Article

The Effects of a Multimedia System in Supermarkets To Alter Shoppers' Food Purchases

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

A randomized-control test of a multimedia nutrition intervention-the Nutrition for a Lifetime System (NLS©)- utilized supermarket receipts to examine effects of NLS treatment on the daily per person nutritional content of participants' supermarket purchases. In regression analyses controlling for background variables, baseline purchases and trends toward increased purchasing, NLS treatment contributed to lower levels of total fat and to higher levels of total fiber and servings of fruits and vegetables at post-test. Redemption of NLS coupons contributed to greater decreases in fat and increases in servings of fruits and vegetables in users' purchases. Implications for future interventions promoting healthier food choices include tailoring program content and addressing broader lifestyle issues such as caloric intake and expenditure.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... In almost half of the studies (16 studies), the goal was to increase sales of healthy products and the most targeted product category was fruits and vegetables, which was covered in 15 studies. Studies defined healthy products as fruit or vegetable [52][53][54][59][60][61][62][63][64][65][66][67][68][69][70], products with high nutritional "grade" (e.g., "3-star"or "green" rating) [57,[71][72][73][74][75][76][77][78], high fiber [61,62,70], low fat products [56,[79][80][81], low-calorie snacks [81] or healthy beverages (e.g., water or diet soda) [56,63]. ...
... In almost half of the studies (16 studies), the goal was to increase sales of healthy products and the most targeted product category was fruits and vegetables, which was covered in 15 studies. Studies defined healthy products as fruit or vegetable [52][53][54][59][60][61][62][63][64][65][66][67][68][69][70], products with high nutritional "grade" (e.g., "3-star"or "green" rating) [57,[71][72][73][74][75][76][77][78], high fiber [61,62,70], low fat products [56,[79][80][81], low-calorie snacks [81] or healthy beverages (e.g., water or diet soda) [56,63]. ...
... Eight studies targeted reduction in unhealthy food products, with reduction in fat (total fat or saturated fat) and sugar soda being the most targeted outcomes [55,56,[61][62][63]66,70,75,76,82,83]. Studies. ...
Article
Full-text available
Grocery stores are important settings to promote healthier food and beverage choices. The present paper aims at reviewing the effectiveness of different types of in-store interventions and how they impact sales of different product category in real grocery stores. Systematic search was conducted in six databases. In-store interventions were categorized according to the framework by Kraak et al. (2017) into one or more of eight interventions (e.g., place, profile, portion, pricing, promotion, healthy default picks, prompting and proximity). This systematic theme-based review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) data screening and selection. Thirty-six studies were included in the qualitative synthesis and 30 studies were included in the meta-analysis, representing 72 combinations of in-store interventions. The analysis demonstrates that interventions overall had small significant effect size (ES) using Cohen's d on food purchase behavior (d = 0.17, 95% CI [0.04, 0.09]), with largest ES for pricing (d = 0.21) and targeting fruits and vegetables (d = 0.28). Analysis of ES of in-store interventions show that pricing, and pricing combined with promotion and prompting, effectively impacted purchase behavior. Interventions significantly impacted both sales of healthy and unhealthy products and significantly increased sales of fruits and vegetables, healthy beverage and total volume of healthy products. Results should however be interpreted with some caution, given the relatively low quality of overall evidence and low number of studies and observations for some types of intervention. Further research exploring impact on different in-store interventions and targeting especially unhealthy products are needed.
... Personalized nutrition education plus incentive programs (n ¼ 25) 35-38,40-43,45,50,80,81,82,100,110, 123,183,197,198,205,208,209,211,213,216 . ...
... The categories found to be most effective at producing healthier shopping behaviors and purchases were signage, displays and nutrition labels (n ¼ 9) 146,148,150,153,155,157,162,163,166 ; gr o up classes/store tours (n ¼ 5) 67, 184,186,187,189 ; and a combination of incentive program, path-to-purchase marketing and personalized nutrition education (n ¼ 21). 40,42,45,47,81,110,183,197,[201][202][203][204][205][206][207][208][209][210][211][212][213] Eating Habits. Sixty-five studies looked at behavior change, focusing on improvement in eating habits, such as inclusion of more fruits and vegetables in the diet or the consumption of fewer sugar-sweetened beverages. ...
... Sixty-five studies looked at behavior change, focusing on improvement in eating habits, such as inclusion of more fruits and vegetables in the diet or the consumption of fewer sugar-sweetened beverages. Fifty-four studies reported improvements in eating habits, with coupon/vouchers (n ¼ 8) 69,72,77,78,89,98,104,108 and a combination of personalized nutrition education with path-to-purchase marketing (n ¼ 3) 83,214,215 and incentive programs (n ¼ 14) 36,37,41,43,45,80-82, 100, 123,198,205,211,216 resulting in the most improvement in eating habits. ...
