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Li Z, Zhang FF, Cash SB, Hager K, Trevino L, Folta SC. Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic. Front Nutr 2024; 11:1304519. [PMID: 38577157 PMCID: PMC10991727 DOI: 10.3389/fnut.2024.1304519] [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: 09/29/2023] [Accepted: 03/07/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Produce prescription programs are rapidly expanding as a type of Food is Medicine intervention with prospects for mitigating food insecurity and reducing diet-related health disparities. Gaining insight into participant perspectives on program logistics and perceived impacts is crucial to program success and improvements. Methods Between May and June 2021, we conducted individual and small group interviews with 23 caregivers with children aged 1-5 years who participated in a produce prescription program from 2020 to 2021 in Texas, U.S. They were provided with a gift card to a major national grocery retailer to purchase fresh produce. The card was reloaded $60 monthly for 8 months with automatic roll-over of unused funds to the next month. Participants also received nutrition education in the form of two videos. A deductive analysis approach was employed, and NVivo qualitative data analysis software was used to perform coding and to assist with subsequent analyses. Results All 23 participants were female, with an average age of 37.5 years, and the majority identified as Hispanic/Latino (83%). About 43% of the families had three or more children. Six themes were generated from interviews. Three of these themes were related to program logistics: (1) ease of program use; (2) participant satisfaction with the incentive; and (3) desire for additional store options. The remaining main themes pertained to program impact: (1) the enhanced ability to purchase produce; (2) the usefulness of the nutrition education; and (3) persistent challenges encountered when preparing the produce for picky eaters and young children. Conclusion A pediatric produce prescription program was perceived as logistically easy and a helpful source of financial support for accessing fresh produce. Program features such as card-based incentive system and partnership with major grocery retailer were favored by participants. For future program design, it may be beneficial to consider collaborating with multiple grocery outlets and enhancing the intensity and targeting of nutrition education.
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Affiliation(s)
- Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Leo Trevino
- Amistad Community Health Center, Corpus Christi, TX, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Mayer ME, McAlister AR, Economos CD, Mack S, Plank K, Cash SB. Using coupons to encourage healthier child snack purchases in corner stores: results from the CHOMPS study. Front Nutr 2024; 11:1290710. [PMID: 38318473 PMCID: PMC10840137 DOI: 10.3389/fnut.2024.1290710] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Objectives To examine youths' (ages 6-15 years) autonomous snack purchases in corner stores and pilot use of coupons to encourage more healthful snack purchases. Methods This pilot study involved four corner stores proximal to K-8 schools in Massachusetts. Kids-only coupons of varying discounts were provided in store and paired with simple visual and verbal economic and health messages. Observational data about youths' autonomous snack purchases was recorded pre- and post-intervention. Outcomes of interest were snack item, price, and nutrient content. Comparisons of purchase characteristics and nutritional content across intervention conditions were made using Chi-squared and t-tests. Results Across all stores, 2,973 purchase observations were recorded totaling approximately $6,000. Researchers estimated that about 55% of shoppers were 10-12 years old. Modest coupon usage (2.2% of purchases) was noted. However, candy purchases decreased, and the percentage of purchase events that included at least one healthier food item more than doubled, regardless of coupon use. Improvements in the nutritional content of snacks were also observed. Conclusion Kids-only coupons have the potential to assist with shifting autonomous snack purchase behavior in outside of school settings.
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Affiliation(s)
- Megan E. Mayer
- Department of Nutrition and Health Studies, Framingham State University, Framingham, MA, United States
| | - Anna R. McAlister
- Gerrish School of Business, Endicott College, Beverly, MA, United States
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Suzanne Mack
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kaela Plank
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Greenthal E, Sorscher S, Pomeranz JL, Cash SB. Availability of calorie information on online menus from chain restaurants in the USA: current prevalence and legal landscape. Public Health Nutr 2023; 26:3239-3246. [PMID: 37700624 PMCID: PMC10755376 DOI: 10.1017/s1368980023001799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/05/2023] [Revised: 06/28/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE Federal law requires calorie information on chain restaurant menus. We sought to assess the prevalence of calorie disclosures on online menus and determine if the menus are controlled by restaurants subject to US labelling requirements. DESIGN Cross-sectional. SETTING Restaurant websites and mobile apps for restaurant located in New York City, Los Angeles, Chicago, and Houston. PARTICIPANTS US chain restaurants (top seventy-five by number of outlets) and third-party platforms (TPP): Grubhub, Uber Eats, DoorDash. RESULTS There was at least one calorie disclosure (for at least one food or beverage, in at least one location) on sixty-eight of seventy-two (94 %) menus on restaurant websites or apps, thirty-two of fifty-five (58 %) menus on DoorDash, six of forty-nine (12 %) menus on Grubhub and thirty of fifty-nine (51 %) menus on Uber Eats. There was consistent calorie labelling (all foods and beverages, all locations) on forty-three of seventy-two (60 %) menus on restaurant websites or apps, fifteen of fifty-five (27 %) menus on DoorDash, three of forty-nine (6 %) menus on Grubhub and eleven of fifty-nine (19 %) menus on Uber Eats. Only four restaurant chains consistently labelled calories for all items, in all locations, on all platforms where their menus were found. All three TPP provided restaurants the ability to enter and modify menu items, making the menus subject to US labelling requirements. Only Uber Eats provided guidance to restaurants on entering calorie information. CONCLUSIONS As consumers increasingly rely on TPP for restaurant ordering, menus on these platforms should include calories in order to promote transparency and nutrition.
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Affiliation(s)
- Eva Greenthal
- Center for Science in the Public Interest, Washington, DC20005, USA
| | - Sarah Sorscher
- Center for Science in the Public Interest, Washington, DC20005, USA
| | | | - Sean B Cash
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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O'Connor LE, Higgins KA, Smiljanec K, Bergia R, Brown AW, Baer D, Davis C, Ferruzzi MG, Miller K, Rowe S, Rueda JMW, Andres A, Cash SB, Coupland J, Crimmins M, Fiecke C, Forde CG, Fukagawa NK, Hall KD, Hamaker B, Herrick KA, Hess JM, Heuven LA, Juul F, Malcomson FC, Martinez-Steele E, Mattes RD, Messina M, Mitchell A, Zhang FF. Perspective: A Research Roadmap about Ultra-Processed Foods and Human Health for the United States Food System: Proceedings from an Interdisciplinary, Multi-Stakeholder Workshop. Adv Nutr 2023; 14:1255-1269. [PMID: 37722488 PMCID: PMC10721509 DOI: 10.1016/j.advnut.2023.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023] Open
Abstract
Our objective was to convene interdisciplinary experts from government, academia, and industry to develop a Research Roadmap to identify research priorities about processed food intake and risk for obesity and cardiometabolic diseases (CMD) among United States populations. We convened attendees at various career stages with diverse viewpoints in the field. We held a "Food Processing Primer" to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods may affect energy intake, obesity, and CMD risk. Breakout groups discussed potential mechanistic and confounding explanations for associations between processed foods and obesity and CMD risk. Facilitators created research questions (RQs) based on key themes from discussions. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs to address gaps. Workshop attendees focused on ultra-processed foods (UPFs; Nova Group 4) because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can exposure assessment of UPF intake be improved? 3) Does UPF intake influence risk for obesity or CMDs, independent of diet quality? 4) What, if any, attributes of UPFs influence ingestive behavior and contribute to excess energy intake? 5) What, if any, attributes of UPFs contribute to clinically meaningful metabolic responses? 6) What, if any, external environmental factors lead people to consume high amounts of UPFs? Uncertainty and complexity around UPF intake warrant further complementary and interdisciplinary causal, mechanistic, and methodological research related to obesity and CMD risk to understand the utility of applying classification by degree of processing to foods in the United States.
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Affiliation(s)
- Lauren E O'Connor
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States.
| | - Kelly A Higgins
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | | | - Robert Bergia
- Archer Daniels Midland (ADM), Decatur, IL, United States
| | - Andrew W Brown
- University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, United States
| | - David Baer
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | - Cindy Davis
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | - Mario G Ferruzzi
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Kevin Miller
- Bell Institute of Health & Nutrition, General Mills, Minneapolis, MN, United States
| | | | | | - Aline Andres
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States
| | - John Coupland
- Penn State University, University Park, PA, United States
| | - Meghan Crimmins
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Chelsey Fiecke
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Arkansas Children's Nutrition Center, Little Rock, AR, United States
| | - Ciarán G Forde
- Wageningen University and Research, Wageningen, The Netherlands
| | - Naomi K Fukagawa
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, United States
| | - Kevin D Hall
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Bruce Hamaker
- Purdue University, West Lafayette, IN, United States
| | - Kirsten A Herrick
- National Cancer Institute, National Institutes of Health, Rockville, MD, United States
| | - Julie M Hess
- Agricultural Research Service, US Department of Agriculture, Grand Forks, ND, United States
| | - Lise Aj Heuven
- Wageningen University and Research, Wageningen, The Netherlands
| | - Filippa Juul
- New York University School of Global Public Health, New York, NY, United States
| | | | | | | | - Mark Messina
- Soy Nutrition Institute Global, Pittsfield, MA, United States
| | - Alyson Mitchell
- Food Science and Technology, University of California at Davis, CA, United States
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States
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Folta SC, Li Z, Cash SB, Hager K, Zhang FF. Adoption and implementation of produce prescription programs for under-resourced populations: clinic staff perspectives. Front Nutr 2023; 10:1221785. [PMID: 37964933 PMCID: PMC10641783 DOI: 10.3389/fnut.2023.1221785] [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: 05/12/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Background Produce prescription programs represent a promising intervention strategy in the healthcare setting to address disparities in diet quality and diet-related chronic disease. The objective of this study was to understand adoption and implementation factors related to these programs that are common across contexts and those that are context-specific. Methods In this qualitative case comparison study, we conducted qualitative interviews with eight clinic staff from five primary care "safety net" clinics, identified by a partnering non-profit organization that operated the programs, in April-July 2021. Results Across clinics, the ability to provide a tangible benefit to patients was a key factor in adoption. Flexibility in integrating into clinic workflows was a facilitator of implementation. Fit with usual operations varied across clinics. Common challenges were the need for changes to the workflow and extra staff time. Clinic staff were skeptical about the sustainability of both the benefits to patients and the ability to continue the program at their clinics. Discussion This study adds to a growing body of knowledge on the adoption and implementation of produce prescription programs. Future research will further this understanding, providing the evidence necessary to guide adopting clinics and to make informed policy decisions to best promote the growth and financial sustainability of these programs.
