To explore differences in the prevalence of outdoor food advertising, and the type and nutritional content of advertised foods, according to an area-based marker of socio-economic position (SEP) in a city in Northern England.

All outdoor advertisements in the city were identified during October–December 2009, their size (in m2) estimated and their location determined using a global positioning system device. Advertisements were classified as food or non-food. Food advertisements were classified into one of six food categories. Information on the nutritional content of advertised foods was obtained from packaging and manufacturer's websites. An area-based marker of SEP was assigned using the location of each advertisement, grouped into three affluence tertiles for analysis.

A city in Northern England.

None.

In all, 1371 advertisements were identified; 211 (15 %) of these were for food. The advertisements covered 6765 m2, of which 1326 m2 (20 %) was for food. Total advertising and food advertising space was largest in the least affluent tertile. There was little evidence of socio-economic trends in the type or nutritional content of advertised foods.

Despite an absence of socio-economic differences in the type and nutritional content of advertised foods, there were socio-economic differences in food advertising space. There may also be socio-economic differences in exposure to outdoor food advertising.

The goal of the present study was to examine the influence of community environment on the nutritional status (weight-for-age and height-for-age) of children (aged 0–59 months) in Bangladesh. In addition, we tested the association between specific characteristics of community environments and child nutritional status.

Cross-sectional survey.

The data are from the nationally representative 2004 Bangladesh Demographic and Health Survey.

Respondents were ever-married women (aged 15–49 years) and their children (n 5731), residing in 361 communities. Child nutritional outcomes are physical measurements of weight-for-age and height-for-age in sd units. We considered the following attributes of community environments potentially related to child nutrition: (i) community water and sanitation infrastructure; (ii) availability of community health and education services; (iii) community employment and social participation; and (iv) education level of the community.

Multilevel regression analysis showed that the spatial distribution of maternal and child covariates did not entirely explain the between-community variation in child nutritional status. The education level of the community emerged as the strongest community-level predictor of child height-for-age (highest v. lowest tertile, β = 0·18 (se 0·07)) and weight-for-age (highest v. lowest tertile, β = 0·21 (se 0·06)). In the height-for-age model, community employment and social participation also emerged as being statistically significant (highest v. lowest tertile, β = 0·13 (se = 0·06)).

The community environment influences child nutrition in Bangladesh, and maternal- and child-level covariates may fail to capture the entire influence of communities. Interventions to reduce child undernutrition in developing countries should take into consideration the wider community context.

The nutritional intake of schoolchildren is affected not only by what is consumed at school but also by what is available in food outlets near schools. The present study surveys the range of food outlets around schools and examines how the availability of healthy food in the food stores encountered varies by income status of the school and by store participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food assistance programme.

Network buffer zones were created to reflect a quarter-mile (400 m) walk from elementary schools with lower- and higher-income student populations in Oakland, CA, USA. All food outlets within these zones were categorised by type, and audits were conducted within food stores using a checklist to assess for the presence or absence of twenty-eight healthy items (in five domains).

Mid-sized city in the USA.

Food outlets near public elementary schools.

There were considerably more food outlets around lower-income schools. Food stores near higher-income schools had higher scores in two of the five domains (healthy beverages/low-fat dairy and healthy snacks). However, there were more food stores near lower-income schools that accepted WIC vouchers. Stratification showed that WIC stores scored higher than non-WIC stores on four of the five domains.

Although higher-income students have more access to healthy food in the environment surrounding their school, this disparity appears to be mitigated by stores that accept WIC and offer more healthy snacking options. Federal programmes such as this may be particularly valuable for children in lower-income areas.

To examine the impact of a 6-month participatory and empowerment-based intervention study on employees’ dietary habits and on changes in the canteen nutrition environment.

Worksites were stratified by company type and by the presence or absence of an in-house canteen, and randomly allocated to either an intervention group (five worksites) or a minimum intervention control group (three worksites). The study was carried out in partnership with a trade union and guided by an ecological framework targeting both individual and environment levels. Outcome measures included: (i) changes in employees’ dietary habits derived from 4 d pre-coded food diaries of a group of employees at the worksites (paired-data structure); and (ii) the canteen nutrition environment as identified by aggregating chemical nutritional analysis of individual canteen lunches (different participants at baseline and at endpoint).

Eight blue-collar worksites (five of these with canteens).

Employees.