Article
As nutrition-related diseases contribute to rising health care costs, food retail settings are providing a unique opportunity for registered dietitian nutritionists (RDNs) to address the nutritional needs of consumers. Food as Medicine interventions play a role in preventing and/or managing many chronic conditions that drive health care costs. The objective of this scoping review was to identify and characterize literature examining Food as Medicine interventions within food retail settings and across consumer demographics. An electronic literature search of 8 databases identified 11,404 relevant articles. Results from the searches were screened against inclusion criteria, and intervention effectiveness was assessed for the following outcomes: improvement in health outcomes and cost-effectiveness. One-hundred and eighty-six papers and 25 systematic reviews met inclusion criteria. Five categories surfaced as single interventions: prescription programs, incentive programs, medically tailored nutrition, path-to-purchase marketing, and personalized nutrition education. Multiple combinations of intervention categories, reporting of health outcomes (nutritional quality of shopping purchases, eating habits, biometric measures), and cost-effectiveness (store sales, health care dollar savings) also emerged. The intervention categories that produced both improved health outcomes and cost-effectiveness included a combination of incentive programs, personalized nutrition education, and path-to-purchase marketing. Food as Medicine interventions in the food retail setting can aid consumers in navigating health through diet and nutrition by encompassing the following strategic focus areas: promotion of health and well-being, managing chronic disease, and improving food security. Food retailers should consider the target population and desired focus areas and should engage registered dietitian nutritionists when developing Food as Medicine interventions.
... Sixteen studies were randomised controlled trials, 14 were controlled before and after trials (CBA), one was a CBA with a non-equivalent comparison group [15] and one was a quasi-experimental repeated measures study [16]. Twelve studies had low risk of bias and were classified as strong [16][17][18][19][20][21][22][23][24][25][26][27], nine were moderate [28][29][30][31][32][33][34][35][36] and 11 were weak [15,[37][38][39][40][41][42][43][44][45][46] (Additional file 2: Table S2). The studies classified as weak were still included as they may still have made an important, if lesser, contribution. ...
... Six studies [22,35,36,37,38,43] offered monetary incentives to customers (Table 7). Monetary incentives included price discounts of 12.5% [22], 50% [35] or store coupon/ vouchers [36][37][38]43] valued from 50 cents per coupon [36,43] to $10 per week [38]. ...
... Six studies [22,35,36,37,38,43] offered monetary incentives to customers (Table 7). Monetary incentives included price discounts of 12.5% [22], 50% [35] or store coupon/ vouchers [36][37][38]43] valued from 50 cents per coupon [36,43] to $10 per week [38]. Five studies were conducted in the USA and one in New Zealand [22] (Additional file 5: Table S5). ...
Article
Full-text available
Point-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting. Records from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome. The search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions. A range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.
... The development of computer-based interventions, however, must rest on a firm theoretical foundation to realize the potential for behavior change and risk reduction (23,24). The Nutrition for a Lifetime System © (NLS) is a self-administered, computer-based intervention based on social cognitive theory (24) developed through a series of small efficacy studies centered in supermarkets (22,25). Though of minimal dose, the NLS provides users with personalized information, behavioral strategies, and incentives for change as well as a vehicle for planning and receiving feedback on personal behavior change goals. ...
... One effective way to increase the accuracy of self-reported food frequency surveys is to collect them in conjunction with perceived or real verifiable objective data (28). Previous research with the NLS found that annotated food shopping receipts, collected over a period of time, can provide an objective, sensitive measure of nutrition behavior of individual food shoppers (21,22,25). In conjunction with a database of supermarket foods developed specifically to evaluate nutritional content of food purchases (21), supermarket receipts can provide rich data regarding the nutritional status of individuals and families whose diets consist largely of foods purchased at food stores. ...
... Participants were recruited in five supermarkets using procedures consistent with store operations involving brief face-to-face contact followed by a mail back of enrollment materials (these procedures are described in detail elsewhere) (25). To enroll in the study, participants were required to complete a detailed demographic survey and to mail back at least 4 weeks of annotated food shopping receipts. ...
Article
Full-text available
This study examined the direct and mediated impact of a self-administered, computer-based intervention on nutrition behavior self-efficacy, and outcome expectations among supermarket food shoppers. The intervention, housed in kiosks in supermarkets and based on social cognitive theory, used tailored information and self-regulation strategies delivered in 15 brief weekly segments. The study sample (N = 277), stratified and randomly assigned to treatment or control, was 96% female, was 92% White, had a median annual income of about $35,000, and had a mean education of 14. 78 +/- 2.11 years. About 12% of the sample reported incomes of $20,000 or less, and about 20% reported 12 years or fewer of education. Analysis of covariance immediately after intervention and at a 4- to 6-month follow-up found that treatment led to improved levels of fat, fiber, and fruits and vegetables. Treatment also led to higher levels of nutrition-related self-efficacy, physical outcome expectations, and social outcome expectations. Logistic regression analysis determined that the treatment group was more likely than the control group to attain goals for fat, fiber, and fruits and vegetables at posttest and to attain goals for fat at follow-up. Latent variable structural equation analysis revealed self-efficacy and physical outcome expectations mediated treatment effects on nutrition. In addition, physical outcome expectations mediated the effect of self-efficacy on nutrition outcomes. Implications for future computer-based health promotion interventions are discussed.
... The NLS programs focused on small, targeted changes within a food group to meet nutritional guidelines. A series of randomized control field studies with NLS demonstrated that NLS users decreased fat and increased fiber, fruits, and vegetables in their supermarket food purchases104105106107 and could maintain some of these changes after contact with the program ended as assessed by a system using participants' food shopping receipts [108] . Program acceptability and nutrition effects held across study participants from a range of socioeconomic groups105106107. ...
... The NLS followed SCT and its programs contained tailored information based on assessments and progress in meeting goals, personal feedback, goal setting, planning, and incentive components. Winett and colleagues developed and tested measures of specific SCT variables operating in the NLS [104]. In a unique empirical test of the SCT model, Anderson, Winett, and colleagues demonstrated that the NLS was effective in changing users' nutrition-related selfefficacy and outcome expectancies, which resulted in dietary changes [105]. ...
