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Quevedo KL, Jáuregui A, Nieto C, Contreras-Manzano A, White CM, Vanderlee L, Barquera S, Corvalán C, Hammond D. Sociodemographic differences in nutrition labels effect on Chilean and Mexican youth. Rev Panam Salud Publica 2024; 48:e33. [PMID: 38576841 PMCID: PMC10993807 DOI: 10.26633/rpsp.2024.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 04/06/2024] Open
Abstract
Objective To examine sociodemographic differences in the awareness, understanding, use and effect of nutrition labels among Mexican and Chilean youth. Methods Online surveys among youth (10-17 years) were obtained in 2019 (n=2631). Participants reported their awareness, understanding, and use of their country-specific nutrition facts tables (NFT) and front-of-pack labels (FOPL) (Chile: warning labels [WLs]; Mexico: guideline daily amounts [GDA]). Additionally, participants reported their perceived healthfulness of a sweetened fruit drink after viewing one of six versions of it with different FOPL (no-label control, Health Star Rating, WLs, GDAs, Traffic Light, or Nutri-Score) during an experimental task. Results Higher self-reported nutrition knowledge was associated with higher NFT and FOPL awareness, understanding, and use, except for WL use. WLs were the most effective FOPL in decreasing the perceived healthfulness of the sweetened fruit drink compared to a no-label condition and other FOP labels. In Chile, the effect of GDA differed by income adequacy, while in Mexico Nutri-Score differed by age. Conclusions Results suggest that nutrition label awareness, use, understanding, and impact differ across demographics, favoring higher income and nutrition knowledge. Despite this, WLs are likely to have a positive impact on nutrition-related knowledge and behaviors among Mexican and Chilean youth, independently of their socio-demographic groups.
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Affiliation(s)
- Kathia Larissa Quevedo
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Alejandra Jáuregui
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Claudia Nieto
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Alejandra Contreras-Manzano
- Consejo Nacional de HumanidadesCiencias y TecnologíasMexico CityMexicoConsejo Nacional de Humanidades, Ciencias y Tecnologías, Mexico City, Mexico
| | - Christine M. White
- University of WaterlooWaterlooCanadaUniversity of Waterloo, Waterloo, Canada.
| | - Lana Vanderlee
- Université LavalQuebecCanadaUniversité Laval, Quebec, Canada
| | - Simón Barquera
- Instituto Nacional de Salud PúblicaCuernavacaMexicoInstituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Camila Corvalán
- Universidad de ChileSantiagoChileUniversidad de Chile, Santiago, Chile
| | - David Hammond
- University of WaterlooWaterlooCanadaUniversity of Waterloo, Waterloo, Canada.
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Thrasher JF, Villalobos-Daniel VE, Fang D, Nieto C, White CM, Armendariz G, Jáuregui A, Hammond D, Davis RE. Assessing transnational spillover effects of Mexico's front-of-package nutritional labeling system among Mexican Americans in the US. Prev Med 2024; 179:107855. [PMID: 38215993 PMCID: PMC10929004 DOI: 10.1016/j.ypmed.2024.107855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Abstract
OBJECTIVE In 2020, Mexico implemented innovative front-of-package nutrition warning labels (FoPWLs) for packaged foods to increase the salience and understanding of nutrition information. This study evaluated Mexican Americans' self-reported exposure to Mexican FoPWLs and self-reported effects of FoPWLs on purchasing behavior. METHODS The 2021 International Food Policy Study surveyed online panels of adult Mexican Americans in the US (n = 3361) to self-report on buying food at Mexican-oriented stores, noticing Mexican FoPWLs, and being influenced by FoPWLs to purchase less of eight different unhealthy foods (each assessed separately). After recoding the frequency of buying foods in Mexican stores and noticing FoPWLs (i.e., "often" or "very often" vs. less often), logistic models regressed these outcomes on sociodemographics, adjusting for post-stratification weights. RESULTS Most participants (88.0%) purchased foods in Mexican stores. Of these, 64.1% reported noticing FoPWLs, among whom many reported that FoPWLs influenced them to buy fewer unhealthy foods (range = 32% [snacks like chips] - 44% [colas]). Participants were more likely to buy foods in Mexican stores and notice FoPWLs if they were younger, had ≥two children at home vs no children (AOR = 1.40, 95%CI = 1.15-1.71; AOR = 1.37, 95%CI = 1.03-1.80, respectively), and more frequently used Spanish (AOR = 1.91, 95%CI = 1.77-2.07; AOR = 1.87, 95%CI = 1.69-2.07). Also, high vs. low education (AOR = 1.51, 95%CI = 1.17-1.94) and higher income adequacy (AOR = 1.37, 95%CI = 1.25-1.51) were positively associated with noticing FoPWLs. Being female and more frequent Spanish use were consistently associated with reporting purchase of fewer unhealthy foods because of FoPWLs. CONCLUSIONS Many Mexican Americans report both exposure to Mexican FOPWLs and reducing purchases of unhealthy foods because of them.
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Affiliation(s)
- James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA; Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Victor Eduardo Villalobos-Daniel
- Non Communicable Diseases and Mental Health, Pan American Health Organization, Washington DC, USA.; Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Dai Fang
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, USA
| | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Gabriela Armendariz
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Canada
| | - Rachel E Davis
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, USA
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Arellano-Gómez LP, Jáuregui A, Nieto C, Contreras-Manzano A, Quevedo KL, White CM, Thrasher JF, Davis RE, Hammond D, Barquera S. Effects of front-of-package caffeine and sweetener disclaimers in Mexico: cross-sectional results from the 2020 International Food Policy Study. Public Health Nutr 2023; 26:3278-3290. [PMID: 37781769 PMCID: PMC10755452 DOI: 10.1017/s1368980023002100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 08/12/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Front-of-package warning labels introduced in Mexico in 2020 included disclaimers that caution against allowing children to consume products with non-sugary sweeteners and caffeine. We examined the awareness and use of the disclaimers among Mexican adults and youth 1 month after the regulation was implemented. We also investigated their impact on the perceived healthfulness of industrialised beverages designed for children. DESIGN Data on the awareness and use of the disclaimers were analysed. Two between-subjects experiments examined the effect of a sweetener disclaimer (Experiment 1, youth and adults) or a caffeine disclaimer (Experiment 2, only adults) on the perceived healthfulness of industrialised beverages. Interactions between experimental conditions and demographic characteristics were tested. SETTING Online survey in 2020. PARTICIPANTS Mexican adults (≥18 years, n 2108) and youth (10-17 years, n 1790). RESULTS Most participants (>80 %) had seen the disclaimers at least rarely, and over 60 % used them sometimes or frequently. The sweetener disclaimer led to a lower perceived healthfulness of a fruit drink (adults: 2·74 ± 1·44; youth: 2·04 ± 0·96) compared with the no-disclaimer condition (adults: 3·17 ± 1·54; youth: 2·32 ± 0·96) (t's: >4·0, P values: <0·001). This effect was larger among older adults and male youth. The caffeine disclaimer did not affect adult's perceived healthfulness of a caffeinated drink (t = 0·861, P value = 0·3894). CONCLUSIONS There were high awareness and use of the sweeteners and caffeine disclaimers shortly after the warning labels were implemented. The sweetener disclaimer appears to be helping consumers modify their perceptions regarding industrialised beverages for children. Findings may help decision-makers improve the regulation and better target communication strategies.
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Affiliation(s)
- Laura Patricia Arellano-Gómez
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
- Department of Psychology, Education and Health, Nutrition and Food Sciences, ITESO Jesuit University of Guadalajara, Guadalajara, Mexico
| | - Alejandra Jáuregui
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
| | - Claudia Nieto
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
| | - Alejandra Contreras-Manzano
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
- National Council for Science and Technology (CONACYT), Mexico City, Mexico
| | - Kathia Larissa Quevedo
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, USA
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Rachel E Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Simón Barquera
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Av. Universidad 655 Col. Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico
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Contreras-Manzano A, White CM, Nieto C, Quevedo KL, Vargas-Meza J, Hammond D, Thrasher JF, Barquera S, Jáuregui A. Self-reported decreases in the purchases of selected unhealthy foods resulting from the implementation of warning labels in Mexican youth and adult population. medRxiv 2023:2023.11.22.23298843. [PMID: 38045333 PMCID: PMC10690347 DOI: 10.1101/2023.11.22.23298843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Front-of-package nutritional warning labels (WLs) are designed to facilitate identification and selection of healthier food choices. We assessed self-reported changes in purchasing different types of unhealthy foods due to WLs in Mexico and the association between the self-reported reductions in purchases of sugary beverages and intake of water and sugar-sweetened beverages. Methods Data came from 14-17 year old youth (n=1,696) and adults ≥18 (n=7,775) who participated in the Mexican arm of the 2020-2021 International Food Policy Study, an annual repeat cross-sectional online survey. Participants self-reported whether the WLs had influenced them to purchase less of each of ten unhealthy food categories due to WLs. Among adults, a 23-item Beverage Frequency Questionnaire was used derive past 7-day intake of water and sugary beverages analyzed to determine the relationship between self-reported reductions in purchasing sugary drinks due to the WLs. Multilevel mixed-effects logistic regression models were fitted to estimate the percentage of participants who self-reported reducing purchases within each food group, and overall. Sociodemographic characteristics associated with this reduction were investigated as well. Results Overall, 44.8% of adults and 38.7% of youth reported buying less of unhealthy food categories due to the implementation of WL, with the largest proportion reporting decreased purchases of cola, regular and diet soda. A greater impact of WLs on the reported purchase of unhealthy foods was observed among the following socio-demographic characteristics: females, individuals who self-identified as indigenous, those who were overweight, individuals with lower educational levels, those with higher nutrition knowledge, households with children, and those with a significant role in household food purchases. In addition, adults who reported higher water intake and lower consumption of sugary beverages were more likely to report reduced purchases of sugary drinks due to the WLs. Adults who reported greater water intake and lower sugary beverages intake were significantly more likely to report buying fewer sugary drinks due to the WLs. Conclusion Our findings suggest that implementation of WLs has reduced purchases of unhealthy foods in Mexico. These results underscore the positive impact of the labeling policy particularly in subpopulations with lower levels of education and among indigenous adults.
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Simpson SL, Khan S, Schiferl LM, Boehl L, Horewitz D, Hausfeld J, Samuels P, Kreeger RN, White CM. Implementation of a Peer-to-Peer Support Program in a Quaternary Pediatric Medical Center. Acad Pediatr 2023; 23:1481-1488. [PMID: 37482296 DOI: 10.1016/j.acap.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
Healthcare worker burnout is a growing epidemic associated with multiple negative outcomes. Compounding the routine stresses of clinical practice, involvement in adverse events can be emotionally devastating. Healthcare organizations have an obligation to mitigate burnout and promote engagement and resiliency. Many institutions have launched wellness initiatives, but the value of these programs is unclear. Here, we describe the implementation of a peer-to-peer support program at our quaternary pediatric medical center. This proactive program is unique in its referral process and scope and has demonstrated efficacy in mitigating the emotional impact of adverse effects. In total, our institution has trained 125 peer supporters. Since initiation, there have been a total of 2187 referrals made to the program. Data collected in 2022 from these referrals showed a 60.3% (n = 1220) response rate to the offer of support. A survey was sent to frontline clinicians from divisions with trained supporters. Of 963 respondents, 71.8% (n = 691) agreed that this program was a valuable resource, and 81.3% (n = 783) recommended peer support to be offered to those involved in adverse and stressful events. Our experience supports that the implementation of a proactive, peer-to-peer support program is both feasible and valuable.
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Affiliation(s)
- Samantha L Simpson
- Division of Neonatology and Pulmonary Biology (SL Simpson), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Sarah Khan
- Division of Hospital Medicine (S Khan), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lindsey M Schiferl
- Data Management, Office of the Chief of Staff (LM Schiferl), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lindsay Boehl
- Program Management, Office of the Chief of Staff (L Boehl), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Debbie Horewitz
- Project Management, Office of the Chief of Staff (D Horewitz), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jackie Hausfeld
- Division of Patient Services Administration (J Hausfeld), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul Samuels
- Department of Anesthesiology (P Samuels and RN Kreeger), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Anesthesia (P Samuels and RN Kreeger), University of Cincinnati, Cincinnati, Ohio
| | - Renee N Kreeger
- Department of Anesthesiology (P Samuels and RN Kreeger), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Anesthesia (P Samuels and RN Kreeger), University of Cincinnati, Cincinnati, Ohio
| | - Christine M White
- Division of Hospital Medicine (CM White), University of Cincinnati, Cincinnati, Ohio; Department of Pediatrics (CM White), College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Quevedo KL, Jáuregui A, Nieto C, Ortiz-Panozo E, Contreras-Manzano A, Barquera S, Vanderlee L, White CM, Hammond D. Public support for food policies in Mexican adults: Findings from the International Food Policy Study, 2017-2021. Prev Med 2023; 175:107710. [PMID: 37775082 PMCID: PMC10644906 DOI: 10.1016/j.ypmed.2023.107710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/01/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
Deaths attributable to unhealthful eating underscore the need to improve dietary patterns through upstream, policy-led solutions. The approval and successful implementation of food policies is partly determined by their public acceptance. Little is known about public support for food policies in Mexico. We aimed to investigate the level of public support for 30 food policies, grouped into 5 domains, and their associated characteristics among Mexican adults. Data are from the 2017-2021 International Food Policy Study (IFPS), a cross-sectional web-based survey of adults. Differences in public support across years were estimated using linear regression models. The association between demographic characteristics and policy support was analyzed using multivariate logistic regression models. The highest mean support was for the subsidies and benefits domain, followed by the labelling and reformulation domain. The level of support varied across years and policy domains. Support was higher in 2019 compared to 2017 and 2018, and subsequently lower in 2020 and 2021 compared to previous years. Older age was associated with greater support across all domains (OR ranged from 0.002 to 0.004, p < 0.01). Female participants and those selfidentifying as indigenous showed greater support for certain policy domains, whereas higher income adequacy was associated with lower support for other policy domains. In Mexico, support for food policies varies across subpopulations. Our findings may serve as a guide to the development and promotion of food policies in Mexico, as well as to improve their feasibility and success.