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Affiliation(s)
- Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Lara-Castor L, Micha R, Cudhea F, Miller V, Shi P, Zhang J, Sharib JR, Erndt-Marino J, Cash SB, Mozaffarian D. Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries. Nat Commun 2023; 14:5957. [PMID: 37788998 PMCID: PMC10614169 DOI: 10.1038/s41467-023-41269-8] [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] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.
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Affiliation(s)
- Laura Lara-Castor
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- University of Thessaly, Volos, Greece
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Medicine, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Julia R Sharib
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Josh Erndt-Marino
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Tufts University School of Medicine, Boston, MA, USA.
- Department of Medicine, Tufts Medical Center, Boston, MA, USA.
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7
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Fretes G, Corvalán C, Economos CD, Wilson NLW, Cash SB. Ultra-processed food consumption is associated with variations in daily routines in elementary schoolchildren during the COVID-19 pandemic in Chile. Public Health Nutr 2023; 26:1956-1967. [PMID: 37528627 PMCID: PMC10564603 DOI: 10.1017/s1368980023001593] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/06/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile. DESIGN Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics. SETTING Low- and middle-income neighbourhoods in southeastern Santiago, Chile. PARTICIPANTS Children from the Food Environment Chilean Cohort (n 428, 8-10 years old). RESULTS Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = -0·19, (95 % CI -0·40, 0·02)) and school characteristics (model 2: β = -0·20, (95 % CI -0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant. CONCLUSIONS Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.
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Affiliation(s)
- Gabriela Fretes
- International Food Policy Research Institute (IFPRI), 1201 Eye St NW, Washington, DC20005, USA
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Avda. Macul 5524, Santiago7830489, Chile
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA02111, USA
| | - Norbert LW Wilson
- Duke Divinity School, Sanford School of Public Policy, and World Food Policy Center, Duke University, 407 Chapel Drive, Durham, NC, 27708-0968, USA
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA02111, USA
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Braga BC, Cash SB, Sarson K, Chang R, Mosca A, Wilson NLW. The gamification of nutrition labels to encourage healthier food selection in online grocery shopping: A randomized controlled trial. Appetite 2023; 188:106610. [PMID: 37269883 DOI: 10.1016/j.appet.2023.106610] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
Food purchase choices, one of the main determinants of food consumption, is highly influenced by food environments. Given the surge in online grocery shopping because of the COVID-19 pandemic, interventions in digital environments present more than ever an opportunity to improve the nutritional quality of food purchase choices. One such opportunity can be found in gamification. Participants (n = 1228) shopped for 12 items from a shopping list on a simulated online grocery platform. We randomized them into four groups in a 2 × 2 factorial design: presence vs. absence of gamification, and high vs. low budget. Participants in the gamification groups saw foods with 1 (least nutritious) to 5 (most nutritious) crown icons and a scoreboard with a tally of the number of crowns the participant collected. We estimated ordinary least squares and Poisson regression models to test the impact of the gamification and budget on the nutritional quality of the shopping basket. In the absence of gamification and low budget, participants collected 30.78 (95% CI [30.27; 31.29]) crowns. In the gamification and low budget condition, participants increased the nutritional quality of their shopping basket by collecting more crowns (B = 4.15, 95% CI [3.55; 4.75], p < 0.001). The budget amount ($50 vs. $30) did not alter the final shopping basket (B = 0.45, 95% CI [-0.02; 1.18], p = 0.057), nor moderated the gamification effect. Gamification increased the nutritional quality of the final shopping baskets and nine of 12 shopping list items in this hypothetical experiment. Gamifying nutrition labels may be an effective strategy to improve the nutritional quality of food choices in online grocery stores, but further research is needed.
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Affiliation(s)
- Bianca C Braga
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Katrina Sarson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Remco Chang
- Computer Science, Halligan Hall, Tufts University, 161 College Avenue, Medford, MA, 02155, USA.
| | - Ab Mosca
- Khoury College of Computer Sciences, Northeastern University, 440 Huntington Avenue, 202 West Village H, Boston, MA, 02115, USA.
| | - Norbert L W Wilson
- Divinity School and Sanford School of Public Policy, 304 Gray, 407 Chapel Drive, Duke Box, #90968, Durham, NC, 27708-0968, USA.
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Hager K, Du M, Li Z, Mozaffarian D, Chui K, Shi P, Ling B, Cash SB, Folta SC, Zhang FF. Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States. Circ Cardiovasc Qual Outcomes 2023; 16:e009520. [PMID: 37641928 PMCID: PMC10529680 DOI: 10.1161/circoutcomes.122.009520] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [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: 08/04/2022] [Accepted: 06/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations. METHODS This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI z-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program. RESULTS After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m2 (-0.64 to -0.09). Child BMI z-score did not change -0.01 (-0.06 to 0.04). CONCLUSIONS In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Kenneth Chui
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Hershey MS, Chang CR, Sotos-Prieto M, Fernandez-Montero A, Cash SB, Christophi CA, Folta SC, Muegge C, Kleinschmidt V, Moffatt S, Mozaffarian D, Kales SN. Effect of a Nutrition Intervention on Mediterranean Diet Adherence Among Firefighters: A Cluster Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2329147. [PMID: 37589978 PMCID: PMC10436136 DOI: 10.1001/jamanetworkopen.2023.29147] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/09/2023] [Indexed: 08/18/2023] Open
Abstract
Importance US firefighters are a working population at risk of chronic diseases, including obesity, cardiovascular disease, and cancer. This risk may be mitigated by a healthy diet. Objective To evaluate the effect of a Mediterranean nutrition intervention using a behavioral/environmental approach (firefighter/fire station/home) at the individual participant level. Design, Setting, and Participants This 12-month cluster randomized clinical trial included US career firefighters from fire stations and homes within 2 Indiana fire departments. Participants were randomized by fire station to either Mediterranean diet or control (usual care). The study was conducted from October 2016 to December 2019, and data were analyzed in November 2022. Intervention For the first 12 months of the study, firefighters located at fire stations randomized to the intervention group were provided with access to supermarket discounts and free samples of Mediterranean diet foods, online nutrition education platforms, email announcements and reminders, family and peer education and support, and chef demonstrations. Firefighters in fire stations allocated to the control group received no intervention and were instructed to follow their usual diet. Main Outcomes and Measures Change in dietary habits at 12 months as measured by a modified Mediterranean diet score (range, 0 to 51 points) at baseline and 6-month and 12-month follow-up. Cardiometabolic parameters were secondary outcomes. Results Of 485 included firefighters, 458 (94.4%) were male, and the mean (SD) age was 47 (7.5) years. A total of 241 firefighters (27 fire stations) were randomized to the Mediterranean nutrition intervention, and 244 (25 fire stations) were randomized to usual diet. Outcomes were analyzed using generalized linear mixed models for modified Mediterranean diet score at 6 months (n = 336) and 12 months (n = 260), adjusting for baseline age, sex, race and ethnicity, fire department, physical activity, and waist circumference. In the intervention group compared with the control group, the modified Mediterranean diet score significantly increased by 2.01 points (95% CI, 0.62-3.40; P = .005) at 6 months and by 2.67 points (95% CI, 1.14-4.20; P = .001) at 12 months. Among secondary outcomes, changes in cardiometabolic risk factors were not statistically significant at 1 year. Results from analyses with multilevel multiple imputation for missingness were similar. Conclusions and Relevance In this Mediterranean nutrition intervention of multicomponent behavioral/environmental changes, career firefighters had increased adherence to a Mediterranean diet. Trial Registration ClinicalTrials.gov Identifier: NCT02941757.
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Affiliation(s)
- Maria Soledad Hershey
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Chia-Rui Chang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red of Epidemiology and Public Health, Madrid, Spain
- Campus of International Excellence (CEI) Universidad Autónoma de Madrid (UAM), Spanish National Research Council (CSIC), Madrid, Spain
| | - Alejandro Fernandez-Montero
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Occupational Medicine, University of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Costas A. Christophi
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Lemesos, Cyprus
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Carolyn Muegge
- National Institute for Public Safety Health, Indianapolis, Indiana
| | | | - Steven Moffatt
- National Institute for Public Safety Health, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Stefanos N. Kales
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Occupational Medicine, Cambridge Hospital, Harvard Medical School, Cambridge, Massachusetts
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Adkins JR, Mulé CM, Linder DE, Must A, Cash SB, Folta SC. Exploring health behaviors and the role of pet dogs in households with autistic children: the DANE study. Front Pediatr 2023; 11:1153124. [PMID: 37520050 PMCID: PMC10376699 DOI: 10.3389/fped.2023.1153124] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Autism spectrum disorder (ASD) often presents a unique set of risk factors that impact healthy eating and physical activity. Animal-assisted interventions (AAI) are a promising approach for autistic children. There is growing evidence for the positive impact of AAIs on self-regulation, which is necessary for initiating and maintaining behavioral changes. Pet dogs offer several potential advantages as a vehicle for an AAI focused on health behaviors. However, little is known about the experiences of autistic children and their families with respect to dog ownership and the mechanisms through which such an AAI might operate. Methods We conducted interviews with ten parent-child dyads to explore the role of pet dogs in the lives and lifestyle habits of families with an autistic child. Interview guides were designed to explore the relationship between the autistic child and the pet dog and the role of the dog in family life; attitudes and practices related to physical activity and nutrition; and thoughts about intervention strategies. We used a directed qualitative content analysis approach for analysis. Results Themes indicate a strong bond between the child and the dog, the child's enjoyment in caring for their dog, and successful integration of dogs within family routines. In contrast, minor themes emerged around the challenges that owning a pet dog posed for families with an autistic child. In terms of nutrition and physical activity, a major theme among children was that healthy eating and exercise were important for both them and their dogs. However, minor themes suggest challenges with healthy eating and exercise and room for improvement for these behaviors. Parents held favorable views toward an intervention that would incorporate the family dog to teach children about nutrition and physical activity, although they expressed some concerns about feasibility. Discussion This exploratory work suggests that AAIs to improve nutrition and physical activity could build on the strong bond that children have with their pet dogs, but should consider the specific needs of each family, including the needs of the pet dog.
