] [Indexed: 11/10/2022] Open
Abstract
Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.
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Affiliation(s)
- Dana Lee Olstad
- Alberta Institute for Human Nutrition, 4-126 Li Ka Shing Centre, 8606 112 St, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Epstein LH, Jankowiak N, Nederkoorn C, Raynor HA, French SA, Finkelstein E. Experimental research on the relation between food price changes and food-purchasing patterns: a targeted review. Am J Clin Nutr 2012; 95:789-809. [PMID: 22378726 PMCID: PMC3302358 DOI: 10.3945/ajcn.111.024380] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
One way in which to modify food purchases is to change prices through tax policy, subsidy policy, or both. We reviewed the growing body of experimental research conducted in the laboratory and in the field that investigates the following: the extent to which price changes influence purchases of targeted and nontargeted foods, total energy, or macronutrients purchased; the interaction of price changes with adjunctive interventions; and moderators of sensitivity to price changes. After a brief overview of economic principles and observational research that addresses these issues, we present a targeted review of experimental research. Experimental research suggests that price changes modify purchases of targeted foods, but research on the overall nutritional quality of purchases is mixed because of substitution effects. There is mixed support for combining price changes with adjunctive interventions, and there are no replicated findings on moderators to price sensitivity in experiments. Additional focused research is needed to better inform food policy development with the aim of improving eating behavior and preventing obesity.
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Affiliation(s)
- Leonard H Epstein
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY 14214-3000, USA.
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Jensen JD, Hartmann H, de Mul A, Schuit A, Brug J. Economic incentives and nutritional behavior of children in the school setting: a systematic review. Nutr Rev 2012; 69:660-74. [PMID: 22029832 DOI: 10.1111/j.1753-4887.2011.00422.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the present review was to examine the existing literature on the effectiveness of economic incentives for producing sound nutritional behavior in schools. Studies published in the English-language literature that included baseline and/or outcome data regarding food and beverage intake of schoolchildren were eligible for inclusion. A systematic search of the literature was conducted to identify relevant primary studies and relevant systematic reviews of primary studies. Altogether, 3,472 research publications were identified in the systematic search, of which 50 papers were retrieved. Of these, 30 publications representing 28 studies fulfilled the criteria for inclusion. The studies addressing price incentives suggest that such incentives are effective for altering consumption in the school setting. Other types of economic incentives have been included in combined intervention schemes, but the inclusion of other intervention elements makes it difficult to draw conclusions about the effectiveness of the economic incentive instruments per se in these studies.
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Affiliation(s)
- Jørgen Dejgård Jensen
- Institute of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark.
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Callaghan C, Mandich G, He M. Healthier snacks in school vending machines: a pilot project in four Ontario high schools. CAN J DIET PRACT RES 2011; 71:186-91. [PMID: 21144135 DOI: 10.3148/71.4.2010.186] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE The Healthy Vending Machine Pilot Project (HVMPP) was a public health initiative intended to create a healthier school nutrition environment by making healthier snacks available in vending machines, while maintaining a profit margin. The HVMPP was evaluated using quantitative and qualitative measures. METHODS Vending machines were stocked with healthier choices and conventional vending products at a 50:50 ratio. The HVMPP was implemented from February to May 2007 in four Ontario secondary schools in Middlesex-London, Elgin, and Oxford counties. Product sales were tracked, and focus groups were conducted to obtain students' opinions about healthy eating and vending choices. RESULTS "Healthier choice" sales ranged from 14% to 17%. In all schools, vending revenues declined from 0.7% to 66%. A majority of participants had substantial knowledge of healthy eating and were in favour of healthier choices in vending machines; however, price, value, and taste were barriers that led them to purchase these products rarely. Students preferred to have "real" healthy snacks, such as yogurt, fruit, and vegetables, available in schools. CONCLUSIONS Replacing 50% of vending stock with healthier snacks resulted in a decline in vending revenues. Future health programs in schools need to provide "real" healthy snacks, such as low-fat dairy products, fruits, and vegetables.
