Availability Of Healthy Options Research Articles

Healthy food and determinants of food choice on online food delivery applications.

Online food delivery applications (OFD apps) provide consumers with a wide range of options to choose from. The present study aimed to assess the usage of OFD apps and investigate the factors that affect food choices with a special emphasis on healthy food choices and hygiene. A cross-sectional study among food delivery application users in Jordan was conducted using an online questionnaire between March and May 2022. A total of 675 eligible subjects participated in the study. Consumers' demographic characteristics, data on consumers' use of OFD apps, consumers' perceptions of healthy food availability in OFD apps, and consumers' attitudes toward food safety and delivery hygiene were collected and analyzed. About 64% of the studied sample used OFD apps weekly. Fast food was the most popular option for ordering (87.1%) and lunchtime was the most preferred time to order food (67.3%) for most of the respondents. Respondents' perceptions of a "healthy meal" was associated with the presence of a variety of vegetables in the meal. Food price, food appearance, time of delivery, macronutrient content information, the availability of healthy options, and considering vegetables as part of a healthy meal were determinants of consumer food choice (p<0.05). The findings suggest that the online food environment in Jordan was perceived to be unhealthy. Nevertheless, the convenient nature and the popularity of OFD apps hold great potential to promote healthy eating among consumers.

Technical Assistance From Public Health Practitioners to Small Food Retailers to Implement Minimum Stocking Standards.

Implementing minimum stocking standard policies in food retail settings has been one strategy used to address lack of healthy food availability. Policies alone may not be enough to increase healthy options, as barriers may arise during implementation, such as lack of distributors and/or refrigeration. Technical assistance (TA) from public health practitioners (PHPs) can bolster the implementation of such policies. This study describes the impact of a pilot intervention where PHPs provided TA to store managers/owners aimed to increase healthy options through implementing minimal stocking standards. This intervention consisted of TA about healthy products, placement, and promotion from state to county/city PHPs and from PHPs to managers/owners of small food retail stores. Thirteen food retailers and PHPs from 11 different agencies participated in this intervention. PHPs interviewed managers/owners pre- and post-intervention to understand perceptions and practices and collected data about the availability of healthy options. PHPs tracked the TA provided to managers/owners and completed a postsurvey, assessing their experience. During the pilot, stores increased the median number of varieties of healthy options. PHPs provided TA around healthy products, placement; and promotion building relationships with distributors and farmers, and overcoming infrastructure barriers. Finding distributors with healthy options remained challenging for some managers/owners. PHPs indicated that continued TA for managers/owners is necessary for sustainability and additional support around distribution and business/economic challenges is needed. Overall, this pilot indicates that PHPs are valuable partners to small food retailers, and in partnership, they have potential to address healthy food access issues.

Dutch Preadolescents' Food Consumption at School: Influence of Autonomy, Competence and Parenting Practices.

Eating habits appear to become less healthy once children move into adolescence. Adolescence is characterized by increasing independence and autonomy. Still, parents continue influencing adolescents’ eating habits. This cross-sectional study used a Self-Determination Theory perspective to examine how parents can support preadolescents’ food-related autonomy and competence and how these factors are associated with healthy eating motivation and food consumption at school. In addition, the effect of relative healthy food availability at home on preadolescents’ food consumption at school was explored. In total, 142 Dutch preadolescents (mean age 12.18) and 81 parents completed questionnaires. The results showed that preadolescents perceived themselves as having higher food-related autonomy and lower competence to eat healthily as compared to their parents’ perceptions. A path analysis was conducted to test the hypothesized model. Although parental support was positively associated with food-related autonomy, higher food-related autonomy was related to less healthy food intake at school. On the other hand, competence to eat healthily indirectly affected preadolescents’ healthy intake ratio through their healthy eating motivation. Finally, the relative availability of healthy options at home was positively associated with preadolescents’ healthy intake ratio outside the home. Findings from the study advance the understanding of individual and environmental factors that influence eating habits during the key life period of early adolescence. The results may inform interventions aiming to guide preadolescents to make healthy food choices on their own.

Healthy snacks in hospitals: Testing the potential effects of changes in availability.

