Assessment of food offerings and marketing strategies in the food-service venues at California Children's Hospitals.
ABSTRACT Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children's hospitals.
We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them.
Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13-30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria.
Most children's hospitals' food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register.
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ABSTRACT: Many small grocery stores or "bodegas" sell prepared or ready-to-eat items, filling a niche in the food environment similar to fast-food restaurants. However, little comparative information is available about the nutrition environments of bodegas and fast-food outlets. This study compared the nutrition environments of bodegas and national chain fast-food restaurants using a common audit instrument, the Nutrition Environment Measures Study in Restaurants (NEMS-R) protocol. The analytic sample included 109 bodegas and 107 fast-food restaurants located in New York City neighborhoods in the upper third and lower third of the census tract poverty rate distribution. Inter-rater reliability was evaluated in 102 food outlets, including 31 from the analytic sample and 71 from a supplementary convenience sample. The analysis compared scores on individual NEMS-R items, a total summary score, and subscores indicating healthy food availability, nutrition information, promotions of healthy or unhealthy eating, and price incentives for healthy eating, using t tests and χ(2) statistics to evaluate differences by outlet type and neighborhood poverty. Fast-food restaurants were more likely to provide nutrition information, and bodegas scored higher on healthy food availability, promotions, and pricing. Bodegas and fast-food restaurants had similar NEMS-R total scores (bodegas 13.09, fast food 14.31; P=0.22). NEMS-R total scores were higher (indicating healthier environments) in low- than high-poverty neighborhoods among both bodegas (14.79 vs 11.54; P=0.01) and fast-food restaurants (16.27 vs 11.60; P<0.01). Results imply different policy measures to improve nutrition environments in the two types of food outlets.Journal of the American Academy of Nutrition and Dietetics 09/2013; DOI:10.1016/j.jand.2013.07.007 · 2.44 Impact Factor
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ABSTRACT: Objective. Medical facilities are natural leaders for health promotion because of their mission, influence, and reach. We sought to determine the frequency of physicians reporting supportive, health-promoting environments in their facility and identify characteristics of physicians and medical practices associated with support. Methods. We analyzed a sample of 1485 U.S. primary care physicians in DocStyles 2012 survey. Physicians rated their facility's support for healthy nutrition, physical activity, and lactation environments. Frequencies and adjusted odds ratios for supportive environments (rated "Good" or "Very Good") were assessed by select characteristics. Results. The frequency of physicians reporting supportive environments was 70.0% for nutrition, 60.0% for physical activity, 76.0% for lactation, and 40.4% for all 3 environments combined. Supportive nutrition [odds ratio: 2.91 (1.49-5.66)] and physical activity [2.13 (1.19-3.83)] environments were associated with physicians seeing upper middle class to affluent patients versus poor patients. Supportive lactation environments were associated with pediatricians [3.35 (2.14-5.25)] and obstetricians/gynecologists [3.39 (2.15-5.33)] versus internists. Conclusions. Less than half of physicians reported their facility supportive of all these environments, suggesting there are many missed opportunities for U.S. medical facilities to promote wellness. Facilities serving poor patients and those staffed by internists and family/general practitioners may represent one area of need.Preventive Medicine 07/2014; 67. DOI:10.1016/j.ypmed.2014.06.031 · 2.93 Impact Factor
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ABSTRACT: To describe the nutrition-related knowledge, attitudes, and behaviors of staff managing cafeterias in New York City (NYC) hospitals. An in-person survey was administered over 7 months to cafeteria managers from hospitals participating in the NYC Department of Health and Mental Hygiene's Healthy Hospital Food Initiative. The survey assessed nutrition knowledge and attitudes; hospital cafeteria practices; and nutrition standards and policies. The majority of questions required a yes or no response, followed by an open-ended request for details related to the response. Other questions were multiple choice or used 5-point Likert scales to measure respondent perceptions. Seventeen cafeteria managers completed the survey. Less than a third of respondents had training in nutrition, and less than a quarter of hospitals followed nutrition standards for food offered in the cafeteria. Most respondents thought cafeterias could play a role in reducing sodium consumption, yet less than half correctly identified the largest sources of sodium in the average diet. The most commonly cited limitation to making healthy changes in the cafeteria was perceived lack of demand for healthy foods/customer support. Characteristics, nutrition knowledge, and attitudes of hospital cafeteria managers vary. Communication with consumers and education of staff who lack training and experience in nutrition may be important focus areas for hospitals looking to improve their food environment.Journal of public health management and practice: JPHMP 07/2013; DOI:10.1097/PHH.0b013e31829f7378 · 1.47 Impact Factor