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Temple JL, Johnson KM, Archer K, LaCarte A, Yi C, Epstein LH. Influence of simplified nutrition labeling and taxation on laboratory energy intake in adults. Appetite 2011; 57:184-92. [DOI: 10.1016/j.appet.2011.04.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 04/15/2011] [Accepted: 04/23/2011] [Indexed: 11/29/2022]
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Improving children's nutrition environments: a survey of adoption and implementation of nutrition guidelines in recreational facilities. BMC Public Health 2011; 11:423. [PMID: 21631946 PMCID: PMC3130673 DOI: 10.1186/1471-2458-11-423] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 06/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. METHODS A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. RESULTS One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. CONCLUSIONS If fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities.
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Posibilidades y limitaciones de las políticas fiscales como instrumentos de salud: los impuestos sobre consumos nocivos. Informe SESPAS 2010. GACETA SANITARIA 2010; 24 Suppl 1:85-9. [DOI: 10.1016/j.gaceta.2010.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Accepted: 03/22/2010] [Indexed: 11/23/2022]
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Pricing and availability intervention in vending machines at four bus garages. J Occup Environ Med 2010; 52 Suppl 1:S29-33. [PMID: 20061884 DOI: 10.1097/jom.0b013e3181c5c476] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effects of lowering prices and increasing availability on sales of healthy foods and beverages from 33 vending machines in 4 bus garages as part of a multicomponent worksite obesity prevention intervention. METHODS Availability of healthy items was increased to 50% and prices were lowered at least 10% in the vending machines in two metropolitan bus garages for an 18-month period. Two control garages offered vending choices at usual availability and prices. Sales data were collected monthly from each of the vending machines at the four garages. RESULTS Increases in availability to 50% and price reductions of an average of 31% resulted in 10% to 42% higher sales of the healthy items. Employees were mostly price responsive for snack purchases. CONCLUSIONS Greater availability and lower prices on targeted food and beverage items from vending machines was associated with greater purchases of these items over an 18-month period. Efforts to promote healthful food purchases in worksite settings should incorporate these two strategies.
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Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A Healthful Options Food Station Can Improve Satisfaction and Generate Gross Profit in a Worksite Cafeteria. ACTA ACUST UNITED AC 2009; 109:914-7. [DOI: 10.1016/j.jada.2009.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 07/25/2008] [Indexed: 10/20/2022]
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McKinnon RA, Reedy J, Morrissette MA, Lytle LA, Yaroch AL. Measures of the food environment: a compilation of the literature, 1990-2007. Am J Prev Med 2009; 36:S124-33. [PMID: 19285203 DOI: 10.1016/j.amepre.2009.01.012] [Citation(s) in RCA: 229] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 12/08/2008] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND Valid and reliable measures are required to assess any effect of the food environment on individual dietary behavior, and form the foundation of research that may inform obesity-related policy. Although many methods of measuring the food environment exist, this area of research is still relatively new and there has been no systematic attempt to gather these measures, to compare and contrast them, or to report on their psychometric properties. EVIDENCE ACQUISITION A structured literature search was conducted to identify peer-reviewed articles published between January 1990 and August 2007 that measured the community-level food environment. These articles were categorized into the following environments: food stores, restaurants, schools, and worksites. The measurement strategies in these studies were categorized as instruments (checklists, market baskets, inventories, or interviews/questionnaires) or methodologies (geographic, sales, menu, or nutrient analyses). EVIDENCE SYNTHESIS A total of 137 articles were identified that included measures of the food environment. Researchers focused on assessing the accessibility, availability, affordability, and quality of the food environment. The most frequently used measure overall was some form of geographic analysis. Eighteen of the 137 articles (13.1%) tested for any psychometric properties, including inter-rater reliability, test-retest reliability, and/or validity. CONCLUSIONS A greater focus on testing for reliability and validity of measures of the food environment may increase rigor in research in this area. Robust measures of the food environment may strengthen research on the effects of the community-level food environment on individual dietary behavior, assist in the development and evaluation of interventions, and inform policymaking targeted at reducing the prevalence of obesity and improving diet.