Hospitals offer snacks for sale to patients, staff and visitors. As food choice is heavily influenced by the options available, the present study (a) audited snack availability and purchase in NHS hospital sites across a large UK city; and (b) tested the potential effects of changes to this availability in an online choice experiment. In Study 1 (audit), single-serve snacks (n=376) available in 76 hospital food retail units were audited. Purchasing data were obtained from six food retail units over four weeks (27,989 sales). In Study 2 (online experiment), participants (n=159) chose snacks from pictured ranges containing 25% (minority), 50% (equivalent) or 75% (majority) healthy options. Available single-serve snacks varied markedly in calorie (18-641 kcals), fat (0-39 g), sugar (0.1-76 g) and salt (0-2.9 g). Only 30% of available snacks were healthy options and only 25% of the most commonly purchased snacks were healthy options. In Study 2, snack choice was significantly associated with the availability of healthy options in the choice array (X2 (2)= 59.71, p<.01). More participants made healthy choices when product ranges contained 75% healthy options compared to 50% (p<.01) and 50% healthy options compared with 25% (p<.01). Healthy snacks are readily available in NHS sites but there is a greater relative variety of unhealthy snack products. Many consumers continue to purchase unhealthy items. Further increasing the availability and variety of healthy options may support consumers to make healthier choices.

The Healthfulness of Eateries at the University of Waterloo: A Comparison across 2 Time Points.

Purpose: The aim of this study was to assess the healthfulness of a sample of campus eateries at 2 time points, 2 years apart. Methods: Five eateries at the University of Waterloo were audited using the Nutrition Environment Measures Survey adapted for university campuses (NEMS-UC) in 2015 and late 2017-early 2018. Based on the availability of healthy options and facilitators of and barriers to healthy eating, possible NEMS-UC scores ranged from -5 to 23 points. Results: Scores were low, ranging from 7 to 14 (mean = 10.8, SD = 2.59) points in 2015 and 7 to 13 (mean = 9.6, SD = 2.19) points in 2017-2018. For all eateries except 1 residence cafeteria, scores at time 2 were the same or lower than scores at time 1. All venues carried whole fruit and vegetable options and lower-fat milks, and most offered whole-wheat options. However, healthier items were often located in low-traffic areas, priced higher than less healthy options, and sometimes limited to prepackaged items. Misleading health messaging was also evident. Conclusions: Increased availability, accessibility, and visibility of healthy offerings is needed to enhance campus food environments and support healthy eating patterns, while barriers such as contradictory messaging should be minimized.

Children's Intake of Food from Non-Fast-Food Outlets and Child-Specific Menus: A Survey of Parents.

Eating out-of-home is associated with higher energy intakes in children. The continued high prevalence of childhood obesity requires a greater understanding of child menu options and eating out frequency to inform appropriate regulatory initiatives. The majority of studies to date have focused on menus from fast-food outlets with few focused on non-fast-food outlets. This study aimed to describe parents’ reports of their child(ren)’s (aged up to 6 years) frequency of consuming foods at non-fast-food outlets, observations of child menus at these outlets, and their purchasing behaviours and future preferences regarding these menus; and if their responses were influenced by sociodemographic characteristics. Ninety-five parents completed a 15-item cross-sectional survey. Overall, children from 54% of families consumed food from non-fast-food outlets at least monthly. Of the 87 parents who reported that their child eats at a non-fast-food restaurant, 71 had children who ordered from child menus every time (7%, n = 5), often (29%, n = 22), sometimes (42%, n = 32) or rarely (16%, n = 12), with a further 7% (n = 5) never ordering from these menus. All parents indicated that they would like to see a higher proportion of healthy child menu items than is currently offered. Parents’ responses were not influenced by sociodemographic characteristics. Parents’ views support implementation of initiatives to increase availability of healthy options on child menus at non-fast-food outlets.

Examining community and consumer food environments for children: An urban-suburban-rural comparison in Southwestern Ontario

The aim of this study is to evaluate how retail food environments for children in the City of London and Middlesex County, Ontario, Canada, vary according to level of urbanicity and level of socioeconomic distress. Urbanicity in this study is defined as a neighbourhood's designation as urban, suburban, or rural. We assessed community food environments (e.g., the type, location, and accessibility of food outlets) using 800m and 1600m network buffers (school zones) around all public and private elementary schools, and we calculated and compared density of junk food opportunities (JFO) (e.g., fast food and full-service restaurants, grocery stores, and convenience stores) within each school zone in urban, suburban and rural settings. The study also assessed consumer food environments (e.g., the price, promotion, placement, and availability of healthy options and nutrition information) through restaurant children's menu audits using the Children's Menu Assessment tool. Results suggest JFO density is greater around elementary schools in areas with higher levels of socioeconomic distress and urbanicity, while urbanicity is also associated with greater use of branded marketing and inclusion of an unhealthy dessert on children's menus.

Barriers to Diet and Exercise among Nepalese Type 2 Diabetic Patients.

