Nutrition Environment Measures Research Articles

Assessing the Healthfulness of University Food Environments: A Systematic Review of Methods and Tools.

The availability, promotion, and price of healthy foods within the university food environment may impact students' dietary choices. This systematic review summarizes the tools and methods used to assess the healthfulness of university food environments where many students spend a significant portion of their emerging adulthood. Thirty-six global studies published between 2012 and 2022 were sourced from PubMed (NNLM), Cochrane Library (Wiley), Web of Science (Clarivate), APA PsycInfo (EBSCO), CINHAL Complete (EBSCO), ProQuest Nursing, and Allied Health, following PRISMA 2020 guidelines. Of the included studies, 58% were institutional-level audits, 17% examined individual-level perceptions, and 25% combined both. Most institutional-level audits focused on one aspect of the food environment (e.g., eateries, vending machines). For studies examining multiple spaces within the campus environment (38%), comprehensive assessments were limited, and most studies had to employ a combination of assessment tools. Surveys were most often used to gather individual perceptions about the food environment. The Nutrition Environment Measures Survey (NEMS) was the most commonly used tool across all studies. This review highlights the need for a standardized tool, method, or a "healthy" benchmark for specific use at universities to improve methodological rigor and comparability of findings across institutions.

Assessing food availability and healthier options in an urban Chinese university: a case study using the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S).

Young adults (18-24 years) in universities are frequently exposed to an environment that promotes unhealthy eating behaviors. Using a validated tool, the Chinese Nutrition Environment Measurement Survey for Stores (C-NEMS-S), we assess the food availability and healthier options in a large, urban Chinese university. We employed C-NEMS-S for scoring criteria and weighting. A total of 52 on-campus canteen outlets were audited in an urban university located in Shijiazhuang City, China. General food outlets (n 43) and self-served food outlets (n 7) were further categorized into eight subtypes. Beverage outlets (n 2) were discussed separately from food outlets. C-NEMS-S scores were significantly different across food outlet types (P = 0.0024), especially between noodle and rice outlets (P = 0.0415). Food availability scores for starchy tubers (P < 0.001), dry beans (P < 0.001), vegetables (P = 0.0225), and fruits (P < 0.001) were significantly different across food outlet subtypes. Healthier options were scarce and only appeared in "grains" (n 2) and "meat and poultry" (n 2) categories. Further research on improving the accustomed audit tool and assessing university student diet quality is warranted.

Validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) for use in Brazil.

The aim of this study is to evaluate the validity and reliability of the Perceived Nutrition Environment Measures Survey (NEMS-P) translated and adapted for use in Brazil. Validation of the NEMS-P questionnaire. The questionnaires were applied to assess validity and reliability, based on exploratory factor analysis, Cronbach's α coefficient and intra-class correlation, with a significance level of 95 %. Brazil. Adults over 20 years of age diagnosed with hypertension were included in the internal validity and reliability test (n 176) and intra-rater reliability (subsample n 35). Factor analysis obtained satisfactory results. Internal consistency was acceptable for most items, with Cronbach's α ranging from 0·6 to 0·9. The intra-rater reliability of the subsample was also valid, with intra-class correlation coefficient values ranging from 0·5 to 0·9. This work reveals the usefulness of the instrument to assess the perceived food environment in the Brazilian context, being able to measure what is proposed according to its theoretical model, and reproduces the values when applied to a sample different from its original validation. However, refinement of some questions is suggested. Finally, it demonstrates the possibility of using the entire instrument or each section independently, according to the food environments to be investigated.

Oil/Salt Use Assessment of Chinese-Style Canteens Based on Consumers' Perception of the Nutrition Environment.

Excess cooking oil and salt use in catering services contributes to obesity and cardiovascular disease, but the assessment of oil/salt use has been a challenge in nutrition environment measurement. We conducted a knowledge, attitude, and practice survey on 250 respondents in five university canteens at China Agricultural University, Beijing, China. Using on-site tools including a newly developed Likert scale and the previously tested Oil-Salt Visual Analogue Scale (OS-VAS), the respondents were asked to evaluate their personal taste, their impression of the oil/salt status of canteen dishes, and their attitude toward oil/salt reduction. Data analysis showed that gender and self-image of body shape had a significant impact on KAP scores and the impression of the oil/salt environment. The respondents' taste preferences correlated with their perception of oil and salt, but knowledge and attitude were not directly related to scores on oil and salt, while weight status was related to oil and salt scores. The Likert scale-based assessment could work but was not as effective as the OS-VAS in distinguishing the differences among the selected canteens. These results indicate that the quality of the nutrition environment in catering services needs to be comprehensively evaluated with an objective evaluation of raters and a subjective evaluation of consumers.

