Make Healthier Food Choices Research Articles

Hindrances and Enablers of Healthy Eating Behavior Among College Students in an HBCU: A Qualitative Study.

Research indicates widespread unhealthy eating habits among college students, posing long-term health risks. This study at a Historically Black College and University (HBCU) aimed to explore the perceived obstacles and facilitators to healthy eating among college students, using the social ecological model (SEM). Through focus group discussions and key informant interviews, the study identified several barriers to healthy eating, including challenges in accessing federal food assistance resources, gaps in nutrition knowledge, cost concerns, limited food variety on campus, difficulty accessing grocery stores, and a lack of cooking skills. To address these barriers, participants suggested various solutions, such as implementing cooking demonstrations, providing nutrition education, increasing food variety on campus, offering gardening opportunities, adjusting cafeteria hours for more flexibility, making fresh produce more available on campus, assisting students in accessing federal food assistance programs, and providing transportation to nearby grocery stores. The findings highlight the need for targeted interventions to promote healthier dietary behaviors among college students, particularly those attending HBCUs. By addressing the identified barriers and implementing the suggested solutions, initiatives can be developed to support students in making healthier food choices, ultimately reducing long-term health risks associated with unhealthy eating habits.

The relationship between the dietary index based Meiji nutritional profiling system for adults and lifestyle-related diseases: a predictive validity study from the National Institute for Longevity Sciences-Longitudinal Study of Aging.

Nutritional profiling system (NPS) holds promise as a public health tool for companies to measure product healthiness and for individuals in making healthier food choices. The Meiji NPS for adults specifically targets lifestyle-related diseases prevalent among Japan's adult population, including overweight/obesity, hypertension, diabetes, and dyslipidemia. This study examined the cross-sectional association between the Meiji NPS for adults Dietary Index (MNfA-DI) and indicators of lifestyle-related diseases in a population. The study comprised 1,272 middle-aged individuals (40-64 years, 50.1% male) who participated in the seventh wave (2010-2012) of the National Institute for Longevity Sciences-Longitudinal Study of Aging project, with no missing data on three-day dietary records. The MNfA-DI was computed at the individual diet level (accounting for the whole diet) using arithmetic energy-weighted means. A higher MNfA-DI indicated a greater nutritional quality of an individual's overall diet. Lifestyle-related disease indicators included body mass index (BMI, kg/m2), body fat (%), systolic and diastolic blood pressure (mmHg), fasting plasma glucose (mg/dL), HbA1c (%), triglyceride levels (mg/dL), LDL, and HDL cholesterol levels (mg/dL). A multiple regression model was used to assess the association between the MNfA-DI and lifestyle-related disease indicators, adjusting for demographics, socioeconomic status, lifestyle factors, disease history, and energy intake as covariates, depending on the outcome. The median (interquartile range) age and MNfA-DI were 53.0 (46.0, 59.0) years and 10.1 (6.0, 14.0) points, respectively. MNfA-DI was negatively associated with body fat [partial regression coefficient (95% confidence interval) -0.04 (-0.07, -0.01)], diastolic blood pressure [-0.08 (-0.17, -0.002)], fasting plasma glucose [-0.18 (-0.33, -0.01)], and triglyceride [-1.36 (-2.16, -0.55)]. Additionally, MNfA-DI was also associated with almost indicators (except for LDL and HDL cholesterol) among participants with a BMI between 18.5 and 24.9 kg/m2. These findings suggest that the Meiji NPS for adults could be associated with a lower risk of lifestyle-related diseases. In addition, from a public health nutrition perspective, the Meiji NPS for adults may be useful to assess the food healthiness of the adult population.

