Relative Impact of Nutritional Warnings and Other Label Features on Cereal Bar Healthfulness Evaluations

ObjectiveTo investigate the relative influence of nutritional warnings and 2 marketing strategies commonly used in food labels, nutrient claims, and fruit images on consumers’ healthfulness judgments.DesignLabels of cereal bars were designed according to a full factorial design with 3 2-level variables: images of fruit (with vs without), nutrient claims about the fiber content (with vs without), and nutritional warnings about excessive content of sugar and saturated fat (with vs without).SettingExperiment conducted in Montevideo, Uruguay.ParticipantsOne hundred Uruguayan people, 75% female, aged 18–56 years.Main Outcome MeasuresHealthfulness perception and eye-tracking variables.AnalysisThe researchers used ANOVA to evaluate the influence of the experimental design's variables on perceived healthfulness and eye-tracking measures.ResultsNutritional warnings caught participants’ attention and reduced the amount of visual attention needed to evaluate healthfulness. Participants mainly relied on nutritional warnings to make healthfulness judgments.Conclusions and ImplicationsFindings of the current work confirm the potential of nutritional warnings to influence consumers’ healthfulness perception, overriding the effect of other label cues used by the food industry to convey the concept of healthfulness.     

The Food Environment of Primary School Learners in a Low-to-Middle-Income Area in Cape Town,South Africa

Rapid changes in food environments, where less nutritious foods have become cheaper and more accessible, have led to the double burden of malnutrition (DBM). The role food environments have played in shaping the DBM has attained global interest. There is a paucity of food environment research in low-to-middle-income countries. We conducted a case study of the food environments of school aged learners. A primary school in Cape Town was recruited. A multi-method design was used: a home food and eating behaviours questionnaire completed by 102 household respondents and four questions completed by 152 learners; learner participatory photography; a semi-structured school principal interview; a tuckshop inventory; observation of three-day tuckshop purchases. Foods that were commonly present in households: refined carbohydrates, fats/oils, chicken, processed meats, vegetables, fruit, legumes, snacks/drinks. Two thirds of households had rules about unhealthy drinks/snacks, ate supper together and in front of the TV, ate a home cooked meal five–seven times/week and ate breakfast together under two times/week. Vegetables were eaten under two times/week in 45% of households. A majority of learners (84%) took a lunchbox to school. Twenty-five learners photographed their food environment and 15 participated in semi-structured interviews. Six themes emerged: where to buy; what is available in the home; meal composition; family dynamics; peer engagement; food preparation. Items bought at informal food outlets included snacks, drinks and grocery staples. The principal interview revealed the establishment of a healthy school food environment, including a vegetable garden, although unhealthy snacks were sold at the tuckshop. Key dimensions of the food environment that require further investigation in disadvantaged urban and informal settlement areas include the home availability of unhealthy foods, eating behaviours in households and healthfulness of foods sold by informal food outlets.     

Can a mortality excess in remote areas of Australia be explained by Indigenous status? A case study using neonatal mortality in Queensland

OBJECTIVE: To assess the extent to which indigenous status confounds the association between remoteness and neonatal mortality in Queensland. METHODS: We used routine data from the Queensland Perinatal Data Collection. Poisson regression modelling was used to assess confounding. RESULTS: Babies born to Indigenous mothers have mortality rates 2.42 times those of the rest of the population, regardless of whether they live in urban, rural or remote areas (95% CI 2.09-2.80). The babies of non-Indigenous women who live in remote areas have a low risk of neonatal death, similar to their rural and urban counterparts. CONCLUSION: In Queensland, the key demographic variable that determines neonatal mortality is indigenous status, not remoteness. IMPLICATIONS: Policymakers should not assume that an excess of a particular health problem in remote areas necessarily reflects equal disadvantage for all the Australians who live there.     