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Affiliation(s)
- Janna R. Adkins
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Christina M. Mulé
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Tufts University School of Medicine, Boston, MA, United States
| | - Deborah E. Linder
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States
| | - Aviva Must
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Hager K, Shi P, Li Z, Chui K, Berkowitz SA, Mozaffarian D, Chhabra J, Wilken J, Vergara C, Becker E, Small S, Ling B, Cash SB, Folta SC, Zhang FF. Evaluation of a Produce Prescription Program for Patients With Diabetes: A Longitudinal Analysis of Glycemic Control. Diabetes Care 2023; 46:1169-1176. [PMID: 36812470 PMCID: PMC10234740 DOI: 10.2337/dc22-1645] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Produce prescriptions have shown promise in improving diabetes care, although most studies have used small samples or lacked controls. Our objective was to evaluate the impacts of a produce prescription program on glycemic control for patients with diabetes. RESEARCH DESIGN AND METHODS Participants included a nonrandom enrollment of 252 patients with diabetes who received a produce prescription and 534 similar control participants from two clinics in Hartford, Connecticut. The start of the COVID-19 pandemic in March 2020 coincided with program implementation. Produce prescription enrollees received vouchers ($60 per month) for 6 months to purchase produce at grocery retail. Controls received usual care. The primary outcome was change in glycated hemoglobin (HbA1c) between treatment and control at 6 months. Secondary outcomes included 6-month changes in systolic (SBP) and diastolic blood pressure (DBP), BMI, hospitalizations, and emergency department admissions. Longitudinal generalized estimating equation models, weighted with propensity score overlap weights, assessed changes in outcomes over time. RESULTS At 6 months, there was no significant difference in change in HbA1c between treatment and control groups, with a difference of 0.13 percentage points (95% CI -0.05, 0.32). No significant difference was observed for change in SBP (3.85 mmHg; -0.12, 7.82), DBP (-0.82 mmHg; -2.42, 0.79), or BMI (-0.22 kg/m2; -1.83, 1.38). Incidence rate ratios for hospitalizations and emergency department visits were 0.54 (0.14, 1.95) and 0.53 (0.06, 4.72), respectively. CONCLUSIONS A 6-month produce prescription program for patients with diabetes, implemented during the onset of the COVID-19 pandemic, was not associated with improved glycemic control.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Kenneth Chui
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology, Tufts Medical Center, Boston, MA
| | | | | | - Cunegundo Vergara
- Hartford Healthcare, Hartford, CT
- University of Connecticut (UConn) Internal Medicine Residency Program, UConn Health Center, Farmington, CT
| | | | | | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Pomeranz JL, Cash SB, Mozaffarian D. US Policies That Define Foods for Junk Food Taxes, 1991-2021. Milbank Q 2023. [PMID: 37101340 DOI: 10.1111/1468-0009.12652] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 01/28/2023] [Accepted: 03/02/2023] [Indexed: 04/28/2023] Open
Abstract
Policy Points Suboptimal diet is a leading cause of mortality and morbidity in the United States. Excise taxes on junk food are not widely utilized in the United States. The development of a workable definition of the food to be taxed is a substantial barrier to implementation. Three decades of legislative and regulatory definitions of food for taxes and related purposes provide insight into methods to characterize food to advance new policies. Defining policies through Product Categories combined with Nutrients or Processing may be a method to identify foods for health-related goals. CONTEXT Suboptimal diet is a substantial contributor to weight gain, cardiometabolic diseases, and certain cancers. Junk food taxes can raise the price of the taxed product to reduce consumption and the revenue can be used to invest in low-resource communities. Taxes on junk food are administratively and legally feasible but no definition of "junk food" has been established. METHODS To identify legislative and regulatory definitions characterizing food for tax and other related purposes, this research used Lexis+ and the NOURISHING policy database to identify federal, state, territorial, and Washington DC statutes, regulations, and bills (collectively denoted as "policies") defining and characterizing food for tax and related policies, 1991-2021. FINDINGS This research identified and evaluated 47 unique laws and bills that defined food through one or more of the following criteria: Product Category (20 definitions), Processing (4 definitions), Product intertwined with Processing (19 definitions), Place (12 definitions), Nutrients (9 definitions), and Serving Size (7 definitions). Of the 47 policies, 26 used more than one criterion to define food categories, especially those with nutrition-related goals. Policy goals included taxing foods (snack, healthy, unhealthy, or processed foods), exempting foods from taxation (snack, healthy, unhealthy, or unprocessed foods), exempting homemade or farm-made foods from state and local retail regulations, and supporting federal nutrition assistance objectives. Policies based on Product Categories alone differentiated between necessity/staple foods on the one hand and nonnecessity/nonstaple foods on the other. CONCLUSIONS In order to specifically identify unhealthy food, policies commonly included a combination of Product Category, Processing, and/or Nutrient criteria. Explanations for repealed state sales tax laws on snack foods identified retailers' difficulty pinpointing which specific foods were subject to the tax as a barrier to implementation. An excise tax assessed on manufacturers or distributors of junk food is a method to overcome this barrier and may be warranted.
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Affiliation(s)
| | - Sean B Cash
- Tufts University Friedman School of Nutrition Science and Policy
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Fretes G, Corvalán C, Reyes M, Taillie LS, Economos CD, Wilson NL, Cash SB. Changes in children's and adolescents' dietary intake after the implementation of Chile's law of food labeling, advertising and sales in schools: a longitudinal study. Int J Behav Nutr Phys Act 2023; 20:40. [PMID: 37016430 PMCID: PMC10074676 DOI: 10.1186/s12966-023-01445-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND In June 2016, a comprehensive food policy was implemented in Chile that included front-of-package warning labels on key nutrients of concern (total sugars, added saturated fats, sodium, and calories), child-directed food advertisement bans, and school regulations. The policy was implemented in 3 phases from 2016 to 2019 and the primary objective was to improve children's food environments. This study's objective was to assess changes in child and adolescent intake of key nutrients of concern (total sugars, saturated fats, and sodium) at school after the initial implementation of Chile's Law of Food Labeling and Advertisement. METHODS Longitudinal study of 349 children from the Food Environment Chilean Cohort (FECHIC) and 294 adolescents from the Growth and Obesity Cohort Study (GOCS). Data were from single 24-hour dietary recalls collected from 2016 to 2019. Fixed-effects models stratified by school, home, and other locations compared nutrient consumption in each year to consumption at the pre-policy 2016 baseline. Nutrient intakes are expressed as percent of total energy. RESULTS Compared to 2016 (pre-policy), total sugars consumed by children at school decreased 4.5 [-8.0, -0.9] percentage points (pp) and 11.8 [-15.4, -8.3] pp in 2018 and 2019 respectively. In 2019, children's saturated fats and sodium intake at school also decreased (1.1 [-1.9, -0.2] pp and 10.3 [-18.1, -2.5] mg/100 kcal respectively). Likewise, in adolescents, total sugars and saturated fats consumed at school decreased in 2018 (5.3 [-8.4, -2.2] pp and 1.5 [-2.7, -0.3] pp respectively). However, consumption of key nutrients of concern at other locations increased after implementation of the policy. CONCLUSIONS After initial implementation of Chile's Labeling Law, intake of most key nutrients of concern significantly declined at school. However, we found evidence of compensatory behavior in out-of-school settings. Further research is needed to evaluate what other actions are needed to impact overall diets in the long term both at schools and out of school.