In search of an appropriate front-of-package nutritional labelling scheme for the CARICOM region

PurposeThis study aims to evaluate the impact of the proposed CARICOM Octagon “High In” Warning Label (OWL), against four alternative Front-of-Package Nutrition Labels (FOPNLs): US “Facts Up Front” (FUF), UK Multi-Traffic Light (MTL), Mexican OWL and the Brazilian Magnifying Glass “High In” Warning Label, on respondents’ purchase intentions, perception of healthiness and understanding of nutritional information across and within food products.Design/methodology/approachIn an online randomized control experiment, adults from eight CARICOM countries (n = 948) were randomly assigned to a control and four treatment FOPNL groups. Respondents were tasked to choose between four categories of mock products with three variations in healthfulness across and within products.FindingsNo statistically significant difference (p > 0.05) was found across FOPNL groups compared to the OWL on outcomes of purchase intentions and perception of healthfulness. Regarding the understanding of nutritional information, FUF performed the best, as participants were 1.76 times (p = 0.03) and 3.23 times (p = 0.00) more likely to correctly identify the products with the highest and lowest amount of sugar, respectively. Results were similar for products with the lowest sodium (odds ratio [OR] = 2.25, p = 0.00) and highest saturated fats (OR = 2.11, p = 0.00).Research limitations/implicationsSome limitations of this study include the use of an online platform to conduct the experiment. Though this was the most cost-effective method of execution and presented many benefits, there were limitations to using this approach. Firstly, this approach may not entirely replicate the real world in store purchasing settings. Although online grocery shopping is becoming increasingly popular, in the Caribbean, most grocery purchases are made in stores. Furthermore, online surveys are more likely to lead to samples with higher educational and income levels than the average population (Bethlehem, 2010). The skewedness observed was not unique to this study and was common with similar published studies (Franco-Arellano et al., 2020; Packer et al., 2021; Talati et al., 2018). Nevertheless, all respondents were randomly assigned to groups, and it was confirmed that there were no systematic differences in the education and income levels of participants across the FOPNL groups.Practical implicationsSome CARICOM policy makers advocate for the use of “High In” warning labels to limit the intake of nutrients of concern (NOCs) and to encourage healthier eating habits among consumers. However, regional private sector stakeholders have expressed concern about the lack of sufficient research undertaken at a regional level, to inform the effectiveness of this model within CARICOM, and some have also expressed a preference for the use of other interpretative and reductive FOPNLs, already in use in the Region. The results of this study reveal that while interpretative FOPNLs like the Draft CARICOM Regional Standard, DCRS5 (OWL) can assist consumers in making healthier purchase decisions, it was outperformed by the MTL on perception of healthiness and by the FUF on the understanding of nutrient information. It was also noted that the DCRS5 (OWL) was more effective when choosing across products with distinct nutritional differences but performed poorly in assisting respondents with making healthy purchasing decisions when all the products contained NOCs above the relevant thresholds. This study’s findings highlight that the existing FOPNL schemes can be further enhanced for improved outcomes. This can be achieved by using a hybrid approach which includes both reductive and interpretative elements to allow for comparison across and within food products. The literature also suggests the use of colour and combining positive as well as negative elements to encourage ease of interpretation, improved understanding and healthier food choices.Social implicationsA properly designed FOPNL can support consumers in making healthier food choices; however, it must be accompanied by measures to raise consumer awareness and increase the health literacy of the population to cause shifts in preferences and behavioural patterns over time. This must also be coupled with policies to make healthy food choices more affordable to the general population.Originality/valueThe results of this study revealed that FUF and MTL performed the best in assisting participants to correctly identify between products with the highest or lowest NOCs at the 5% significant level, and that the OWL performed poorly in assisting participants with making healthy purchasing decisions when all the products contained NOCs above the relevant thresholds.