Consumer satisfaction with pork meat and derived products in five European countries

This paper investigates consumers' satisfaction level with pork meat and derived products in five European countries. Data were collected through a cross-sectional web-based survey in Belgium, Denmark, Germany, Greece, and Poland during January 2008 with a total sample of 2437 consumers. Data included socio-demographics and questions regarding satisfaction with 27 common pork-based products; classified into fresh pork, processed pork and pork meat products. Satisfaction was evaluated in terms of overall satisfaction, as well as satisfaction with health-giving qualities, price, convenience and taste. Logistic regression analyses showed taste as the main determinant of satisfaction, followed by convenience. Healthfulness is not a significant driver of overall satisfaction. Price influences satisfaction with fresh pork more than with processed products. Tasty pork, easy to prepare and consume, with adequate promotion of its healthfulness, and with a good price/quality relationship appears to be the key factor to satisfy pork consumers.     

“Healthy”/“Unhealthy” Food Brands Influence Health,Calorie, and Price Ratings of Food

ObjectiveTo assess the effect of healthy or unhealthy food brands on consumer ratings of a food's perceived healthfulness, caloric content, and estimated price.MethodsUsing a crossover design, 35 adults aged 18–25 years scored a variety of healthy and unhealthy foods paired with “healthy” or “unhealthy” brands or with no brand present, on their healthfulness, caloric content, and estimated price. For each outcome measure, ANOVA was used to evaluate the effect of brand condition on healthy and unhealthy foods.ResultsPairing an unhealthy food with a “healthy brand” led to increased ratings of healthfulness (P < .001), decreased estimates of caloric content (P < .001), and increased price (P < .001). Pairing a healthy food with an “unhealthy brand” led to decreased ratings of healthfulness (P < .001), increased estimates of caloric content (P < .001), and decreased price (P < .001).Conclusions and ImplicationsThese findings extend previous research showing that brands may influence perceptions of food products. Future studies are needed to understand the implications of pairing healthy foods with “unhealthy brands” on actual food intake.     

Would Students Prefer to Eat Healthier Foods at School?

BACKGROUND: This study sought to elucidate students' perceptions of school food environments and to assess correlations between perceptions and purchasing and consumption behaviors at school. METHODS: Seventh and ninth graders (n = 5365) at 19 schools in multiethnic, low‐income California communities participating in the Healthy Eating Active Communities program completed questionnaires assessing their attitudes and behaviors regarding school food environments during spring 2006. RESULTS: Most students (69%) reported that fresh fruit was important to be able to buy at school; more than chips (21%), candy (28%), or soda (31%). Reported importance of food offerings was correlated with the consumption of those items. Most students did not perceive foods/beverages offered at school to be healthy; fewer than a quarter reported eating fruits or vegetables (FV) at school. Students eating school lunch were more than twice as likely to consume FV, though if they also purchased from competitive venues, their consumption of candy, chips, and soda was similar to their peers who purchased only competitive foods. CONCLUSION: Students report healthy foods to be important to be able to buy at school, but do not perceive their school food environment to be healthy and consume more unhealthy foods at school. Students served healthy items via school lunch are more likely to consume them; however, they also purchase and consume unhealthy items if available. Findings suggest that modifying school food environments to facilitate consumption of healthy foods and limit unhealthy foods will better match students' preferences and could lead to improved dietary intake.     

Warning: attending a sport, racing or arts venue may be beneficial to your health

Abstract: Concerted efforts to create health–promoting sport, racing and arts venues have become possible since the advent of health promotion foundations in four of Australia's eight states and territories. Large numbers of Australians attend sport, racing and arts venues in pursuit of leisure activities. There is evidence that sport and racing participants and spectators, and certain subgroups of the arts community, have adverse risk–factor profiles that make them an ideal target for health promotion interventions. Through the use of sponsorship, health promotion foundations 'purchase' health–promoting policies in sport, racing and arts settings–policies that have the potential to become institutionalised once sponsorship dollars are depleted. This paper discusses the policies 'purchased' by the foundations and outlines a comprehensive surveillance and evaluation system developed for the Western Australian Health Promotion Foundation. The system monitors the implementation of health–promoting environments at the micro level (sponsorship project); intermediate level (sponsored group); and macro level (community). The article concludes by outlining some of the lessons learned in Western Australia. These provide the basis for development of best practice in working with sport, racing and arts groups, and other sectors outside health, to create health–promoting environments.     