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Affiliation(s)
- Gabriela Fretes
- International Food Policy Research Institute (IFPRI), 1201 Eye St NW, Washington, DC USA
| | - Camila Corvalán
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Marcela Reyes
- Instituto de Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
- Global Food Research Program, Carolina Population Center, Chapel Hill, NC USA
| | | | - Norbert L.W. Wilson
- Duke Divinity School, Sanford School of Public Policy, and World Food Policy Center, Duke University, Durham, NC USA
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA USA
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15
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Webb P, Livingston Staffier K, Lee H, Howell B, Battaglia K, Bell BM, Matteson J, McKeown NM, Cash SB, Zhang FF, Decker Sparks JL, Blackstone NT. Measurement of diets that are healthy, environmentally sustainable, affordable, and equitable: A scoping review of metrics, findings, and research gaps. Front Nutr 2023; 10:1125955. [PMID: 37077905 PMCID: PMC10106581 DOI: 10.3389/fnut.2023.1125955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
IntroductionResearch on the impacts of dietary patterns on human and planetary health is a rapidly growing field. A wide range of metrics, datasets, and analytical techniques has been used to explore the role of dietary choices/constraints in driving greenhouse gas (GHG) emissions, environmental degradation, health and disease outcomes, and the affordability of food baskets. Many argue that each domain is important, but few have tackled all simultaneously in analyzing diet-outcome relationships.MethodsThis paper reviews studies published between January 2015 and December 2021 (inclusive) that examined dietary patterns in relation to at least two of the following four thematic pillars: (i) planetary health, including, climate change, environmental quality, and natural resource impacts, (ii) human health and disease, (iii) economic outcomes, including diet cost/affordability, and (iv) social outcomes, e.g., wages, working conditions, and culturally relevant diets. We systematically screened 2,425 publications by title and abstract and included data from 42 eligible publications in this review.ResultsMost dietary patterns used were statistically estimated or simulated rather than observed. A rising number of studies consider the cost/affordability of dietary scenarios in relation to optimized environmental and health outcomes. However, only six publications incorporate social sustainability outcomes, which represents an under-explored dimension of food system concerns.DiscussionThis review suggests a need for (i) transparency and clarity in datasets used and analytical methods; (ii) explicit integration of indicators and metrics linking social and economic issues to the commonly assessed diet-climate-planetary ecology relationships; (iii) inclusion of data and researchers from low- and middle-income countries; (iv) inclusion of processed food products to reflect the reality of consumer choices globally; and (v) attention to the implications of findings for policymakers. Better understanding is urgently needed on dietary impacts on all relevant human and planetary domains simultaneously.
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Affiliation(s)
- Patrick Webb
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
- *Correspondence: Patrick Webb,
| | - Kara Livingston Staffier
- Nutritional Epidemiology Program, Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States
| | - Hyomin Lee
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Brian Howell
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Kyra Battaglia
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Brooke M. Bell
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Julia Matteson
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Nicola M. McKeown
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
- Department of Health Science, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, United States
| | - Sean B. Cash
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Fang Fang Zhang
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Jessica L. Decker Sparks
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Nicole Tichenor Blackstone
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Abstract
Dollar stores have rapidly expanded their food offerings in recent years. These foods tend to be higher in calories and lower in nutrients, raising public health concerns, especially in rural and low-income areas where food-access challenges are often greatest. However, there is limited empirical evidence evaluating the impact of this expansion on household food purchases on a national scale. Using data from a yearly, nationally representative panel of approximately 50 000 households, we estimated the share of food purchases from 2008 to 2020 by store type and evaluated the role of dollar stores as food retailers in the United States. We found that dollar stores were the fastest-growing food retailers by household expenditure share (increasing by 89.7%), with rural growth outpacing growth elsewhere (increasing by 102.9%). Though dollar stores still represent a small share of national household food purchases (2.1% in 2020), they play an increasingly prominent role in food-at-home purchases for certain disadvantaged and rural communities. Understanding the quality of the foods they offer and how this may affect diet-related health outcomes is warranted. (Am J Public Health. 2023;113(3):331-336. https://doi.org/10.2105/10.2105/AJPH.2022.307193).
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Affiliation(s)
- Wenhui Feng
- Wenhui Feng is with the Department of Public Health and Community Medicine, Tufts University, Boston, MA. Elina T. Page is with the Economic Research Service, US Department of Agriculture, Washington, DC. Sean B. Cash is with the Friedman School of Nutrition Science and Policy, Tufts University
| | - Elina T Page
- Wenhui Feng is with the Department of Public Health and Community Medicine, Tufts University, Boston, MA. Elina T. Page is with the Economic Research Service, US Department of Agriculture, Washington, DC. Sean B. Cash is with the Friedman School of Nutrition Science and Policy, Tufts University
| | - Sean B Cash
- Wenhui Feng is with the Department of Public Health and Community Medicine, Tufts University, Boston, MA. Elina T. Page is with the Economic Research Service, US Department of Agriculture, Washington, DC. Sean B. Cash is with the Friedman School of Nutrition Science and Policy, Tufts University
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Pomeranz JL, Cash SB, Springer M, Del Giudice IM, Mozaffarian D. Opportunities to address the failure of online food retailers to ensure access to required food labelling information in the USA. Public Health Nutr 2022; 25:1-9. [PMID: 35067257 PMCID: PMC9991769 DOI: 10.1017/s1368980021004638] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/14/2021] [Accepted: 11/04/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The rapid growth in web-based grocery food purchasing has outpaced federal regulatory attention to the online provision of nutrition and allergen information historically required on food product labels. We sought to characterise the extent and variability that online retailers disclose required and regulated information and identify the legal authorities for the federal government to require online food retailers to disclose such information. DESIGN We performed a limited scan of ten products across nine national online retailers and conducted legal research using LexisNexis to analyse federal regulatory agencies' authorities. SETTING USA. PARTICIPANTS N/A. RESULTS The scan of products revealed that required information (Nutrition Facts Panels, ingredient lists, common food allergens and per cent juice for fruit drinks) was present, conspicuous and legible for an average of only 36·5 % of the products surveyed, ranging from 11·4 % for potential allergens to 54·2 % for ingredients lists. More commonly, voluntary nutrition-related claims were prominently and conspicuously displayed (63·5 % across retailers and products). Our legal examination found that the Food and Drug Administration, Federal Trade Commission and United States Department of Agriculture have existing regulatory authority over labelling, online sales and advertising, and Supplemental Nutrition Assistance Programme retailers that can be utilised to address deficiencies in the provision of required information in the online food retail environment. CONCLUSIONS Information regularly provided to consumers in conventional settings is not being uniformly provided online. Congress or the federal agencies can require online food retailers disclose required nutrition and allergen information to support health, nutrition, equity and informed consumer decision-making.
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Affiliation(s)
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Morgan Springer
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Linder DE, Folta SC, Must A, Mulé CM, Cash SB, Halbreich ED, Colón C, Sullivan S, Sanabria E, Gibbs D, Farrell T. A Stakeholder-Engaged Approach to Development of an Animal-Assisted Intervention for Obesity Prevention Among Youth With Autism Spectrum Disorder and Their Pet Dogs. Front Vet Sci 2021; 8:735432. [PMID: 34869717 PMCID: PMC8636006 DOI: 10.3389/fvets.2021.735432] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
Stakeholder involvement in research has been demonstrated to increase the effectiveness, validity, and quality of a study. This paper describes the engagement of a stakeholder panel in the development and implementation of an animal-assisted intervention (AAI) assessment and program for children diagnosed with Autism Spectrum Disorder (ASD). Canines for Autism Activity and Nutrition (CAAN) aims to promote physical activity and wellness among children diagnosed with ASD by integrating activities with their pet dog during the child's ongoing Applied Behavioral Analysis (ABA) in-home therapy sessions. Feedback from stakeholders guided program development at each stage of the research process, including this publication. Utilizing a stakeholder-informed approach was essential for the development of assessment tools, program materials, and program design. Methods that may assist others to effectively partner with stakeholders to implement an AAI among children diagnosed with ASD or related disorders are described.
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Affiliation(s)
- Deborah E. Linder
- Tufts Institute for Human-Animal Interaction, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Aviva Must
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Christina M. Mulé
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
- Division of Developmental Behavioral Pediatrics, Department of Pediatrics, Tufts University School of Medicine, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Eli D. Halbreich
- Department of Psychology, Tufts University School of Arts and Sciences, Medford, MA, United States
| | | | - Sandy Sullivan
- Massachusetts Bay Transportation Authority, Boston, MA, United States
| | | | - Debra Gibbs
- Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Terri Farrell
- The Shriver Center, The University of Massachusetts Chan Medical School, Worcester, MA, United States
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Ahmed S, Brinkley S, Smith E, Sela A, Theisen M, Thibodeau C, Warne T, Anderson E, Van Dusen N, Giuliano P, Ionescu KE, Cash SB. Climate Change and Coffee Quality: Systematic Review on the Effects of Environmental and Management Variation on Secondary Metabolites and Sensory Attributes of Coffea arabica and Coffea canephora. Front Plant Sci 2021; 12:708013. [PMID: 34691093 PMCID: PMC8531415 DOI: 10.3389/fpls.2021.708013] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
Climate change is impacting crop performance and agricultural systems around the world with implications for farmers and consumers. We carried out a systematic review to synthesize evidence regarding the effects of environmental factors associated with climate change and management conditions associated with climate adaptation on the crop quality of a culturally-relevant perennial crop, coffee (Coffea arabica and Coffea canephora). Seventy-three articles were identified that addressed the study's research question including 42 articles on environmental factors, 20 articles on management conditions, and 11 articles on both. While variation was found between studies, findings highlight that coffee quality is vulnerable to changes in light exposure, altitude, water stress, temperature, carbon dioxide, and nutrient management. Both increases as well as decreases were found in secondary metabolites and sensory attributes that determine coffee quality in response to shifts in environmental and management conditions. The most consistent evidence identified through this systematic review includes the following two trends: (1) increased altitude is associated with improved sensory attributes of coffee and; (2) increased light exposure is associated with decreased sensory attributes of coffee. Research gaps were found regarding the effects of shifts in carbon dioxide, water stress, and temperature on the directionality (increase, decrease, or non-linear) of coffee quality and how this varies with location, elevation, and management conditions. This systematic review further identified the following research needs: (1) long-term studies that examine the interactive effects of multiple environmental factors and management conditions on coffee quality; (2) studies that examine the interaction between sensory attributes and secondary metabolites that determine coffee quality and; (3) studies on the feasibility of various climate-adaptation strategies for mitigating the effects of climate change on coffee quality. Evidence-based innovations are needed to mitigate climate impacts on coffee quality toward enhanced sustainability and resilience of the coffee sector from farm to cup.