Exploring the perception of small and medium food enterprises in Lincolnshire, UK on the use of front‐of‐pack nutrition labels by consumers

SummaryThe food and drink industry is the UK's largest manufacturing sector, and small to medium‐sized enterprises (SMEs) play a key role in the UK's food system. This study investigates food‐providing SMEs' knowledge of nutrition labels and perceptions of the use of front‐of‐pack nutrition labels in making informed and healthy food choices by consumers. The SMEs were based in Lincolnshire, UK, and comprised food manufacturers (75%), food retailers (14%) and food service providers (11%) (n = 35). A 25‐item questionnaire was developed and validated to collect responses. The questionnaire link was disseminated by email and completed online. Comparisons were made between competing answers using Cochran's Q tests, each with post‐hoc pairwise McNemar test comparisons. Confidence intervals were computed using ordinal regressions. More than half of the SMEs' products (58%) had UK traffic light (TL) colour‐coded schemes and % Guideline Daily Amounts (GDAs). The SMEs stated that the TL label was the best format that provided ‘at‐a‐glance’ information, and this was significantly higher than %GDA and interpretative text (Ps < 0.003). Nearly 49% of the SMEs were unaware of the front‐of‐pack labels being not mandatory in the United Kingdom. Many (86%) acknowledged that the nutrition information on food products was helpful or very helpful for consumers in making purchasing decisions. The SMEs seemed to place the costs of implementing FOP labels on food products above their helpfulness in making healthier food decisions by consumers. This research is one of the first to investigate the perceptions of SMEs on how consumers utilise nutrition labels when making healthier food choices in the United Kingdom. Government subsidies on the costs incurred by incorporating TL labelling on the products are necessary in order to have front of pack (FOP) labels mandatory in the United Kingdom. Greater food industry involvement in academic and policy‐related research is essential to creating a healthier and more sustainable food environment.

Tensorial Principal Component Analysis in Detecting Temporal Trajectories of Purchase Patterns in Loyalty Card Data: Retrospective Cohort Study.

Loyalty card data automatically collected by retailers provide an excellent source for evaluating health-related purchase behavior of customers. The data comprise information on every grocery purchase, including expenditures on product groups and the time of purchase for each customer. Such data where customers have an expenditure value for every product group for each time can be formulated as 3D tensorial data. This study aimed to use the modern tensorial principal component analysis (PCA) method to uncover the characteristics of health-related purchase patterns from loyalty card data. Another aim was to identify card holders with distinct purchase patterns. We also considered the interpretation, advantages, and challenges of tensorial PCA compared with standard PCA. Loyalty card program members from the largest retailer in Finland were invited to participate in this study. Our LoCard data consist of the purchases of 7251 card holders who consented to the use of their data from the year 2016. The purchases were reclassified into 55 product groups and aggregated across 52 weeks. The data were then analyzed using tensorial PCA, allowing us to effectively reduce the time and product group-wise dimensions simultaneously. The augmentation method was used for selecting the suitable number of principal components for the analysis. Using tensorial PCA, we were able to systematically search for typical food purchasing patterns across time and product groups as well as detect different purchasing behaviors across groups of card holders. For example, we identified customers who purchased large amounts of meat products and separated them further into groups based on time profiles, that is, customers whose purchases of meat remained stable, increased, or decreased throughout the year or varied between seasons of the year. Using tensorial PCA, we can effectively examine customers' purchasing behavior in more detail than with traditional methods because it can handle time and product group dimensions simultaneously. When interpreting the results, both time and product dimensions must be considered. In further analyses, these time and product groups can be directly associated with additional consumer characteristics such as socioeconomic and demographic predictors of dietary patterns. In addition, they can be linked to external factors that impact grocery purchases such as inflation and unexpected pandemics. This enables us to identify what types of people have specific purchasing patterns, which can help in the development of ways in which consumers can be steered toward making healthier food choices.