Food Outlet Density,Distance, and Food Quality Offered to Preschool-Aged Children at Family Child Care Homes

ObjectiveTo examine how food environments around family child care homes (FCCHs) are associated with the healthfulness of foods served to children.DesignCross-sectional data from a mail survey of FCCH providers, InfoUSA.ParticipantsThe study included 132 Mississippi FCCHs (26% response).Main Outcome MeasuresDependent: compliance with nutrition best practices for 9 food categories; composite healthfulness score. Independent: counts of supermarkets, small-medium grocery stores, produce stores, convenience stores within 5 miles; distance to supermarket.AnalysisLogistic regression estimated associations between best-practice compliance and food environment. Linear regression estimated associations between composite food healthfulness and food environment. Models stratified by rural/urban location.ResultsRural FCCHs with higher counts of supermarkets, convenience stores, and produce stores had lower compliance with selected best practices (fried/prefried potatoes, high-sugar/high-fat foods). Urban FCCHs with more supermarkets had higher compliance with fruit not canned in syrup; those with more small-medium grocery stores and convenience stores had lower compliance with selected best practices (fried/prefried potatoes, vegetables, low-fat meats).Conclusions and ImplicationsFood environment measures were associated with some nutrition best practices, though not consistently in the expected direction. Future research could examine food quality at stores near rural FCCHs. Programs that improve local food environments may improve foods served at FCCHs.     

Spatial patterning of supermarkets and fast food outlets with respect to neighborhood characteristics

A large body of literature has reported differences in exposure to environments supporting either healthy (e.g. supermarkets) or unhealthy (e.g. fast food outlets) dietary choices by neighborhood characteristics. We explored the associations of both supermarkets and fast food outlets availability with neighborhood characteristics, and clustering of these two outlet types in a largely rural state. Compared to block groups without a supermarket, those with a supermarket had a significantly higher income, higher housing value, larger population with high school education and above, lower minority population and lower population living below poverty even after controlling for urbanicity and population density of census block groups. Surprisingly, a similar relationship was found for block groups with and without fast food outlets. This was due to spatial co-occurrence and clustering of fast food outlets around supermarket locations. Hence, future studies exploring the associations of food environment with diet or diet-related health outcome should concurrently examine all aspects of food environment (healthy and unhealthy).     

Raising the level of analysis of food-borne outbreaks: food-sharing networks in rural coastal Ecuador

OBJECTIVES: Consuming contaminated food is a well-documented individual-level risk factor for diarrheal disease. The sharing of food also influences the distribution of diarrheal disease risk through a community and region. Understanding this social process at a population level is therefore an important dimension of risk not captured by standard individual-level analyses. We examined social networks related to food-sharing in rural villages at 2 scales: within a village, examining whether connections within these networks clustered or were uniformly spread; and among villages, looking at whether food-sharing networks differed according to the village's remoteness from a population center. METHODS: We surveyed 2129 individuals aged 13 years and older in 2003-2004, within a representative (block-randomized) sample of 21 rural villages in Esmeraldas province, northern coastal Ecuador. We calculated degree (number of social contacts) for a social network defined by sharing food. RESULTS: Networks of households sharing food differ according to remoteness from a metropolitan center. On average, residents living in "far villages" had 2 more social contacts than those in "close villages," and 12 more years of residence in their village. Estimates of transmissibility (a measure of outbreak potential) based on network structure varied as much as 2-fold across these villages. CONCLUSIONS: Food-sharing practices link particular households in rural villages and have implications for the spread of food-borne pathogens. The food-sharing networks in remote rural villages are heterogeneous and clustered, consistent with contemporary theories about disease transmitters. Network-based measures may offer tools for predicting patterns of disease outbreaks, as well as guidance for interventions.     