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Rosenkranz RR, Dzewaltowski DA. Model of the home food environment pertaining to childhood obesity. Nutr Rev 2008; 66:123-40. [DOI: 10.1111/j.1753-4887.2008.00017.x] [Citation(s) in RCA: 228] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mâsse LC, Frosh MM, Chriqui JF, Yaroch AL, Agurs-Collins T, Blanck HM, Atienza AA, McKenna ML, Igoe JF. Development of a School Nutrition-Environment State Policy Classification System (SNESPCS). Am J Prev Med 2007; 33:S277-91. [PMID: 17884576 DOI: 10.1016/j.amepre.2007.07.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 06/04/2007] [Accepted: 07/22/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND As policy strategies are rapidly being developed to address childhood overweight, a system was developed to systematically and reliably classify state policies related to the school nutrition environment. This study describes the development process, the inter-rater reliability to code state policies enacted as of December 2003, and the variability in state policies related to the school nutrition environment. METHODS The development of the School Nutrition Environment State Policy Classification System (SNESPCS) included a comprehensive review of published literature, reports from government and nongovernmental sources, input from an expert panel, and select experts. Baseline statutes and regulations for each of the 50 states and the District of Columbia were retrieved from Westlaw (data retrieved in 2005-2006 and analyzed in 2006) and pilot testing of the system was conducted. RESULTS SNESPCS included 11 policy areas that relate to a range of environmental and surveillance domains. At baseline, states had no (advertising/promotion and preferential pricing) or modest (school meal environment, reimbursable school meals, coordinating or advisory councils, body mass index screening) activities in many of the policy areas. As of 2003, 60% of the states had policies related to the sale of foods in school that compete with the school meal program. CONCLUSIONS Evaluation of policies that affect the school-nutrition environment is in its earliest stage. SNESPCS provides a mechanism for assessing variation in state policies that can be incorporated in an evaluation framework aimed at elucidating the impact of state policies on the school environment, social norms, and children's dietary behaviors in schools.
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Affiliation(s)
- Louise C Mâsse
- Centre for Community Child Health Research, University of British Columbia, Vancouver, British Columbia.
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Kremers SPJ, de Bruijn GJ, Droomers M, van Lenthe F, Brug J. Moderators of environmental intervention effects on diet and activity in youth. Am J Prev Med 2007; 32:163-72. [PMID: 17197152 DOI: 10.1016/j.amepre.2006.10.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 08/16/2006] [Accepted: 10/05/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND The complexity of the relationship between environmental factors on the one hand and dietary behavior and physical activity on the other necessitates the search for moderators of environmental influences. The current evidence base is reviewed regarding potential moderating factors in the effectiveness of environmental interventions aimed at diet and/or physical activity of children and adolescents. METHODS The following databases were used: (1) Medline, (2) PubMed, (3) PsychInfo, (4) Web of Science, and (5) ERIC. Additionally, all potentially relevant references in recent reviews were checked. RESULTS Of the 41 studies included in the review, only seven studies (17%) were identified that reported tests of potential moderators of intervention effects. Gender proved to be the most frequently studied potential moderator. Additionally, race, age, and site have been studied regarding their potential role in modifying the effect of environmental interventions. DISCUSSION The small number of studies identified in this review prohibited us from attempting to formulate a conclusion on differential environment-behavior relationships in distinct subgroups. Rather than being an exception, it is argued that tests of effect modifiers should become common practice in behavioral nutrition and physical activity research to increase our understanding of mechanisms of behavior change and to optimize interventions.
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Affiliation(s)
- Stef P J Kremers
- Department of Health Education and Health Promotion, Universiteit Maastricht, Maastricht, The Netherlands.
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Johnson-Taylor WL, Everhart JE. Modifiable environmental and behavioral determinants of overweight among children and adolescents: report of a workshop. Obesity (Silver Spring) 2006; 14:929-66. [PMID: 16861599 DOI: 10.1038/oby.2006.109] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The number of children at risk for overweight and the number of overweight children are increasing and have become a serious public health concern. Interventions that could be applied at the population level have not been proven effective. The development of effective strategies is thought to be hampered by the lack of understanding of which behavioral and environmental factors need to be modified. On June 14 and 15, 2004, the NIH held a meeting of experts to discuss the issue of modifiable determinants of obesity in children and adolescents. Included were presentations on interventions among children that have been proven effective, dietary and physical activity behavioral determinants, physical, social, and family environmental determinants, and the quality of measures of determinants and correlates of overweight.
