Nutritional Quality Of Food Purchases Research Articles

The revised Healthy Purchase Index (r-HPI): a validated tool for exploring the nutritional quality of household food purchases

BackgroundThe Healthy Purchase Index (HPI) assesses the nutritional quality of food purchases (FP) from food group expenditure shares only. However, it was developed from the FP of a disadvantaged population.ObjectiveTo adapt and validate the HPI for a general population.MethodsFP were obtained from a representative sample of French households (Kantar WorldPanel) subdivided into two subsamples. The first sample (n = 4375) was used to adapt and validate the score; the second sample (n = 2188) was used to test external validity. The revised-HPI (r-HPI) includes 2 subscores: the diversity subscore and the quality subscore. Diversity subscore points were awarded when expenditure shares were above the 25th percentile for 5 food groups (“Fruits”, “Vegetables”, “Starches”, “Dairy”, “Meat, Fish and Eggs”). Regression models between the expenditure shares of each food group and the Mean Adequacy Ratio (MAR) and the Mean Excess Ratio (MER) of FP were used to select quality subscore components and define cut-offs for point allocation. Construct validity was assessed on the first sample using Spearman’s correlations between the r-HPI and the four nutritional quality indicators (NRF9.3, MAR, MER, energy density), and also by comparing the r-HPI of monthly FP of sub-populations defined by criteria known to influence diet quality (age, gender, income, education) and between households having a monthly food basket of higher (MAR > median and MER and energy density < median) vs. lower nutritional quality within the population, using Wilcoxon tests or pairwise comparisons of contrasts. External validity was tested by performing the same analyses on the 2nd sample of 2188 households.ResultsThe adaptation led to include new components (e.g. red meat) and define new cut-offs (e.g. − 1 point when budget share for red meat > 21%). The r-HPI (mean = 6.50 ± 3.58) was strongly correlated with NRF9.3, MAR, MER and energy density (0.59, 0.52, − 0.41 and − 0.65, respectively, p < 0.01) and poorly correlated with total energy content (− 0.096, p < 0.001). The r-HPI was significantly higher in women (β = 1.41 [0.20], p < 0.01), households having a food basket of higher nutritional quality (β = 4.15 [0.11], p < 0.001), and increased significantly with age, income and education levels. Similar results were obtained in the 2nd sample.ConclusionWe showed the validity of the r-HPI in a large sample of French households. As it does not require food quantity or nutrient content, it can be used as a valuable tool to explore FP behaviours. Cut-offs can be used in health promotion to provide nutri-economic counselling.

The Effect of a Future-Self Avatar Mobile Health Intervention (FutureMe) on Physical Activity and Food Purchases: Randomized Controlled Trial.

BackgroundInsufficient physical activity and unhealthy diets are contributing to the rise in noncommunicable diseases. Preventative mobile health (mHealth) interventions may help reverse this trend, but present bias might reduce their effectiveness. Future-self avatar interventions have resulted in behavior change in related fields, yet evidence of whether such interventions can change health behavior is lacking.ObjectiveWe aimed to investigate the impact of a future-self avatar mHealth intervention on physical activity and food purchasing behavior and examine the feasibility of a novel automated nutrition tracking system. We also aimed to understand how this intervention impacts related attitudinal and motivational constructs.MethodsWe conducted a 12-week parallel randomized controlled trial (RCT), followed by semistructured interviews. German-speaking smartphone users aged ≥18 years living in Switzerland and using at least one of the two leading Swiss grocery loyalty cards, were recruited for the trial. Data were collected from November 2020 to April 2021. The intervention group received the FutureMe intervention, a physical activity and food purchase tracking mobile phone app that uses a future-self avatar as the primary interface and provides participants with personalized food basket analysis and shopping tips. The control group received a conventional text- and graphic-based primary interface intervention. We pioneered a novel system to track nutrition by leveraging digital receipts from loyalty card data and analyzing food purchases in a fully automated way. Data were consolidated in 4-week intervals, and nonparametric tests were conducted to test for within- and between-group differences.ResultsWe recruited 167 participants, and 95 eligible participants were randomized into either the intervention (n=42) or control group (n=53). The median age was 44 years (IQR 19), and the gender ratio was balanced (female 52/95, 55%). Attrition was unexpectedly high with only 30 participants completing the intervention, negatively impacting the statistical power. The FutureMe intervention led to small statistically insignificant increases in physical activity (median +242 steps/day) and small insignificant improvements in the nutritional quality of food purchases (median −1.28 British Food Standards Agency Nutrient Profiling System Dietary Index points) at the end of the intervention. Intrinsic motivation significantly increased (P=.03) in the FutureMe group, but decreased in the control group. Outcome expectancy directionally increased in the FutureMe group, but decreased in the control group. Leveraging loyalty card data to track the nutritional quality of food purchases was found to be a feasible and accepted fully automated nutrition tracking system.ConclusionsPreventative future-self avatar mHealth interventions promise to encourage improvements in physical activity and food purchasing behavior in healthy population groups. A full-powered RCT is needed to confirm this preliminary evidence and to investigate how future-self avatars might be modified to reduce attrition, overcome present bias, and promote sustainable behavior change.Trial RegistrationClinicalTrials.gov NCT04505124; https://clinicaltrials.gov/ct2/show/NCT04505124