Article
A major focus of Healthy People 2010 is promoting weight management and physical activity because overweight, obesity, and a sedentary lifestyle are strongly associated with risk for heart disease and stroke, diabetes, cancers, and premature death. Prevalence data and a focused review of weight management and physical activity studies point to the long-term weight gain prevention in normal weight (21-25 BMI), overweight (25-29 BMI), and even moderate obese (30-34 BMI) people as one alternative to prioritizing weight loss in health behavior interventions. This is because on a population basis annual weight gain is small (approximately 0.8 kg/year) and preventing weight gain appears to require only an energy shift of about 100 cal/day either through a modest increase in physical activity and/or consuming slightly less calories to maintain an energy balance. A more dynamic use of social cognitive theory (SCT) for developing programs to maintain health behavior changes is emerging with some evidence of long-term maintenance. The high use of the Internet provides a vehicle to reach different population segments with readily accessible, SCT-tailored long-term programs. Research studies using the Internet with tailored SCT interventions have shown changes in nutrition practices, physical activity, and weight loss for up to a year. One promising approach to weight gain prevention in population segments is the development and wide spread use of longer-term Internet programs using specific principles and procedures from SCT.
... All but 1 of the 9 studies comparing price decreases with control detected a statistically significant increase in purchases for ≥1 of the target items (see Table 3); none of the studies that decreased prices of healthy food reported increases in purchases of unhealthy items. Both Anderson et al. (19) and Ni Mhurchu et al. (37), reporting studies that aimed to increase healthy food purchases, found a statistically significant increase in purchase of target items and a statistically significant decrease in purchases of fat. Three studies aiming to increase purchases across a range of items only found differences for one of the products measured; Ball et al. (21) (targeting fruit, vegetables, and beverages) only detected a statistically significant increase in vegetable purchases but no differences in consumption; Geliebter et al. (29) (also targeting fruit, vegetables, and beverages) found an increase in purchasing of fruit and vegetables, but no differences in consumption and no differences in beverage purchases; and Budd et al. (23) only detected a statistically significant increase in healthier snack foods, despite also targeting beverages, vegetables, and whole-wheat bread. ...
Article
Full-text available
Background: Diet is an important determinant of health, and food purchasing is a key antecedent to consumption. Objective: We set out to evaluate the effectiveness of grocery store interventions to change food purchasing, and to examine whether effectiveness varied based on intervention components, setting, or socioeconomic status. Design: We conducted a systematic review of randomized controlled trials (search performed June 2017). Studies must have: aimed to change food purchasing; been implemented in grocery stores (real or simulated); reported purchasing; and had a minimal control or compared interventions fulfilling our criteria. Searching, screening, bias assessment, and data extraction followed Cochrane methods. We grouped studies by intervention type (economic, environmental, swaps, and/or education), synthesized results narratively, and conducted an exploratory qualitative comparative analysis. Results: We included 35 studies representing 89 interventions, >20,000 participants, and >800 stores. Risk of bias was mixed. Economic interventions showed the most promise, with 8 of the 9 studies in real stores and all 6 in simulated environments detecting an effect on purchasing. Swap interventions appeared promising in the 2 studies based in real stores. Store environment interventions showed mixed effects. Education-only interventions appeared effective in simulated environments but not in real stores. Available data suggested that effects of economic interventions did not differ by socioeconomic status, whereas for other interventions impact was variable. In our qualitative comparative analysis, economic interventions (regardless of setting) and environmental and swap interventions in real stores were associated with statistically significant changes in purchasing in the desired direction for ≥1 of the foods targeted by the intervention, whereas education-only interventions in real stores were not. Conclusions: Findings suggest that interventions implemented in grocery stores-particularly ones that manipulate price, suggest swaps, and perhaps manipulate item availability-have an impact on purchasing and could play a role in public health strategies to improve health. Review protocol registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42017068809.
... Information is an indispensable prerequisite of an individual's behavior. It is the base of knowledge and personal risk perception, which in turn can lead to behavior change (e.g., Schwarzer, 1992), and it affects food choice in the supermarket (Anderson et al., 1997;Levy, Mathews, Stephenson, Tenney, & Schucker, 1985). However, meat in supermarkets, if packaged at all, is usually sparsely labeled (Bredahl, 2003), displaying no more information than price, weight, and best-usedbefore date. ...
Article
Full-text available
Consumers want more information about the food they consider buying. One way to provide such information is via food labeling, but not all label information can be used effectively. We tested how information on actual meat labels from a supermarket environment analysis was evaluated against a realistic new label when labels were seen separately vs. in a conjoint (simultaneous) presentation. Participants (M = 24 years; 49% women) evaluated how much money they would pay for identical meat products with different label information. Conjoint presentation of labels led to opposite product rankings compared to separate presentations in some conditions (preference-reversal effect). We discuss the importance of food labels that provide transparent, evaluable information for supporting informed, responsible meat product decisions.
... Parents participating in the study will be asked to complete assessments on their readiness to engage in weight control behaviors [21,22], self-efficacy to lose weight [21,23], and empowerment to access resources for healthy weight [24]. Parents will also report on their behaviors that support child weight loss efforts [25], and potential self-regulatory mediator variables such as goal setting and adherence to GSH recommendations [26][27][28][29][30][31][32][33][34]. Finally, parents will report on their child's dietary and physical activity behaviors, and provide information on resources utilization for the cost effectiveness analysis. ...
Article
Full-text available
Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity.