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Affiliation(s)
- Selena Ahmed
- Food and Health Lab, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Sarah Brinkley
- Department of Horticultural Sciences, Center for Coffee Research and Education, Texas A&M University, College Station, TX, United States
| | - Erin Smith
- Food and Health Lab, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Ariella Sela
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Mitchell Theisen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Cyrena Thibodeau
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Teresa Warne
- Food and Health Lab, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | | | | | - Peter Giuliano
- Specialty Coffee Association, Santa Ana, CA, United States
- Coffee Science Foundation, Santa Ana, CA, United States
| | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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20
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Tsai M, Cash SB, Anzman-Frasca S, Goldberg JP, Johnson SK, Oslund J, Folta SC. Helping parents provide vegetable snacks: Investigating price and taste as barriers. Appetite 2021; 166:105481. [PMID: 34175360 DOI: 10.1016/j.appet.2021.105481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.
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Affiliation(s)
- Marisa Tsai
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA; Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, 1111 Franklin Street, Tenth Floor, Oakland, CA 94607, USA.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences and Center for Ingestive Behavior Research, University at Buffalo, G56 Farber Hall, South Campus, Buffalo, NY, USA.
| | - Jeanne P Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sarah K Johnson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Jennifer Oslund
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
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21
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Must A, Mulé CM, Linder DE, Cash SB, Folta SC. Animal-Assisted Intervention: A Promising Approach to Obesity Prevention for Youth With Autism Spectrum Disorder. Front Vet Sci 2021; 8:646081. [PMID: 34095272 PMCID: PMC8171662 DOI: 10.3389/fvets.2021.646081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aviva Must
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Christina M. Mulé
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Tufts University School of Medicine, Boston, MA, United States
| | - Deborah E. Linder
- Tufts Institute for Human-Animal Interaction, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Blondin SA, Cash SB, Griffin TS, Goldberg JP, Economos CD. Meatless Monday National School Meal Program Evaluation: Impact on Nutrition, Cost, and Sustainability. Journal of Hunger & Environmental Nutrition 2020. [DOI: 10.1080/19320248.2020.1842283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Stacy A. Blondin
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sean B. Cash
- Food Policy and Applied Nutrition, Tufts Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Timothy S. Griffin
- Food Policy and Applied Nutrition, Tufts Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Jeanne P. Goldberg
- Food Policy and Applied Nutrition, Tufts Friedman School of Nutrition Science and Policy, Boston, MA, USA
| | - Christina D. Economos
- Food Policy and Applied Nutrition, Tufts Friedman School of Nutrition Science and Policy, Boston, MA, USA
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Folta SC, Anzman-Frasca S, Tsai M, Johnson SK, Rossi M, Cash SB. Snack It Up for Parents: Brief Videos and Tip Sheets for Promoting Vegetable Snacks to School-Aged Children. J Nutr Educ Behav 2020; 52:565-567. [PMID: 31917130 DOI: 10.1016/j.jneb.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Sara C Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY
| | | | | | | | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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24
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Lehnerd ME, Goldberg JP, Folta SC, Cash SB, Griffin TS, Lucas R, Sacheck JM. Qualitative Exploration of Farm to School Program Adoption and Expansion in Massachusetts Schools. Journal of Hunger & Environmental Nutrition 2020. [DOI: 10.1080/19320248.2019.1610539] [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: 10/26/2022]
Affiliation(s)
- Megan E. Lehnerd
- Department of Food and Nutrition, Framingham State University, Framingham, MA, USA
| | - Jeanne P. Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Timothy S. Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Rebecca Lucas
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jennifer M. Sacheck
- Exercise and Nutrition Sciences Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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25
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Scott ER, Li X, Wei JP, Kfoury N, Morimoto J, Guo MM, Agyei A, Robbat A, Ahmed S, Cash SB, Griffin TS, Stepp JR, Han WY, Orians CM. Changes in Tea Plant Secondary Metabolite Profiles as a Function of Leafhopper Density and Damage. Front Plant Sci 2020; 11:636. [PMID: 32547579 PMCID: PMC7272924 DOI: 10.3389/fpls.2020.00636] [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] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/24/2020] [Indexed: 05/12/2023]
Abstract
Insect herbivores have dramatic effects on the chemical composition of plants. Many of these induced metabolites contribute to the quality (e.g., flavor, human health benefits) of specialty crops such as the tea plant (Camellia sinensis). Induced chemical changes are often studied by comparing plants damaged and undamaged by herbivores. However, when herbivory is quantitative, the relationship between herbivore pressure and induction can be linearly or non-linearly density dependent or density independent, and induction may only occur after some threshold of herbivory. The shape of this relationship can vary among metabolites within plants. The tea green leafhopper (Empoasca onukii) can be a widespread pest on tea, but some tea farmers take advantage of leafhopper-induced metabolites in order to produce high-quality "bug-bitten" teas such as Eastern Beauty oolong. To understand the effects of increasing leafhopper density on tea metabolites important for quality, we conducted a manipulative experiment exposing tea plants to feeding by a range of E. onukii densities. After E. onukii feeding, we measured volatile and non-volatile metabolites, and quantified percent damaged leaf area from scanned leaf images. E. onukii density had a highly significant effect on volatile production, while the effect of leaf damage was only marginally significant. The volatiles most responsive to leafhopper density were mainly terpenes that increased in concentration monotonically with density, while the volatiles most responsive to leaf damage were primarily fatty acid derivatives and volatile phenylpropanoids/benzenoids. In contrast, damage (percent leaf area damaged), but not leafhopper density, significantly reduced total polyphenols, epigallocatechin gallate (EGCG), and theobromine concentrations in a dose-dependent manner. The shape of induced responses varied among metabolites with some changing linearly with herbivore pressure and some responding only after a threshold in herbivore pressure with a threshold around 0.6 insects/leaf being common. This study illustrates the importance of measuring a diversity of metabolites over a range of herbivory to fully understand the effects of herbivores on induced metabolites. Our study also shows that any increases in leafhopper density associated with climate warming, could have dramatic effects on secondary metabolites and tea quality.
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Affiliation(s)
- Eric R. Scott
- Department of Biology, Tufts University, Medford, MA, United States
- *Correspondence: Eric R. Scott, ;
| | - Xin Li
- Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, China
| | - Ji-Peng Wei
- Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, China
| | - Nicole Kfoury
- Department of Chemistry, Tufts University, Medford, MA, United States
| | - Joshua Morimoto
- Department of Chemistry, Tufts University, Medford, MA, United States
| | - Ming-Ming Guo
- Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, China
| | - Amma Agyei
- Department of Biology, Tufts University, Medford, MA, United States
| | - Albert Robbat
- Department of Chemistry, Tufts University, Medford, MA, United States
| | - Selena Ahmed
- Food and Health Lab, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Sean B. Cash
- Friedman School of Nutrition and Policy, Tufts University, Medford, MA, United States
| | - Timothy S. Griffin
- Friedman School of Nutrition and Policy, Tufts University, Medford, MA, United States
| | - John R. Stepp
- Department of Anthropology, University of Florida, Gainsville, FL, United States
| | - Wen-Yan Han
- Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, China
- Wen-Yan Han,
| | - Colin M. Orians
- Department of Biology, Tufts University, Medford, MA, United States
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26
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Kfoury N, Scott ER, Orians CM, Ahmed S, Cash SB, Griffin T, Matyas C, Stepp JR, Han W, Xue D, Long C, Robbat A. Plant-Climate Interaction Effects: Changes in the Relative Distribution and Concentration of the Volatile Tea Leaf Metabolome in 2014-2016. Front Plant Sci 2019; 10:1518. [PMID: 31824541 PMCID: PMC6882950 DOI: 10.3389/fpls.2019.01518] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/31/2019] [Indexed: 06/08/2023]
Abstract
Climatic conditions affect the chemical composition of edible crops, which can impact flavor, nutrition and overall consumer preferences. To understand these effects, we sampled tea (Camellia sinensis (L.) Kuntze) grown in different environmental conditions. Using a target/nontarget data analysis approach, we detected 564 metabolites from tea grown at two elevations in spring and summer over 3 years in two major tea-producing areas of China. Principal component analysis and partial least squares-discriminant analysis show seasonal, elevational, and yearly differences in tea from Yunnan and Fujian provinces. Independent of location, higher concentrations of compounds with aromas characteristic of farmers' perceptions of high-quality tea were found in spring and high elevation teas. Yunnan teas were distinct from Fujian teas, but the effects of elevation and season were different for the two locations. Elevation was the largest source of metabolite variation in Yunnan yet had no effect in Fujian. In contrast seasonal differences were strong in both locations. Importantly, the year-to-year variation in chemistry at both locations emphasizes the importance of doing multi-year studies, and further highlights the challenge farmers face when trying to produce teas with specific flavor/health (metabolite) profiles.