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Affiliation(s)
- Kathia Larissa Quevedo
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Claudia Nieto
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Alejandra Contreras-Manzano
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico; National Council for Humanities, Science and Technology, 1528 de los Insurgentes Avenue, Crédito Constructor, Benito Juárez 03940, Mexico City, Mexico.
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, 655 University Avenue, Santa María Ahuacatitlan, 62100 Cuernavaca, Morelos, Mexico.
| | - Lana Vanderlee
- School of Nutrition, Université Laval, 2440 boulevard Hochelaga, Quebec, QC G1V 0A6, Canada.
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada.
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Hammond D, Acton RB, Rynard VL, White CM, Vanderlee L, Bhawra J, Reyes M, Jáuregui A, Adams J, Roberto CA, Sacks G, Thrasher JF. Awareness, use and understanding of nutrition labels among children and youth from six countries: findings from the 2019 - 2020 International Food Policy Study. Int J Behav Nutr Phys Act 2023; 20:55. [PMID: 37143053 PMCID: PMC10157591 DOI: 10.1186/s12966-023-01455-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Nutrition facts tables (NFTs) on pre-packaged foods are widely used but poorly understood by consumers. Several countries have implemented front-of-package labels (FOPLs) that provide simpler, easier to use nutrition information. In October 2020, Mexico revised its FOPL regulations to replace industry-based Guideline Daily Amount (GDA) FOPLs with 'Warning' FOPLs, which display stop signs on foods high in nutrients of concern, such as sugar and sodium. This study examined self-reported awareness, use, and understanding of NFTs and FOPLs among young people in six countries with different FOPLs, with an additional focus on changes before and after implementation of Mexico's FOPL warning policy. METHODS A 'natural experiment' was conducted using 'pre-post' national surveys in Mexico and five separate comparison countries: countries with no FOPL policy (Canada and the US), countries with voluntary FOPL policies (Traffic Lights in the UK and Health Star Ratings in Australia), and one country (Chile) with mandatory FOPL 'warnings' (like Mexico). Population-based surveys were conducted with 10 to 17-year-olds in 2019 (n = 10,823) and in 2020 (n = 11,713). Logistic regressions examined within- and between-countries changes in self-reported awareness, use, and understanding of NFTs and FOPLs. RESULTS Across countries, half to three quarters of respondents reported seeing NFTs 'often' or 'all the time', approximately one quarter reported using NFTs when deciding what to eat or buy, and one third reported NFTs were 'easy to understand', with few changes between 2019 and 2020. In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were higher than for NFTs in all countries, and compared with GDA FOPLs in Mexico (p < .001). Mandated Warning FOPLs in Mexico and Chile had substantially higher levels of awareness, use, and understanding than the voluntary Traffic Lights in the UK and Health Star Ratings in Australia (p < .001 for all). CONCLUSIONS Mandated easy-to-understand FOPLs are associated with substantially greater levels of self-reported awareness, use and understanding at the population-level compared to NFT and GDA-based labeling systems.
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Affiliation(s)
- David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Vicki L Rynard
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, 2425 Rue de L'Agriculture, Québec City, QC, G1V 0A6, Canada
| | - Jasmin Bhawra
- School of Occupational and Public Health, Toronto Metropolitan University, 288 Church Street, Suite 300, ON, M5B 1Z5, Toronto, Canada
| | - Marcela Reyes
- Instituto de Nutrición Y Tecnología de los Alimentos (INTA), Universidad de Chile, Avda. El Líbano, 5524, Macul, Santiago, Chile
| | - Alejandra Jáuregui
- Center for Health and Nutrition Research, Instituto Nacional de Salud Pública, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
| | - Jean Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Box 285, Cambridge, CB2 0QA, UK
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 1121 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
- Center for Population Health Research, Instituto Nacional de Salud Pública, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100, Cuernavaca, Mexico
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Acton RB, Bagnato M, Remedios L, Potvin Kent M, Vanderlee L, White CM, Hammond D. Examining differences in children and adolescents' exposure to food and beverage marketing in Canada by sociodemographic characteristics: Findings from the International Food Policy Study Youth Survey, 2020. Pediatr Obes 2023; 18:e13028. [PMID: 36958860 DOI: 10.1111/ijpo.13028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Many countries, including Canada, are considering regulations to restrict food and beverage marketing to children. However, little evidence is available outside of the US on how marketing exposure differs across sociodemographic subgroups. OBJECTIVE To investigate potential associations between child and adolescent sociodemographic characteristics and exposure to food and beverage marketing in Canada. METHODS Participants (n = 3780) aged 10-17 self-reported exposure to food and beverage marketing across food categories, locations and marketing techniques. Logistic regression models tested relationships between sociodemographics (age, sex, ethnicity and income adequacy) and marketing exposure. RESULTS Among other differences identified, 13-17 years old were more likely than 10-12 years old to report seeing unhealthy food marketing online. Girls were more likely than boys to see such marketing online and in retail settings, while boys were more likely to see it in video games. Minority ethnicities (including Indigenous youth) and respondents with lower income adequacy generally reported more exposure than White and higher income respondents, respectively. CONCLUSIONS This study highlights important differences in marketing exposure among youth of different sociodemographic groups in Canada, including greater exposure to marketing among those most disadvantaged and emphasizes the essential need to consider food marketing across equity groups when developing restrictions on marketing to kids.
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Affiliation(s)
- Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Mariangela Bagnato
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren Remedios
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé et Société (NUTRISS), Université Laval, Québec, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Bhawra J, Kirkpatrick SI, Hall MG, Vanderlee L, White CM, Hammond D. Patterns and correlates of nutrition knowledge across five countries in the 2018 international food policy study. Nutr J 2023; 22:19. [PMID: 36922823 PMCID: PMC10018957 DOI: 10.1186/s12937-023-00844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Nutrition knowledge is an important determinant of diet-related behaviour; however, the use of disparate assessment tools creates challenges for comparing nutrition knowledge levels and correlates across studies, geographic contexts, and populations. Using the Food Processing Knowledge (FoodProK) score - a measure of nutrition knowledge based on consumers' ability to understand and apply the concept of food processing in a functional task - nutrition knowledge levels and associated correlates were assessed in five countries. METHODS Adults, aged ≥18 years, were recruited through the Nielsen Consumer Insights Global Panel in Australia (n = 3997), Canada (n = 4170), Mexico (n = 4044), the United Kingdom (UK) (n = 5363), and the United States (US) (n = 4527). Respondents completed web-based surveys in November-December 2018. Functional nutrition knowledge was measured using the FoodProK score. Linear regression models examined associations between FoodProK score and sociodemographic, dietary behaviours, and knowledge-related characteristics. RESULTS FoodProK scores (maximum, 8 points) were highest in Canada (mean: 5.1) and Australia (5.0), followed by the UK (4.8), Mexico (4.7), and the US (4.6). Health literacy and self-rated nutrition knowledge were positively associated with FoodProK scores (p < .001). FoodProK scores were higher among those who reported vegetarian/other dietary practices (p < .001); made efforts to consume less sodium, trans fats, or sugars (p < .001); ≥60 years (p = 0.002), female (p < .001), and 'majority' ethnic group respondents in their respective countries (p < .001). CONCLUSIONS This study found differences in consumers' ability to distinguish levels of food processing for common foods, with somewhat lower levels of nutrition knowledge in countries with the highest intake of highly processed foods. Nutrition knowledge differences based on consumer characteristics highlight the need for accessible policy interventions that support uptake of healthy eating efforts across populations to avoid exacerbating nutrition-related disparities. Tools such as the FoodProK can be used to evaluate the impact of policies targeting nutrition knowledge across contexts.
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Affiliation(s)
- Jasmin Bhawra
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Canada
| | | | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - Lana Vanderlee
- École de Nutrition, Centre nutrition, santé et société (Centre NUTRISS) and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada.
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10
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Corkum A, Vanderlee L, White CM, Hammond D. Awareness of Canada's Food Guide Among Canadian Youth. CAN J DIET PRACT RES 2023; 84:49-53. [PMID: 36004730 DOI: 10.3148/cjdpr-2022-019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Canada's Food Guide (CFG) contains recommendations for healthy eating for Canadians. The objective was to examine the awareness of and learning about CFG by Canadian youth.Methods: Cross-sectional online surveys were conducted with 3,674 youth aged 10-17 years in Canada in November/December 2019. Logistic binary regression models examined awareness of CFG, learning about CFG in school, and learning about healthy eating in schools in the past 12 months.Results: Most participants reported hearing of CFG (84.5%), learning about CFG in school (86.6%), and learning about healthy eating in school (65.4%) in the past 12 months. Awareness of CFG was higher among females (OR: 1.61; 95% CI: 1.32-1.96), older youth (1.70; 1.39-2.07), and those in Atlantic Canada (OR: 1.77; 95% CI: 1.10, 2.84). Significantly fewer East/Southeast Asian, South Asian, Latino, and Middle Eastern participants reported hearing of CFG compared to white participants (p < 0.05 for all). Unstated/missing BMI (0.56; 0.45-0.71) and living in BC (OR: 0.61; 95% CI: 0.45, 0.82) were negatively associated with hearing about CFG. Similar results were observed in the models on learning about CFG and healthy eating in school.Conclusions: This study indicates discrepancies in awareness of CFG among youth by sex, ethnicity, region, and BMI which may suggest differences in use of CFG and healthy eating behaviours.
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Affiliation(s)
- Adèle Corkum
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON
| | - Lana Vanderlee
- École de Nutrition, Centre nutrition, santé et société (Centre NUTRISS) and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC
| | - Christine M White
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON
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11
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Yin E, Cameron AJ, Schultz S, White CM, Vanderlee L, Hammond D, Sacks G. Public Support for Nutrition-Related Actions by Food Companies in Australia: A Cross-Sectional Analysis of Findings from the 2020 International Food Policy Study. Int J Environ Res Public Health 2023; 20:4054. [PMID: 36901060 PMCID: PMC10002083 DOI: 10.3390/ijerph20054054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Unhealthy food environments contribute to unhealthy population diets. In Australia, the government currently relies on voluntary food company actions (e.g., related to front-of-pack labelling, restricting promotion of unhealthy foods, and product formulation) as part of their efforts to improve population diets, despite evidence that such voluntary approaches are less effective than mandatory policies. This study aimed to understand public perceptions of potential food industry nutrition-related actions in Australia. An online survey was completed by 4289 Australians in 2020 as part of the International Food Policy Study. The level of public support was assessed for six different nutrition-related actions related to food labelling, food promotion, and product formulation. High levels of support were observed for all six company actions, with the highest support observed for displaying the Health Star Rating on all products (80.4%) and restricting children's exposure to online promotion of unhealthy food (76.8%). Findings suggest the Australian public is strongly supportive of food companies taking action to improve nutrition and the healthiness of food environments. However, given the limitations of the voluntary action from food companies, mandatory policy action by the Australian government is likely to be needed to ensure company practices align with public expectations.
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Affiliation(s)
- Ebony Yin
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Adrian J. Cameron
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Sally Schultz
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
| | - Christine M. White
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Lana Vanderlee
- School of Nutrition, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC G1V 0A6, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Gary Sacks
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, Deakin University, Burwood 3125, Australia
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12
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Acton RB, Rynard VL, Adams J, Bhawra J, Cameron AJ, Contreras-Manzano A, Davis RE, Jáuregui A, Sacks G, Thrasher JF, Vanderlee L, White CM, Hammond D. Awareness, use and understanding of nutrition labels among adults from five countries: Findings from the 2018-2020 International Food Policy Study. Appetite 2023; 180:106311. [PMID: 36122623 DOI: 10.1016/j.appet.2022.106311] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/15/2022]
Abstract
Few studies have compared the effects of different front-of-package label (FOPL) systems in the 'real world'. This study assessed adults' awareness, use and understanding of nutrition facts labels (NFLs) and nationally implemented FOPLs such as Health Star Ratings (HSR), Traffic lights, and Guideline Daily Amounts (GDAs) in five countries, including before and after implementation of Mexico's warning FOPLs in 2020. Data were from the International Food Policy Study, an annual repeat cross-sectional study conducted in 2018-2020 among adults (N=64,032) in Australia, Canada, Mexico, the UK and the US. Self-reported awareness, use, and understanding of NFLs (in all five countries) and FOPLs (in Australia, Mexico, and UK) were assessed over time, between countries, and between NFLs and FOPLs. Most respondents in all countries reported seeing their country's NFLs (awareness) 'often' or 'all the time' across all three years, with one third to half of respondents using NFLs 'often' or 'all the time' (Australia: 43-45%; Canada: 47-50%; Mexico: 36-39%; UK: 32-34%; US: 47-49%), and approximately one half to two thirds finding NFLs 'easy' or 'very easy to understand' (56-57%; 67-69%; 51-54%; 48-51%; 70-71%). In 2020, awareness, use and self-reported understanding of the Warning FOPLs in Mexico were highest among all countries with a FOPL (p<0.001), whereas awareness and use were lowest for Australia's HSR (p<0.001). In countries with FOPLs, self-reported understanding was higher for FOPLs than NFLs, except for the GDA FOPL in Mexico. Only modest changes were observed over time. Warning FOPLs were associated with greater levels of self-reported awareness, use and understanding among adults compared to NFLs and GDA-based FOPLs. FOPLs implemented on a voluntary basis, such as Australia's HSR, may be less likely to be seen and used.