Article
In an evaluation of the theoretical foundations of behavior change, the current study examined whether social cognitive (SCT) variables mediated treatment effects on physical activity and nutrition in the recently reported Guide-to-Health trial (GTH). Adults (N = 661) were assessed at baseline, seven months and 16 months to examine whether treatment-related changes in SCT variables at seven months mediated change in nutrition and physical activity at 16 months. GTH treatment effects were mediated by self-efficacy, self-regulation and social support; self-regulation mediated self-efficacy. Social-cognitive variables explained only part of the treatment effects suggesting future investigations evaluate the environmental-selection and affective processes of behavior change.
Article
Understanding the need for and accessibility to healthier foods have not improved the overall diets of the U.S. population. Social cognitive theory (SCT) may explain how other variables, such as self-regulation and self-efficacy, may be key to integrating healthier nutrition into U.S. lifestyles. To determine how SCT accounts for the nutritional content of food purchases and consumption among adults in a health promotion study. Participants were 712 churchgoers (18% African American, 66% female, 79% overweight or obese) from 14 churches in southwestern Virginia participating in the baseline phase of a larger health promotion study. Data were collected on the nutrition related social support, self-efficacy, outcome expectations, and self-regulation components of SCT, as well as on the fat, fiber, fruit, and vegetable content of food-shopping receipts and food frequency questionnaires. These data were used to test the fit of models ordered as prescribed by SCT and subjected to structural equation analysis. SCT provided a good fit to the data explaining 35%, 52%, and 59% of observed variance in percent calories from fat, fiber g/1000 kcals and fruit and vegetable servings/1000 kcals. Participants' age, gender, socioeconomic status, social support, self-efficacy, negative outcome expectations, and self-regulation made important contributions to their nutrition behavior -- a configuration of influences consistent with SCT. These results suggest a pivotal role for self-regulatory behavior in the healthier food choices of adults. Interventions effective at garnering family support, increasing nutrition related self-efficacy, and overcoming negative outcome expectations should be more successful at helping adults enact the self-regulatory behaviors essential to buying and eating healthier foods.
Article
To examine food and nutrient availability in New Zealand using supermarket sales data in conjunction with a brand-specific supermarket food composition database (SFD). The SFD was developed by selecting the top-selling supermarket food products and linking them to food composition data from a variety of sources, before merging with individualised sales data. Supermarket food and nutrient data were then compared with data from national nutrition and household budget/economic surveys. A supermarket in Wellington, New Zealand. Eight hundred and eighty-two customers (73% female; mean age 38 years) who shopped regularly at the participating supermarket store and for whom electronic sales data were available for the period February 2004-January 2005. Top-selling supermarket food products included full-fat milk, white bread, sugary soft drinks and butter. Key food sources of macronutrients were similar between the supermarket sales database and national nutrition surveys. For example, bread was the major source of energy and contributed 12-13% of energy in all three data sources. Proportional expenditure on fruit, vegetables, meat, poultry, fish, farm products and oils, and cereal products recorded in the Household Economic Survey and supermarket sales data were within 2% of each other. Electronic supermarket sales data can be used to evaluate a number of important aspects of food and nutrient availability. Many of our findings were broadly comparable with national nutrition and food expenditure survey data, and supermarket sales have the advantage of being an objective, convenient, up-to-date and cost-effective measure of household food purchases.
Article
Full-text available
Background: Theory-based interventions accessible to large groups of people are needed to induce favorable shifts in health behaviors and body weight. Purpose: The aim was to assess nutrition; physical activity; and, secondarily, body weight in the tailored, social cognitive Guide to Health (GTH) Internet intervention delivered in churches. Methods: Participants (N = 1,071; 33% male, 23% African American, 57% with body mass index > or = 25, 60% sedentary, Mdn age = 53 years) within 14 Baptist or United Methodist churches were randomized to the GTH intervention only (GTH-Only; 5 churches), with church-based supports (GTH-Plus; 5 churches), or to a waitlist (control; 4 churches). Verified pedometer step counts, measured body weight, fat, fiber, and fruit and vegetable (F&V) servings from food frequency and supermarket receipts were collected at pretest, posttest (7 months after pretest), and follow-up (16 months after pretest). Results: Participants in GTH-Only increased F&V at post (approximately 1.50 servings) compared to control (approximately 0.50 servings; p = .005) and at follow-up (approximately 1.20 vs. approximately 0.50 servings; p m = .038) and increased fiber at post (approximately 3.00 g) compared to control (approximately 1.5 g; p = .006) and follow-up (approximately 3.00 g vs. approximately 2.00 g; p = .040). GTH-Plus participants compared to control increased steps at post (approximately 1,500 steps/day vs. approximately 400 steps/day; p = .050) and follow-up (approximately 1,000 steps/day vs. approximately - 50 steps/day; p = .010), increased F&V at post (approximately 1.5 servings; p = .007) and follow-up (approximately 1.3 servings; p = .014), increased fiber at post (approximately 3.00A g; p = .013), and follow-up (approximately 3.00; p = .050) and decreased weight at post (approximately - 0.30 kg vs. approximately + 0.60 kg; p = .030). Conclusions: Compared to control, both GTH treatments improved nutrition at posttest, but church supports improved physical activity and nutrition at posttest and follow-up, suggesting environmental supports may improve Internet-based interventions.