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Affiliation(s)
- Nicole Kfoury
- Department of Chemistry, Tufts University, Medford, MA, United States
- Sensory and Science Center, Medford, MA, United States
| | - Eric R. Scott
- Department of Biology, Tufts University, Medford, MA, United States
| | - Colin M. Orians
- Sensory and Science Center, Medford, MA, United States
- Department of Biology, Tufts University, Medford, MA, United States
| | - Selena Ahmed
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Sean B. Cash
- Sensory and Science Center, Medford, MA, United States
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Timothy Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Corene Matyas
- Department of Geography, University of Florida, Gainesville, FL, United States
| | - John Richard Stepp
- Department of Anthropology, University of Florida, Gainesville, FL, United States
| | - Wenyan Han
- Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, China
| | - Dayuan Xue
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Chunlin Long
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Albert Robbat
- Department of Chemistry, Tufts University, Medford, MA, United States
- Sensory and Science Center, Medford, MA, United States
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27
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Ahmed S, Griffin TS, Kraner D, Schaffner MK, Sharma D, Hazel M, Leitch AR, Orians CM, Han W, Stepp JR, Robbat A, Matyas C, Long C, Xue D, Houser RF, Cash SB. Environmental Factors Variably Impact Tea Secondary Metabolites in the Context of Climate Change. Front Plant Sci 2019; 10:939. [PMID: 31475018 PMCID: PMC6702324 DOI: 10.3389/fpls.2019.00939] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/04/2019] [Indexed: 05/20/2023]
Abstract
Climate change is impacting food and beverage crops around the world with implications for environmental and human well-being. While numerous studies have examined climate change effects on crop yields, relatively few studies have examined effects on crop quality (concentrations of nutrients, minerals, and secondary metabolites). This review article employs a culturally relevant beverage crop, tea (Camelia sinensis), as a lens to examine environmental effects linked to climate change on the directionality of crop quality. Our systematic review identified 86 articles as relevant to the review question. Findings provide evidence that shifts in seasonality, water stress, geography, light factors, altitude, herbivory and microbes, temperature, and soil factors that are linked to climate change can result in both increases and decreases up to 50% in secondary metabolites. A gap was found regarding evidence on the direct effects of carbon dioxide on tea quality, highlighting a critical research area for future study. While this systematic review provides evidence that multiple environmental parameters are impacting tea quality, the directionality and magnitude of these impacts is not clear with contradictory evidence between studies likely due to confounding factors including variation in tea variety, cultivar, specific environmental and agricultural management conditions, and differences in research methods. The environmental factors with the most consistent evidence in this systematic review were seasonality and water stress with 14 out of 18 studies (78%) demonstrating a decrease in concentrations of phenolic compounds or their bioactivity with a seasonal shift from the spring and /or first tea harvest to other seasons and seven out of 10 studies (70%) showing an increase in levels of phenolic compounds or their bioactivity with drought stress. Herbivory and soil fertility were two of the variables that showed the greatest contradictory evidence on tea quality. Both herbivory and soil fertility are variables which farmers have the greatest control over, pointing to the importance of agricultural management for climate mitigation and adaptation. The development of evidence-based management strategies and crop breeding programs for resilient cultivars are called for to mitigate climate impacts on crop quality and overall risk in agricultural and food systems.
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Affiliation(s)
- Selena Ahmed
- Food and Health Lab, Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Timothy S. Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Debra Kraner
- Food and Health Lab, Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - M. Katherine Schaffner
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Deepak Sharma
- Food and Health Lab, Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Matthew Hazel
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Alicia R. Leitch
- Food and Health Lab, Sustainable Food Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Colin M. Orians
- Department of Biology, Tufts University, Medford, MA, United States
| | - Wenyan Han
- Tea Research Institute, Chinese Academy of Agricultural Sciences, Hangzhou, China
| | - John Richard Stepp
- Department of Anthropology, University of Florida, Gainesville, FL, United States
| | - Albert Robbat
- Department of Chemistry, Tufts University, Medford, MA, United States
| | - Corene Matyas
- Department of Geography, University of Florida, Gainesville, FL, United States
| | - Chunlin Long
- Key Laboratory of Ethnomedicine of Ministry of Education, and College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Dayuan Xue
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Robert F. Houser
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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Schleicher M, Cash SB, Freeman LM. Determinants of pet food purchasing decisions. Can Vet J 2019; 60:644-650. [PMID: 31156266 PMCID: PMC6515811] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this study was to identify determinants of pet food purchasing decisions. An online survey was administered via e-mail, newsletters, and social media. A total of 2181 pet owners completed the survey: 1209 dog owners and 972 cat owners; 26% of respondents were animal professionals. Pet food characteristics ranked the highest were health and nutrition, quality, ingredients, and freshness. The veterinary healthcare team was reported to be the primary (43.6%) and most important source of nutrition information for pet owners; Internet sources were the primary information source for 24.6% of respondents. Most pet owners reported giving equal (53.1%) or more priority (43.6%) to buying healthy food for their pets compared with themselves. Results suggest that pet owners face numerous challenges in determining the best diet to feed their pets.
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Affiliation(s)
- Molly Schleicher
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, Massachusetts 02111-1817, USA (Schleicher, Cash, Freeman); Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Freeman)
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, Massachusetts 02111-1817, USA (Schleicher, Cash, Freeman); Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Freeman)
| | - Lisa M Freeman
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, Massachusetts 02111-1817, USA (Schleicher, Cash, Freeman); Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Road, North Grafton, Massachusetts 01536, USA (Freeman)
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29
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Huang H, Kfoury N, Orians CM, Griffin T, Ahmed S, Cash SB, Stepp JR, Xue D, Long C, Robbat A. 2014-2016 seasonal rainfall effects on metals in tea (Camelia sinensis (L.) Kuntze). Chemosphere 2019; 219:796-803. [PMID: 30572233 DOI: 10.1016/j.chemosphere.2018.12.075] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 12/03/2018] [Accepted: 12/09/2018] [Indexed: 06/09/2023]
Abstract
Plant-climate interactions affect the edible crop composition, impacting flavor, nutrition, and overall consumer liking. In this study, principal components analysis was used to assess the macro- and micronutrient metal concentrations in pre-monsoon (spring), monsoon (summer), and post-monsoon (autumn) tea (Camelia sinensis (L.) Kuntze) from Yunnan Province, China in 2014-2016. Statistical differences were observed (p = 1.35E-24). Fe, Ca, Mg, Mn, Al, and Ba concentrations were higher in June (monsoon) than in March (pre-monsoon) and September (post-monsoon) compared to Pb, K, Cu, Zn, and Na, which were higher in March and September. Although Fe, Ca, Mg, Mn, Al, and Ba concentrations increased during the monsoon season, sensory analysis did not detect metallic taste in either minimally processed or farmer-processed (commercial) teas. This finding shows the seasonal differences in flavor were due to striking differences in organic chemical composition and concentration.
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Affiliation(s)
- Hui Huang
- Department of Chemistry, Tufts University, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA; School of Resources and Chemical Engineering, Sanming University, Fujian, China
| | - Nicole Kfoury
- Department of Chemistry, Tufts University, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA; Tufts University Sensory and Science Center, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA
| | - Colin M Orians
- Tufts University Sensory and Science Center, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA; Department of Biology, Tufts University, Medford, MA, 02155, USA
| | - Timothy Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Selena Ahmed
- Food and Health Lab, Sustainable Food and Bioenergy Systems Program, Department of Health and Human Development, Montana State University, Bozeman, MT, 59717, USA
| | - Sean B Cash
- Tufts University Sensory and Science Center, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - John Richard Stepp
- Department of Anthropology, University of Florida, Gainesville, FL, 32611, USA
| | - Dayuan Xue
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Chunlin Long
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Albert Robbat
- Department of Chemistry, Tufts University, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA; Tufts University Sensory and Science Center, 200 Boston Ave, Suite G700, Medford, MA, 02155, USA.
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30
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Amin SA, Lehnerd M, Cash SB, Economos CD, Sacheck JM. Development of a Tool for Food Literacy Assessment in Children (TFLAC). J Nutr Educ Behav 2019; 51:364-369. [PMID: 30851841 DOI: 10.1016/j.jneb.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Food literacy provides a framework for food-related knowledge, skills, and behaviors. The aim of this study was to develop a Tool for Food Literacy Assessment in Children (TFLAC), grades 4-5. METHODS Development of the TFLAC consisted of 3 phases: (1) content validity using a 2-round modified Delphi panel (n = 16) and content validity ratios (CVR); (2) pilot-testing (n = 38); and (3) assessment of internal consistency and test-retest reliability (n = 706) using Cronbach α and intraclass correlation coefficients, respectively. Statistical significance was set at P < .05. RESULTS Round 1 (CVR = 0.40) and 2 (CVR = 0.70) Delphi panel feedback and the pilot test informed modifications to the TFLAC question format, wording, and difficulty. Food literacy domain-specific Cronbach α values were acceptable (range, .80-.98) except for cooking knowledge (.63), and intraclass correlation coefficients were 0.64-0.70 (P < .001). CONCLUSIONS AND IMPLICATIONS The TFLAC meets basic psychometric standards and may serve as a foundation for nutrition education intervention design and evaluation. Further testing with a broader geographic audience may be warranted.
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Affiliation(s)
- Sarah A Amin
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI.
| | - Megan Lehnerd
- Department of Food and Nutrition, Framingham State University, Framingham, MA
| | - Sean B Cash
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Christina D Economos
- Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Jennifer M Sacheck
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Corrigan JR, Alhabash S, Rousu M, Cash SB. How much is social media worth? Estimating the value of Facebook by paying users to stop using it. PLoS One 2018; 13:e0207101. [PMID: 30566473 PMCID: PMC6300191 DOI: 10.1371/journal.pone.0207101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022] Open
Abstract
Facebook, the online social network, has more than 2 billion global users. Because those users do not pay for the service, its benefits are hard to measure. We report the results of a series of three non-hypothetical auction experiments where winners are paid to deactivate their Facebook accounts for up to one year. Though the populations sampled and the auction design differ across the experiments, we consistently find the average Facebook user would require more than $1000 to deactivate their account for one year. While the measurable impact Facebook and other free online services have on the economy may be small, our results show that the benefits these services provide for their users are large.
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Affiliation(s)
- Jay R. Corrigan
- Department of Economics, Kenyon College, Gambier, OH, United States of America
| | - Saleem Alhabash
- Department of Advertising + Public Relations, Michigan State University, East Lansing, MI, United States of America
| | - Matthew Rousu
- Sigmund Weis School of Business School, Susquehanna University, Selinsgrove, PA, United States of America
| | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- * E-mail:
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Boehm R, Schuknecht TJ, Cash SB. Cool Intentions: Adding Refrigerators to Elementary Classrooms Improves Fruit and Vegetable Access in a Pilot Study. J Nutr Educ Behav 2018; 50:746-747. [PMID: 29779996 DOI: 10.1016/j.jneb.2018.04.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Rebecca Boehm
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| | - Tara J Schuknecht
- Department of Consumer Science, University of Wisconsin, Madison, WI
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.