Adaptation and validation of the Perceived Nutrition Environment Measures Survey for the Chilean context (NEMS-P-Ch)

Adaptation and validation of the Perceived Nutrition Environment Measures Survey for the Chilean context (NEMS-P-Ch)

Enhanced Measurement of Sugar-Sweetened Beverage Marketing to Young Immigrant Children in Grocery Store Environments.

The marketing of Sugar-Sweetened Beverages (SSBs) within grocers is an obesogenic factor that negatively impacts children's nutritional behavior, specifically for people from racial and ethnic minority groups, such as immigrants. We aimed to develop and employ a methodology that more precisely assesses the availability, price, and promotion of SSBs to young immigrant children within independently owned grocery stores. A case comparison design was used to explore the differences in the grocery store landscape of SSB marketing by conducting an enhanced Nutrition Environment Measures Survey-SSB (NEMS-SSB) within 30 grocery stores in the Hispanic and Latino enclaves in Southwest Detroit, in the Arab and Chaldean enclaves in North-central Detroit, and in Warren, Hamtramck, and Dearborn, in comparison with 48 grocers in Metro Detroit. Unsweetened, plant-based, and organic toddler and infant beverages, as well as questions about marketing, were added to the original NEMS to capture the promotion tactics used in marketing SSBs. NEMS-SSB scores revealed that, in the immigrant enclaves, there was a significantly higher availability of SSBs in grocery stores (-2.38), and they had lower prices than those in the comparison group (-0.052). Unsweetened, plant-based, and organic beverages were unavailable in 97% of all participating grocery stores across both groups. Signage featuring cartoon characters was the most frequent in-store SSB marketing tactic across both groups. Widespread SSB marketing toward toddlers within the grocery stores in immigrant enclaves could be linked with the higher early childhood obesity prevalence among the immigrant population. Our findings can assist local and national organizations in developing and implementing healthy eating interventions. This study must be repeated in other immigrant enclaves across states to provide comparable results.

Evaluating the outcomes and implementation determinants of interventions co-developed using human-centered design to promote healthy eating in restaurants: an application of the consolidated framework for implementation research.

Restaurants are an emerging yet underutilized setting to facilitate healthier eating, particularly among minoritized communities that disproportionately experience health inequities. The present study aimed to examine outcomes from interventions co-developed using Human-Centered Design (HCD) in two Latin American restaurants, including sales of healthier menu items (HMI) and the consumer nutrition environment. In addition, we aimed to assess implementation outcomes (acceptability, fidelity, and sustainability) and elucidate the determinants for implementation using the Consolidated Framework for Implementation Research. This study used a mixed-methods, longitudinal design. Data were collected pre-, during, and post-intervention testing. Intervention outcomes were examined through daily sales data and the Nutrition Environment Measures Survey for Restaurants (NEMS-R). Changes in HMI sales were analyzed using interrupted time series. Implementation outcomes and determinants were assessed through site visits [observations, interviews with staff (n = 19) and customers (n = 31)], social media monitoring, and post-implementation key informant interviews with owners and staff. Qualitative data were analyzed iteratively by two independent researchers using codes developed a priori based on CFIR. The HCD-tailored interventions had different outcomes. In restaurant one (R1), where new HMI were introduced, we found an increase in HMI sales and improvements in NEMS-R scores. In restaurant two, where existing HMI were promoted, we found no significant changes in HMI sales and NEMS-R scores. Acceptance was high among customers and staff, but fidelity and sustainability differed by restaurant (high in R1, low in R2). Barriers and facilitators for implementation were found across all CFIR constructs, varying by restaurant and intervention. Most relevant constructs were found in the inner setting (restaurant structure, implementation climate), individual characteristics, and process (HCD application). The influence of outer setting constructs (policy, peer pressure) was limited due to lack of awareness. Our findings provide insights for interventions developed in challenging and constantly changing settings, as in the case of restaurants. This research expands the application of CFIR to complex and dynamic community-based settings and interventions developed using HCD. This is a significant innovation for the field of public health nutrition and informs future interventions in similarly dynamic and understudied settings.