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Affiliation(s)
- Wendy L Johnson-Taylor
- Division of Nutrition Research Coordination, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-5461, USA.
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Kim D, Kawachi I. Food taxation and pricing strategies to "thin out" the obesity epidemic. Am J Prev Med 2006; 30:430-7. [PMID: 16627131 DOI: 10.1016/j.amepre.2005.12.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Revised: 12/06/2005] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
This article highlights characteristics of two related yet distinct economic approaches to addressing the current obesity epidemic in the United States: the general taxation of soft drinks, snack foods, and/or fast foods, and the application of pricing incentives/disincentives on foods sold in schools and worksites. The article specifically focuses on the: (1) rationale for, (2) potential barriers and limitations to, and (3) possible unintended consequences of implementing these policy interventions at the state level. Novel empirical evidence showing strong positive associations between the presence of state-level taxation on soft drinks or snack foods between 1991 and 1998 and relative changes in obesity prevalence over the same time period is further presented. The article concludes by summarizing the similarities and dissimilarities of the two approaches, and by emphasizing some of the gaps and priorities regarding these strategies that should be addressed in future research and policies to best effect obesity prevention.
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Affiliation(s)
- Daniel Kim
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Les déterminants de la saine alimentation chez les Canadiens à faible revenu. Canadian Journal of Public Health 2005. [DOI: 10.1007/bf03405200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kubik MY, Lytle L, Fulkerson JA. Fruits, vegetables, and football: findings from focus groups with alternative high school students regarding eating and physical activity. J Adolesc Health 2005; 36:494-500. [PMID: 15901514 DOI: 10.1016/j.jadohealth.2004.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 05/12/2004] [Indexed: 11/17/2022]
Abstract
PURPOSE To increase our understanding of factors that may influence the dietary and physical activity practices of adolescents attending an alternative high school (AHS). METHODS Seventy students (36 girls, 34 boys) from urban and suburban AHSs in the Minneapolis-St. Paul metropolitan area participated in 7 focus groups to discuss their perceptions and opinions about factors that influence their eating and physical activity behaviors and to offer suggestions regarding school-based strategies to support and to promote healthy physical activity and eating practices among students. Mixed-gender groups were facilitated by a trained moderator by using a set of standardized questions to guide the 45- to 60-minute discussions. Focus groups were audiotaped, transcribed, and analyzed using a 3-step process for qualitative analysis. RESULTS Time, cost, availability, and convenience were identified as key factors that influenced students' food choices and the choice to be active physically. Access to healthy foods and physical activity was problematic, especially at school. Students also reported that social support from their friends, family, and teachers, and role-modeling behaviors of adults enhanced their likelihood of eating healthy foods and being active. CONCLUSIONS Study findings suggest that programs that target social-environmental factors that include norms, role models, social support, and opportunities to practice a health behavior have the potential to affect positively the dietary and physical activity practices of teenagers attending an AHS. Interventions that aim to increase opportunities at school to practice healthy eating and physical activity may be effective, especially in promoting and supporting healthy behavior change among students.
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Affiliation(s)
- Martha Y Kubik
- School of Nursing, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Abstract
Environmental intervention represents an effective strategy to promote the purchase and consumption of healthful foods in community-based settings. Three such studies promoted the consumption of healthier snacks and lower-fat foods at worksites and at schools. The first study examined lower prices and point-of-purchase promotion on sales of lower-fat snacks in vending machines in 12 worksites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower-fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, as compared to usual-price conditions. The second study examined the impact of a 50% price reduction on the consumption of fresh fruit and baby carrots in 2 secondary school cafeterias. In the third study, 20 secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-y period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. School-based environmental interventions to increase availability and promotion of lower-fat foods and healthier snacks can increase purchase of these foods among adolescents.
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Affiliation(s)
- Simone A French
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55454-1015, USA.