In the intervention group (n 102), several significant positive nutritional effects were observed among employees, including a median daily decrease in intake of fat (−2·2 %E, P = 0·002) and cake and sweets (−18 g/10 MJ, P = 0·002) and a median increase in intake of dietary fibre (3 g/10 MJ, P < 0·001) and fruit (55 g/d, P = 0·007 and 74 g/10 MJ, P = 0·009). With regard to the canteen nutrition environment, a significant reduction in the percentage of energy obtained from fat was found in the intervention group (median difference 11 %E, P < 0·001, n 144).

The present study shows that moderate positive changes in dietary patterns can be achieved among employees in blue-collar worksites.

To evaluate the impact of an educational and environmental intervention on the availability and consumption of fruits and vegetables in workplace cafeterias.

This was a randomized intervention study involving a sample of companies that were divided into intervention and control groups. The intervention, which focused on change in the work environment, was based on an ecological model for health promotion. It involved several different aspects including menu planning, food presentation and motivational strategies to encourage the consumption of fruits and vegetables. The impact of the intervention was measured by changes (between baseline and follow-up) in the availability of fruits and vegetables that were eaten per consumer in meals and the consumption of fruits and vegetables in the workplace by workers. We also evaluated the availability of energy, macronutrients and fibre.

Companies of São Paulo, Brazil.

Twenty-nine companies and 2510 workers.

After the intervention we found an average increase in the availability of fruits and vegetables of 49 g in the intervention group, an increase of approximately 15 %, whereas the results for the control group remained practically equal to baseline levels. During the follow-up period, the intervention group also showed reduced total fat and an increase in fibre in the meals offered. The results showed a slight but still positive increase in the workers’ consumption of fruits and vegetables (about 11 g) in the meals offered by the companies.

Interventions focused on the work environment can be effective in promoting the consumption of healthy foods.

To explore why there is a lack of acceptance among Western Australian (WA) adults of the Go for 2&5®fruit and vegetable social marketing message to consume at least five servings of vegetables per day.

A series of focus group discussions comprised of homogeneous groups varied by sex and age, until saturation of themes was achieved, followed by thematic analysis.

Part of qualitative research for the Go for 2&5® fruit and vegetable social marketing campaign in WA (2009 population: 2·2 million).

WA adults stratified by sex and age groups (18–29 and 30–55 years) drawn from the second and third quartiles of socio-economic disadvantage.

Familiarity with the Go for 2&5® message was excellent. Understanding of what constitutes ‘two servings of fruit’ was excellent and regarded by participants as highly achievable. Understanding of what constitutes ‘five servings of vegetables’ was suboptimal with widespread overestimation contributing to the belief that it is unrealistic. Participants did not know how the 2&5 recommendation was formulated and believed that daily consumption of two servings of fruit and five of vegetables would confer no greater health benefit than one of fruit and three of vegetables. Participants assumed that the 2&5 recommendation was ‘aspirational’ in the sense that it was purposely exaggerated to simply encourage greater overall consumption.

A convincing case needs to be presented to WA adults as to why they should consume five servings of vegetables per day. Continuing efforts to educate incorporating what constitutes a serving will assist perceptions that the recommendation is realistic.

The purpose of the present study was to investigate the nutrition information needs of the Pacific Islander and African migrant communities of Logan.

The present study was structured as a needs assessment and used qualitative research methods. An integrative review was used to gather and analyse data relating to comparative and normative needs, while semi-structured interviews were undertaken for the felt and expressed needs.

Logan City, Queensland, Australia.

African and Pacific Islander migrants and health and social service providers within the Logan region.

The study identified the need for more accessible means of information delivery such as visual and face-to-face methods or hands-on demonstrations. The study found that information should be delivered in a staged approach on topics including food safety, Australian foods, healthy eating and diet–disease relationships, according to a migrant’s length of residence in Australia.

The present study contributes to our understanding of the nutrition information needs of African and Pacific Islander migrant communities of Logan. These findings will enable the development of more appropriate nutrition information and health services for these Logan communities and other similar communities across Australia.

The Groningen Overweight and Lifestyle (GOAL) study primarily aims at preventing weight gain by nurse practitioners (NP) guided by a standardized computerized software program. Since favourable changes in physical activity (PA) and diet may improve health independently of weight (loss), insight into effects on lifestyle habits is essential. We examined the 1-year effects of lifestyle counselling by NP on PA and diet, compared with usual care from the general practitioner (GP-UC).

A randomized controlled trial.

Eleven general practice locations in the Netherlands.

A total of 341 GOAL participants with overweight or obesity and either hypertension or dyslipidaemia, or both, who completed an FFQ and Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) at baseline and after 1 year.