Adaptação transcultural da versão brasileira do Perceived Nutrition Environment Measures Survey

ABSTRACT Objective The objective of this study was to cross-culturally adapt the Perceived Nutrition Environment Measures Survey for use in the Brazilian context. Methods Independent translations into Portuguese of the original version and respective back-translations into English were performed. The steps were evaluated by an expert committee and the translated version was applied in a group of both genders, of different ages and education. Results After suggested modifications in the translation processes, the expert committee considered that the translated and adapted version presented conceptual and semantic equivalence. The translated version was applied to a sample of twenty people and only one question related to the amount of fat in the food required a new round to obtain understanding and clarity. Conclusion We present an adapted version of Perceived Nutrition Environment Measures Survey for the Brazilian context, which has adequate conceptual, cultural, and semantic equivalence, being objective and comparable to the original version. Future studies should confirm clarity, reliability, and validity.

Food availability and affordability in a Mediterranean urban context: associations by store type and area-level socio-economic status.

Although food environments have been highlighted as potentially effective targets to improve population diets, evidence on Mediterranean food environments is lacking. We examined differences in food availability and affordability in Madrid (Spain) by store type and area-level socio-economic status (SES). Cross-sectional study. Trained researchers conducted food store audits using the validated Nutrition Environment Measures Survey in Stores for Mediterranean contexts (NEMS-S-MED) tool to measure the availability and price of twelve food groups (specific foods = 35). We computed NEMS-S-MED scores and summarised price data with a Relative Price Index (RPI, comparing prices across stores) and an Affordability Index (normalising prices by area-level income). We compared the availability and affordability of 'healthier-less healthy' food pairs, scores between food store types (supermarkets, specialised, convenience stores and others) and area-level SES using ANOVA and multi-level regression models. City of Madrid. 2016 and 2019 to cover a representative sample. Food stores within a socio-economically diverse sample of sixty-three census tracts (n 151). Supermarkets had higher food availability (37·5/49 NEMS-S-MED points), compared to convenience stores (13·5/49) and specialised stores (8/49). Supermarkets offered lower prices (RPI: 0·83) than specialised stores (RPI: 0·97) and convenience stores (RPI: 2·06). Both 'healthy' and 'less healthy' items were more available in supermarkets. We found no differences in food availability or price by area-level SES, but affordability was higher in higher-income areas. Supermarkets offered higher food availability and affordability for healthy and less healthy food items. Promoting healthy food availability through supermarkets and specialised stores and/or limiting access to convenience stores are promising policy options to achieve a healthier food environment.

Refining the Nutrition Environment Measures Survey (NEMS) for Healthy Community Stores: Adaptations to Capture Alternative Food Retailers and Align with Dietary Guidelines.

Inadequate consumption of healthy food is an ongoing public health issue in the United States. Food availability measures of supply versus consumption of healthy foods are disconnected in many studies. There is a need for an objective assessment of the food environment in order to assess how the food supply aligns with the Healthy Eating Index (HEI). Data were collected as part of the Healthy Community Stores Case Study Project, including a refined Nutrition Environment Measures Survey for Healthy Community Stores (NEMS-HCS) and an updated Healthy Food Availability Index that aligns with the Healthy Eating Index (HFAHEI). This paper will focus on the NEMS-HCS development process, findings, and HFAHEI application. All food items were more likely to be found at grocery stores rather than corner stores. Food pricing was often above the Consumer Price Index averages for six food items. The NEMS-HCS assessment better aligned with the HEI because it included a wider variety of meats, frozen fruits and vegetables, and an increased selection of whole grains. HFAHEI scoring was inclusive of non-traditional and alternative community stores with a health focus, making it suitable for use at the local level, especially in neighborhoods where supermarkets and large chain stores are less common.