Article
Full-text available
A social-cognitive model of nutrition behavior (A. Bandura, 1997) was tested using structural equation modeling of data from 307 food shoppers recruited from 5 supermarkets in Southwest Virginia. The shoppers were participating in the baseline phase of an ongoing nutrition promotion program. As part of the evaluation, data were collected on the self-efficacy and outcome-expectations components of social-cognitive theory as well as on food purchases and intake. The structural analyses presented here support the social-cognitive model. Self-efficacy, physical outcome expectations, age, socioeconomic status, and number of children were important predictors of nutrition behavior among shoppers. Implications for interventions using social-cognitive variables to improve the nutritional content of food purchases and intake are discussed.
Article
Full-text available
The Eat4Life program is a linear series of five Internet-based modules that focuses on changing health behaviors and serves as an adjunct to health curriculums. The goals of the program involve increasing high school girls' con-sumption of regular meals, fruits and vegetables, and fiber and reducing the consumption of high-fat snacks, high-fat dairy products, and regular sodas. Additional goals include decreasing the fat grams and calories consumed from fast food and increasing the frequency and duration of exercise and activity. The modules involve text, graphics, and pictures with considerable interactions and use a number of established behavior change tactics such as personalization of content through frequent assessments, prescriptive strategies, and personalized goals and feedback. Girls using the modules as part of their health classes (N = 103) were compared to girls who were in health classes, but did not use the modules (N = 77). Across four cohorts of experimental and comparison classes, girls using the modules reported that they made relatively consistent changes in all nutrition areas except for reducing the consumption of high-fat dairy products. Similar consistent findings were found for changes in fast food consumption and aerobic conditioning activity. While it is important to develop measures to corroborate self-report indices and to sustain initial student changes, future work also needs to focus on Internet-based programs directed toward the mediators of change such as teachers.
Article
Epidemiological analyses conclude that the major contributors to all-cause premature mortality and morbidity are smoking, alcohol abuse, inappropriate diet, and a sedentary lifestyle. Efforts to modify these health behaviors in populations with community and worksite interventions, although initially promising, have had difficulty in sustaining health-behavior changes. More intensive, theoretically based interventions targeted to at-risk groups and delivered in smaller social units, such as churches and other religious organizations, have been recommended. An intervention based on social cognitive theory that entails integrating self-regulatory procedures with social and environmental supports in rural churches serving people from lower socioeconomic groups is described in detail.
Article
Computers have been promoted as a tool to facilitate learning. Subsequently, health education software programs have been developed, but few of these programs have been evaluated. Little is known about how students use or learn from computer-assisted instruction (CAI). Qualitative research methods are needed to reveal the critical issues related to CAI in nutrition education and establish the direction for future research. The purpose of this paper is to describe a process evaluation model that was used to test a nutrition education CAI program for middle school students. The specific outcome that was measured was learning. Learning was assessed by changes in students’ cognitive structures of basic nutrition concepts included in the program. Concept maps were used to represent students’ cognitive structure and were constructed from data collected by semistructured interviews with children before and after they completed the program. Context was defined by students’ interaction with the computer and with other students. These data were collected by observation and analyzed by grounded theory methods.The value of the model is in the integration of measurements of change and context. Together, change and context provide a dynamic, continuous, and inductive evaluation of the learning process and the effectiveness of a nutrition education program.
Article
The purpose of this study was to develop a system for characterizing food purchases by families using supermarket receipt data. One hundred and five shoppers contributed data that represented 363 people (138 children and 225 adults). Participants provided food purchase receipt data for at least 6 weeks, which included an average of at least 20 food items/week. Receipt information was entered by trained technicians for analysis using a database of over 2600 distinct foods containing nutritional information. Eighty-five percent of the items on the store receipts were identifiable by item and quantity from the information printed on the receipt; the data on the remaining items was determined by shopper annotation or by use of a default value. The average percent of energy purchased as fat by this convenience sample was 38.4%, total fiber purchased was 6.61 g/1000 kcal, and number of servings of fruits and vegetables was 1.44/1000 kcal. All foods were divided among 11 categories to evaluate the contributions of particular food groups to energy, fat, and fiber purchase.The three major contributors to fat purchase were, in order, “add-on and cooking fats;” “meats, poultry, and fish;” and “dairy.” Purchased fiber came primarily from “produce,” with “breads” and “cereals” next in proportion. The families at highest risk for poor nutrition quality of purchases were those with lower socioeconomic status, more children, and younger age of the primary shopper. This receipt collection system was successful in providing specific nutrition data on purchases of over 100 families. The assessment system is unique in that tracking of shopping patterns of individual families can be accomplished.