Consumers’ Perceptions of the Design of Front-of-Package Warning Labels—A Qualitative Study in China

The warning label is identified as a simple front-of-package labeling format that assists consumers in making healthier food choices at the point of purchase. The color and/or shape of the design elements of the packaging labels can influence the understanding and purchase intention outcomes. This study aimed to explore the perceptions of consumers regarding differently designed warning labels (WLs) to identify a possibly suitable warning label design in the Chinese context. Using a qualitative approach, we collected data through 12 focus group discussions consisting of 116 participants residing in 6 provinces. Participants were selected by purposive sampling. Data were coded following inductive thematic analysis and summarized into three themes: (1) perceived preference for the appearance of the WLs, (2) perceived benefits of the WLs, and (3) suggestions for promoting the WLs. Participants preferred the black shield label showing a high content of the nutrients of concern (e.g., sodium, added sugar, and saturated fat) in both Chinese and English. Consumers generally agreed that the WLs were easy to understand and offered a simple method for choosing healthier foods. They anticipated that WLs could encourage the food industry to reformulate their products. Our study results will support the design and facilitate the use of WLs in China.

Nutrition Label Literacy and Food Choices among Mobile Food Pantry Participants

Objective: We assessed nutrition label literacy and whether the implementation of traffic light labeling (TLL) would facilitate participants’ perceptions about the usefulness of TLL in making healthier food choices at a university’s mobile food pantry. Methods: TLL was implemented during 3 mobile food pantry distribution sessions on a university campus in the southwestern United States during spring of 2020. College students, staff, and community members utilizing the mobile food pantry selected food items based on the TLL perceptions after receiving nutrition education. We used items from validated surveys, demographic items, and TLL perception questions to collect our data from participants (N = 112). Results: We found statistically significant associations between nutrition label literacy and choosing healthier food items based on TLL perceptions; participants who had lower nutrition label literacy scores perceived the TLL to be the most helpful in selecting healthier food items (p = .02). Statistically significant association also was noted between race/ethnicity and nutrition label literacy (p = .004) and overweight participants perceiving the TLL method to be restrictive when choosing food items(p = .02). Conclusions: Assessing nutrition label literacy and whether the implementation of the TLL would facilitate participants perceptions about the usefulness of the TLL in making healthier food choices identifies opportunities to improve nutrition label literacy among individuals who utilize mobile food pantries; in addition, it highlights the importance of nutrition label literacy in making informed and/or healthy food choices.

Can Food Labels Improve the Food Systems in the World?

Food systems across the world have changed from wholesome foods to fast and ultra-refined foods. This nutrition transition has contributed immensely to the rapidly increasing Non-Communicable Diseases (NCDs) such as diabetes and obesity across the globe. There is a growing need to support consumers in making healthier food choices through information, education and communication, and by targeting the market environment through food labelling. Food labels include ingredients, amounts, allergens, name of manufacturer, country of origin, date of manufacture and expiry. This article aims to raise awareness of the effectiveness of food labelling to improve the food system and, in return, combat the rising NCDs. Nutrition labelling has shown positive results in shaping consumer food choices and improving the quality of food production by food manufacturers. Unfortunately, there is a tendency for food companies to market false information about food, marketing an item to consumers as a healthy food option, when in fact, it is not.Despite increasing calls for mandatory food labelling as a policy strategy to halt the rising prevalence of NCDs, governments require clear evidence supporting the effectiveness of food labelling in improving food choices to make informed decisions. Mandatory labelling would require a strong commitment from all stakeholders, including the food industry, governments, consumer organisations and the trade industry.

Using a Sensory Learning Framework to Design Effective Curricula: Evidence from Indigenous Nutrition Education Programs