After 1 year, the NP group spent 33 min/week more on walking compared with the GP-UC group who spent −5 min/week on walking (P = 0·05). No significant differences were found between the NP and GP-UC groups on the percentage of persons complying with the PA guidelines. In both groups, nutrient intake changed in a favourable direction and participants complied more often with dietary guidelines, but without overall difference between the NP and GP-UC groups.

With the exception of an increase in walking (based on self-reported data) in the NP group, no intervention effects on PA and diet occurred. Positive changes in nutrient intake were seen in both groups.

To study the association between the availability of healthy foods and BMI by neighbourhood race and socio-economic status (SES).

Trained staff collected demographic information, height, weight and 24 h dietary recalls between 2004 and 2008. Healthy food availability was determined in thirty-four census tracts of varying racial and SES composition using the Nutrition Environment Measures Survey–Stores in 2007. Multilevel linear regression was used to estimate associations between healthy food availability and BMI.

Baltimore City, Maryland, USA.

Adults aged 30–64 years (n 2616) who participated in the Healthy Aging in Neighborhoods of Diversity across the Life Span study.

Among individuals living in predominantly white neighbourhoods, high availability of healthy foods was associated with significantly higher BMI compared with individuals living in neighbourhoods with low availability of healthy food after adjustment for demographic variables (β = 3·22, P = 0·001). Associations were attenuated but remained significant after controlling for dietary quality (β = 2·81, P = 0·012).

Contrary to expectations, there was a positive association between the availability of healthy food and higher BMI among individuals living in predominantly white neighbourhoods. This result could be due to individuals in neighbourhoods with low healthy food availability travelling outside their neighbourhood to obtain healthy food.

To determine the extent to which national and local UK guidelines for the early years sector address key recommendations for encouraging healthy eating based on best available evidence.

Phase 1 comprised a literature review to identify new evidence to assess current relevance of the Caroline Walker Trust (CWT) ‘Eating well for under-5 s in child care’ guidelines. Phase 2 assessed the completeness of seven local to national-level government guidelines by comparison with the ‘gold standard’ CWT guidelines.

Desk-based review using secondary data.

Research literature and statutory guidelines on healthy eating in early years settings.

Phase 1 retrieved seventy-five papers, of which sixty were excluded as they addressed compliance with nutritional and food-based standards only. One report examined a social marketing tool and was deemed too narrow. The remaining fourteen documents assessed interventions to encourage healthy eating in early years settings. Following quality assessment, seven documents were included. Nine key recommendations were identified: (i) role of government; (ii) early years setting policy/guidelines; (iii) training; (iv) menu planning; (v) parents; (vi) atmosphere and encouragement; (vii) learning through food; (viii) sustainability; and (ix) equal opportunities. Phase 2 identified that all seven guidelines included the nine key recommendations but sporadic cover of sub-key recommendations.

More detail is needed on how early years settings can encourage children to eat healthily. Research is required to develop second-layer guidance for interactive materials. Clear processes of communication and support for parents are required. Ways food relates to children's wider learning and social development need further thought, requiring collaboration between the Department of Health and the Department for Education.

To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping.

Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables.

Random selection of households from fifty small areas in Melbourne, Australia, in 2003.

The main food shoppers in each household (n 2564).

A lack of money was significantly more likely among the young and in households with single adults. Difficultly lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficultly lifting and reduced car access.

In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Non-supermarket food retailers can be a promising channel for increasing the availability of healthy foods in underserved communities. The present paper reports on retailer practices, attitudes and beliefs about the supply of healthy foods before and after the introduction of new subsidies for healthy foods by the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in October 2009.

We designed and conducted in-person standardized interviews with store owners and managers to assess perceptions of demand and profits for different foods, supply networks, barriers to stocking healthy foods and their changes following implementation of the new WIC packages.

Non-supermarket retailers in five towns of Connecticut, USA (n 68 in 2009 and n 58 in 2010).

Owners and managers of WIC-authorized and non-WIC convenience stores and non-chain grocery stores.

Retailers identified customer demand as the primary factor in stocking decisions. They reported observing a significantly weaker demand for healthy foods compared with unhealthy foods, although it improved for certain foods with the new WIC subsidies. Less healthy foods were also perceived as more profitable. Supplier networks varied by product from convenient manufacturer delivery for salty snacks to self-supply for produce. WIC retailers were able to quickly adapt and supply healthy foods required under the new WIC programme guidelines.

Retailers other than supermarkets currently perceive little demand for healthy foods, but new WIC subsidies have the power to change these perceptions. Supply barriers seem secondary in the limited offerings of healthy foods by stores and could be overcome when policy changes generate new demand for healthy foods.