Thesis
Full-text available
Die vorliegende Dissertation setzt sich damit auseinander, wie das Zusammenspiel von essensbezogener Umwelt und Kognition Ernährungsentscheidungen beeinflusst. Im ersten Manuskript, “When Diets Last: Lower Cognitive Complexity Increases Diet Adherence” wird die Bedeutung der kognitiven Komplexität von Ernährungsregeln für das Einhalten einer Diät untersucht. Können Diäten scheitern, weil sie aus kognitiver Perspektive zu komplex sind, z.B. weil sich Diäthaltende nicht alle wichtigen Informationen merken oder verarbeiten können? 1136 Diäthaltende nahmen an einer längsschnittlichen Onlinestudie teil. Vorangegangenes Diätverhalten, Selbstwirksamkeit, Planung und wahrgenommene Regelschwierigkeit erhöhten das Risiko, die Diät vorzeitig aufzugeben, wobei Selbstwirksamkeit und wahrgenommene Regelschwierigkeit die einflussreichsten Faktoren waren. Im zweiten Manuskript „Meat Label Design: Effects on Stage Progression, Risk Perception, and Product Evaluation” wird der Einfluss gesundheitsrelevanter Information auf Labeln für Produktbewertung und Intention, Tierhaltung und Inhaltsstoffe von Lebensmitteln in die Kaufentscheidung einzubeziehen, untersucht. Es wurde betrachtet, wie Inhalt und Kontext (separate versus conjoint Darbietung) der Labelinformation die Bewertung von Fleischprodukten beeinflusst. Die Ergebnisse zeigen, dass sich bei einer conjoint im Gegensatz zur separaten Darbietung die Bewertung der Produkte umkehrt. Darüber hinaus hatten Personen, die zuvor nicht motiviert waren gesundheitsrelevante Aspekte in ihr Einkaufsverhalten einzubeziehen, nach Betrachten der Label eine höhere Intention diese zu berücksichtigen. Im dritten Manuskript, „Predicting Children’s Meal Preferences: How Much Do Parents Know?“, wurden Präferenzvorhersagen bezüglich der Essensentscheidungen Anderer erforscht. Es wurde untersucht, wie gut und mit Hilfe welcher Information Eltern die Mittagessenpräferenzen ihrer Kinder vorhersagen. Die Vorhersagegenauigkeit der Eltern entsprach der Stabilität der Essenspräferenzen ihrer Kinder, d.h. dass die Eltern so genau waren, wie möglich. Die Ergebnisse suggerieren, dass Eltern vor allem spezifisches Wissen über die Präferenzen ihrer Kinder und Projektion ihrer eigenen Vorlieben für die Vorhersagen nutzten.
Article
Background: Effectiveness of using visual approaches in health education and its influential factors were still in debate. Objectives: To assess the effects of visualized nutrition education on dietary knowledge and behavioral changes, and factors influencing them. Methods: A comprehensive search of PubMed, EMBASE, Scopus and Cochrane Library was conducted. Eligible studies were trials assessed effects of visualized nutrition education on dietary knowledge or behavior changes, compared with non-visualized or no education group. Results: Fourteen studies (n = 7,259) were qualitatively analyzed and 7 of them were included in the meta-analysis. We found a higher fiber intake in both short term (1.59g/1000kcals, 95%CI 0.90-2.27) and long term (1.36g/1000kcals, 95%CI 0.64-2.09). A marginal advantage was shown in short-term fruits and vegetables consumption (F&V consumption) (standardized mean difference (SMD) = 0.08, 95%CI -0.00-0.16). The education effects were more pronounced when education was delivered in series (SMDF&V consumption = 0.09, 95%CI 0.00-0.17), avoiding loss-framing (SMDFat intake = 0.31, 95%CI 0.10-0.51) and video modeling (SMDF&V consumption = 0.23, 95%CI 0.03-0.43), with short length plus cultural adaptation. Conclusions: Visualized nutrition education was overall promising in improving dietary behaviors. Delivering in series, short in length, with cultural adaptation were features tended to enlarge the benefits of visualized education while loss-framing and video modeling might be avoided.
Article
Full-text available
Purpose of Review Update the state of evidence on the effectiveness of retail food environment interventions in influencing diet and explore the underlying role of public policy, through a systematic review of population-level interventions to promote health in the retail food environment, including community and consumer environments. Diet-related outcomes included purchasing, dietary intakes, diet quality, and health including weight. We coded studies for enabling public policy levers underpinning the intervention, using two widely used conceptual frameworks. Recent Findings Of 86 articles (1974–2018), the majority (58 articles, 67%) showed at least one positive effect on diet. Thirteen articles (15%) discussed natural experiments, 27 articles (31%) used a design involving comparison groups including 23 articles (27%) specifically describing randomized controlled trials, and 46 (53%) were quasi-experimental (cross-sectional) evaluations. Across the “4Ps” of marketing (product, promotion, placement, and price), promotion comprised the greatest proportion of intervention strategies, especially in earlier literature (pre-2008). Few studies combined geographic access interventions with 4P strategies, and few used robust dietary intake assessments. Behavior change communication remains an intervention mainstay, but recent work has also incorporated environmental and social planning, and fiscal strategies. More recent interventions were multi-component. Summary The retail food environment intervention literature continues to grow and has become more robust overall, with clearer evidence of the effect of interventions on diet-related outcomes, including consumer purchasing, dietary intakes, and health. There is still much scope for development in the field. Attention to enabling public policy could help to strengthen intervention implementation and evaluation in the retail food environment.
Article
The use of computers to promote healthy behavior is increasing. To evaluate the efficacy of these computer-delivered interventions, we conducted a meta-analysis of the published literature. Studies examining health domains related to the leading health indicators outlined in Healthy People 2010 were selected. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included. All studies were coded independently by two raters for study and participant characteristics, design and methodology, and intervention content. We calculated weighted mean effect sizes for theoretically-meaningful psychosocial and behavioral outcomes; moderator analyses determined the relation between study characteristics and the magnitude of effect sizes for heterogeneous outcomes. Compared with controls, participants who received a computer-delivered intervention improved several hypothesized antecedents of health behavior (knowledge, attitudes, intentions); intervention recipients also improved health behaviors (nutrition, tobacco use, substance use, safer sexual behavior, binge/purge behaviors) and general health maintenance. Several sample, study and intervention characteristics moderated the psychosocial and behavioral outcomes. Computer-delivered interventions can lead to improved behavioral health outcomes at first post-intervention assessment. Interventions evaluating outcomes at extended assessment periods are needed to evaluate the longer-term efficacy of computer-delivered interventions.