Food Environments in Times of Crises: Examining Menu Changes in Response to COVID-19 Among Hispanic Caribbean Restaurants in New York City

ABSTRACT The COVID-19 pandemic has affected independently owned restaurants with implications for food access and health equity. Changes in healthy food availability (HFA) were examined in a randomly selected sample of Hispanic Caribbean restaurants in New York City, before and after the COVID-19 onset (n = 76), using an adapted Nutrition Environment Measurement Survey for Restaurants. An overall decrease in HFA scores was found and changes HFA components (fried foods and vegetarian options increased, 100% fruit juice decreased, p < 0.10). Changes were examined against restaurant characteristics. This work augments our understanding of ethnic restaurants and the nutrition implications of business adaptations when responding to emergencies.

Association between the community food environment and dietary patterns in residents of areas of different socio-economic levels of a southern capital city in Brazil.

This study aimed to verify the association between the community food environment and dietary patterns in a population of different socio-economic levels. This cross-sectional study was conducted with a sample of 400 adults and elderly aged between 20 and 70 years residing in the central area of Porto Alegre, Rio Grande do Sul. Four dietary patterns were explored: healthy, traditional Brazilian, refined carbohydrates and sugars, and fast food. The community food environment included the identification of all food stores by areas where individuals lived and auditing based on the Nutrition Environment Measures Survey in Stores (NEMS-S) score. Poisson regression was used to estimate the prevalence ratios (PR) and their respective 95 % CI. After the adjustment for individual sociodemographic characteristics, residents of the area with the best community food environment (highest NEMS-S score) had 12 % and 18 % lower probabilities of high consumption (upper tertile) of the traditional (PR = 0·88; 95 % CI (0·78, 0·98)) and refined carbohydrate and sugar (PR = 0·82; 95 % CI (0·73, 0·92)) dietary patterns, respectively, compared with those living in the area with the worst community food environment (lowest NEMS-S score). Healthy and fast-food dietary patterns showed no association with the community food environment. In conclusion, the community food environment is a factor associated with the consumption of certain dietary patterns, independent of individual sociodemographic characteristics. Thus, aspects of the community food environment become important in food and nutrition actions and policies aimed at health promotion.

Adaptation and Validation of the Nutrition Environment Measures Survey in Stores (NEMS-S) in Costa Rica

ABSTRACT This study adapted and validated the NEMS-S in Costa Rica. Twenty-nine food stores were assessed, three times, by two raters. Inter-rater precision and intra-rater stability were quantified. Construct validity was determined with the known-groups method. Relative precision ranged from 0.54 to 0.77 and was 0.87 for total score. Relative stability ranged from 0.58 to 0.96 and was 0.94 for total score. For construct validity, the hypothesized relationship that supermarkets would have the highest scores was supported. The instrument has moderate to excellent precision and stability, has construct validity, and can be useful to develop policies that encourage healthy environments in food stores.

Forms of Community Engagement in Neighborhood Food Retail: Healthy Community Stores Case Study Project.

Community engagement is well established as a key to improving public health. Prior food environment research has largely studied community engagement as an intervention component, leaving much unknown about how food retailers may already engage in this work. The purpose of this study was to explore the community engagement activities employed by neighborhood food retailers located in lower-income communities with explicit health missions to understand the ways stores involve and work with their communities. A multiple case study methodology was utilized among seven retailers in urban U.S. settings, which collected multiple sources of data at each retailer, including in-depth interviews, store manager sales reports, store observations using the Nutrition Environment Measures Survey for Stores, public documents, and websites. Across-case analysis was performed following Stake’s multiple case study approach. Results indicated that retailers employed a wide variety of forms of community engagement within their communities, including Outreach, Building Relationships through Customer Relations, Giving Back, Partnering with Community Coalitions, and Promoting Community Representation and Inclusiveness. Strategies that built relationships through customer relations were most common across stores; whereas few stores demonstrated community inclusiveness where members participated in store decision making. Findings provide a more comprehensive view of the ways local food retailers aim to develop and sustain authentic community relationships. Additional research is needed to evaluate the impact of community engagement activities on improving community health.