Historical redlining and food environments: A study of 102 urban areas in the United States

ObjectiveUnhealthy food environments are disproportionally concentrated in neighborhoods with clustering of racial/ethnic minorities and poverty. This disparity has been blamed, in part, on market self-regulation. This explanation risks overlooking past and current practices of racial segregation that have created and reinforced the obstacles blocking investments from food retailers in marginalized neighborhoods. We fill this gap by investigating how the long-term ramifications of redlining, discriminatory housing practices enacted by federal Home Owner Lending Corporation (HOLC) in the 1930s, has evolved generations later to disproportionally exposing neighborhoods to unhealthy food environments.MethodsWe overlaid historical redlining maps over 2010 food environment observations at the census tract level to identify areas with less healthy food environments and to assess the historical context of those areas. For 11,651 census tracts within 102 U.S. urban areas, we described the healthiness of food environments as measured by the modified retail food environment index (mRFEI). Using hurdle models with random effects, we further examined the association between redlining housing practice and food environments.ResultsThe results indicate that historically redlined neighborhoods show a higher likelihood for unhealthy retail food environments even for census tracts with present-day economic and racial privilege.ConclusionThe current evidence shows how structural discrimination manifested by unjust housing practices and racial residential segregation fueled an uneven food environment where minority neighborhoods disproportionally bore the brunt of restrictive food access. It highlights an urgent need to ameliorate patterns of housing inequality as a fix to unequal food environments.     

Minority stress and community connectedness among gay,lesbian and bisexual Australians: a comparison of rural and metropolitan localities

Objective: To determine whether lesbian, gay and bisexual (LGB) Australians residing in rural‐remote and other non‐inner metropolitan localities experience increased levels of minority stress and reduced social support relative to their inner metropolitan counterparts. Methods: A convenience sample of (n=1306) LGB Australians completed an online survey that assessed minority stressors, level of connection with other LGB individuals and social isolation. Postcodes provided were coded into three metropolitan and two rural zones. A series of hierarchical regression analyses were undertaken to examine the effect of locality on minority stress and social support independent of sex, age, ethnicity, education and income. Results: Those residing in rural‐remote localities reported significantly increased concealment of sexuality from friends, more concern regarding disclosure of sexuality, less LGB community involvement, fewer friendships with other LGB people and, among men, higher levels of internalised homophobia than those residing in inner metropolitan areas. Unexpectedly, those residing in outer metropolitan areas of major cities experienced comparable levels of minority stress and LGB disconnection to those in rural and remote Australia. Conclusions: LGB individuals in rural‐remote and outer metropolitan areas of major cities face increased exposure to a number of minority stressors and less LGB community connectedness. These are risk factors associated with psychiatric morbidity in LGB populations. Implications: Health promotion targeted at reducing homophobia and discrimination in rural‐remote and outer metropolitan communities and additional services to assist LGB Australians struggling with stigma and isolation in non‐inner city areas may help mitigate the disadvantages faced by these LGB populations.     

A cross-national comparison of lifestyle between China and the United States, using a comprehensive cross-national measurement tool of the healthfulness of lifestyles: the Lifestyle Index