Article
Full-text available
Many women are not meeting dietary recommendations for fiber and fat intakes. Health educators need to know which foods are major sources of these nutrients. This study analyzed the contributions of 27 food groups to fiber, fat, saturated fat, and cholesterol intakes of 2134 women aged 19 to 50 years in USDA's Continuing Survey of Food Intakes by Individuals, the 1985 and 1986 surveys (CSFII 85-86). Major determinants of fiber intake include frequency of use of certain food groups (vegetables, including potatoes, bread, fruit, soups, ready-to-eat cereal) and choice of particular foods within the larger food groups (e.g., whole grain bread, high fiber cereal). Major determinants of total fat, saturated fat, and cholesterol intakes included frequency of use of certain foods (sweet grains, beef, eggs, cheeses/cream, whole milks) and additions to foods (regular salad dressing and butter/margarine). Demographic characteristics were related to various food group consumption parameters. Information about the relationships between food group and nutrient intake and the effects of household income, race/ethnicity, and region of residence on food group intake indicate opportunities to refine nutritional education programs.
Article
Full-text available
Twenty-four hour dietary recall data from the Second National Health and Nutrition Examination Survey (1976-80) were used to estimate the numbers of servings of fruit and vegetables consumed by Black and White adults, to examine the types of servings (e.g., potatoes, garden vegetables, fruit, and juice), and to estimate the mean intake of calories, fat, dietary fiber, and vitamins A and C by number of servings. An estimated 45 percent of the population had no servings of fruit or juice and 22 percent had no servings of a vegetable on the recall day. Only 27 percent consumed the three or more servings of vegetables and 29 percent had the two or more servings of fruit recommended by the US Departments of Agriculture and of Health and Human Services; 9 percent had both. Consumption was lower among Blacks than Whites. The choice of vegetables lacked variety. Diets including at least three servings of vegetables and two servings of fruit contained about 17 grams of dietary fiber. Although caloric and fat intake increased with increasing servings of fruit and vegetables, the percent of calories from fat remained relatively constant. Although these data are 10 years old, more recent surveys have shown similar results. The discrepancy between dietary guidelines and the actual diet suggests a need for extensive public education.
Article
Full-text available
Twenty-four hour recall data from adults interviewed in the Second National Health and Nutrition Examination Survey, NHANES II, were used as the basis to estimate total dietary fiber intake in the United States. Food fiber values were calculated for the 2500 foods in NHANES II in two ways: 1) using fiber values compiled from the literature by NCI and 2) values based on the Southgate methodology. Mean dietary fiber intake in the US adult population (greater than 19 y of age) is 11.1 g/d using the first set of values and 13.3 g/d according to Southgate values. On a per 1000 kcal basis, women consume more dietary fiber (6.5 g/1000 kcal) than men (5.5 g/1000 kcal) at every age. Fiber intake by geographic region, age, race, and sex is discussed. Our study indicates that dietary fiber intake in the United States is considerably lower than that previously reported.
Article
Full-text available
The National Cancer Institute (NCI) believes that the potential for dietary changes to reduce the risk of cancer is considerable and that the existing scientific data provide evidence that is sufficiently consistent to warrant prudent interim dietary guidelines that will promote good health and reduce the risk of some types of cancer. Six interim dietary guidelines and their scientific rationale are discussed herein. The evidence presented for the scientific rationale is based on the 1982 National Academy of Sciences Committee report Diet, Nutrition and Cancer and NCI's own scientific reviews that link long-term dietary patterns with cancer risk. These guidelines to the American public are consistent with other dietary recommendations from the US departments of Agriculture and Health and Human Services, the American Cancer Society, and the American Heart Association.
Article
Full-text available
A self-administered diet history questionnaire has been developed for epidemiologic and clinical use. Both the food list and the nutrient values to be associated with it were developed using dietary data from 11,658 adult respondents to the Second National Health and Nutrition Examination Survey (NHANES II). Food items were selected on the basis of their contribution to total population intake of energy and each of 17 nutrients in the NHANES II data, and represent over 90% of each of those nutrients. Associated nutrient composition values were determined from the NHANES II database using frequency of consumption data in that survey. Portion sizes to be associated with each food item were derived from observed portion size distributions in NHANES II, based on three-dimensional models. The resulting food list and its corresponding brief data base, when used to calculate nutrients from a diet record, yielded correlations of r greater than 0.70 with the more detailed method. Field administration produced mean values comparable to national data.
Article
Full-text available
The results of an evaluation of "Eat for Health," a supermarket nutrition intervention, are presented. The study tested whether such a program could be successfully carried out and whether it could effect changes in knowledge, attitudes, and food purchasing behavior in line with nutrition and cancer risk reduction guidelines. The evaluation consisted of an in-store monitoring element, an in-store and telephone consumer survey, and an analysis of sales data on selected foods. A matched-pair design, using a total of 40 stores in the intervention and comparison groups, was used. The intervention was successfully implemented and had limited success in changing some food purchasing behaviors. There appeared to be no effect on knowledge and attitudes except for increased awareness of a link between diet and cancer and of the program itself. Despite the intervention's success, limitations of the consumer survey and sales data analyses and the continuing diffusion of nutrition messages throughout society make it difficult to specify the impact of this program on consumer nutrition knowledge and behaviors.