This study aims to identify the modifiable barriers encountered by type 2 diabetic patients in Nepal to achieving their recommended dietary and exercise advice. A cross-sectional study was conducted among 197 type 2 diabetic patients, attending a diabetic clinic. Binary logistic regression models were used to identify perceived barriers. About 41% and 46% of the participants were noncompliant to diet and exercise advice, respectively; only 35.5% the participants were compliant to both. Perceived social acceptability (OR = 0.14; 95% CI: 0.03–0.58) and reminder to action (OR = 2.77; 95% CI: 1.38–5.53) were associated with noncompliance to diet. Most of the barriers to diet were related to taste, feast and festivals, lack of knowledge, and availability of healthy options. Self-efficacy (OR = 0.09; 95% CI: 0.02–0.34) and social acceptability (OR = 0.12; 95% CI: 0.04–0.34) were significant predictors of noncompliance to exercise. The supportive role of children and spouse and the opposing role of friends and relatives were important for compliance to both. A misconception on diabetes severity, effectiveness of healthy lifestyle, and exercise timing was prevalent among the study participants. Addressing the modifiable barriers identified in this study is essential for successful diabetes management in Nepal.

Evaluation of Healthy2Go: A country store transformation project to improve the food environment and consumer choices in Appalachian Kentucky.

Rates of obesity and type 2 diabetes in Kentucky's Cumberland Valley region are among the highest in the United States and limited access to healthy food contributes to these epidemics. The aim of Healthy2Go (H2G), a country store transformation project launched by Spread the Health Appalachia (STHA), was to improve awareness and availability of healthy options in small, rural stores. Ten country stores participated in H2G and received training and technical assistance to increase availability and awareness of healthy foods. Stores made inventory changes; installed point-of-purchase educational and in-store marketing materials directing shoppers to healthier options; provided nutrition education such as healthy recipes; and altered the display and location of healthy items. To measure changes within stores and the potential impact on resident eating and purchasing habits, STHA used four instruments: a modified version of the Nutrition Environs Measures Survey – Corner Stores at baseline and follow-up, a bimonthly store inventory assessment, a final store owner survey, and a Community Nutrition Survey at baseline (n = 287) and follow-up (n = 281). The stores in the H2G program (n = 10) had a 40% increase in stocking fresh produce, a 20% increase in produce variety, and trends towards increasing healthy inventory. During the same period, surveyed residents reported a statistically significant increase in the frequency of healthy food consumption. Small store transformation programs can improve availability of and access to healthy food in rural settings and influence local purchasing patterns.

Physical micro-environment interventions for healthier eating in the workplace: protocol for a stepped wedge randomised controlled pilot trial

BackgroundAn estimated one third of energy is consumed in the workplace. The workplace is therefore an important context in which to reduce energy consumption to tackle the high rates of overweight and obesity in the general population. Altering environmental cues for food selection and consumption—physical micro-environment or ‘choice architecture’ interventions—has the potential to reduce energy intake. The first aim of this pilot trial is to estimate the potential impact upon energy purchased of three such environmental cues (size of portions, packages and tableware; availability of healthier vs. less healthy options; and energy labelling) in workplace cafeterias. A second aim of this pilot trial is to examine the feasibility of recruiting eligible worksites, and identify barriers to the feasibility and acceptability of implementing the interventions in preparation for a larger trial.MethodsEighteen worksite cafeterias in England will be assigned to one of three intervention groups to assess the impact on energy purchased of altering (a) portion, package and tableware size (n = 6); (b) availability of healthier options (n = 6); and (c) energy (calorie) labelling (n = 6). Using a stepped wedge design, sites will implement allocated interventions at different time periods, as randomised.DiscussionThis pilot trial will examine the feasibility of recruiting eligible worksites, and the feasibility and acceptability of implementing the interventions in preparation for a larger trial. In addition, a series of linear mixed models will be used to estimate the impact of each intervention on total energy (calories) purchased per time frame of analysis (daily or weekly) controlling for the total sales/transactions adjusted for calendar time and with random effects for worksite. These analyses will allow an estimate of an effect size of each of the three proposed interventions, which will form the basis of the sample size calculations necessary for a larger trial.Trial registrationISRCTN52923504

Stakeholder Perspectives on Implementing Menu Labeling in a Cafeteria Setting.

Mandatory and voluntary menu-labeling policies are increasingly common to support informed food choices among consumers. This study sought to examine stakeholder perspectives of developing, implementing, and maintaining a voluntary menu-labeling program in a hospital cafeteria setting. Semi-structured qualitative interviews were conducted with 9 key cafeteria stakeholders. Data were coded by 2 independent researchers. Themes were generated deductively around 4 key themes: (1) motivation for the program; (2) program and menu development; (3) program implementation process; and, (4) "lessons learned," and inductively as they emerged from interview transcripts. These themes were mapped onto Damschroder's Consolidated Framework for Implementation Research. Motivations for the program were both internal and external to enable consumers to make educated food choices. Barriers to implementation included financial resources, digital menu board maintenance, and availability of healthy options from providers. Supports included availability of nutritional analysis software and nutritional information, and controlled food preparation. Ownership, program adaptation, a supportive collegial environment, a program champion and a culture valuing healthy eating were conducive to successful implementation. Both internal and external factors can support the voluntary implementation of menu-labeling programs.