BACKGROUND: Extensive studies have revealed the importance of a healthy lifestyle and the role of each lifestyle factor in health. However, lifestyle factors have rarely been studied simultaneously. The authors propose an integrated approach to summarize total healthfulness of lifestyles and to enhance understanding of lifestyle patterns across countries. METHODS: The authors created an overall measure of lifestyle called the Lifestyle Index (LI), integrating diet, physical activity, smoking, and alcohol use to provide a global tool of monitoring healthfulness and patterns of lifestyles. Using the LI, the authors conducted a cross-national comparison between China (n = 8352) and the United States (n = 9750). RESULTS: The LI effectively reflected the healthfulness of lifestyle components in both countries. The mean of the LI scores was slightly higher in China than the US. Scores of diet quality, physical activity, and smoking were higher in China, but scores of alcohol behavior were higher in the US. Similar lifestyle patterns but different unhealthy behaviors were identified in these countries. CONCLUSIONS: An assessment of total healthfulness of lifestyles and a better understanding of lifestyle patterns across countries using the LI can provide practical guidance to developing and targeting public health promotion activities to improve global public health.     

Breakfast choice: An experiment combining a nutritional training workshop targeting adolescents and the promotion of unhealthy products

A randomised control trial was conducted to determine changes in the food and drink choices of adolescents following their participation in a 50‐min nutrition workshop. The experiment was conducted at 104 schools in Barcelona (126 classes, 3,291 adolescents). Schools were randomly selected and stratified by district and by public or private status. The students were given three types of vouchers with different options regarding the type of food for which the vouchers could be exchanged (standard for healthy food and drink, two for one for unhealthy food, and two for one for unhealthy drink). Difference‐in‐differences linear models that control for individual, family, school or neighbourhood characteristics, and the influence of peers were applied. The probability of students' choosing unhealthy food and drink fell by 7.1% and 4.4%, respectively, following participation in the nutrition workshop. The promotion of unhealthy beverages counteracted the positive impact of the workshop on beverage choice.     

Quality of Nutrition Environments,Menus and Foods Served,and Food Program Achievement in Oklahoma Family Child Care Homes

Child care environments foster children’s healthy eating habits by providing exposure to healthy foods and feeding practices. We assessed the healthfulness of nutrition environments, menu/meal quality, and the achievement of Child and Adult Care Food Program (CACFP) guidelines and best practices in Oklahoma CACFP-enrolled family child care homes (FCCHs) (n = 51). Two-day classroom observations were conducted. Healthfulness of classroom nutrition environments was assessed using the Environment and Policy Assessment and Observation (EPAO). Foods served to and consumed by children were quantified using the Dietary Observations in Child Care (DOCC) tool. Nutrient analysis was performed to determine total energy for foods listed on menus, served to, and consumed by children. Menu and meal food variety and CACFP Guideline Achievement Scores were determined. Average nutrition environment score was 11.7 ± 1.2 (61.5% of maximum possible score). Energy (kcals) from menus and consumed by children was insufficient to meet two-thirds of their daily reference intake. Children were exposed to 1.7 vegetables and 1.3 fruits per meal. CACFP Guideline Achievement Scores were 66.3% ± 7.8 for menus and 59.3% ± 7.6 for mealtimes. Similar to previous research, our findings indicate a need for improved FCCH nutrition practices. Tailored interventions for FCCHs are needed.     

Characterizing Dietary Intakes in Rural Australian Adults: A Systematic Literature Review

Rural Australians experience a higher burden of diet-related chronic disease than their metropolitan counterparts. Dietary intake data is needed to understand priorities for nutrition initiatives that reduce disparities in the health of rural Australians. A systematic literature review aimed to synthesize the evidence on dietary intakes in adult populations residing in rural and remote Australia, to identify areas for intervention, and make recommendations for future research. A comprehensive search of five electronic databases was conducted and 22 articles were identified for inclusion. Half of the included studies (50%) collected dietary data using non-validated questionnaires and nearly half (41%) did not benchmark dietary intakes against public health guidelines. Most studies (95%) showed that rural populations have suboptimal dietary intakes. Despite the high level of preventable diet-related disease in rural and remote Australia, this review identified that there is insufficient high-quality dietary data available and a lack of consistency between dietary outcomes collected in research to inform priority areas for intervention. Further cross-sectional or longitudinal data should be collected across all remoteness areas, using robust, validated dietary assessment tools to adequately inform nutrition priorities and policies that reduce rural health disparities.     