Article
Objective. —To examine trends in overweight prevalence and body mass index of the US adult population.Design. —Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.Setting/Participants. —Between 6000 and 13000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANESII), and 1988 to 1991 (NHANES III phase 1).Results. —In the period 1988 to 1991,33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.Conclusions. —These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.(JAMA. 1994;272:205-211)
Article
A nutrition information program, consisting of brand-specific nutrition shelf-tags and a supplementary explanatory booklet, was tested for two years in Baltimore stores of the Giant Food chain, replicating a previous successful trial of the program in Washington, DC. Over the two-year evaluation period, market shares of shelf-tagged products increased 12% on average in Baltimore stores in 8 of 16 product categories that had been included in the original program trial. The largest marketshare increases occurred for products with the most flagged nutrients. Products with fewer flagged nutrients actually lost marketshare, suggesting that shopper purchases tended to be influenced by the number of featured nutrients as well as by the nature of the nutrients themselves. Responses to a shopper survey as well as the sales data converged to indicate that shopper concerns about nutrition and health status of family members are more highly correlated with program use than are education, income, and age.
Book
This book reviews epidemiological and other knowledge about cancer to provide an overview of what is known, what is not known, and where important knowledge should be sought about practicable means of avoiding cancer. Although the perspective offered will be of interest to specialists in cancer research or regulation, no specialist knowledge by the reader is assumed, so students of many subjects will enjoy the clarity of thought and style which it offers.
Article
Low intake of vegetables, fruits, and carotenoids is consistently associated with increased risk of lung cancer in both prospective and retrospective studies. In addition, low levels of beta-carotene in serum or plasma are consistently associated with the subsequent development of lung cancer. The simplest explanation is that beta-carotene is protective. Since retinol (preformed vitamin A) is not related in a similar manner to lung cancer risk, beta-carotene appears to function through a mechanism that does not require conversion into vitamin A. However, the importance of other carotenoids and other constituents of vegetables and fruit has not been adequately explored. Both prospective and retrospective studies suggest that vegetable and fruit intake may reduce the risk of cancers of the mouth, pharynx, larynx, esophagus, stomach, colon, rectum, bladder, and cervix. But because of fewer studies and less consistency among studies, the epidemiologic evidence is at present less persuasive than for lung cancer.
Article
In a dozen case-control and cohort studies, high intake of fruits and vegetables containing carotenoids has been associated with a reduced risk of lung cancer. In contrast, little relation has been found between intake of preformed vitamin A and this disease. Although initial studies suggested that persons with lower levels of serum retinol have higher future rates of lung cancer, this idea was not confirmed in subsequent investigations. Prediagnostic levels of beta-carotene in blood, however, have been inversely related with risk of lung cancer. Available data thus strongly support the hypothesis that dietary carotenoids reduce the risk of lung cancer, but the data are also compatible with the possibility that some other factor in these foods is responsible for the lower risk. Even if ultimately shown to be casual, the relation between diet and lung cancer is modest compared with the deleterious effect of cigarette smoking.
Article
The stages of change construct, which addresses the readiness to change, has only recently been applied to dietary behavior, such as fat consumption. This article describes the application of the stages of change construct to dietary fat and fiber consumption and examines the association of dietary stages to eating practices and related demographic and psychosocial factors in a large, geographically diverse population of workers. We present results from the baseline survey of 17,121 employees in the Working Well Trial. We assessed stage from an algorithm based on seven items and measured dietary intake with an 88-item food frequency questionnaire. Findings indicated that a greater proportion of the population has actively tried to reduce fat intake than to consume more fiber. Stage of change was associated with fat, fiber, and fruit and vegetable intake in a stepwise manner, as predicted. In multivariate analyses that controlled for demographic characteristics, stage of change predicted between 8 and 13% of the variance in dietary intake, and more than demographic variables. These findings have implications for the design of nutrition interventions and for the evaluation of intermediate outcomes.
Article
To determine dietary fiber intake of children and young adults. Cross-sectional surveys of children and young adults in Bogalusa, La. Twenty-four-hour dietary recalls were collected from 1976 to 1988 on five cohorts of 10-year-olds (n = 1,254), two cohorts of 13-year-olds (n = 360), and young adults (n = 504) 19 to 28 years of age. Dietary fiber intake data were analyzed for age, race, and gender differences and for secular trends. Descriptive and inferential statistics were calculated where appropriate. Dietary composition and food sources were examined for race-specific and gender-specific quartiles for dietary fiber intake adjusted per 1,000 kcal. Even after adjusting for energy intake, total dietary fiber intake remained unchanged from 1976 to 1988, averaging 12 g or 5 g/1,000 kcal. Blacks and males had higher total fiber intakes than whites and females at all ages. Consumption of vegetables and soups and breads and grains accounted for 53% (10-year-olds) to 70% (13-year-olds) of the total fiber consumed. When children were stratified into quartiles on the basis of fiber intake per 1,000 kcal, the percentage of energy from total fat and saturated fat was lower, and the percentage of energy from carbohydrate was higher, in children with higher fiber intakes per 1,000 kcal. Dietary fiber intake of children has remained the same in the past 12 years and is comparable with the intake of young adults, which is well below the recommended level. Children with high fiber intakes (upper quartile) consumed less fat, particularly saturated fat, and more carbohydrate than children with low fiber intakes. Increasing consumption of whole-grain products, fruits, vegetables, and legumes (prepared with minimal added fat) will be necessary to reach the goal of optimal fiber intake and could result in an eating pattern that approaches the current recommendations for dietary fat and saturated fat.