The Snack Food Environment Pre and Post Pandemic University Closure; Evaluating Changes to the Healthfulness of Snacks Offered

ObjectivesThe snack food environment on college campuses plays a large role in the overall diet quality of students. Typically known for adding excess calories, salt, and fats to student diets, vending machines (VM) are a major component of the snack food environment. The recent COVID-19 pandemic has affected both snack consumption and the snacks available on campus. Studies indicate that stress eating has risen in response to the pandemic and supply chain issues have disrupted policy attempts to improve food environments. Therefore, the purpose of this study is to examine the quality of snack foods available on campus pre- and post-school closure due to COVID-19 at a large university in South Florida. MethodsA VM audit of the campus was conducted pre-closure between June 2019 and January 2020 and post-reopening in September 2021. Utilizing the Nutrition Environment Measurement Scale for Vending Machines (NEMS-V), all VM within the campus were scored by the principal investigator pre-closure and 15% of VM on campus were randomly selected for evaluation when the university reopened fully to students. NEMS-V grades the healthfulness of foods and beverages into three categories (green/healthy, yellow/unhealthy, and red/very unhealthy) based upon calorie content, calories from fat, grams of sodium, grams of sugar, etc. ResultsChanges to VM during this time included the addition of 20 very unhealthy and six healthy items and a decrease in choices with 104 empty slots (28%) post reopening compared to 12 (3%) pre-pandemic. The overall healthfulness of VM taken together was 84% unhealthy and 17% healthy pre-pandemic, and 82% unhealthy and 18% healthy post reopening. However, with the reduction in choices the range of unhealthy items was 73–94% pre-pandemic and 59–97% post reopening. No VM pre-pandemic had fewer than four healthy options while five VM had between one and three healthy options post reopening. ConclusionsThese findings indicate the need to explore options for contingency plans related to maintaining the quality of food environments during emergencies. Diet quality can be affected by these stressful events through increased desire to snack and the options available for snacking. This is of particular importance in places where people spend large portions of their time like schools and workplaces. Funding SourcesFIU, UGS, Doctoral Evidence Acquisition Fellowship.

Geographic remoteness and socioeconomic disadvantage reduce the supportiveness of food and physical activity environments in Australia

ObjectiveAn analysis of food and physical activity environments in relation to socioeconomic disadvantage was conducted in 25 communities across Queensland, Australia. MethodsPhysical activity and food environments were assessed in 25 Queensland communities using The Systematic Pedestrian and Cycling Environmental Scan (SPACES) and the Nutrition Environment Measurement Survey (NEMS). Spearman's correlation tested the association between physical activity and food environments and degree of remoteness and socioeconomic disadvantage of each region. ResultsA significant negative association was observed between the supermarket food environment and degree of remoteness and socioeconomic disadvantage. All regions have a moderately supportive environment for physical activity. Food availability and price varied in supermarkets with more remote communities having less supportive food environments. ConclusionsAreas with a high degree of remoteness and socioeconomic disadvantage were more likely to experience disadvantages in the physical activity, supermarket, and restaurant food environments than metropolitan areas and socioeconomically disadvantaged areas. Implications for public healthSocioeconomic disadvantage and remoteness were associated with reduced supportiveness of the built environment hindering the ability of consumers to make healthy food and physical activity choices. Improving the food and physical activity environments in these areas may assist in reducing the health inequalities experienced by these communities.

Validity of a Market Basket Assessment Tool for Use in Supplemental Nutrition Assistance Program Education Healthy Retail Initiatives

ObjectiveTo assess the validity of the Market Basket Analysis Tool (MBAT) for food environment quality within various retail environments compared to the Nutrition Environment Measures Survey in Stores (NEMS-S). MethodsIn-store assessments using the MBAT and the NEMS-S on the same day in a given store were conducted in grocery stores, corner stores, pharmacies, and dollar stores in a metropolis, and urban and rural counties across 4 states: Louisiana, Mississippi, North Carolina, and Virginia. Descriptive statistics, correlations, and ANOVAs were used to assess store location, store type differences, and MBAT and NEMS-S scores. ResultsMarket Basket Analysis Tool and NEMS-S data were collected from 114 stores. Market Basket Analysis Tool and NEMS-S total and all individual component scores were significantly correlated (r = 0.84, P ≤ 0.0001; r range, 0.51–0.88; P ≤ 0.0001). Conclusions and ImplicationsThe MBAT offers a methodology to measure the food retail environment focusing on the availability of healthful food items with a reduced training time and streamlined data collection compared with the NEMS-S. Future work can assess the completion time of the MBAT compared with the NEMS-S and the ability of the MBAT to detect changes in food environment quality post healthy food retail interventions.