As health disparities among Native Americans persist, promoting better health outcomes is of paramount concern among Indigenous populations. A variety of programs exist that try to alleviate problems resulting in higher rates of diet-related chronic diseases and premature death. For this study, we collaborated with an Indigenous-led nonprofit that implemented a series of nutrition education courses designed to empower community members to make healthier food choices. The theoretically based curriculum, which provided learners with information in the form of sensory-based modules, e.g., food preparation, food handling, cultural awareness, and practical cooking skills, was introduced in various communities in the Great Plains and Southwest. The nutrition education programs were modeled after a canonical educational learning model, Bloom’s Taxonomy, designed to provide participants with information and resources necessary to make healthier food choices across three cognitive domains (i.e., tiers). We used a mixed-methods approach, coupling Principal Components Analysis with a qualitative SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis, to assess each program’s capacity to enhance learning retention, i.e., to assess the salience of information provided and the extent to which each program was more or less successful in participants’ learning. We found that course content and instruction are strongly correlated with program satisfaction. In addition, from the qualitative analysis, we found that as each successive module of the program challenged higher cognitive domains, participants were more likely to indicate satisfaction in the course material as well as state a desired change in their behavior, which we attribute to participants’ ability to synthesize and evaluate information. Aspects of this programming framework have the potential to be adapted to and integrated into other Native communities striving for the successful adoption of healthier diets.

Pleasure or Health? The Role of Mental Simulation in Desire and Food Choices.

Many times, desire possesses us and impedes us from making healthier food choices. From a grounded cognition perspective, we investigated the role of two types of mental simulation (process and outcome) in desire and food choice to understand the processes that modulate them and find strategies that encourage healthier food choices. In addition to these explicit measures, we used two implicit methods to measure approach-avoidance tendencies and visual attention. Our results showed that imagining the consumption of vice and virtue foods increased desire for the product imagined and seemed to favor the choice of a vice food. However, at an implicit level, the motivation to approach and avoid food products was neutral. Imagining the post-consumption of a vice food decreased desire for the imagined food and although it tempted people at an implicit level, it made people more prone to choose a virtue food. When a vice food was imagined, attentional bias increased for all types of food regardless of the simulation. When a virtue food was imagined, there was no effect on choice, motivation nor attentional bias. In conclusion, simply imagining certain foods is a potential solution for promoting healthier and thoughtful choices.

Learners’ experience and perceived impact of a health literacy program in adult basic education: a qualitative study

Qualitative interview study. We conducted semistructured interviews as part of the evaluation of the 18-week health literacy program, with participants purposively recruited from six health literacy classes (n = 22). Researchers trained in qualitative methods interviewed adult learners either face to face or over the phone using a topic guide. Data was analysed using the Framework method, a matrix-based approach to thematic analysis. The majority of interviewees were female, lived in metropolitan areas and were from non-English-speaking backgrounds. Most had existing self-reported health problems and inadequate functional health literacy. Most participants described positive impacts of the health literacy course on their language, literacy and numeracy skills, functional health literacy skills, and health knowledge. They also reported being able to translate this into health actions including interacting with providers, accessing and using healthcare, and managing health and illness (e.g. making healthier food choices). Learners also described positive social outcomes of the course, including feelings of connectedness and interpersonal trust within a new network of learners, and reported sharing new knowledge with others in their communities. The findings add value to existing limited evidence that has demonstrated the untapped potential of adult basic education to develop health literacy skills among socially disadvantaged groups. Learners valued the opportunity to share experiences in structured group learning, and reported confidence to transfer new knowledge into their home and wider social network.

Nutritional Score of Meat Products at Retail in Serbia

Nutri-score is simplified front-of-pack nutrition labelling on packed food products, used in a broad international context to categorize food products into five colour/letter grades (best A to worst E) that reflect the foods’ nutritional quality. The labels serve as potential help for consumers to make healthier food choices and encourage food industries to improve the nutritional quality of the foods they produce. The aim of this study was to determine the nutritional scores and grades of meat products present on the Serbian retail market. Ultimately, this should point out to consumers the importance of proper nutrition and encourage the meat industry to adapt to new labelling requirements. During a two year period, 310 packaged locally-produced meat products were purchased at retail, graded according to the Nutri-score method and categorized into 13 ad hoc product groups. The results obtained showed that 82.5% of all examined meat products had nutritional scores that meant they were classified as unhealthy foods, while only 2.9% of meat products (these were fresh meat or minced meats) were classified as healthy foods. Of the total number of examined meat products, 41.5% were classified as grade E, 41% were classified as grade D, 13% received grade C, 1.6% received grade B, while only 2.9 % were classified as grade A. Sodium chloride was an especially burdensome parameter in 10 groups (77% of all products examined), while the presence of saturated fat was troublesome in 7 groups (54%) and high energy balance in 2 groups (15%). Serbian manufacturers are advised to implement new formulations and/or procedures in an effort to reduce these parameters in the meat products they produce.