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Affiliation(s)
- Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
| | - Vicki L Rynard
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
| | - Jasmin Bhawra
- School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada.
| | - Adrian J Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Alejandra Contreras-Manzano
- Center for Health and Nutrition Research, Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos, Zip code, 62100, Mexico.
| | - Rachel E Davis
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Alejandra Jáuregui
- Center for Health and Nutrition Research, Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos, Zip code, 62100, Mexico.
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, santé et société (NUTRISS), Université LavalQuébec, Québec, G1V 0A6, Canada.
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
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13
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Edwards AA, van Dijk W, White CM, Schatschneider C. Screening screeners: calculating classification indices using correlations and cut-points. Ann Dyslexia 2022; 72:445-460. [PMID: 35687313 PMCID: PMC9713677 DOI: 10.1007/s11881-022-00261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
Given the recent push for universal screening, it is important to take into account how well a screener identifies children at risk for reading problems as well as how screener and sample information contribute to this classification. Picking the best cut-point for a particular sample and screening goal can be challenging given that test manuals often report classification information for a specific cut-point and sample base rate which may not generalize to other samples. By assuming a bivariate normal distribution, it is possible to calculate all of the classification information for a screener based on the correlation between the screener and outcome, the cut-point on the outcome (i.e., the base rate in the sample), and the cut-point on the screener. We provide an example with empirical data to validate these estimation procedures. This information is the basis for a free online tool that provides classification information for a given correlation between screener and outcome and cut-points on each. Results show that the correlation between screener and outcome needs to be greater than .9 (higher than observed in practice) to obtain good classification. These findings are important for researchers, administrators, and practitioners because current screeners do not meet these requirements. Since a correlation is dependent on the reliability of the measures involved, we need screeners with better reliability and/or multiple measures to increase reliability. Additionally, we demonstrate the impact of base rate on positive predictive power and discuss how gated screening can be useful in samples with low base rates.
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Affiliation(s)
- Ashley A Edwards
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA.
| | - Wilhelmina van Dijk
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
| | - Christine M White
- Department of Psychology, Florida State University, 1107 West Call Street, Tallahassee, FL, 32306, USA
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14
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Weaver SJ, Edwards H, McIntyre T, Temple SM, Alexander Q, Behrens MC, Biedebach RE, Budwal SS, Carlson JE, Castagnoli JO, Fundingsland AD, Hart DV, Heaphy JS, Keller SW, Lucatero KI, Mills KH, Moallemi NM, Murguia AM, Navarro L, O'Brien E, Perez JK, Schauerman TJ, Stephens DM, Venturini MC, White CM, Taylor EN. Cutaneous Evaporative Water Loss in Lizards is Variable across Body Regions and Plastic in Response to Humidity. HERPETOLOGICA 2022. [DOI: 10.1655/herpetologica-d-21-00030.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Savannah J. Weaver
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Haley Edwards
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Tess McIntyre
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - S. Mieko Temple
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Quinton Alexander
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Matthew C. Behrens
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Reilly E. Biedebach
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Shawn S. Budwal
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Jacqueline E. Carlson
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - J. Owen Castagnoli
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Ashley D. Fundingsland
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Dashiell V. Hart
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Jenna S. Heaphy
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Spencer W. Keller
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Karisma I. Lucatero
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Kai H. Mills
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Nikki M. Moallemi
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Andrea M. Murguia
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Leonardo Navarro
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Eli O'Brien
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Julia K. Perez
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Thomas J. Schauerman
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Dylan M. Stephens
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Mia C. Venturini
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Christine M. White
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
| | - Emily N. Taylor
- California Polytechnic State University, Biological Sciences, 1 Grand Avenue, San Luis Obispo, CA 93407-0401, USA
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15
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Hammond D, Vanderlee L, White CM, Acton RB, White M, Roberto CA, Cameron A, Sacks G, Kirkpatrick S, Dubin J, Adams J, Jauregui A, Thrasher JF. The Conceptual Framework for the International Food Policy Study: Evaluating the Population-Level Impact of Food Policy. J Nutr 2022; 152:1S-12S. [PMID: 35274695 PMCID: PMC9188864 DOI: 10.1093/jn/nxac042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/14/2022] Open
Abstract
An unhealthy diet is among the leading global causes of death and disability. Globally, a range of policies are being implemented to support healthy food choices at a population level, including novel polices in the areas of food marketing, nutrition labeling, and taxation of less healthy foods. There is a need to evaluate and inform the implementation of these policies, including their impacts on marginalized population subgroups. The International Food Policy Study (IFPS) consists of repeated cross-sectional surveys conducted in 5 high- and upper-middle-income countries: Australia, Canada, Mexico, the United Kingdom, and the United States. In each country, approximately 4000 adults and 1200 children and youth (aged 10-17) were recruited from a global commercial panel to complete an online survey using consistent measures and methodologies across countries. The first annual IFPS surveys were conducted in 2017 with adults; annual surveys for young people aged 10-17 were launched in 2019 in the same countries, as well as in Chile. The design of the IFPS surveys creates a framework for evaluating "natural experiments" in food policies, including comparisons over time within countries implementing the policy and comparisons with countries in which the policy was not implemented. IFPS surveys have 3 primary areas of focus: 1) knowledge, attitudes, and beliefs associated with specific policies; 2) diet-related behaviors; and 3) dietary intake, including 24-hour dietary recalls for adults in 4 of the 5 countries. Surveys also assess food insecurity, income adequacy, sex and gender, race/ethnicity, and a range of other measures to assess trends among priority subgroups. Overall, the IFPS project has the potential to address important gaps in national monitoring surveys for dietary patterns, and to evaluate the impacts of novel food policies implemented in any of the 5 countries over the study period.
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Affiliation(s)
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adrian Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Sharon Kirkpatrick
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Joel Dubin
- Department Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada
| | - Jean Adams
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Alejandra Jauregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - James F Thrasher
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Hock K, Barquera S, Corvalán C, Goodman S, Sacks G, Vanderlee L, White CM, White M, Hammond D. Awareness of and Participation in School Food Programs in Youth from Six Countries. J Nutr 2022; 152:85S-97S. [PMID: 35274730 PMCID: PMC9188863 DOI: 10.1093/jn/nxac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND School-based meal programs can promote healthy dietary intake in youth. However, limited data exist regarding the impact of income-targeted school meal programs across countries, particularly among food-insecure youth. OBJECTIVES We examined self-reported awareness of and participation in free school meal programs, and associations with dietary intake in youth from 6 countries with differing national school meal policies. METHODS Data were collected through the 2019 International Food Policy Study Youth Survey, a cross-sectional survey of 10,565 youth aged 10-17 y from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Regression models examined: 1) country differences in awareness of and participation in breakfast and lunch programs; and 2) associations between lunch program participation and intake of fruit and vegetables, and "less healthy" foods during the previous school lunch day. RESULTS Awareness of and participation in free breakfast and lunch programs varied across countries. Approximately half of USA and Chilean students participated in school lunch programs-the countries with the most comprehensive national policies-compared with one-fifth of students in the United Kingdom, and ∼5% in Australia, Canada, and Mexico (P < 0.001 for all contrasts). In the United States and Chile, more than two-thirds of youth with the highest level of food insecurity participated in lunch programs, compared with 45% in the United Kingdom, 27% in Canada, and ≤20% in Australia and Mexico. In all countries, youth reporting school lunch program participation were more likely to report fruit and vegetable intake during their previous school lunch (P < 0.001), and higher intake of "less healthy" food in all countries except the United States and Chile. CONCLUSIONS More comprehensive national policies were associated with greater participation in school meal programs, particularly among youth at greatest risk of food insecurity, as well as healthier dietary intake from school lunches.
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Affiliation(s)
- Karen Hock
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Simón Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Camila Corvalán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Samantha Goodman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Melbourne Burwood Campus, Burwood, Victoria, Australia
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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17
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Cameron AJ, Oostenbach LH, Dean S, Robinson E, White CM, Vanderlee L, Hammond D, Sacks G. Consumption Frequency and Purchase Locations of Foods Prepared Outside the Home in Australia: 2018 International Food Policy Study. J Nutr 2022; 152:76S-84S. [PMID: 35274693 PMCID: PMC9188859 DOI: 10.1093/jn/nxab437] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/17/2021] [Accepted: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Foods prepared outside the home (e.g., fast-food chains, restaurants) represent increasing proportions of diets worldwide, and have been associated with higher energy intakes and BMIs. To improve the healthiness of population diets, it is important to understand patterns of consumption of these foods, and whether related policy measures are effective. OBJECTIVES This study aimed to identify the frequency and sources of consumption of foods prepared outside the home in Australia, and to understand the impact of nutrition information in restaurants on related food choices. METHODS Data were from a web-based survey (the International Food Policy Study) completed in 2018 by Australian adults aged ≥18 years (n = 4103). The number of meals prepared outside the home, their purchase locations, and the extent to which nutrition information was noticed and influenced purchasing decisions were each analyzed by sociodemographic characteristics and BMI, with linear models also adjusted for sex, age group, education, ethnicity, and BMI. RESULTS An average of 2.73 (95% CI, 2.61-2.86) meals per week were prepared outside the home, with higher frequencies among men, younger ages, and more highly educated participants. A wide variety of sources for these foods was observed, with fast-food outlets being most common. Around one-quarter of all foods prepared outside the home were delivered. A small percentage (14.9%; 95% CI, 13.3%-16.7%) of participants reported noticing nutrition information, but among those who did, around half reported that it influenced their behavior. CONCLUSIONS Foods prepared outside the home are commonly purchased in Australia, particularly by young adults, from a variety of outlet types. While current menu energy labeling regulations may provide some population health benefit, a broader policy focus on foods prepared outside the home is needed as part of efforts to improve population diets.
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Affiliation(s)
- Adrian J Cameron
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Laura H Oostenbach
- Institute for Physical Activity and Nutrition Research (IPAN), Deakin University, Geelong, Australia
| | - Sarah Dean
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Ella Robinson
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary Sacks
- School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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18
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Acton RB, Vanderlee L, Cameron AJ, Goodman S, Jáuregui A, Sacks G, White CM, White M, Hammond D. Self-Reported Impacts of the COVID-19 Pandemic on Diet-Related Behaviors and Food Security in 5 Countries: Results from the International Food Policy Study 2020. J Nutr 2022; 152:35S-46S. [PMID: 35274699 PMCID: PMC8992246 DOI: 10.1093/jn/nxac025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/08/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of daily life, including dietary intake; however, few studies have reported its impacts on dietary behaviors and food security across multiple countries. OBJECTIVES We examined self-reported impacts of COVID-19 on food behaviors, food security, and overall diet healthfulness in 5 countries. METHODS Adults aged 18-100 years (n = 20,554) in Australia, Canada, Mexico, the United Kingdom, and the United States completed an online survey in November and December 2020 as part of the International Food Policy Study, an annual, repeat cross-sectional survey. Survey measures assessed perceived impacts of the COVID-19 pandemic on eating food prepared away from home, having food delivered from a restaurant, and buying groceries online, as well as perceived food security and overall diet healthfulness. Regression models examined associations between each outcome and sociodemographic correlates. RESULTS Across all countries, 62% of respondents reported eating less food prepared away from home due to the pandemic, while 11% reported eating more. Some participants reported having less food delivered from a restaurant (35%) and buying fewer groceries online (17%), while other respondents reported more of each (19% and 25%, respectively). An average of 39% reported impacts on their food security, and 27% reported healthful changes to their overall diet. The largest changes for all outcomes were observed in Mexico. Participants who were younger, ethnic minorities, or had lower income adequacy tended to be more likely to report food-related changes in either direction; however, these relationships were often less pronounced among respondents in Mexico. CONCLUSIONS Respondents reported important changes in how they sourced their food during the pandemic, with trends suggesting shifts towards less food prepared away from home and more healthful diets overall. However, changes in diet and food behaviors occurred in both healthful and less healthful directions, suggesting that dietary responses to the pandemic were highly variable.