Nutrition-Labeling Regulation Impacts on Restaurant Environments

Recent attempts to improve the healthfulness of away-from-home eating include regulations requiring restaurants to post nutrition information. The impact of such regulations on restaurant environments is unknown. To examine changes in restaurant environments from before to after nutrition-labeling regulation in a newly regulated county versus a nonregulated county. Using the Nutrition Environment Measures Survey-Restaurant version audit, environments within the same quick-service chain restaurants were evaluated in King County (regulated) before and 6 and 18 months after regulation enforcement and in Multnomah County (nonregulated) restaurants over a 6-month period. Data were collected in 2008-2010 and analyses conducted in 2011. Overall availability of healthy options and facilitation of healthy eating did not increase differentially in King County versus Multnomah County restaurants aside from the substantial increase in onsite nutrition information posting in King County restaurants required by the new regulation. Barriers to healthful eating decreased in King County relative to Multnomah County restaurants, particularly in food-oriented establishments. King County restaurants demonstrated modest increases in signage that promotes healthy eating, although the frequency of such promotion remained low, and the availability of reduced portions decreased in these restaurants. The healthfulness of children's menus improved modestly over time, but not differentially by county. A restaurant nutrition-labeling regulation was accompanied by some, but not uniform, improvements in other aspects of restaurant environments in the regulated compared to the nonregulated county. Additional opportunities exist for improving the healthfulness of away-from-home eating beyond menu labeling.

Study on some factors for healthy nutrition environment in restaurants in Southwestern Bulgaria

The purpose – The purpose of the study is to conduct a regional survey in tourist companies in Southwestern Bulgaria for examining some key factors for building/forming a healthy nutrition environment. Design – The special focus is given to analysis of the key factors for creating healthy nutrition environment in restaurants. Methodology – A cross sectional survey conducted including 34 respondents from 120 operating hotels with restaurants in Southwestern Bulgaria and 30 independent restaurants in Blagoevgrad, Kyustendil and Samokov – the three main towns in the area. The level of knowledge on healthy nutrition and healthy foods was assessed using a 5-rank scale and the healthy practices was conducted in the aspects: availability of healthy options, point-of-purchase information to facilitate healthy choices and promotion and communication of healthy foods. Approach- Implementation of healthy eating practice is studied in restaurants as the restaurant is one of the most important public places that form a healthy nutrition environment and create conditions for implementation of initiatives to support healthy food choices. Findings – It is indicated that the management staff of the surveyed tourist companies shows good level of knowledge and awareness on healthy nutrition issues. Despite good theoretical knowledge, however, the implementation of healthy practices in the restaurant business is insufficiently developed. There is no clear concept for introduction of healthy eating practice in restaurants and there is no active communication with the client in this regard either. The main conclusion focuses on the need of collaboration between nutrition specialists, academic institutions in tourism, and restaurant and hotel entrepreneurs to implement the principles of healthy eating in out-of-home settings. The originality of this research – The originality of the study lies in the fact that for the first time in Bulgaria the preconditions for the formation of a healthy environment in restaurants are explored.

Availability of healthier options in traditional and nontraditional rural fast-food outlets.

BackgroundFood prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods.MethodsUsing all traditional and nontraditio nal fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthiermenu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines.ResultsTraditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a s imilar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes.ConclusionConvenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify potential targets for intervention.

Barriers to healthy eating by National Health Service (NHS) hospital doctors in the hospital setting: results of a cross-sectional survey

BackgroundWith high levels of obesity and related illness, improving the health of the nation is a major public health concern. This study aimed to identify factors that prevent healthy eating among doctors, and that are associated with satisfaction with catering services.FindingsMethods: Cross-sectional survey of 328 NHS doctors working in two NHS Trusts with on-site hospital canteen. Questionnaire to establish perceived barriers to healthy eating, weekly use and satisfaction with the hospital canteen, lifestyle and dietary habits, gender, age, height, weight, job details, and affect.Results: 70% of doctors reported using their hospital canteen each week, with 2 visits per week on average.Canteen opening times, lack of selection and lack of breaks were the most commonly perceived barriers to healthy eating. Availability of healthy options caused the most dissatisfaction. Only 12% felt the NHS was supportive of healthy eating. 74% did not feel their canteen advocated healthy eating. Canteen use is associated with younger age (r = -0.254, p < 0.0001) and health score (r = 0.123, p = 0.049).ConclusionInterventions to encourage regular meal breaks, eating breakfast and drinking more water each day need developing. Improved canteen accessibility and availability of healthy options at evenings and weekends may be beneficial.