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Abstract
Background. Recent efforts supporting children’s dietary behaviors suggest the importance of food literacy (FL), which is a multidimensional concept that encompasses food-related knowledge, skills, and behaviors. To date, FL has been largely informed by adult and adolescent research. Aims. To assess the FL experiences, perceived skills, and knowledge of school-age children to inform FL educational opportunities. Method. Six focus groups were conducted with children (age 9-12 years) from three Massachusetts elementary schools. Two team members independently reviewed and coded a portion of the transcripts to assess interrater reliability. Predominant themes connected to children’s perceived FL skills and knowledge were identified using an inductive and deductive content analysis approach. Results. There were five central FL themes identified during the focus groups ( n = 31 children), including (1) food systems concepts; (2) food safety and food freshness; (3) gardening environment, perceived skills, and knowledge; (4) cooking environment, perceived skills, and safety; and (5) autonomy of meal preparation. Discussion. The themes that emerged in these focus groups with children provided new information surrounding children’s perceived FL skills and knowledge as well as important context regarding the food environment (school vs. home). These findings captured important concepts across the “farm to plate” spectrum and highlight potential school-based opportunities where FL topics could be expanded upon most successfully. Conclusion. This formative research informed educational opportunities for a FL curriculum, which holds promise for improving food-based education and programs, designing more effective interventions, and developing measurement tools.
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Kfoury N, Morimoto J, Kern A, Scott ER, Orians CM, Ahmed S, Griffin T, Cash SB, Stepp JR, Xue D, Long C, Robbat A. Striking changes in tea metabolites due to elevational effects. Food Chem 2018; 264:334-341. [PMID: 29853384 DOI: 10.1016/j.foodchem.2018.05.040] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/30/2018] [Accepted: 05/06/2018] [Indexed: 10/17/2022]
Abstract
Climate effects on crop quality at the molecular level are not well-understood. Gas and liquid chromatography-mass spectrometry were used to measure changes of hundreds of compounds in tea at different elevations in Yunnan Province, China. Some increased in concentration while others decreased by 100's of percent. Orthogonal projection to latent structures-discriminant analysis revealed compounds exhibiting analgesic, antianxiety, antibacterial, anticancer, antidepressant, antifungal, anti-inflammatory, antioxidant, anti-stress, and cardioprotective properties statistically (p = 0.003) differentiated high from low elevation tea. Also, sweet, floral, honey-like notes were higher in concentration in the former while the latter displayed grassy, hay-like aroma. In addition, multivariate analysis of variance showed low elevation tea had statistically (p = 0.0062) higher concentrations of caffeine, epicatechin gallate, gallocatechin, and catechin; all bitter compounds. Although volatiles represent a small fraction of the total mass, this is the first comprehensive report illustrating how normal variations in temperature, 5 °C, due to elevational effects impact tea quality.
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Affiliation(s)
- Nicole Kfoury
- Department of Chemistry, Tufts University, Medford, MA 02155, USA; Tufts University Sensory and Science Center, Medford, MA 02155, USA
| | - Joshua Morimoto
- Department of Chemistry, Tufts University, Medford, MA 02155, USA
| | - Amanda Kern
- Tufts University Sensory and Science Center, Medford, MA 02155, USA
| | - Eric R Scott
- Department of Biology, Tufts University, Medford, MA 02155, USA
| | - Colin M Orians
- Tufts University Sensory and Science Center, Medford, MA 02155, USA; Department of Biology, Tufts University, Medford, MA 02155, USA
| | - Selena Ahmed
- Department of Health and Human Development, Montana State University, Bozeman, MT 59717, USA
| | - Timothy Griffin
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - Sean B Cash
- Tufts University Sensory and Science Center, Medford, MA 02155, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 02111, USA
| | - John Richard Stepp
- Department of Anthropology, University of Florida, Gainesville, FL 32611, USA
| | - Dayuan Xue
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Chunlin Long
- College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Albert Robbat
- Department of Chemistry, Tufts University, Medford, MA 02155, USA; Tufts University Sensory and Science Center, Medford, MA 02155, USA.
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Blondin SA, Goldberg JP, Cash SB, Griffin TS, Economos CD. Factors Influencing Fluid Milk Waste in a Breakfast in the Classroom School Breakfast Program. J Nutr Educ Behav 2018; 50:349-356.e1. [PMID: 29422439 DOI: 10.1016/j.jneb.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine predictors of fluid milk waste in a Breakfast in the Classroom School Breakfast Program. DESIGN Cross-sectional with 3 repeated measures/classroom. SETTING Elementary schools in a medium-sized, low-income, urban school district. PARTICIPANTS Twenty third- through fourth-grade classrooms across 6 schools. MAIN OUTCOMES Dependent variables include percentage of total and served milk wasted. Independent variables included observed daily menu offerings, program factors, and teacher and student behavior. ANALYSIS Descriptive statistics were used to characterize variables across classrooms and schools. Multilevel mixed-effects models were used to test associations between predictors and outcomes of interest. P ≤ .05 was considered statistically significant. RESULTS Total milk waste increased 12% when juice was offered and 3% for each additional carton of unserved milk. Teacher encouragement to take and/or consume breakfast was associated with a 5% and 9% increase in total and served milk waste, respectively. When students were engaged in other activities in addition to eating breakfast, total milk waste decreased 10%. CONCLUSIONS AND IMPLICATIONS Beverage offerings were predictive of greater total milk waste. Teacher and student behavior also appeared to influence milk consumption. Findings suggest that specific changes to School Breakfast Program implementation policies and practices could have an important role in waste mitigation.
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Affiliation(s)
| | - Jeanne P Goldberg
- Division of Nutrition Interventions, Communication, and Behavior Change Program, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sean B Cash
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Timothy S Griffin
- Division of Agriculture, Food, and Environment, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Christina D Economos
- Division of Nutrition Interventions, Communication, and Behavior Change Program, Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Sotos-Prieto M, Cash SB, Christophi CA, Folta S, Moffatt S, Muegge C, Korre M, Mozaffarian D, Kales SN. Rationale and design of feeding America's bravest: Mediterranean diet-based intervention to change firefighters' eating habits and improve cardiovascular risk profiles. Contemp Clin Trials 2017; 61:101-107. [PMID: 28710052 DOI: 10.1016/j.cct.2017.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 03/19/2017] [Revised: 06/08/2017] [Accepted: 07/07/2017] [Indexed: 11/19/2022]
Abstract
Among US firefighters, cardiovascular disease is the leading cause of on-duty death. Poor diet contributes to this burden, but effective strategies to encourage healthy eating in the fire service are not established. "Feeding America's Bravest" motivates firefighters and their families to modify their food culture and reduce cardiometabolic risk profiles by adopting Mediterranean diet principles. Feeding America's Bravest is a cluster-randomized, controlled trial within the 44 stations of the Indianapolis Fire Department, including about 1000 firefighters. It compares a Mediterranean Diet Nutritional Intervention (MDNI) (group 1) vs. usual care (group 2) for 12months; followed by 12months of self-sustained continuation phase in the group 1 and cross-over to Mediterranean Diet Nutritional Intervention in group 2. Group 2 will receive the MDNI for 6months to test the efficacy of a shorter intervention followed by 6months of self-sustained phase. The intervention includes behavioral and environmental components. The primary outcome is 12-month change in Mediterranean diet score comparing group 1 vs. group 2; we will also assess 12- and 24-month change in group 1, and 6- and 12-month change in group 2, from baseline. Secondary outcomes are changes in body weight, body composition and other cardiometabolic risk markers; and correlations between self-reported dietary habits and biomarkers of dietary adherence. This innovative trial tests a novel worksite approach to introduce Mediterranean diet among US firefighters, through multi-pronged MDNI combining evidence-based behavior change strategies with economic incentives, family and peer support and environmental changes, informing recommendations for the US fire service and potentially other similar workforces. TRIAL REGISTRATION NUMBER NCT02941757.
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Affiliation(s)
- Mercedes Sotos-Prieto
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Department of Food Science and Nutrition, School of Applied Heath Sciences and Wellness, Ohio University, Athens, OH 45701, United States.
| | - Sean B Cash
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Costas A Christophi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States; Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, 30 Archbishop Kyprianou Str., 3036 Lemesos, Cyprus.
| | - Sara Folta
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Steven Moffatt
- National Institute for Public Safety Health, IN 324 E New York Street, Indianapolis, IN 46204, United States.
| | - Carolyn Muegge
- National Institute for Public Safety Health, IN 324 E New York Street, Indianapolis, IN 46204, United States.
| | - Maria Korre
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States.
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, United States.
| | - Stefanos N Kales
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States.