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Affiliation(s)
- Rachel B Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - Adrian J Cameron
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Samantha Goodman
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Alejandra Jáuregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada,Address correspondence to DH (e-mail:)
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19
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Demers-Potvin É, White M, Potvin Kent M, Nieto C, White CM, Zheng X, Hammond D, Vanderlee L. Adolescents' media usage and self-reported exposure to advertising across six countries: implications for less healthy food and beverage marketing. BMJ Open 2022; 12:e058913. [PMID: 35589343 PMCID: PMC9121490 DOI: 10.1136/bmjopen-2021-058913] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES The study objectives were to examine: (1) adolescents' media viewing habits, (2) associations with media viewing and self-reported exposure to unhealthy food and beverage advertising and (3) differences in trends among younger and older adolescents in six high and upper middle-income countries. DESIGN Repeat cross-sectional online survey. SETTING Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States of America (USA). PARTICIPANTS Respondents to the International Food Policy Study who provided information on all variables of interest in November-December 2019 aged 10-17 years (n=9171). OUTCOME MEASURES Self-reported exposure to screen-based media (screen time by media channel), use of social media platforms and self-reported location and frequency of exposure to unhealthy food and beverage advertising. RESULTS The average amount of time spent in front of various screens ranged from 7.6 hours to 10.2 hours across countries per week day, which may include possible viewing of multiple media channels simultaneously. Overall, Instagram was the most popular social media platform (52%-68% by country), followed by Facebook (42%-79%) and Snapchat (28%-52%). The percentage of respondents who self-reported having seen unhealthy food advertisements in the past 30 days was highest on television (43%-69%), followed by digital media (27%-60%) and gaming applications (10%-17%). Self-reported daily exposure to advertising varied between countries for sugary drinks (10%-43%) and fast food (19%-44%) and was positively associated with self-reported screen time. Self-reported exposure to screen-based media and social media platforms differed by sociodemographic characteristics and was higher among older adolescents than younger adolescents. CONCLUSIONS The important amount of time spent on screen-based media reported by adolescents and large percentage of adolescents reporting social media usage, coupled with high rates of self-reported advertising exposure, support the need for policies to restrict marketing of unhealthy food and beverages appealing to adolescents on screen-based media.
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Affiliation(s)
- Élisabeth Demers-Potvin
- École de nutrition, Centre NUTRISS - Nutrition, santé et société, Institut sur la nutrition et les aliments fonctionnels, Université Laval, Quebec City, Quebec, Canada
| | - Martin White
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Claudia Nieto
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Christine M White
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Xueying Zheng
- Health Education East of England, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Merseyside, UK
| | - David Hammond
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- École de nutrition, Centre NUTRISS - Nutrition, santé et société, Institut sur la nutrition et les aliments fonctionnels, Université Laval, Quebec City, Quebec, Canada
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20
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Nieto C, Jáuregui A, Contreras-Manzano A, Potvin Kent M, Sacks G, White CM, Pauzé E, Vanderlee L, Thrasher JF, Barquera S, Hammond D. Adults' Exposure to Unhealthy Food and Beverage Marketing: A Multi-Country Study in Australia, Canada, Mexico, the United Kingdom, and the United States. J Nutr 2022; 152:25S-34S. [PMID: 35544288 PMCID: PMC9188858 DOI: 10.1093/jn/nxab449] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/10/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Food marketing increases product appeal, purchasing, and consumption, using diverse strategies and locations to reach consumers. OBJECTIVES The aim of this study was to examine differences in adults' self-reported exposure to various marketing strategies (brand and licensed characters, celebrities, and sponsorship of sports and cultural events) and locations (television, radio, and digital media) across 5 countries: Australia, Canada, Mexico, the United Kingdom, and the United States. METHODS We analyzed cross-sectional survey data on self-reported exposure to food marketing strategies and locations collected in 2018 by the International Food Policy Study. Participants (n = 21,678) aged ≥18 years completed an online survey. Exposures to unhealthy food marketing strategies and locations in the prior 30 days were self-reported. Regression models examined differences in marketing exposure and locations across countries. RESULTS The average number of unhealthy food marketing strategies to which participants reported being exposed ranged from 0.5 in the United Kingdom to 2.3 in Mexico. Self-reported exposure to strategies across all countries was highest for brand characters (32%), followed by licensed characters (22%). In total, the reported mean exposure of marketing locations was 1.6 in the prior month. Television was the most prevalent location (44%), followed by digital marketing (32%). Adjusted models indicated that the odds of reporting exposure to marketing strategies and marketing locations were higher for Mexico compared to the rest of the countries. CONCLUSIONS Adults report a variety of exposures to unhealthy food marketing in all countries, but exposure was highest in Mexico. Special attention should be paid to regulating marketing strategies, such as brand characters and licensed characters, and locations, such as television and digital marketing.
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Affiliation(s)
- Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | - Monique Potvin Kent
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Elise Pauzé
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Lana Vanderlee
- École de Nutrition, Centre Nutrition, santé et société (Centre NUTRISS), and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, South Carolina, USA,Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Simón Barquera
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
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21
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Acton RB, Vanderlee L, Adams J, Kirkpatrick SI, Pedraza LS, Sacks G, White CM, White M, Hammond D. Tax awareness and perceived cost of sugar-sweetened beverages in four countries between 2017 and 2019: findings from the international food policy study. Int J Behav Nutr Phys Act 2022; 19:38. [PMID: 35361251 PMCID: PMC8973878 DOI: 10.1186/s12966-022-01277-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 02/24/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects-via awareness of the tax-may impact the effectiveness of SSB taxes on consumer purchases. OBJECTIVE The study sought to examine perceived cost of SSBs, tax awareness, and changes in beverage purchasing over time and across four countries with and without SSB taxes. METHODS The study used data from the 2017, 2018 and 2019 waves of the International Food Policy Study. Annual cross-sectional online surveys were conducted in Australia, Mexico, UK and US, which captured perceived cost of SSBs relative to non-SSBs in all countries (with Australia as a no-tax comparator), and measures of tax awareness and participants' reported changes in beverage purchasing in response to SSB taxes in Mexico (tax implemented in 2014), UK (tax implemented in 2018) and US (subnational taxes since 2015). Logistic regression models evaluated the measures across years and socio-demographic groups. RESULTS Perceived cost of SSBs relative to non-SSBs was higher in Mexico (all three years) and the UK (2018 and 2019 following tax implementation) than Australia and the US. Tax awareness was higher in UK than Mexico, and decreased over time among Mexican respondents. Patterns of reported beverage purchasing changes in response to the tax were similar across Mexico, UK and US, with the largest changes reported by Mexican respondents. Respondents with characteristics corresponding to lower socioeconomic status were less likely to be aware of an SSB tax, but more likely to perceive SSBs to cost more than non-SSBs and report changes in purchasing in response to the tax, where there was one. CONCLUSIONS This study suggests that in countries where a national SSB tax was present (Mexico, UK), perceived cost of SSBs and tax awareness were higher compared to countries with no SSB tax (Australia) or subnational SSB taxes (US), respectively, and suggests that perceived cost and tax awareness represent distinct constructs. Improving the 'signalling effect' of existing SSB taxes may be warranted, particularly in tax settings where consumer behaviour change is a policy objective.
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Affiliation(s)
- Rachel B Acton
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Lana Vanderlee
- École de Nutrition, Centre de Nutrition, Santé Et Société (NUTRISS), Université Laval, 2425 rue de L'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Jean Adams
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - Sharon I Kirkpatrick
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Lilia S Pedraza
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Col. Santa María Ahuacatitlán, Cerrada los Pinos Y Caminera, Av. Universidad 655, C.P. 62100, Morelos, Mexico
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Melbourne Burwood Campus, Burwood, VIC, 3125, Australia
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Martin White
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Box 285, Cambridge, CB2 0QQ, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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22
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Sosa T, Mayer B, Chakkalakkal B, Drozd A, Hater K, Johnson A, Nasr A, Seger BM, Meyer R, Dewan M, White CM, Brady PW. Improving Shared Situation Awareness for High-risk Therapies in Hospitalized Children. Hosp Pediatr 2022; 12:37-46. [PMID: 34859255 DOI: 10.1542/hpeds.2021-006193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND High-risk therapies (HRTs), including medications and medical devices, are an important driver of preventable harm in children's hospitals. To facilitate shared situation awareness (SA) and thus targeted harm prevention, we aimed to increase the percentage of electronic health record (EHR) alerts with the correct descriptor of an HRT from 11% to 100% on a high-acuity hospital unit over a 6-month period. METHODS The interdisciplinary team defined an HRT as a medication or device with a significant risk for harm that required heightened awareness. Our aim for interventions was to (1) educate staff on a new HRT algorithm; (2) develop a comprehensive table of HRTs, risks, and mitigation plans; (3) develop bedside signs for patients receiving HRTs; and (4) restructure unit huddles. Qualitative interviews with families, nurses, and medical teams were used to assess shared SA and inform the development and adaptation of interventions. The primary outcome metric was the percentage of EHR alerts for an HRT that contained a correct descriptor of the therapy for use by the care team and institutional safety leaders. RESULTS The percentage of EHR alerts with a correct HRT descriptor increased from an average of 11% to 96%, with special cause variation noted on a statistical process control chart. Using qualitative interview data, we identified critical awareness gaps, including establishing a shared mental model between nursing staff and the medical team as well as engagement of families at the bedside to monitor for complications. CONCLUSIONS Explicit, structured processes and huddles can increase HRT SA among the care team, patient, and family.
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Affiliation(s)
| | | | | | | | | | | | | | - Brandy M Seger
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Maya Dewan
- Critical Care Medicine
- Biomedical Informatics
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine M White
- Divisions of Hospital Medicine
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Patrick W Brady
- Divisions of Hospital Medicine
- James M. Anderson Center for Health System Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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23
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Hock K, Acton RB, Jáuregui A, Vanderlee L, White CM, Hammond D. Experimental study of front-of-package nutrition labels' efficacy on perceived healthfulness of sugar-sweetened beverages among youth in six countries. Prev Med Rep 2021; 24:101577. [PMID: 34976639 PMCID: PMC8683942 DOI: 10.1016/j.pmedr.2021.101577] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 10/25/2022] Open
Abstract
Front-of-package (FOP) nutrition labels have been proposed as a strategy to help limit sugar-sweetened beverage (SSB) consumption among youth. However, few studies have examined the efficacy of FOP labels in youth across different countries. A between-group experiment was conducted to examine the impact of FOP labels (no-label control, Health Star Rating, 'High in' Octagon, Guideline Daily Amount (GDA), Traffic Light, or Nutri-Score) on perceived healthfulness of an SSB. The study was conducted online in November-December 2019 with 10,762 children aged 10-17 from six countries: Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. A binary logistic regression model tested the impacts of FOP label condition, country, and sociodemographic characteristics on participants' likelihood of perceiving the SSB to be Unhealthy. Compared to the control condition, participants in each of the five FOP label conditions were significantly more likely to perceive the SSB as Unhealthy (p < 0.002). The 'High in' Octagon label had the greatest impact on perceived healthfulness across five out of six countries, whereas the GDA and Nutri-Score labels demonstrated the lowest impact across all six countries. The impact of FOP labels was consistent across sex, age, race/ethnicity, and perceived income adequacy. FOP labels can significantly reduce the perceived healthfulness of SSBs among youth across multiple countries. The current study adds to the evidence that 'high in' labels, which use intuitive symbols such as the octagon 'stop sign', are the most efficacious labels for helping consumers identify foods high in nutrients of concern, including SSBs.
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Affiliation(s)
- Karen Hock
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Rachel B. Acton
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Alejandra Jáuregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, MOR 62100, Mexico
| | - Lana Vanderlee
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada
| | - Christine M. White
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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24
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Sosa T, Sitterding M, Dewan M, Coleman M, Seger B, Bedinghaus K, Hawkins D, Maddock B, Hausfeld J, Falcone R, Brady PW, Simmons J, White CM. Optimizing Situation Awareness to Reduce Emergency Transfers in Hospitalized Children. Pediatrics 2021; 148:peds.2020-034603. [PMID: 34599089 DOI: 10.1542/peds.2020-034603] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in our system, we aimed to decrease emergency transfers (ETs) to the ICU by 50% over 10 months. METHODS An interdisciplinary team of physicians, nurses, respiratory therapists, and families convened to improve the original SA model for clinical deterioration and address communication inadequacies and evolving technology in our inpatient system. The key drivers included the establishment of a shared mental model, psychologically safe escalation, and efficient and effective SA tools. Novel interventions including the intentional inclusion of families and the interdisciplinary team in huddles, a mental model checklist, door signage, and an electronic health record SA navigator were evaluated via a time series analysis. Sequential inpatient-wide testing of the model allowed for iteration and consensus building across care teams and families. The primary outcome measure was ETs, defined as any ICU transfer in which the patient receives intubation, inotropes, or ≥3 fluid boluses within 1 hour. RESULTS The rate of ETs per 10 000 patient-days decreased from 1.34 to 0.41 during the study period. This coincided with special cause improvement in process measures, including risk recognition before medical response team activation and the use of tools to facilitate shared SA. CONCLUSIONS An innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs.