Feasibility of a Multidisciplinary and Culturally Adapted Pediatric Weight Management Program for Latino Families: Results From the Vidas Activas y Familias Saludables Pilot Study

ObjectiveTo determine the feasibility of a pediatric weight management program for low-income Latino families. MethodsA pretest-posttest pilot study was conducted among 60 Latino children, aged 4–9, who were overweight/obese (body mass index-for-age ≥85th percentile). The 10-week group-based community program addressed diet, exercise, and behavior modification. Demand was assessed through recruitment and attendance, acceptability using postintervention surveys with participants, and limited efficacy testing of participant anthropometrics and cardiometabolic markers. ResultsOverall 65% of families were retained for follow-up. All families reported feeling more confident in making healthier food choices and would participate in the program again. Pre/post intervention testing found statistically significant decreases (P < .05) in body mass index for age z score, waist circumference, and % body fat. Conclusions and ImplicationsThis culturally adapted group intervention for Latino families was acceptable and shows promise for improved health status, although it needs to be replicated with a larger group and longer follow-up.

How the French Nutri-Score can impact sales of processed-foods? A complex system perspective

Abstract Background Nutri-Score (NS) is France Front-of-Pack Food Labelling System to provide at-a-glance information about the nutritional quality of pre-packaged food products. Based on the Food Standards Agency nutrient profiling system, its algorithm generates a score by taking into account the presence of both the harmful and beneficial contents in food. In this presentation, we report on our analysis of the logic model of NS and on its potential impact on the production and marketing of processed foods. Methods We reviewed the scientific and grey literature on NS to identify its potential mechanisms and loci of change. We also appraised the policy against Meadow’s leverage points for system change. Results The official adoption of the NS algorithm is instrumental in modifying both consumer food-related behaviours and food industry corporate practices. The algorithm takes 3 forms: 1) the front-of-pack logo indicating an integrated colour/letter score for the product, 2) mobile device applications which help consumers assess the nutritional value of food products even without an affixed logo, 3) nutritional parameters which influence food manufacturing decision-making in the industry. NS can trigger different drivers of corporate practice. From the current uptake trends, small and medium size food manufacturers appear more likely to welcome the NS Logo as a means to stand out against the multinational corporations presently dominating the market. As for the capacity of NS to transform the existing systems of producing and marketing processed foods, we find that it is mostly by changing the flow of information. NS presents new information, previously inaccessible to consumers, to support the population in making healthier food choices by providing a means for nuanced nutritional comparisons between food products of the same category. Conclusions We conclude on the potential evolution of Nutri-Score and how its uptake by food corporations may be fostered. Key messages Nutri-Score’s impact is through: the front-of-pack logo; nutrition apps; and as a parameter of food industry decision-making. Nutri-Score impacts the flow of information of the processed-food system.

The effect of the spatial positioning of a healthy food cue on food choice from a pictorial-style menu

The present study aimed to investigate the effect of the spatial positioning of a healthy food cue in the context of unhealthy food cues on subsequent food choice. Undergraduate women (N = 143) were asked to choose a food from a pictorial-style menu that presented a salad and three unhealthier food options in a horizontal line. The position of the salad was manipulated to be presented either (a) in the middle, (b) at the end, or (c) separated by 5 cm to the right of the line of unhealthier food options. Participants also completed a questionnaire measure of dietary restraint. Participants were significantly more likely to choose the salad when it was presented separately rather than in the middle of the unhealthier food options. This effect was not moderated by dietary restraint. The findings point to the possibility of designing pictorial menus in fast-food outlets in such a way as to subtly nudge people towards making healthier food choices.