The present study aimed to highlight the similarities and differences between perceived and objective measures of the food store environment among low-income women and the association with diet and weight.

Cross-sectional analysis of food store environment. Store level was characterized by: (i) the availability of healthy foods in stores where participants shop, using food store audits (objective); and (ii) summary scores of self-reported perception of availability of healthy foods in stores (perceived). Neighbourhood level was characterized by: (i) the number and type of food stores within the census tract (objective); and (2) summary scores of self-reported perception of availability of healthy foods (perceived).

Six counties in North Carolina.

One hundred and eighty-six low-income women.

Individuals who lived in census tracts with a convenience store and a supercentre had higher odds of perceiving their neighbourhood high in availability of healthy foods (OR = 6·87 (95 % CI 2·61, 18·01)) than individuals with no store. Overall, as the number of healthy foods available in the store decreased, the probability of perceiving that store high in availability of healthy foods increased. Individuals with a supercentre in their census tract weighed more (2·40 (95 % CI 0·66, 4·15) kg/m2) than individuals without one. At the same time, those who lived in a census tract with a supercentre and a convenience store consumed fewer servings of fruits and vegetables (−1·22 (95 % CI −2·40, −0·04)).

The study contributes to a growing body of research aiming to understand how the food store environment is associated with weight and diet.

We evaluated the association between serum ferritin (s-ferritin), transferrin saturation and dietary patterns, in connection with ethnicity, geographical settlement and lifestyle factors.

In 2003–2004, a cross-sectional study of health and living conditions was carried out in northern Norway.

A questionnaire explored, among other factors, ethnicity and food consumption habits. Principal component analysis was used to assess the association between variables. Seven principal components were then used as input to a cluster analysis. To characterise food consumptions, five dietary patterns were identified and used to assess the effect of food consumption habits on Fe stores.

A total of 16 323 men and women between the ages of 36 and 79 years participated.

Participants who frequently consumed reindeer meat had higher levels of s-ferritin (P < 0·0001) than did individuals with other dietary patterns. This pattern was highly represented by subjects with three generations of Sami language (Sami I). Further, mean transferrin saturation in the reindeer group was higher compared with the other dietary clusters for men (P < 0·04) and women (P < 0·02). However, the reindeer pattern individuals also had the highest proportion of subjects with overweight and obesity. Obesity was positively associated with s-ferritin in both men and women (P < 0·0001).

The differences in Fe status described earlier between inland Sami and non-Sami can be explained by several factors such as food habits, age and obesity. High level of s-ferritin may reflect high intake of reindeer meat. Being overweight and obese is also associated with s-ferritin levels.

To describe fruit and vegetable intake of pre-school and school children in the Czech Republic and to provide information about their preferences and dietary habits.

Cross-sectional dietary survey conducted by the method of repeated 24 h recall on two non-consecutive days. Usual intakes were calculated for three age categories (4–6, 7–10 and 11–14 years).

The whole area of the Czech Republic.

A subgroup of 602 children aged 4–14 years was extracted from the representative sample of respondents participating in a national dietary survey (SISP) realized in the years 2003 and 2004.

Estimated average usual intakes of fruit and vegetables were 209 (sd 69) g/d in children aged 4–6 years, 230 (sd 84) g/d in children aged 7–10 years, and 284 (sd 133) g/d and 261 (sd 140) g/d respectively in boys and girls aged 11–14 years. Only 22 % of children had total daily intake of fruit and vegetables of five or more servings on the day of the survey. Fruits were consumed almost two times more often than vegetables in all age groups studied. The majority of fruit consumption comprised apples and bananas, which made up more than 60 % of the whole fruit intake. Fruiting vegetables were the most frequently consumed group of vegetables.

Fruit and vegetable intakes in all age categories were under recommended levels and the diversity of fruit and vegetables consumed by the Czech children was relatively low.

To assess the feasibility of combining short-term and long-term dietary assessment instruments as new concept for improving usual dietary intake assessment on the individual level.

Feasibility study of completing three 24 h dietary recalls (24-HDR) and a self-administered food propensity questionnaire (FPQ). The 24-HDR was conducted by monthly telephone interviews, using EPIC-SOFT software. The FPQ was completely standardized across cohorts and offered either as a web-based tool or in paper format.

Random sample derived from five ongoing European cohort studies (EPIC-San Sebastian, EPIC-Florence, EPIC-Potsdam, Estonia Genome Center (EGC) and Norwegian Women and Cancer study (NOWAC)).

A total of 400 participants.