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Affiliation(s)
| | | | - Maya Dewan
- Critical Care Medicine.,Biomedical Informatics.,Departments of Pediatrics
| | | | - Brandy Seger
- James M. Anderson Center for Health Systems Excellence
| | | | | | - Benjamin Maddock
- Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Richard Falcone
- Pediatric General and Thoracic Surgery.,Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Patrick W Brady
- Divisions of Hospital Medicine.,Departments of Pediatrics.,James M. Anderson Center for Health Systems Excellence
| | - Jeffrey Simmons
- Divisions of Hospital Medicine.,Departments of Pediatrics.,James M. Anderson Center for Health Systems Excellence
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25
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Madsen NL, Porter A, Cable R, Hanke SP, Hoerst A, Neogi S, Brower LH, White CM, Statile AM. Improving Discharge Efficiency and Charge Containment on a Pediatric Acute Care Cardiology Unit. Pediatrics 2021; 148:peds.2020-004663. [PMID: 34417288 DOI: 10.1542/peds.2020-004663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital discharge delays can negatively affect patient flow and hospital charges. Our primary aim was to increase the percentage of acute care cardiology patients discharged within 2 hours of meeting standardized medically ready (MedR) discharge criteria. Secondary aims were to reduce length of stay (LOS) and lower hospital charges. METHODS A multidisciplinary team used quality improvement methods to implement and study MedR discharge criteria in our hospital electronic health record. The criteria were ordered on admission and modified on daily rounds. Bedside nurses documented the time when all MedR discharge criteria were met. A statistical process control chart measured interventions over time. Discharge before noon and 30-day readmissions were also tracked. Average LOS was examined, comparing the first 6 months of the intervention period to the last 6 months. Inpatient charges were reviewed for patients with >2 hours MedR discharge delay. RESULTS The mean percentage of patients discharged within 2 hours of meeting MedR discharge criteria increased from 20% to 78% over 22 months, with more patients discharged before noon (19%-32%). Median LOS decreased from 11 days (interquartile range: 6-21) to 10 days (interquartile range: 5-19) (P = .047), whereas 30-day readmission remained stable at 16.3%. A total of 265 delayed MedR discharges beyond 2 hours occurred. The sum of inpatient charges from care provided after meeting MedR criteria was $332 038 (average $1253 per delayed discharge). CONCLUSIONS Discharge timeliness in pediatric acute care cardiology patients can be improved by standardizing medical discharge criteria, which may shorten LOS and decrease medical charges.
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Affiliation(s)
- Nicolas L Madsen
- Heart Institute .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Andrew Porter
- Division of Pediatric Cardiology, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Rhonda Cable
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Samuel P Hanke
- Heart Institute.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,James M Anderson Center for Health Systems Excellence
| | | | - Smriti Neogi
- James M Anderson Center for Health Systems Excellence
| | - Laura H Brower
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Christine M White
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,James M Anderson Center for Health Systems Excellence.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela M Statile
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,James M Anderson Center for Health Systems Excellence.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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26
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Goodman S, Armendariz GC, Corkum A, Arellano L, Jáuregui A, Keeble M, Marshall J, Sacks G, Thrasher JF, Vanderlee L, White CM, Hammond D. Recall of government healthy eating campaigns by consumers in five countries. Public Health Nutr 2021; 24:3986-4000. [PMID: 33843564 PMCID: PMC10195272 DOI: 10.1017/s1368980021001415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine awareness and recall of healthy eating public education campaigns in five countries. DESIGN Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country. SETTING Online surveys. PARTICIPANTS Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463). RESULTS Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico). CONCLUSIONS In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.
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Affiliation(s)
- Samantha Goodman
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, OntarioN2L 3G1, Canada
| | - Gabriela C Armendariz
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Adele Corkum
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, OntarioN2L 3G1, Canada
| | - Laura Arellano
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
- Nutrition and Food Sciences, Psychology Education and Health Department, Instituto Tecnológico y de Estudios Superiores de Occidente (ITESO), Tlaquepaque, Jalisco, Mexico
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Matthew Keeble
- Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Josephine Marshall
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, MR, Mexico
| | - Lana Vanderlee
- École de Nutrition, Centre nutrition, Santé et Société (Centre NUTRISS) and Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC, Canada
| | - Christine M White
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, OntarioN2L 3G1, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, OntarioN2L 3G1, Canada
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Gómez-Donoso C, Sacks G, Vanderlee L, Hammond D, White CM, Nieto C, Bes-Rastrollo M, Cameron AJ. Public support for healthy supermarket initiatives focused on product placement: a multi-country cross-sectional analysis of the 2018 International Food Policy Study. Int J Behav Nutr Phys Act 2021; 18:78. [PMID: 34127002 PMCID: PMC8201822 DOI: 10.1186/s12966-021-01149-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food retail environments have an influential role in shaping purchasing behavior and could contribute to improving dietary patterns at a population level. However, little is known about the level of public support for different types of initiatives to encourage healthy food choices in supermarkets, and whether this varies across countries or context. The current study aimed to explore the level of support for three potential supermarket initiatives focused on product placement across five countries, and factors that may influence this support. METHODS A total of 22,264 adults from Australia, Canada, Mexico, the United Kingdom and the United States (US) provided information on support for three supermarket initiatives related to product placement (targeting product positioning: 'checkouts with only healthy products', 'fewer end-of-aisle displays containing unhealthy foods or soft drinks' or availability: 'more shelf space for fresh and healthier foods') as part of the online 2018 International Food Policy Study. The proportion of respondents that supported each initiative was assessed across countries, and multivariable logistic regression analyses were conducted to evaluate the influence of sociodemographic factors on support. RESULTS The initiative that received the highest support was 'more shelf space for fresh and healthier foods': 72.0% [95% CI 71.3-72.7], whereas 'checkouts with only healthy products' received the lowest support: 48.6% [95% CI 47.8-49.4]. The level of support differed between countries (p < 0.001 for all initiatives), with the US generally showing the lowest support and Mexico the highest. Noteworthy, in the overall sample, there was not much opposition to any of the initiatives (2.5-14.2%), whereas there was a large proportion of neutral responses (25.5-37.2%). Respondents who were older, female, highly educated, and those who reported having more nutrition knowledge tended to be more supportive, with several differences between countries and initiatives. CONCLUSIONS Most people in the assessed five countries showed a generally high level of support for three placement initiatives in supermarkets to encourage healthy food choices. Support varied by type of initiative (i.e., product positioning or availability) and was influenced by several factors related to country context and sociodemographic characteristics. This evidence could prompt and guide retailers and policy makers to take stronger action to promote healthy food choices in stores.
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Affiliation(s)
- Clara Gómez-Donoso
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia
| | - Lana Vanderlee
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels, École de nutrition, Université Laval, Québec, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Claudia Nieto
- Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Maira Bes-Rastrollo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain
- Biomedical Research Centre Network on Physiopathology of Obesity and Nutrition (CIBERobn), Institute of Health Carlos III, Madrid, Spain
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood VIC, Geelong, 3125, Australia.
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Vanderlee L, Czoli CD, Pauzé E, Potvin Kent M, White CM, Hammond D. A comparison of self-reported exposure to fast food and sugary drinks marketing among parents of children across five countries. Prev Med 2021; 147:106521. [PMID: 33744330 DOI: 10.1016/j.ypmed.2021.106521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/28/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022]
Abstract
Exposure to unhealthy food and beverage marketing is an important environmental determinant of dietary intake. The current study examined self-reported exposure to marketing of unhealthy foods and beverages across various media channels and settings among parents of children younger than 18 years in five high and upper-middle income countries. Data from 4827 parents living with their children were analyzed from the International Food Policy Study (2017), a web-based survey of adults aged 18-64 years from Canada, the United States (US), the United Kingdom (UK), Australia, and Mexico. Respondents reported their exposure to marketing of fast food and of sugary drinks across media channels/settings overall and how often they see fast food and sugary drink marketing while viewing media with their children. Regression models examined differences across countries and correlates of marketing exposure. Parents in Mexico and the US reported greater exposure to marketing for fast food and sugary drinks compared to parents in Australia, Canada, and the UK. Patterns of exposure among parents were generally consistent across countries, with TV, digital media, and radio being the most commonly reported media channels for both fast food and sugary drinks. Exposure to marketing of fast food and sugary drinks was associated with a variety of sociodemographic factors, most strongly with ethnicity and education, and sociodemographic trends differed somewhat between countries. The findings demonstrate differences in self-reported parental exposure to marketing of fast food and sugary drinks between countries, and may help to evaluate the impact of marketing restrictions implemented over time.
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Affiliation(s)
- Lana Vanderlee
- École de Nutrition, Centre de nutrition, santé et société (NUTRISS), Université Laval, 2425 rue de L'Agriculture, Québec, Québec G1V 0A6, Canada.
| | - Christine D Czoli
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada; Heart and Stroke Foundation of Canada, Ottawa, 110-1525 Carling Avenue, Ottawa, Ontario, K1Z 8R9, Canada
| | - Elise Pauzé
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada.
| | - Monique Potvin Kent
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa, Ontario K1G 5Z3, Canada.
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, Ontario N2L 3G1, Canada.
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Vanderlee L, White CM, Kirkpatrick SI, Rynard VL, Jáuregui A, Adams J, Sacks G, Hammond D. Nonalcoholic and Alcoholic Beverage Intakes by Adults across 5 Upper-Middle- and High-Income Countries. J Nutr 2021; 151:140-151. [PMID: 33245111 PMCID: PMC7779239 DOI: 10.1093/jn/nxaa324] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/19/2020] [Accepted: 10/01/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Despite considerable public health interest in sugary drink consumption, there has been little comparison of intake across countries. OBJECTIVES This study aimed to compare the consumption frequency and amounts of commonly consumed beverages among adults in 5 upper-middle- and high-income countries, and examine differences in consumption between population subgroups. METHODS Adults aged 18-65 y completed online surveys in December 2017 in Australia (n = 3264), Canada (n = 2745), Mexico (n = 3152), the United Kingdom (n = 3221), and the USA (n = 4015) as part of the International Food Policy Study. The frequency of consuming beverages from 22 categories in the past 7 d was estimated using the Beverage Frequency Questionnaire. Regression models were used to examine differences in the likelihood of any consumption and in the amounts consumed of sugar-sweetened beverages (SSBs), sugary drinks (SSBs and 100% juice), diet, and alcoholic beverages between countries and across sociodemographic subgroups. RESULTS The prevalence of reported SSB consumption in the past 7 d ranged from 47% (United Kingdom) to 81% (Mexico), and that of sugary drinks ranged from 62% (United Kingdom) to 87% (Mexico). Rates of consumption of diet drinks ranged from 26% (Mexico) to 37% (United Kingdom), whereas alcoholic drink consumption rates ranged from 45% (USA) to 52% (Canada). Respondents in Mexico were more likely to consume SSBs and sugary drinks, and in greater amounts, than those in other countries. Respondents in the United Kingdom were more likely to consume diet drinks than those in Australia, Canada, and Mexico, and greater amounts of diet drinks were consumed in the United Kingdom and the USA. Across countries, younger respondents and males were more likely to consume greater amounts of SSBs and sugary drinks. CONCLUSIONS Most adult respondents across all countries consumed SSBs and sugary drinks, with greater consumption in Mexico and the USA. Consumption varied greatly across countries, but patterns of association among subpopulations were relatively similar.
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Affiliation(s)
- Lana Vanderlee
- NUTRISS Centre, School of Nutrition, Laval University, Québec, Québec, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Vicki L Rynard
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Alejandra Jáuregui
- Centre for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Jean Adams
- Centre for Diet & Activity Research, Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong, Victoria, Australia
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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White CM, Bakhiet S, Bates M, Ruttle C, Pilkington LJ, Keegan H, O'Toole SA, Sharp L, O'Kelly R, Tewari P, Flannelly G, Martin CM, O'Leary JJ. Exposure to tobacco smoke measured by urinary nicotine metabolites increases risk of p16/Ki-67 co-expression and high-grade cervical neoplasia in HPV positive women: A two year prospective study. Cancer Epidemiol 2020; 68:101793. [PMID: 32841926 DOI: 10.1016/j.canep.2020.101793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Human papillomavirus (HPV) is considered the strongest epidemiologic risk factor for cervical cancer. However, it is not a sufficient cause given the high prevalence of transient infections. We examined the relationship between exposure to tobacco smoke, measured using urinary nicotine metabolite concentrations, and p16/Ki-67 co-expression in cervical smears and subsequent risk of developing CIN2+/CIN3+ lesions in HPV positive women. METHODS This prospective longitudinal study enrolled women presenting to colposcopy with cytological abnormalities LSIL/ASCUS at the National Maternity Hospital, Dublin. Women gave a urine sample which was used to perform the Nicotine Metabolite Assay (Siemens). HPV positive (HC2) cervical smears were stained by immunocytochemistry for p16/Ki-67 (CINtec PLUS, Roche). Two year follow-up data, including histological diagnosis, was collected for each woman. Crude and adjusted odds ratios were calculated using logistic regression to investigate associations between tobacco smoke, p16/Ki-67 positivity and CIN2+/CIN3 + . RESULTS In total, 275 HPV positive women were included. Women with nicotine metabolite concentrations above 500 ng/mL, indicative of smoking, were classified as smokers. Smokers were at an increased risk of testing positive for p16/Ki-67 (OR 1.678; 1.027-2.740) and CIN2+ and CIN3+ (OR 1.816; 1.107-2.977 and OR 2.453; 1.200-5.013) in compared to non-smokers. In p16/Ki-67 positive women, smoking further increased their risk of CIN2+/CIN3+ (OR 2.290; 1.017-5.159 and OR 3.506 (1.534-8.017). CONCLUSION HPV positive women exposed to tobacco smoke are at a higher risk of testing positive for p16/Ki-67 co-expression. Risk of high-grade disease is almost doubled in women who are exposed to tobacco smoke.