Associations Between Retail Food Environment and Nutritional Quality of Food Purchases in French Households: The Mont’Panier Cross-Sectional Study

ObjectivesThe purpose of this study was to assess whether the retail food environment, measured by multiple indicators around home and in activity space, was associated with nutritional quality of food purchases. MethodsThis cross-sectional study included 462 households from a quota sampling survey conducted in the south of France (Montpellier Metropolitan Area). The revised Healthy Purchase Index was implemented in order to assess nutritional quality of food purchases. Food environment indicators (presence, number, relative density and proximity of food outlets) were calculated around home and in activity space (around home, work, other places of activity and along commuting journeys) using a geographical information system. Six different types of food outlets were studied: supermarkets, markets, greengrocers, bakeries, other specialized food stores (butcher’s, fishmonger’s and dairy stores) and small grocery stores. Associations between food environment and nutritional quality of food purchases were assessed using multilevel models, and geographically weighted regressions to account for spatial non-stationarity. Models were adjusted for households’ socioeconomic and demographic characteristics. ResultsNutritional quality of food purchases was positively associated with the number of greengrocers around home (1 vs 0: β = 0.25, 95%CI = [0.01, 0.49]; >1 vs 0: β = 0.25, 95%CI = [0.00, 0.50]), but negatively associated with the number of markets around home (1 vs 0: β = –0.20, 95%CI = [–0.40, 0.00]; >1 vs 0: β = –0.37, 95%CI = [–0.69, –0.06]). These associations varied across space in the studied area. For households with lower income, number of greengrocers in activity space was positively associated with nutritional quality of food purchases (1 vs 0: β = 0.70, 95%CI = [0.12, 1.3]; >1 vs 0: β = 0.67, 95%CI = [0.22, 1.1]). ConclusionsGreengrocers might be an efficient food store type to promote healthier dietary behaviors. Further studies, particularly interventional studies, are needed to confirm these results in order to guide public health policies in actions designed to improve the food environment. Funding SourcesRégion Occitanie; Institut national de recherche pour l’agriculture, l’alimentation et l’environnement (INRAE); ANR (the French National Research Agency).

Associations between retail food environment and the nutritional quality of food purchases in French households: The Mont'Panier cross-sectional study.

PurposeThe purpose of this study was to assess whether the retail food environment, measured by multiple indicators around the home and in activity space, was associated with the nutritional quality of food purchases.MethodsThis cross-sectional study included 462 households from a quota sampling survey conducted in the south of France (Montpellier Metropolitan Area). The revised Healthy Purchase Index was implemented in order to assess the nutritional quality of food purchases. Food environment indicators (presence, number, relative density and proximity of food outlets) were calculated around the home and in activity space using a geographical information system. Six different types of food outlets were studied: supermarkets, markets, greengrocers, bakeries, other specialized food stores (butcher’s, fishmonger’s and dairy stores) and small grocery stores. Associations between food environment and the nutritional quality of food purchases were assessed using multilevel models, and geographically weighted regressions to account for spatial non-stationarity. Models were adjusted for households’ socioeconomic and demographic characteristics.ResultsThe nutritional quality of food purchases was positively associated with the number of greengrocers around the home (1 vs. 0: β = 0.25, 95%CI = [0.01, 0.49]; >1 vs. 0: β = 0.25, 95%CI = [0.00, 0.50]), but negatively associated with the number of markets around the home (1 vs. 0: β = -0.20, 95%CI = [-0.40, 0.00]; >1 vs. 0: β = -0.37, 95%CI = [-0.69, -0.06]). These associations varied across space in the area studied. For lower income households, the number of greengrocers in activity space was positively associated with the nutritional quality of food purchases (1 vs. 0: β = 0.70, 95%CI = [0.12, 1.3]; >1 vs. 0: β = 0.67, 95%CI = [0.22, 1.1]).ConclusionsGreengrocers might be an effective type of food store for promoting healthier dietary behaviors. Further studies, particularly interventional studies, are needed to confirm these results in order to guide public health policies in actions designed to improve the food environment.

Associations between food environment and nutritional quality of food purchases in French households: The Mont'Panier cross-sectional study

Associations between food environment and nutritional quality of food purchases in French households: The Mont'Panier cross-sectional study

Using a Naturalistic Store Laboratory for Clinical Trials of Point-of-Sale Nutrition Policies and Interventions: A Feasibility and Validation Study.