Assessing the Influence of Food Insecurity and Retail Environments as a Proxy for Structural Racism on the COVID-19 Pandemic in an Urban Setting.

A collaborative partnership launched the Great Grocer Project (GGP) in March 2021 in Detroit, Michigan where health inequities, including deaths due to COVID-19, have historically been politically determined and informed by socially entrenched norms. Institutional and structural racism has contributed to a lack of diversity in store ownership among Detroit grocers and limited access to high-quality, affordable healthy foods as well as disparate food insecurity among Detroit residents. The GGP seeks to promote Detroit’s healthy grocers to improve community health and economic vitality through research, programs, and policies that have the potential to advance health equity. A cross-sectional design was used to explore relationships between scores from the Nutrition Environment Measures Surveys-Stores (NEMS-S) in 62 stores and city-level data of COVID-19 cases and deaths as well as calls to 211 for food assistance. Regression and predictive analyses were conducted at the ZIP code level throughout the city to determine a relationship between the community food environment and food insecurity on COVID-19 cases and deaths. COVID-19 cases and deaths contributed to greater food insecurity. The use of ZIP code data and the small sample size were limitations within this study. Causation could not be determined in this study; therefore, further analyses should explore the potential effects of individual grocery stores on COVID-related outcomes since a cluster of high-scoring NEMS-S stores and calls to 211 for food security resources inferred a potential protective factor. Poor nutrition has been shown to be associated with increased hospitalizations and deaths due to COVID-19. It is important to understand if a limited food environment can also have a negative effect on COVID-19 rates and deaths. Lessons learned from Detroit could have implications for other communities in using food environment improvements to prevent an uptick in food insecurity and deaths due to COVID-19 and other coronaviruses.

The obesogenity of restaurant food: Mapping the nutritional foodscape of Franklin County, Ohio using food review images

Geographical research on the community food environment emphasizes the spatial dimension of food access, where food quality and nutrition are overlooked. While the nutritional quality of food stores can be evaluated by audit tools, such as the Nutrition Environment Measurement Survey series, these tools cannot be readily applied on a large scale. To aid in the nutrition assessment of the community food environment, this article proposes an innovative image recognition approach that identifies the nutrition information of restaurant food by crowdsourcing food images and retrieving their nutrition information in a case study of Franklin County, Ohio. As these food images are derived from food review websites, they represent consumers' actual dietary quality as a more direct, quantifiable measure of the community food environment. The derived nutrition information is applied for further analysis to characterize neighborhood obesogenity, referring to as factors in the built environments that facilitate the development of obesity. The proposed crowdsourcing-image recognition approach enriches the understanding of health inequities from a nutrition science perspective, which is beyond the tradition of food access in the spatial dimension only.

Development of a Nutrition Environment Assessment Tool for Latino Ethnic Stores

The objectives were to: (1) adapt the Nutrition Environment Measures Survey for Stores (NEMS-S) to better culturally fit small Latino grocery stores (tiendas) in Iowa; (2) assess the newly adapted Latino NEMS-S for inter-rater and test-retest reliability; and (3) compare Latino and original NEMS-S summary scores. This pilot instrument, containing culturally appropriate foods from the original NEMS-S and 2015 US Dietary Guidelines for Americans, underwent two rounds of formative evaluation. The new instrument and scoring protocol were applied to a random sample of 42 of 81 possible tiendas in Iowa. Cohen’s kappa was used to assess inter-rater and test-retest reliability for availability and quality of indicator food items (total scores and food category sub scores). There were no differences in summary scores for inter-rater or test-retest reliability using paired t-tests. Inter-rater agreement was high (range 0.82–1.00; p < 0.001). Tiendas averaged 42.0 ± 7.5 of 57 possible points on the Latino NEMS-S, but only 12.0 ± 4.6 of 54 points on the original NEMS-S (p < 0.001). The Latino NEMS-S is a reliable tool for assessing the food environment within Iowa tiendas. Culturally specific instruments can describe diverse food environments more accurately and guide public health nutrition interventions within communities.