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Affiliation(s)
- Christine M White
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland.
| | - Salih Bakhiet
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Mark Bates
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Carmel Ruttle
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | | | - Helen Keegan
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Sharon A O'Toole
- Dept. Obstetrics and Gynaecology, Trinity College Dublin, Dublin 2, Ireland
| | - Linda Sharp
- Institute of Health & Society, Newcastle University, UK
| | - Ruth O'Kelly
- Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Prerna Tewari
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | | | - Cara M Martin
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - John J O'Leary
- Dept. Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin 2, Ireland; Dept. Pathology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
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Keeble M, Adams J, Sacks G, Vanderlee L, White CM, Hammond D, Burgoine T. Use of Online Food Delivery Services to Order Food Prepared Away-From-Home and Associated Sociodemographic Characteristics: A Cross-Sectional, Multi-Country Analysis. Int J Environ Res Public Health 2020; 17:ijerph17145190. [PMID: 32709148 PMCID: PMC7400536 DOI: 10.3390/ijerph17145190] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022]
Abstract
Online food delivery services like Just Eat and Grubhub facilitate online ordering and home delivery of food prepared away-from-home. It is poorly understood how these services are used and by whom. This study investigated the prevalence of online food delivery service use and sociodemographic characteristics of customers, in and across Australia, Canada, Mexico, the UK, and the USA. We analyzed online survey data (n = 19,378) from the International Food Policy Study, conducted in 2018. We identified respondents who reported any online food delivery service use in the past 7 days and calculated the frequency of use and number of meals ordered. We investigated whether odds of any online food delivery service use in the past 7 days differed by sociodemographic characteristics using adjusted logistic regression. Overall, 15% of respondents (n = 2929) reported online food delivery service use, with the greatest prevalence amongst respondents in Mexico (n = 839 (26%)). Online food delivery services had most frequently been used once and the median number of meals purchased through this mode of order was two. Odds of any online food delivery service use were lower per additional year of age (OR: 0.95; 95% CI: 0.94, 0.95) and greater for respondents who were male (OR: 1.50; 95% CI: 1.35, 1.66), that identified with an ethnic minority (OR: 1.57; 95% CI: 1.38, 1.78), were highly educated (OR: 1.66; 95% CI: 1.46, 1.90), or living with children (OR: 2.71; 95% CI: 2.44, 3.01). Further research is required to explore how online food delivery services may influence diet and health.
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Affiliation(s)
- Matthew Keeble
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB22 0QQ, UK; (J.A.); (T.B.)
- Correspondence: ; Tel.: +(44)1223-746870
| | - Jean Adams
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB22 0QQ, UK; (J.A.); (T.B.)
| | - Gary Sacks
- Global Obesity Centre, Deakin University, Geelong VIC 3220, Australia;
| | - Lana Vanderlee
- School of Nutrition, Université Laval, Quebec, QC G1V 0A6, Canada;
| | - Christine M. White
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.W.); (D.H.)
| | - David Hammond
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (C.M.W.); (D.H.)
| | - Thomas Burgoine
- UKCRC Centre for Diet and Activity Research (CEDAR), MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB22 0QQ, UK; (J.A.); (T.B.)
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Musial A, Butts B, Loechtenfeldt A, Herrmann LE, Schmidlin E, Kelley J, Hail T, White CM, Thomson J. Challenges Following Hospital Discharge for Children With Medical Complexity. Hosp Pediatr 2020; 10:531-536. [PMID: 32444420 DOI: 10.1542/hpeds.2019-0306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The transition from hospital to home is a period of risk, particularly for children with medical complexity. Our aim was to identify and address discharge challenges through execution of postdischarge phone calls. METHODS In this prospective study, we designed and executed a postdischarge phone call for patients discharged from an inpatient complex care team between May and November 2018. The call included dichotomous and open-ended questions to identify challenges regarding health status, follow-up appointments, medications, home nursing, medical supplies and/or equipment, and discharge instructions. These were recorded in the electronic health record. Details regarding identified challenges and corrective actions were categorized by 2 reviewers and adjudicated by a third reviewer if disagreement occurred. RESULTS Descriptive statistics were used to summarize these findings. Sixty-seven phone calls were completed within 1 week of discharge. Two-thirds of calls identified at least 1 challenge, and more than one-third of calls identified 2 or more challenges for a total of 90 challenges. The most common challenges involved health status (26.7%), follow-up appointments (21.1%), and medications (20%). The majority of challenges were addressed by either caregivers or the multidisciplinary team, with the exception of home nursing challenges. CONCLUSIONS Discharge challenges were commonly identified by caregivers of children with medical complexity. The majority of postdischarge challenges were addressed, with some addressed by families themselves. These results can inform health care providers about challenges to anticipate and suggest future interventions to mitigate anticipated challenges for a safe discharge and transition of care for these at-risk patients.
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Affiliation(s)
| | - Breann Butts
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Lisa E Herrmann
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | | | | | | | - Christine M White
- Division of Hospital Medicine and.,Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Joanna Thomson
- Division of Hospital Medicine and.,Pediatric Residency Program, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
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Vanderlee L, White CM, Hammond D. Evaluation of a voluntary nutritional information program versus calorie labelling on menus in Canadian restaurants: a quasi-experimental study design. Int J Behav Nutr Phys Act 2019; 16:92. [PMID: 31653256 PMCID: PMC6814965 DOI: 10.1186/s12966-019-0854-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background A significant proportion of the Canadian diet comes from foods purchased in restaurant settings. In an effort to promote healthy eating, the province of British Columbia (BC) implemented the Informed Dining Program (IDP), a voluntary, industry supported information program in 2012, while the province of Ontario implemented mandatory calorie labelling on menus in 2017. The study examined differences in awareness and the self-reported influence of nutrition information on food choices in restaurants with voluntary nutrition information, calorie labelling on menus, and no nutrition information program. Methods Exit surveys were conducted outside of nine chain restaurants in Toronto, Ontario and Vancouver, British Columbia (Canada) in 2012, 2015, and 2017 with varying nutrition information programs implemented. Logistic regression analyses compared self-reported noticing and influence of nutrition information in restaurants with: 1) the IDP which provided nutrition information upon request, 2) calorie labelling on menus, and 3) control restaurants with no specific nutrition information program in place, adjusted for year, city and socio-demographic characteristics. Awareness and knowledge of the IDP were also examined. Results There were no significant differences in noticing and self-reported influence of nutrition information on food choices between restaurants with the IDP and restaurants with no program. Participants were more likely to notice nutrition information in restaurants when calorie information was provided on menus (57%) compared to in restaurants with the IDP (22%, AOR = 6.20, 95%CI 3.51–10.94, p < 0.001) or restaurants with no nutrition information program (20%, AOR = 7.44, 95%CI 4.21–13.13, p < 0.001). Participants in restaurants with menu labelling were also more likely to report that nutrition information influenced their food purchase (38%) compared to restaurants with the IDP (12%, AOR = 4.43, 95%CI 2.36–8.30, p < 0.001) and restaurants with no nutrition information program (12%, AOR = 5.29, 95%CI 2.81–9.95, p < 0.001). Fewer than 1 in 5 participants who visited an IDP restaurant had heard of the IDP across all data collection years in both cities. Conclusions There was no evidence that voluntary programs which provide nutrition information upon request were effective. Providing calorie information on menus increased the likelihood that consumers noticed and that their food choices were influenced by nutrition information in restaurant settings.
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Affiliation(s)
- Lana Vanderlee
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
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Nieto C, Jáuregui A, Contreras-Manzano A, Arillo-Santillan E, Barquera S, White CM, Hammond D, Thrasher JF. Understanding and use of food labeling systems among Whites and Latinos in the United States and among Mexicans: Results from the International Food Policy Study, 2017. Int J Behav Nutr Phys Act 2019; 16:87. [PMID: 31623663 PMCID: PMC6798377 DOI: 10.1186/s12966-019-0842-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world. METHODS Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline Daily Amounts (GDA) that shows levels of nutrients of concern; 3. Multiple Traffic-Light (MTL) that color codes each GDA nutrient (green = healthy; yellow = moderately unhealthy; red = unhealthy); 4. Health Star Rating System (HSR) that rates foods on a single dimension of healthiness; 5. Warning Label (WL) with a stop sign for nutrients present in unhealthy levels. Participants rated each label on understanding ("easy"/"very easy to understand" vs "difficult"/"very difficult to understand"), and, for NFTs and GDAs, frequency of use ("sometimes"/"often" vs "never"). Mixed logistic models regressed understanding and frequency of use on indicators of labeling systems (NFT = ref), testing for interactions by ethnicity (US Latinos, US Whites, Mexicans), while controlling for sociodemographic and obesity-related factors. RESULTS Compared to the NFT, participants reported greater understanding of the WL (OR = 4.8; 95% CI = 4.4-5.3) and lower understanding of the HSR (OR = 0.34, 95% CI = 0.31-0.37) and the MTL (OR = 0.56, 95% CI = 0.52-0.61), with similar patterns across ethnic subgroups. Participants used GDAs less often than NFTs (OR = 0.48; 95%CI = 0.41-0.55), with the greatest difference among US Whites (OR = 0.10; 95%CI = 0.07-0.14). CONCLUSIONS Understanding and use of the GDA was similar to that of the NFT. Whites, Latinos, and Mexicans consistently reported the best understanding for WLs, a FOPL that highlights unhealthfulness of a product. Therefore, a FOPL summary indicator, such as WLs, may be more effective in both the US and Mexico for guiding consumers towards informed food choices.
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Affiliation(s)
- Claudia Nieto
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Alejandra Jáuregui
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Alejandra Contreras-Manzano
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Edna Arillo-Santillan
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- School of Demography, ANU College of Arts and Social Sciences, The Australian National University, 9 Fellows Road Acton ACT 260, Canberra, Australia
| | - Simón Barquera
- Nutrition and Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col, Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Christine M. White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - James F. Thrasher
- Population Health Research Center, Mexican National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC 29208 USA
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Kwon J, Cameron AJ, Hammond D, White CM, Vanderlee L, Bhawra J, Sacks G. A multi-country survey of public support for food policies to promote healthy diets: Findings from the International Food Policy Study. BMC Public Health 2019; 19:1205. [PMID: 31477071 PMCID: PMC6721115 DOI: 10.1186/s12889-019-7483-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor diet is a significant contributor to the burden of global disease. There are numerous policies available to address poor diets; however, these policies often require public support to encourage policy action. The current study aimed to understand the level of public support for a range of food policies and the factors associated with policy support. METHODS An online survey measuring support for 13 food policies was completed by 19,857 adults in Australia, Canada, Mexico, the United Kingdom (UK) and the United States (US). The proportion of respondents that supported each policy was compared between countries, and the association between demographic characteristics and policy support was analysed using multivariate logistic regression. RESULTS The level of support varied between policies, with the highest support for policies that provided incentives (e.g., price subsidies) or information (e.g., calorie labelling on menus), and the lowest support for those that imposed restrictions (e.g., restrictions on sponsorship of sport events). This pattern of support was similar in all countries, but the level differed, with Mexico generally recording the highest support across policies, and the US the lowest. Several demographic characteristics were associated with policy support; however, these relationships varied between countries. CONCLUSION The results suggest that support for food policies is influenced by several factors related to the policy design, country, and individual demographic characteristics. Policymakers and advocates should consider these factors when developing and promoting policy options.
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Affiliation(s)
- Janelle Kwon
- Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Adrian J Cameron
- Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Lana Vanderlee
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Gary Sacks
- Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia.
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Statile AM, White CM, Sucharew HJ, Moore M, Tubbs-Cooley HL, Simmons JM, Shah SS, Auger KA. Comparison of Parent Report with Administrative Data to Identify Pediatric Reutilization Following Hospital Discharge. J Hosp Med 2019; 14:411-414. [PMID: 31112494 PMCID: PMC6613522 DOI: 10.12788/jhm.3200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. The H2O primary outcome, reutilization (hospital readmission, emergency department visit, or urgent care visit), relied on administrative data to identify reutilization events after discharge. We sought to compare parent recall of reutilization events two weeks after discharge with administrative records. Agreement was relatively high for any reutilization (kappa 0.74); however, this high agreement was driven by agreement between sources when no reutilization occurred (sources agreed 98%-99%). Agreement between sources was lower when reutilization occurred (48%-76%). Some discrepancies were related to parents misclassifying the site of care. The possibility of inaccurate parent report of reutilization has clinical implications that may be mitigated by confirmation of parent-reported data through verification with additional sources, such as electronic health record review.