Overall, the total participation rate for the present study was 65·3 % (n 261). On average, completion of the 24-HDR was highest for the first 24-HDR (63·0 %) and decreased slightly for the second (60·3 %) and third 24-HDR (56·3 %). The proportions of selecting the web-based FPQ varied among the study centres, with the highest in EGC (92·9 %) and NOWAC (70·0 %) and the lowest in EPIC-San Sebastian (25·5 %) and EPIC-Potsdam (33·9 %). Web users rarely requested support and were younger and more highly educated than those who completed the paper format.

The present study supports the feasibility of a combined application of three 24-HDR and an FPQ in culturally different populations. The varying acceptance of the web-based instrument across populations requires a flexible application of assessment instruments.

To assess the prevalence of high blood pressure (BP) and the association of overweight and obesity with high BP among adolescents in Aracaju, Brazil.

Cross-sectional study. The main outcome measure was the proportion of adolescents with high BP (sex-, age- and height-specific ≥95th percentile). The main predictor variables were overweight and obesity defined according to the criteria of the International Obesity Task Force. Other covariates included age, socio-economic status and leisure-time physical activity.

Aracaju, Brazil, capital city of Sergipe State, north-eastern Brazil.

A random sample of 1002 adolescents (442 boys and 560 girls) aged 12–17 years selected from twenty public schools and ten private schools were studied.

The prevalence of high BP was 16·9 % (95 % CI 13·1, 21·7) in boys and 12·9 % (95 % CI 9·0, 18·0) in girls. After adjusting for age, socio-economic status and leisure-time physical activity in both boys and girls, overweight (prevalence ratio (PR) = 1·93, 95 % CI 1·08, 3·48; PR = 4·34, 95 % CI 2·58, 7·30, respectively) and obesity (PR = 4·87, 95 % CI 2·35, 10·11; PR = 5·18, 95 % CI 2·67, 10·06, respectively) were found to be associated with high BP.

These findings indicate a high prevalence of high BP in both boys and girls in Aracaju, Brazil. Overweight and obesity were strongly associated with high BP. These findings underscore the urgent need for public health measures to prevent increasing high BP in adolescents in Brazil. Targeting intervention in adolescence may be a critical method for preventing high BP in later life.

To assess parents’ responses to common, potentially misleading strategies for marketing energy-dense and nutrient-poor (EDNP) child-oriented foods.

Between-subjects online experiment to test whether nutrient claims and sports celebrity endorsements on the front of packs of EDNP products lead parents to prefer and rate these foods more favourably.

Australia.

A total of 1551 parents of children aged 5–12 years, who were the main household grocery buyers.

Inclusion of nutrient claims or sports celebrity endorsements on EDNP products led parents to perceive these products to be more nutritious than if they did not include such promotions. When asked to choose between a pair of different products (EDNP v. healthier), 56 % of parents did not read a nutrition information panel (NIP) before making their choice and this did not differ by promotion condition. These parents were more likely to choose an EDNP product if it included a nutrient claim (OR = 1·83, 95 % CI 1·31, 2·56; P < 0·001) or sports celebrity endorsement (OR = 2·37, 95 % CI 1·70, 3·32; P < 0·001). Sports celebrity endorsements also enhanced parent's perceptions of typical consumers of the product, perceptions of product healthiness and quality, as well as purchase intentions.

Nutrient claims and sports celebrity endorsements tip consumer preferences towards EDNP products bearing such promotions, especially among the majority who do not read the NIP. As parents largely determine what foods are available to children at home, it is critical that initiatives aimed at reducing the persuasive impact of food marketing include this target group.

To examine the prevalence of food insecurity and to identify factors that contribute to it in the Republic of Korea.

A cross-sectional study.

Data were selected from a secondary data set, the third Korean Welfare Panel Study. Household food insecurity was measured with a six-item Korean version of the US Household Food Security Survey Module. The differences in proportions or means of household characteristics, householder's characteristics, economic status and social benefits by food insecurity status were tested with the χ2 or t test. The independent associations of food insecurity with each characteristic were assessed with multivariate logistic regression analysis.

The sample size consisted of 6238 households.

The prevalence of food insecurity was 5·3 % among all households and 25·7 % among low-income households. Risk factors that were associated with a higher risk of food insecurity included living alone, unemployment, no job, low household income and living in a leased or rented home. For low-income households, living in a leased or rented home increased the risk of food insecurity. Among food-insecure households, 26·1 % of the full sample of households and 34·3 % of low-income households were participating in food assistance programmes.

Food insecurity among the Korean population was related to household type, income, job status and housing. Food assistance programmes were not enough to completely alleviate food insecurity.