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Hartmann M, Cash SB, Yeh CH, Landwehr SC, McAlister AR. Children's purchase behavior in the snack market: Can branding or lower prices motivate healthier choices? Appetite 2017. [PMID: 28625855 DOI: 10.1016/j.appet.2017.06.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/19/2022]
Abstract
BACKGROUND Children's dietary-related diseases and their associated costs have expanded dramatically in many countries, making children's food choice a policy issue of increasing relevance. As children spend a considerable amount of money on energy-dense, nutrient-poor (EDNP) products, a better understanding of the main drivers of children's independent food purchase decisions is crucial to move this behavior toward healthier options. OBJECTIVE The objective of the study is to investigate the role of branding and price in motivating children to choose healthier snack options. METHODS The study investigates snack choices of children ages 8 to 11, using a survey and a purchase experiment. The research took place in after-school programs of selected schools in the Boston area. Participants included 116 children. Products in the choice experiment differed on three factors: product type, brand, and price. Data were analyzed using aggregated and mixed logit models. RESULTS Children's purchase decisions are primarily determined by product type (Importance Value (IV) 56.6%), while brand (IV 22.8%) and price (IV 20.6%) prove to be of less relevance. Only those children who state that they like the familiar brand reveal a preference for the branded product in their purchase decision. Price is a significant predictor of choice when controlling for whether or not children obtain an allowance. CONCLUSION It is not simple brand awareness but a child's liking of the brand that determines whether a brand is successful in motivating a child to choose a product. The extent of children's experience with money influences their price responsiveness. To the extent that children who receive an allowance are primarily the ones buying food snacks, higher prices for EDNP snacks could be successful in motivating children to choose a healthier option.
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Affiliation(s)
- Monika Hartmann
- Institute for Food and Resource Economics, University of Bonn, Nussallee 21, D-53115 Bonn, Germany.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA.
| | - Ching-Hua Yeh
- Institute for Food and Resource Economics, University of Bonn, Nussallee 21, D-53115 Bonn, Germany.
| | - Stefanie C Landwehr
- Institute for Food and Resource Economics, University of Bonn, Nussallee 21, D-53115 Bonn, Germany.
| | - Anna R McAlister
- Curtis L. Gerrish School of Business, Endicott College, 376 Hale Street, Beverly, MA 01915, USA.
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Blondin SA, Cash SB, Goldberg JP, Griffin TS, Economos CD. Nutritional, Economic, and Environmental Costs of Milk Waste in a Classroom School Breakfast Program. Am J Public Health 2017; 107:590-592. [PMID: 28207338 DOI: 10.2105/ajph.2016.303647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To measure fluid milk waste in a US School Breakfast in the Classroom Program and estimate its nutritional, economic, and environmental effects. METHODS Fluid milk waste was directly measured on 60 elementary school classroom days in a medium-sized, urban district. The US Department of Agriculture nutrition database, district cost data, and carbon dioxide equivalent (CO2e) emissions and water footprint estimates for fluid milk were used to calculate the associated nutritional, economic, and environmental costs. RESULTS Of the total milk offered to School Breakfast Program participants, 45% was wasted. A considerably smaller portion of served milk was wasted (26%). The amount of milk wasted translated into 27% of vitamin D and 41% of calcium required of School Breakfast Program meals. The economic and environmental costs amounted to an estimated $274 782 (16% of the district's total annual School Breakfast Program food expenditures), 644 893 kilograms of CO2e, and 192 260 155 liters of water over the school year in the district. CONCLUSIONS These substantial effects of milk waste undermine the School Breakfast Program's capacity to ensure short- and long-term food security and federal food waste reduction targets. Interventions that reduce waste are urgently needed.
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Affiliation(s)
- Stacy A Blondin
- All of the authors are with Tufts University Friedman School of Nutrition Science and Policy, Boston, MA
| | - Sean B Cash
- All of the authors are with Tufts University Friedman School of Nutrition Science and Policy, Boston, MA
| | - Jeanne P Goldberg
- All of the authors are with Tufts University Friedman School of Nutrition Science and Policy, Boston, MA
| | - Timothy S Griffin
- All of the authors are with Tufts University Friedman School of Nutrition Science and Policy, Boston, MA
| | - Christina D Economos
- All of the authors are with Tufts University Friedman School of Nutrition Science and Policy, Boston, MA
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Cash SB, Adamowicz WL, Allen S, McAlister AR. Children's response to food price and warning interventions when purchasing snack foods. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.842.13] [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: 11/11/2022]
Affiliation(s)
- Sean B Cash
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMA
| | - Wiktor L. Adamowicz
- Resource Economics and Environmental SociologyUniversity of AlbertaEdmontonABCanada
| | - Shannon Allen
- Resource Economics and Environmental SociologyUniversity of AlbertaEdmontonABCanada
| | - Anna R. McAlister
- Advertising, Public Relations, and RetailingMichigan State UniversityEast LansingMI
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de Wals P, Cash SB, von Tigerstrom B, Chauliac M, Mongeau L, Kendall P, Le Bodo Y. Is Sugar-Sweetened Beverages Taxation Relevant to Support Healthy Lifestyles and to Prevent Obesity? Can J Diabetes 2013. [DOI: 10.1016/j.jcjd.2013.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Y Freedhoff
- Department of Family Medicine, University of Ottawa, Bariatric Medical Institute, Ottawa, ON
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Faulkner GEJ, Grootendorst P, Nguyen VH, Andreyeva T, Arbour-Nicitopoulos K, Auld MC, Cash SB, Cawley J, Donnelly P, Drewnowski A, Dubé L, Ferrence R, Janssen I, Lafrance J, Lakdawalla D, Mendelsen R, Powell LM, Traill WB, Windmeijer F. Economic instruments for obesity prevention: results of a scoping review and modified Delphi survey. Int J Behav Nutr Phys Act 2011; 8:109. [PMID: 21978599 PMCID: PMC3207922 DOI: 10.1186/1479-5868-8-109] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comprehensive, multi-level approaches are required to address obesity. One important target for intervention is the economic domain. The purpose of this study was to synthesize existing evidence regarding the impact of economic policies targeting obesity and its causal behaviours (diet, physical activity), and to make specific recommendations for the Canadian context. METHODS Arksey and O'Malley's (2005) methodological framework for conducting scoping reviews was adopted for this study and this consisted of two phases: 1) a structured literature search and review, and 2) consultation with experts in the research field through a Delphi survey and an in-person expert panel meeting in April 2010. RESULTS Two key findings from the scoping review included 1) consistent evidence that weight outcomes are responsive to food and beverage prices. The debate on the use of food taxes and subsidies to address obesity should now shift to how best to address practical issues in designing such policies; and 2) very few studies have examined the impact of economic instruments to promote physical activity and clear policy recommendations cannot be made at this time. Delphi survey findings emphasised the relatively modest impact any specific economic instrument would have on obesity independently. Based on empirical evidence and expert opinion, three recommendations were supported. First, to create and implement an effective health filter to review new and current agricultural polices to reduce the possibility that such policies have a deleterious impact on population rates of obesity. Second, to implement a caloric sweetened beverage tax. Third, to examine how to implement fruit and vegetable subsidies targeted at children and low income households. CONCLUSIONS In terms of economic interventions, shifting from empirical evidence to policy recommendation remains challenging. Overall, the evidence is not sufficiently strong to provide clear policy direction. Additionally, the nature of the experiments needed to provide definitive evidence supporting certain policy directions is likely to be complex and potentially unfeasible. However, these are not reasons to take no action. It is likely that policies need to be implemented in the face of an incomplete evidence base.
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Affiliation(s)
- Guy E J Faulkner
- Faculty of Physical Education and Health, University of Toronto, 55 Harbord Street, Toronto, ON M5S2W6, Canada.
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Abstract
The allocation of resources with respect to food safety issues requires that decision makers prioritize these issues, which may conflict with the public's opinions on these matters. The purpose of this study was to compare how Canadian expert and lay respondents rank different food hazards, with a view to better understanding their underlying rationales for making decisions on food safety. A Carnegie Mellon risk ranking model was adapted for use by individuals with different backgrounds to rank six food safety issues: bovine spongiform encephalopathy (BSE), Escherichia coli O157:H7, Salmonella, botulism, paralytic shellfish poisoning (PSP), and acrylamide. Focus groups were conducted using public (n=29) and expert (n=21) participants. Key themes were identified from the focus groups as reasons why issues were rated high or low. The most common themes for high rankings were prevalence (of an agent) and/or severity (of a disease) and knowledge and control of a food safety issue. For the lowest rankings, common themes included low prevalence and severity and personal control over an issue. Explanations for why choices were made included availability, affect, numeracy, and optimistic bias. The majority of the rationales used by all participants were similar with the exception of the high ranking given to acrylamide by the public participants. The effect of attribute framing seemed to be the most influential in a participant's choices. Understanding that comparable reasoning is used in food safety decisions by both experts and the public has important implications for developing productive risk communication dialogues about issues and priorities.
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Affiliation(s)
- Kevin Webster
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
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Minaker LM, Raine KD, Cash SB. Measuring the food service environment: development and implementation of assessment tools. Can J Public Health 2010. [PMID: 20209734 DOI: 10.1007/bf03404337] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The food environment is increasingly being implicated in the obesity epidemic, though few reported measures of it exist. In order to assess the impact of the food environment on food intake, valid measures must be developed and tested. The current study describes the development of a food service environment assessment tool and its implementation in a community setting. METHODS A descriptive study with mixed qualitative and quantitative methods at a large, North American university campus was undertaken. Measures were developed on the basis of a conceptual model of nutrition environments. Measures of community nutrition environment were the number, type and hours of operation of each food service outlet on campus. Measures of consumer nutrition environment were food availability, food affordability, food promotion and nutrition information availability. Seventy-five food service outlets within the geographic boundaries were assessed. RESULTS Assessment tools could be implemented in a reasonable amount of time and showed good face and content validity. The food environments were described and measures were grouped so that food service outlet types could be compared in terms of purchasing convenience, cost/value, healthy food promotion and health. Food service outlet types that scored higher in purchasing convenience and cost/value tended to score lower in healthy food promotion and health. CONCLUSION This study adds evidence that food service outlet types that are convenient to consumers and supply high value (in terms of calories per dollar) tend to be less health-promoting. Results from this study also suggest the possibility of characterizing the food environment according to the type of food service outlet observed.
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Affiliation(s)
- Leia M Minaker
- Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, AB
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