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Affiliation(s)
- Angela M Statile
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Angela M Statile, MD, MEd; E-mail: ; Telephone: 513-803-3237
| | - Christine M White
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heidi J Sucharew
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Margo Moore
- Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Heather L Tubbs-Cooley
- The Ohio State University College of Nursing Center for Women, Children, and Youth, Columbus, Ohio
| | - Jeffrey M Simmons
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Samir S Shah
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Katherine A Auger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Hammond D, Reid JL, Rynard VL, Fong GT, Cummings KM, McNeill A, Hitchman S, Thrasher JF, Goniewicz ML, Bansal-Travers M, O'Connor R, Levy D, Borland R, White CM. Prevalence of vaping and smoking among adolescents in Canada, England, and the United States: repeat national cross sectional surveys. BMJ 2019; 365:l2219. [PMID: 31221636 PMCID: PMC6582265 DOI: 10.1136/bmj.l2219] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine differences in vaping and smoking prevalence among adolescents in Canada, England, and the United States. DESIGN Repeat cross sectional surveys. SETTING Online surveys in Canada, England, and the US. PARTICIPANTS National samples of 16 to 19 year olds in 2017 and 2018, recruited from commercial panels in Canada (n=7891), England (n=7897), and the US (n=8140). MAIN OUTCOME MEASURES Prevalence of vaping and smoking was assessed for use ever, in the past 30 days, in the past week, and on 15 days or more in the past month. Use of JUUL (a nicotine salt based electronic cigarette with high nicotine concentration) and usual vaping brands were also assessed. Logistic regression models examined differences in vaping and smoking between countries and over time. RESULTS The prevalence of vaping in the past 30 days, in the past week, and on 15 days or more in the past month increased in Canada and the US between 2017 and 2018 (P<0.001 for all), including among non-smokers and experimental smokers, with no changes in England. Smoking prevalence increased in Canada (P<0.001 for all measures), with modest increases in England, and no changes in the US. The percentage of ever vapers who reported more frequent vaping increased in Canada and the US (P<0.01 for all), but not in England. The use of JUUL increased in all countries, particularly the US and Canada-for example, the proportion of current vapers in the US citing JUUL as their usual brand increased threefold between 2017 and 2018. CONCLUSIONS Between 2017 and 2018, among 16 to 19 year olds the prevalence of vaping increased in Canada and the US, as did smoking in Canada, with little change in England. The rapidly evolving vaping market and emergence of nicotine salt based products warrant close monitoring.
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Affiliation(s)
- David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Jessica L Reid
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Vicki L Rynard
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - Richard O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, NY, USA
| | - David Levy
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Czoli CD, Goniewicz ML, Palumbo M, Leigh N, White CM, Hammond D. Identification of flavouring chemicals and potential toxicants in e-cigarette products in Ontario, Canada. Can J Public Health 2019; 110:542-550. [PMID: 31025300 DOI: 10.17269/s41997-019-00208-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The current study examined constituents of e-cigarette products on the Canadian market, with a focus on the province of Ontario. METHODS E-cigarettes were systematically purchased at 80 retail outlets across 4 cities in Ontario, Canada, in January-February 2015. Product constituents were identified using gas chromatography and mass spectrometry. Additionally, tobacco-specific nitrosamines (TSNAs) were quantified in tested products using liquid chromatography with tandem mass spectrometry. RESULTS A total of 166 e-cigarette products were purchased, including disposable products (33%), refillable products (14%), and e-liquids (53%). Overall, e-cigarette products had an average of 6.2 (SD = 3.6) flavouring chemicals. E-cigarettes with sweet flavours (e.g., desserts, alcoholic drinks) had a significantly greater number of flavouring chemicals when compared with tobacco- and menthol-flavoured products (p < 0.05). Approximately one fifth (21%) of products contained flavouring chemicals with potential risk of inhalation toxicity (benzyl alcohol, benzaldehyde, vanillin). An additional 8 toxicants (e.g., acrolein, diacetyl) were detected in a total of 14 e-cigarette products. Measurable levels of TSNAs were detected in 70% of tested products. CONCLUSION E-cigarettes purchased in Ontario, Canada, contained several constituents that may present excess risk, including some flavouring chemicals and carcinogenic nitrosamines. Further research is needed to determine whether the levels of these constituents have implications for the magnitude of risk to users. The findings reveal several policy gaps that may be addressed by developing regulatory product standards and labelling practices for e-cigarettes.
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Affiliation(s)
- Christine D Czoli
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Mary Palumbo
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Noel Leigh
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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Czoli CD, White CM, Reid JL, OConnor RJ, Hammond D. Awareness and interest in IQOS heated tobacco products among youth in Canada, England and the USA. Tob Control 2019; 29:89-95. [PMID: 30696783 PMCID: PMC7958490 DOI: 10.1136/tobaccocontrol-2018-054654] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 12/30/2022]
Abstract
Introduction Heated tobacco products (HTPs), such as IQOS, have been introduced in a growing number of international markets. However, little is known about perceptions of HTP products among youth. Methods Data are from Wave 1 of the International Tobacco Control Youth Tobacco and E-cigarette Survey (2017), a web-based cohort survey of 16- to 19-year-olds from Canada, England, and the United States (US). Respondents (n=12,064) were shown an image of IQOS and asked about their awareness, interest in trying, and susceptibility to trying the product. Youth awareness, interest in trying, and susceptibility to trying IQOS were analyzed using descriptive statistics, and logistic regression models were used to examine correlates of these outcomes. Results Overall, 7.0% of youth reported awareness of IQOS (England=5.6%, Canada=6.4%, and US=9.1%) and 38.6% expressed interest in trying the product (England=41.8%, Canada=33.0%, and US=40.9%). Within each country, all key outcomes varied by smoking status: greater proportions of youth who were currently smoking or had a history of smoking reported being aware of, interested in trying, and susceptible to trying IQOS. Interest and susceptibility to trying IQOS were associated with male sex, current tobacco use, and current e-cigarette use. Across all countries, susceptibility to trying IQOS (25.1%) was higher than for tobacco cigarettes (19.3%), but lower than for e-cigarettes (29.1%). Conclusions Awareness of heated tobacco products, such as IQOS, is emerging among youth in Canada, England, and the US. Interest in trying these products is very high among smokers, but also present among non-smokers.
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Affiliation(s)
- Christine D Czoli
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Heart and Stroke Foundation, Ottawa, Ontario, Canada
| | - Christine M White
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard J OConnor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Vanderlee L, Reid JL, White CM, Acton RB, Kirkpatrick SI, Pao CI, Rybak ME, Hammond D. Evaluation of a 24-Hour Caffeine Intake Assessment Compared with Urinary Biomarkers of Caffeine Intake among Young Adults in Canada. J Acad Nutr Diet 2018; 118:2245-2253.e1. [PMID: 30497637 PMCID: PMC10074169 DOI: 10.1016/j.jand.2018.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Caffeine is a widely consumed stimulant, and caffeine-containing products are increasingly available on the market. Few tools are available to capture caffeine intake, particularly among young adults. To estimate caffeine consumption in the previous 24 hours, the 24-Hour Caffeine Intake Recall (CIR-24) was modeled after the Automated Self-Administered 24-Hour Dietary Assessment Tool, using a brand-specific database of caffeine-containing foods, beverages, and supplements. OBJECTIVE To evaluate the accuracy of the CIR-24 compared with caffeine concentration biomarkers in urine and a caffeinated beverage intake frequency screener (CBQ) designed to assess usual intake among a young adult population in Canada. DESIGN/PARTICIPANTS In all, 79 young adults, aged 18 to 29 years, provided 24-hour urine samples and completed the CIR-24 and CBQ. MAIN OUTCOME MEASURES Excretion for caffeine and eight caffeine metabolites were quantified from urine samples using high-performance liquid chromatography-polarity switching electrospray ionization-tandem quadrupole mass spectrometry with stable isotope-labeled internal standards. STATISTICAL ANALYSES PERFORMED Pearson correlations and weighted κ coefficients were calculated for the self-report tools and caffeine biomarkers. RESULTS The CIR-24 was significantly positively associated with all caffeine biomarkers (rp=0.28 to 0.52, κ=0.39 to 0.59), and the CBQ was significantly positively associated with all but one biomarker (rp=0.21 to 0.40, κ=0.32 to 0.45). The CIR-24 yielded a higher mean intake of caffeine than the CBQ. There was strong linear correlation between the CIR-24 and CBQ (rp=0.60, P<0.001), but poor agreement in absolute caffeine consumed (t=2.83, P=0.006); quartile ranking concordance was 0.44 (P<0.001). The CIR-24 performed better than the CBQ across all biomarkers in both linear correlation and quartile ranking. CONCLUSIONS Although both the CIR-24 and CBQ performed reasonably well in capturing caffeine intake compared with urinary biomarkers of caffeine consumption, the CIR-24 had stronger agreement than the CBQ. The results suggest that the CIR-24 is a promising tool for evaluating caffeine intake among this population.
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Vanderlee L, Hobin EP, White CM, Hammond D. Grocery Shopping, Dinner Preparation, and Dietary Habits among Adolescents and Young Adults in Canada. CAN J DIET PRACT RES 2018; 79:157-163. [DOI: 10.3148/cjdpr-2018-025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: The current study aimed to characterize grocery shopping and dinner preparation behaviours among young people in Canada and to examine associations with eating habits. Methods: A cross-sectional online survey was conducted with 2008 participants aged 16–24 from across Canada. The survey measured self-reported grocery shopping and dinner preparation behaviours, frequency of eating breakfast and eating meals prepared away from home, frequency of vegetable and fruit intake, and socio-demographic characteristics. Chi-square tests examined differences in proportions; logistic and linear regressions examined dietary habits, including covariates for grocery shopping and dinner preparation and socio-demographics. Results: Overall, 37.3% had helped with grocery shopping in the past week, and 84.3% had participated in dinner preparation at least 1 day in the past week. Engaging in shopping at least once weekly was associated with increased vegetable and fruit consumption only, whereas more frequent engagement in dinner preparation was associated with increased vegetable and fruit consumption, more frequent breakfast consumption, and fewer meals consumed that were prepared away from home (P < 0.001 for all). Conclusions: Increased participation in grocery shopping and dinner preparation were associated with healthier dietary habits. Interventions that increase these behaviours may contribute to improving dietary behaviours among adolescents and young adults.
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Affiliation(s)
- Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, ON
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | | | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON
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Goodman S, Vanderlee L, White CM, Hammond D. A quasi-experimental study of a mandatory calorie-labelling policy in restaurants: Impact on use of nutrition information among youth and young adults in Canada. Prev Med 2018; 116:166-172. [PMID: 30261242 DOI: 10.1016/j.ypmed.2018.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/24/2018] [Accepted: 09/22/2018] [Indexed: 10/28/2022]
Abstract
In 2017, Ontario became the first Canadian province to require calorie amounts on menus/menu boards of chain restaurants. The province of British Columbia (BC) implemented a voluntary nutrition information initiative in which calorie and sodium information were available upon request. A quasi-experimental design was used to examine the use of nutrition information in Ontario (mandatory calorie labelling), compared to BC (voluntary policy) and three other provinces with no formal menu labelling policy ('control'). Data were collected from youth and young adults (16-30 years) in all provinces pre- (fall 2016; n = 2929) and post- (fall 2017; n = 968) implementation of Ontario's calorie-labelling policy in January 2017. Generalized estimating equations tested differences between provinces over time in noticing and impact of nutrition information and support of mandatory calorie labelling. Noticing of nutrition information in restaurants increased in Ontario significantly more than in BC (+25.1% vs. +1.6%; AOR = 4.26, 95% CI = 2.39-7.61) and control provinces (+6.5%; AOR = 3.00, 95% CI = 1.91-4.73). Ontario respondents were significantly more likely to report that the nutrition information influenced their order than those in BC (+12.9% vs. +2.2%; AOR = 3.53, 95%CI = 1.61-7.76) and control provinces (+2.0%; AOR = 3.71, 95%CI = 1.87-7.36). Policy support increased in all groups at follow-up, with a significantly greater increase in Ontario than control provinces (+12.9% vs. +5.7%; AOR = 1.57, 95%CI = 1.06-2.34). Socio-demographic differences were also observed. Findings suggest that the mandatory menu labelling policy implemented in Ontario has increased noticing and use of nutrition information, with no evidence to support the effectiveness of voluntary policies that require consumers to request nutrition information.
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Affiliation(s)
- Samantha Goodman
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
| | - Lana Vanderlee
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada; Department of Nutritional Sciences, University of Toronto, FitzGerald Building, room 71, 150 College Street, Toronto, Ontario M5S 3E2, Canada.
| | - Christine M White
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada.
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Abstract
OBJECTIVE The glans penis may show a deep groove (surgically favorable), or may appear flat with an absent sulcus (unfavorable). Glans dehiscence following hypospadias repair, especially after multiple surgeries, frequently results in a scarred, obliterated, or absent urethral plate. The glans penis appears to be flat and grooveless. This study reported on the outcome of a two-stage salvage repair for glans dehiscence in 49 consecutive patients. MATERIALS AND METHODS Retrospective chart review was performed for all patients who underwent repair for glans dehiscence following hypospadias repair. RESULTS Between January 2009 and April 2015, 49 children aged 16 months to 18 years presented with glans dehiscence following hypospadias repair. The prior number of operations ranged from one to six. Eleven children had urethral fistulas, and seven had chordee. In the first stage, the flat glans was incised deeply to visualize, but spare, the corpora. Thereafter, a free graft of oral mucosa harvested either from the lower lip or cheek, or the residual preputial skin, was sutured to the glans cleft. The grafts were fenestrated, quilted in the midline, and a tie-over dressing was applied. Any fistula or chordee was repaired during the first stage. The neo-plate was tubularized 6-12 months later, and urine drainage with a catheter was maintained for 10-14 days. In 11 patients, skin flaps appeared dusky, and nitroglycerine ointment 2% was applied for 24 h to enhance the blood supply of the tissues. Subsequently, six of these children received nine or ten 90-min hyperbaric oxygen therapy sessions. Following the first stage, two patients developed hypertrophy of the mucosal grafts, and one skin graft contracted. These three patients underwent revision using a second buccal mucosal graft harvested from the cheek. One recurrent fistula was closed during the second stage. Following the second stage two patients developed a urethral fistula, and the distal sutures broke down in one patient, resulting in an over-sized meatus. None developed meatal stenosis or glans dehiscence. CONCLUSION Graft initial take and subsequent behavior were unpredictable, but the two stage approach optimized the process of take and healing. Glans dehiscence was repaired safely and successfully by developing a deep groove, with creation of a new urethral plate followed by tubularization in two stages.