Adopting and implementing nutrition guidelines in recreational facilities: Public and private sector roles. A multiple case study

ABSTRACT: BACKGROUND: Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children's access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. METHODS: We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. RESULTS: The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers' nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. CONCLUSIONS: ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.     

“No‐one’s driving this bus” – qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men

Objective : HIV prevention tools such as pre‐exposure prophylaxis require equitable access and uptake to protect all at‐risk populations. This project assessed the perceived barriers to accessible HIV prevention for Aboriginal and Torres Strait Islander gay and bisexual men (GBM) and evaluated the presence of health promotion for pre‐exposure prophylaxis (PrEP) for this population from the perspective of service providers. Methods : Eighteen semi‐structured interviews with healthcare providers, researchers and AIDS Council employees were qualitatively analysed for themes and concepts related to PrEP‐specific health promotion. Results : Respondents noted AIDS Councils and affiliated sexual health clinics had been instrumental in promoting PrEP to at‐risk GBM. However, many Aboriginal gay and bisexual men who are not well connected with these communities and services may not have been exposed to this health promotion and therefore have not accessed PrEP effectively. Conclusions : Aboriginal community and gay community controlled health organisations need to collaborate to ensure they deliver effective and tailored health promotion to Aboriginal communities. Implications for public health : The rising HIV notification rates in Aboriginal Australians is an example of the health gap experienced by First Nation people. Effective HIV prevention is required to ensure this gap does not widen further, and that Australia meets its goal of preventing all new HIV infections. However, these efforts will be hampered by ineffective health promotion of HIV prevention tools, such as PrEP, for Aboriginal Australians.     

Healthfulness,Modernity, and Availability of Food and Beverages: Adolescents’ Perceptions in Southern India

This study uses freelists to document perceptions of healthfulness, modernity, and availability of foods and beverages among adolescents ages 13–18 years (n = 26) in urbanizing India. Among the 10 foods and beverages adolescents perceived as “new,” half were also seen as modern and unhealthy, 4 as traditional and unhealthy, and 3 as modern and healthy. Of those 10 “new” foods, 4 were reported as available only in supermarkets, 4 only in kiraana (local) stores, and 6 in both. Adolescents ascribed healthfulness and modernity to food and beverage items and were aware of their availability across stores.     

The extent and nature of food promotion directed to children in Australian supermarkets

The aim of this study was to describe the nature and amount of sales promotion use on food packaging in selected Australian supermarkets, specifically those directed at children through the use of premium offers, such as giveaways and competitions, and cartoon and movie character promotions. The study also examined the promotion of healthy versus unhealthy foods. Nine supermarkets located across the metropolitan area of Sydney, Australia were surveyed to assess the extent and nature of food promotion directed at children. The number and types of promotions were measured within seven food categories: sweet biscuits, snack foods, confectionery, chips/savoury snacks, cereals, dairy snacks and ice cream. Any foods that utilized promotional tactics were categorized as either healthy or unhealthy, according to set criteria. The study found that within the seven food categories between 9 and 35% of food products used promotional tactics. The use of television, movie celebrities and cartoon characters for promotion was most common, making up 75% of all promotions. Giveaways accounted for 13% of all promotions. When used, giveaways were commonly used in conjunction with another promotional method. Data from this study also confirmed that 82% of all food promotions were for unhealthy foods and only 18% were used to promote healthy foods. However, for dairy snacks and ice cream the majority of promotions, 99 and 65%, respectively, were healthier choices. This was the first study to describe the extent and nature of food promotions used in supermarkets. The promotion of unhealthy foods in supermarkets is common and is one of the many factors contributing to today's obesity promoting environment. Further research is required to determine the impact of food promotions on children's dietary intake, and to determine the most effective ways to restrict the promotion of unhealthy foods.