P105 Outcome Evaluation of Ohio State University Extension SNAP-Ed Social Marketing Campaign

Background USDA's Food and Nutrition Service encourages social marketing to enhance nutrition education in SNAP-Ed. In 2018, Ohio State University (OSU) Extension implemented Celebrate Your Plate (CYP), a social marketing campaign intended to increase awareness of the importance of eating fruits and vegetables across two quadrants of Ohio comprising 45 counties. Objective To measure awareness of CYP and assess healthy behaviors of low-income Ohioans in areas with the campaign. Study Design, Settings, Participants Low-income Ohioans residing in the two quadrants were randomly selected for a telephone survey. Data were collected at three time points between May and September 2018; post-implementation in one quadrant, and pre- and post-implementation in the other. Measurable Outcome/Analysis Indicators from the SNAP-Ed Evaluation Framework related to healthy eating and food resource management were measured along with demographic characteristics. Data were weighted to represent SNAP recipients in the quadrants. Comparisons between quadrants, demographics and campaign exposure were made using 95% confidence intervals to determine significant differences. Results Post-implementation, 18% of low-income Ohioans were exposed to CYP. Exposure was highest among women (23%), households with children (27%), and participants in food assistance programs (26%). Ohioans exposed to the campaign ate more fruits and vegetables daily than those unexposed, although this was not significant. Among assistance programs participants, campaign exposure was significantly associated with higher readiness to increase vegetable consumption. Reported barriers to eating healthier were cost, health reasons, dislike, and being too busy to shop for, cook or prepare healthy foods. Actions taken after campaign exposure included thinking about making healthier food choices, buying and eating more fruits and vegetables, and planning healthy meals for their family. Conclusion OSU Extension successfully launched a multi-modal social marketing campaign in 2018 recognized by nearly one-fifth of low-income Ohioans. CYP was particularly effective in reaching Ohioans participating in assistance programs and may increase their readiness to increase fruit and vegetable consumption.

P171 A Follow-Up Outcome Evaluation of Alabama SNAP-Ed's Social Marketing Campaign

Background In 2017, Alabama Cooperative Extension System at Auburn University (ACES) contracted Altarum to conduct outcome and formative evaluations of its Live Well Alabama social marketing campaign. Based on Altarum's findings, ACES updated the three core messages and accompanying images for its billboard campaign that relaunched in early 2018. Objective To measure campaign exposure and assess dietary and health behaviors among selected Alabama Supplemental Nutrition Assistance Program-Education (SNAP-Ed) parents. Study Design, Settings, Participants Altarum conducted an outcome evaluation using measures from the SNAP-Ed Evaluation Framework. An updated telephone survey was utilized to collect data from parents of third grade Body Quest students in spring 2018. Measurable Outcome/Analysis Descriptive statistics described the sample population and outcome variables. Significant differences between groups were estimated using 95% confidence intervals. Differences between the 2017 and 2018 evaluations were noted. Results A total of 366 surveys were completed. About half (51%) of respondents were exposed to at least one billboard message, a significant increase from 2017 (38%). Repeated exposure to billboards was strong with 39%, 41%, and 56% of all exposed respondents reporting seeing the Fruit and Vegetable, Physical Activity, and Water billboards five or more times, respectively. Exposed respondents reported that viewing the billboards led them to drink more water (38%); eat more fruits and vegetables (37%); think about making healthier food choices (33%); plan healthy meals (32%); and buy more fruits and vegetables (31%). Respondents exposed to billboards consumed significantly more cups of fruit than those unexposed (1.7 and 1.3 cups, respectively) and were significantly more likely to report consuming water two or more times per day than those unexposed. Similar to 2017 results, lack of time was reported as the primary barrier to increasing vegetable consumption and physical activity. Conclusion ACES successfully revised and relaunched its billboard social marketing campaign in 2018 that was recognized by over one-half of the surveyed target audience.