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Affiliation(s)
- C M White
- New Jersey Medical School, Newark, NJ, USA.
| | - M K Hanna
- RWJ Saint Barnabas Medical Center, West Orange, NJ, USA; New York-Presbyterian Weill Cornell Hospital, New York, USA
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Abstract
Transition of care from the intensive care unit (ICU) to the ward is usually an indication of the patient's improving clinical status, but is also a time when patients are particularly vulnerable. The transition between care teams poses a higher risk of medical error, which can be mitigated by safe and complete patient handoff and medication reconciliation. ICU readmissions are associated with increased mortality as well as ICU and hospital length of stay (LOS); however tools to accurately predict ICU readmission risk are limited. While there are many mechanisms in place to carefully identify patients appropriate for transfer to the ward, the optimal timing of transfer can be affected by ICU strain, limited resources such as ICU beds, and overall hospital capacity and flow leading to suboptimal transfer times or delays in transfer. The patient and family perspectives should also be considered when planning for transfer from the ICU to the ward. During times of transition, families will meet a new care team, experience uncertainty of future care plans, and adjust to a different daily routine which can lead to increased stress and anxiety. Additionally, a subset of patients, such as those with new technology, require additional multidisciplinary support, education and care coordination which can contribute to longer hospital LOS if not addressed proactively early in the hospitalization while the patient remains in the ICU. In this review article, we describe key components of the transfer from ICU to the ward, discuss current strategies to optimize timing of patient transfers, explore strategies to partner with patients and families during the transfer process, highlight patient populations where additional considerations are needed, and identify future areas of exploration which could improve the care transition from the ICU to the ward.
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Affiliation(s)
- Lori A Herbst
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA.,Geriatrics & Palliative Care Division, Department of Family & Community Medicine, UC College of Medicine, Cincinnati, OH, USA
| | - Sanyukta Desai
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA
| | - Karen Jerardi
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA
| | - Katie A Meier
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA
| | - Angela M Statile
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA
| | - Christine M White
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, UC College of Medicine, Cincinnati, OH, USA
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Schondelmeyer AC, Brower LH, Statile AM, White CM, Brady PW. Quality Improvement Feature Series Article 3: Writing and Reviewing Quality Improvement Manuscripts. J Pediatric Infect Dis Soc 2018; 7:188-190. [PMID: 29040710 DOI: 10.1093/jpids/pix078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/23/2017] [Indexed: 11/12/2022]
Abstract
Achieving rapid and meaningful improvement in healthcare requires the dissemination of quality improvement project results via publication. Doing this well requires detailed descriptions of the complex interventions and of the context in which the improvement took place. This report builds on the first 2 articles in the series to cover important considerations in writing quality improvement manuscripts with a focus on how it differs from writing traditional clinical research reports. The recommendations we outline here also apply to reviewing quality improvement manuscripts.
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Affiliation(s)
- Amanda C Schondelmeyer
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio.,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Laura H Brower
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Angela M Statile
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Christine M White
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio.,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Patrick W Brady
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio.,James M. Anderson Center for Health Systems Excellence, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
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Bhawra J, Reid JL, White CM, Vanderlee L, Raine K, Hammond D. Are young Canadians supportive of proposed nutrition policies and regulations? An overview of policy support and the impact of socio-demographic factors on public opinion. Can J Public Health 2018; 109:498-505. [PMID: 29981092 PMCID: PMC6964476 DOI: 10.17269/s41997-018-0066-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Many countries, including Canada, are considering nutrition policies that seek to improve dietary behaviour and related health outcomes. The current study examined support for policy measures among youth and young adults in Canada. METHODS Participants aged 16-30 years were recruited for online surveys using in-person intercept sampling in five Canadian cities as part of the Canada Food Study conducted in October-December, 2016 (n = 2729). Items included support for 21 specific policies in seven key areas: menu labelling, food package symbols and warnings, school policies, taxation and subsidies, zoning restrictions, marketing bans, and food formulation. Linear regression models examined support by age, sex, city, race/ethnicity, parental status, body mass index (BMI), and health literacy. RESULTS Very high levels of support were observed for menu labelling in restaurants and schools, as well as food package symbols and warnings. Taxation, zoning restrictions (e.g., fast food and convenience stores near schools), and bans on marketing to children received relatively lower levels of support. In general, policy support increased with age for all 21 policies (p < 0.01) and greater health literacy for 4 policies (p < 0.05). Males were less supportive than females for 5 policies (p < 0.01). There were significant differences in support for specific race/ethnicity groups for 4 policies (p < 0.05). Support for menu labelling policies increased with BMI (p < 0.05). CONCLUSION Overall, youth and young adults in Canada reported high levels of support for menu labelling, food package symbols/warnings, and school policies. Levels of support were generally consistent across socio-demographic subgroups, with some exceptions.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jessica L Reid
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Kim Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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Vanderlee L, Reid JL, White CM, Hobin EP, Acton RB, Jones AC, O'Neill M, Kirkpatrick SI, Hammond D. Evaluation of the online Beverage Frequency Questionnaire (BFQ). Nutr J 2018; 17:73. [PMID: 30068342 PMCID: PMC6090967 DOI: 10.1186/s12937-018-0380-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background The contribution of beverages to overall diet is of increasing interest to researchers and policymakers, particularly in terms of consumption of drinks high in added sugars; however, few tools to assess beverage intake have been developed and evaluated. This study aimed to evaluate the relative validity of a new online Beverage Frequency Questionnaire (BFQ) among young adults in Canada. Methods A cross-sectional relative validation study was conducted among young adults aged 16–30 years (n = 50). Participants completed a 17-item BFQ, a 7-day food record (7dFR), and a single-item measure of sugary drink intake. Pearson correlations and paired t-tests were used to evaluate correlation and agreement between the measures for 17 individual beverage categories, total drink consumption, total alcoholic beverage consumption, and two definitions of drinks with excess sugars. Cognitive interviews were conducted to examine participant interpretation and comprehensiveness of the BFQ. Results Estimates of beverage intake based on the BFQ and the 7dFR were highly correlated, specifically for the total number and volume of beverages consumed, total alcoholic beverage consumption, sugary drink intake, and each of the 17 beverage categories with 3 exceptions: coffee or tea with sugar or cream, specialty coffees, and hard alcohol with caloric mix. Paired t-tests between the BFQ and the 7dFR indicated that the average reported volume was significantly different only for sweetened fruit drinks. The single-item measure of sugary beverage intake was not significantly correlated with the 7dFR. Cognitive interviewing demonstrated high comprehension levels, and confirmed the appropriateness of the BFQ beverage categories and sizes. Conclusions Overall, the results suggest that the BFQ performed well relative to a 7dFR and had high usability among this study population, indicating its promise for collecting population-level data on beverage intake, including sugar-sweetened beverages, which are known indicators of diet and health. Electronic supplementary material The online version of this article (10.1186/s12937-018-0380-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - Jessica L Reid
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - Erin P Hobin
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada.,Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Rachel B Acton
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - Amanda C Jones
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - Meghan O'Neill
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada.
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Wiggers D, Vanderlee L, White CM, Reid JL, Minaker L, Hammond D. Food sources among young people in five major Canadian cities. Can J Public Health 2018; 109:506-515. [PMID: 29981100 DOI: 10.17269/s41997-018-0083-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/20/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine food sources among young people in five major Canadian cities. METHODS As part of the 2016 Canada Food Study, respondents aged 16-30 were recruited from five Canadian cities (Toronto, Montreal, Halifax, Edmonton, and Vancouver) using in-person intercept sampling and completed an online survey (n = 2840 retained for analysis). Descriptive statistics were used to summarize food preparation and purchase locations. A linear regression model was fitted to examine correlates of the proportion of meals that were ready-to-eat or prepared outside the home. RESULTS In total, 80% of meals were prepared at home and 20% were prepared outside the home. More than 25% of meals prepared at home were ready-to-eat/box food. Of all meals consumed, 42% were either ready-to-eat/box food prepared at home or prepared outside the home. Food for meals prepared at home was purchased predominantly at grocery stores/supercentres while meals prepared outside the home were purchased predominantly at fast food/quick service/coffee shop outlets. Respondents who were younger, identified as Aboriginal, had obesity, had no children, lived in residence at school, university, or college, and reported poorer cooking skills reported more meals that were ready-to-eat or prepared outside the home. CONCLUSIONS The current findings indicate that a substantial proportion of meals consumed by young people consist of meals either prepared outside the home or ready-to-eat/box food prepared at home. Dietary recommendations should highlight basic patterns of food preparation and eating, such as limiting ultra-processed food and food prepared outside the home.
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Affiliation(s)
- Danielle Wiggers
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Leia Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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Islam F, Thrasher JF, Szklo A, Figueiredo VC, Perez CDA, White CM, Hammond D. Cigarette flavors, package shape, and cigarette brand perceptions: an experiment among young Brazilian women. Rev Panam Salud Publica 2018; 42:e5. [PMID: 31093036 PMCID: PMC6385815 DOI: 10.26633/rpsp.2018.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 06/09/2017] [Indexed: 12/25/2022] Open
Abstract
Objective In 2012, a new Brazilian regulation prohibited the use of flavor additives in tobacco products. To better understand the potential impact of this regulation, this study examines how flavor descriptors on cigarette packaging influence brand perceptions among young Brazilian women. Methods An online cross-sectional experiment was conducted with Brazilian women aged 16–26 (N = 640: 182 smokers and 458 nonsmokers) who rated 10 cigarette packages from one of three conditions: 1) branded packs; 2) packs with the same size, shape, and verbal descriptions as in condition 1, but without brand imagery (i.e., “plain pack”); and 3) packs from condition 2 but without brand descriptors (i.e., “plain pack, no descriptors”). Mixed-effects linear regression models were utilized to determine what associations that pack features (i.e., experimental condition; flavor descriptor vs. not; slim pack vs. not) had with participant ratings of nine characteristics, including appeal, taste, smoothness, and attributes of people who smoke the brand. Results Flavored branded packs were rated as more appealing, better tasting, and smoother than flavored plain packs with descriptors. Compared to flavored plain packs with descriptors, the same packs without descriptors were rated less positively on eight of the nine characteristics. Compared to nonsusceptible nonsmokers, susceptible nonsmokers rated flavored packs more positively on eight of the nine characteristics. Slim packs were rated more positively than regular packs on eight of the nine characteristics. Conclusions Slim packs and brands highlighting tobacco flavors appear to increase positive perceptions of tobacco products. Banning tobacco flavorings and slim packs may reduce the appeal of smoking for young Brazilian women, as well as for other vulnerable populations.
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Affiliation(s)
- Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - André Szklo
- Department of Epidemiology, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeska Carvalho Figueiredo
- Centro de Estudos sobre Tabaco e Saúde (CETAB), Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Wiggers D, Reid JL, White CM, Hammond D. Use and Perceptions of Caffeinated Energy Drinks and Energy Shots in Canada. Am J Prev Med 2017; 53:866-871. [PMID: 28755982 DOI: 10.1016/j.amepre.2017.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION In Canada, energy drinks and energy shots are currently classified and regulated differently (food and drugs versus natural health products, respectively), on the assumption that they are used and perceived differently. The current study examined potential differences in use and perceptions of energy drinks and shots. METHODS An online survey was conducted in 2015 using a national commercial online panel of youth and young adults aged 12-24 years (n=2,040 retained for analysis in 2016). Participants were randomized to view an image of an energy shot or drink, and were asked about 14 potential reasons for using the product. Past consumption of each product was also assessed. Chi-square and t-tests were conducted to examine differences in use and perceptions between products. RESULTS Overall, 15.6% of respondents reported using both energy shots and drinks. Of all respondents, <1% had tried only energy shots, whereas 58.0% had tried only energy drinks. For each product, the most commonly reported reasons for use were "to stay awake" and "to increase concentration or alertness." Out of 14 potential reasons for use, respondents were significantly more likely to endorse seven of the reasons for energy drinks rather than shots; however, the magnitude of these differences was modest and the ordering of the reasons for use of each product was comparable. CONCLUSIONS Despite differences in prevalence of ever-use of energy shots and drinks, consumption patterns and perceived reasons for using the products are similar. The findings provide little support for regulating energy shots differently than energy drinks.
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Affiliation(s)
- Danielle Wiggers
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica L Reid
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Christine M White
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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