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Marketing Strategies Can Maximize Food and Nutrition Professionalsʼ Effectiveness With Children. TOP CLIN NUTR 2005. [DOI: 10.1097/00008486-200501000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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French SA, Story M, Fulkerson JA, Hannan P. An environmental intervention to promote lower-fat food choices in secondary schools: outcomes of the TACOS Study. Am J Public Health 2004; 94:1507-12. [PMID: 15333303 PMCID: PMC1448482 DOI: 10.2105/ajph.94.9.1507] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2003] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated an environmental intervention intended to increase sales of lower-fat foods in secondary school cafeterias. METHODS Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. RESULTS A steeper rate of increase in sales of lower-fat foods in year 1 (10% intervention vs -2.8% control, P =.002) and a higher percentage of sales of lower-fat foods in year 2 (33.6% intervention vs 22.1% control, P =.04) were observed. There were no significant changes in student self-reported food choices. CONCLUSIONS School-based environmental interventions to increase availability and promotion of lower-fat foods can increase purchase of these foods among adolescents.
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Affiliation(s)
- Simone A French
- University of Minnesota, Division of Epidemiology, Minneapolis, MN 55454, USA.
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Fiske A, Cullen KW. Effects of promotional materials on vending sales of low-fat items in teachers' lounges. ACTA ACUST UNITED AC 2004; 104:90-3. [PMID: 14702590 DOI: 10.1016/j.jada.2003.10.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the impact of an environmental intervention in the form of promotional materials and increased availability of low-fat items on vending machine sales. Ten vending machines were selected and randomly assigned to one of three conditions: control, or one of two experimental conditions. Vending machines in the two intervention conditions received three additional low-fat selections. Low-fat items were promoted at two levels: labels (intervention I), and labels plus signs (intervention II). The number of individual items sold and the total revenue generated was recorded weekly for each machine for 4 weeks. Use of promotional materials resulted in a small, but not significant, increase in the number of low-fat items sold, although machine sales were not significantly impacted by the change in product selection. Results of this study, although not statistically significant, suggest that environmental change may be a realistic means of positively influencing consumer behavior.
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Affiliation(s)
- Amy Fiske
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
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French SA, Stables G. Environmental interventions to promote vegetable and fruit consumption among youth in school settings. Prev Med 2003; 37:593-610. [PMID: 14636793 DOI: 10.1016/j.ypmed.2003.09.007] [Citation(s) in RCA: 158] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND This paper reviews the available literature on the school food environment with a focus on identifying effective strategies to promote vegetable and fruit (VF) consumption among youth in school settings. METHODS Studies were identified through a search of electronic databases as well as references cited within published articles. Seven studies were identified that evaluated changes in VF intake and included a control group. Four additional school-based interventions were reviewed that focused on changes in VF intake as part of a multibehavior intervention. RESULTS Multicomponent school interventions have been effective in increasing F intake, with reported increases ranging from 0.2 to 0.6 servings per day. Impact on V intake has been less effective, with increases ranging from 0 to 0.3 servings per day. Total VF increases ranged from 0 to 0.6 servings per day. Results of environmental-only, school-based interventions have shown positive effects on students' choice of targeted foods. CONCLUSIONS Environmental change interventions in schools show potential for positively affecting VF consumption among youth.
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Everett Jones S, Brener ND, McManus T. Prevalence of school policies, programs, and facilities that promote a healthy physical school environment. Am J Public Health 2003; 93:1570-5. [PMID: 12948982 PMCID: PMC1448012 DOI: 10.2105/ajph.93.9.1570] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the extent to which schools in the United States have health-promoting policies, programs, and facilities. METHODS We analyzed data from the School Health Policies and Programs Study 2000. RESULTS We found that public schools (vs private and Catholic schools), urban schools (vs rural and suburban schools), and schools with larger enrollments (vs smaller schools) had more health-promoting policies, programs, and facilities in place. On average, middle schools had 11.0 and middle/junior and high schools had 10.4 out of a possible 18 policies, programs, and facilities. CONCLUSIONS Although some schools had many healthy physical environment features, room for improvement exists. Resources are available to help schools improve their health-promoting policies, programs, and facilities.
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Affiliation(s)
- Sherry Everett Jones
- Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop K-33, Atlanta, GA 30341, USA.
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Abstract
Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.
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Affiliation(s)
- Simone A French
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
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