P53 Awareness and Perceptions of Maine SNAP-Ed Among Maine SNAP Recipients

Background Contracted by the State of Maine—DHHS Office for Family Independence (OFI), Altarum has served as the external evaluator for Maine Supplemental Nutrition Assistance Program-Education (SNAP-Ed) since 2013. Objective Assess awareness, perceived value, and barriers to accessing Maine SNAP-Ed direct education classes among Maine SNAP recipients. Study Design, Settings, Participants Altarum conducted a cross-sectional telephone survey using a list of adult Maine SNAP recipients provided by the State of Maine–DHHS OFI. Measurable Outcome/Analysis Respondents were asked about awareness, perceived value, and barriers to participation in Maine SNAP-Ed direct education classes. Results were weighted to reflect characteristics of Maine SNAP recipients. Descriptive statistics and 95% confidence intervals were calculated to identify significant differences between groups. Results Approximately half of Maine SNAP recipients (49%) were aware of Maine SNAP-Ed. Many SNAP recipients (45%) learned about SNAP-Ed classes through other assistance programs (e.g., WIC). A majority (61%) recognized one or more of Maine SNAP-Ed's direct education classes by name. Only 7% of SNAP recipients had taken a Maine SNAP-Ed direct education class. However, most SNAP recipients (72%) were “somewhat” or “very interested” in learning how to eat healthy. Those who had taken a Maine SNAP-Ed class reported that the program helped them plan healthy meals for themselves and their family (96%), try a new recipe (91%), and think about making healthier food choices (91%). Barriers to participation mentioned by those who had not taken a Maine SNAP-Ed class included: being unaware that nutrition education classes were offered (52%), difficulty with the locations (43%), disbelieving classes would change behaviors (40%), and being too busy (35%). Approximately 4 in 10 who had not participated (41%) were uninterested in taking a nutrition education class. Conclusion The majority of Maine SNAP recipients were aware of SNAP-Ed and interested in learning to eat healthy. Maine SNAP-Ed may be able to increase program participation by addressing identified barriers.

Who Values Gluten-Free? Dietary Intake, Behaviors, and Sociodemographic Characteristics of Young Adults Who Value Gluten-Free Food

BackgroundOver the past decade, consumer demand for gluten-free products has increased, but little is known about the public health impact of and factors correlated with valuing gluten-free food. ObjectiveDescribe the sociodemographic and behavioral characteristics of young adults valuing gluten-free as an important food attribute, and compare their dietary intake with other young adults. DesignCross-sectional analysis of survey data collected in 2015 to 2016 as part of the fourth wave of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. Participants/settingPopulation-based sample of 1,819 young adults (25 to 36 years) (57% women, 69% white), initially recruited in Minneapolis-St Paul, MN, public middle and senior high schools. MeasuresValuing gluten-free food, weight goals and weight control behaviors, food production values, eating behaviors, physical activity, and dietary intake. Statistical analyses performedLogistic regression models were used to investigate associations with potential correlates of valuing gluten-free food. For dietary intake, adjusted mean estimates were calculated for those who did and those who did not value gluten-free foods. ResultsApproximately 13% of young adults valued gluten-free food, a characteristic most strongly related to valuing food production practices (eg, organic, locally grown); factors such as Nutrition Facts use and having a weight goal were also related to gluten-free food values. Valuing gluten-free food was related to engagement in both healthy behaviors (eg, eating breakfast daily, eating more fruits and vegetables) and unhealthy behaviors (eg, using diet pills to control weight). Conclusions and relevanceYoung adults valuing gluten-free food generally engaged in healthier behaviors and had better dietary intake; of concern, they were also more likely to engage in unhealthy weight control behaviors. Valuing gluten-free food may be part of a cluster of behaviors representing an interest in making healthier food choices but may also be a marker for unhealthy weight preoccupation and behaviors.

Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women’s Eating Behavior

The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people’s eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women’s susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project’s findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.