Point-of-sale policies such as warnings and taxes are promising tools for improving the nutritional quality of food purchases. Research studies conducted in naturalistic store laboratories could improve the quality of evidence about point-of-sale interventions by allowing for realistic exposure in a controlled setting. This study aimed to assess whether purchasing behavior in a naturalistic store laboratory setting was similar to real-life purchasing behavior and to evaluate participants’ perceptions of store realism and the acceptability of research study protocols in this setting. In a longitudinal observational study in 2019, Latinx parents in North Carolina (n = 61) attended five weekly visits at the UNC Mini Mart, a naturalistic store laboratory that resembled a small convenience store. At each visit, participants purchased a week’s supply of beverages. Purchases of beverages in the Mini Mart were compared to participants’ purchases from receipts submitted the week prior to the study. Analyses compared the percentage of participants buying sugary drinks and non-sugary drinks in the Mini Mart vs. in real stores using Chi-Square tests with Fisher’s p. The percentage of parents who purchased sugary drinks in the Mini Mart (93%) was not significantly different from the percentage who purchased sugary drinks during the week before the study (74%, p = 0.28). The percentage purchasing non-sugary drinks was similar in the two settings (85% in the Mini Mart vs. 85% from receipts, p = 0.33). Nearly all participants reported that their Mini Mart purchases were similar to real-life purchases (96%); the Mini Mart felt like a real store (94%); they could find all the beverages they were looking for (92%); and they could imagine doing their real-life beverage shopping in the Mini Mart (92%). Moreover, retention was high, with 97% of participants attending the final study visit. These results indicate that naturalistic store laboratories are a promising method for increasing the ecological validity of trials to evaluate point-of-sale interventions.

Nutritional quality of retail food purchases is not associated with participation in the Supplemental Nutrition Assistance Program for nutrition-oriented households.

The Supplemental Nutrition Assistance Program (SNAP) provides millions of low-income Americans food benefits and other forms of nutrition assistance. Evidence indicates that SNAP reduces food insecurity. However, there is a concern that the food benefit may increase the demand for less healthy foods more than healthier foods, thereby reducing the overall nutritional quality of the participant's food basket. This paper aims to examine the association of SNAP participation with the nutritional quality of food-at-home purchases of low-income households and to investigate the potential heterogeneity among consumers with different levels of nutrition attitude. This analysis used food purchase data from the USDA National Household Food Acquisition and Purchase Survey (FoodAPS). Our study sample included 2,218 low-income households, of which 1,184 are SNAP participants, and 1,034 are income-eligible nonparticipants. Multivariate regressions were performed to explore the SNAP-nutritional quality association. A household's nutrition attitude was measured using its response to a question on whether the household searched for nutrition information online in the last 2 months. Households that affirmed they had an online nutrition search were treated as nutrition-oriented households (21.2% of the low-income sample), and households that did not were considered less nutrition-oriented households (78.8%). For robustness, we also created an alternative nutrition attitude measure based on reported use of the nutrition facts label. We found that among less nutrition-oriented households, SNAP participants had a statistically significant 0.097 points (p = 0.018) lower Guiding Stars rating than low-income nonparticipants. However, there was no significant SNAP-nutritional quality association among nutrition-oriented households. In conclusion, SNAP participation was associated with lower nutritional quality of food purchases among less nutrition-oriented households, but not among nutrition-oriented households. The results suggest that the intended nutritional benefits of restrictions on purchases of healthy foods may not reach the subgroup of nutrition-oriented SNAP participants.

The Effect of Dynamic Food Labels with Real-Time Feedback on Diet Quality: Results from a Randomized Controlled Trial.

The rising prevalence of non-communicable diseases has brought attention to the importance of consuming a healthy diet. One strategy to improve diet quality is through front-of-pack (FOP) nutrition labels. Taking advantage of an online grocery store, we allowed consumers to choose the FOP labels they preferred, and combined this information with real-time feedback on the overall nutritional quality of the shopping basket. We hypothesized that these dynamic food labels with real-time feedback (DFLF) would improve nutritional quality of food purchases. This trial followed a two-arm (no-label control and DFLF) crossover design with 125 participants exposed to each condition once in random order via an online grocery store. A first difference regression model allowed for estimating the unbiased effect of the DFLF on diet quality, measured by the weighted average Nutri-Score (ranging 1 to 5) per serving (primary) and changes in select nutrients and calories. The mean weighted Nutri-Score was 0.4 (12.6%) higher in the DFLF arm (CI: [0.2, 0.6]) relative to the control. The DFLF also decreased the amount of sugar per serving by 0.9 g (CI: [−1.7, −0.0]) and total sugar per shop by 169.5 g (CI: [−284.5, −54.5]). The DFLF features significantly improved nutrition quality relative to no labelling, as measured by average Nutri-Score values. These results shed light on the considerable potential of the online shopping environment to improve diet quality through customization and real time feedback.

Nudging while online grocery shopping: A randomized feasibility trial to enhance nutrition in individuals with food insecurity

Food insecurity, the inability to acquire adequate food due to insufficient resources for food, is associated with an increased risk for obesity and associated health problems. This study assessed the feasibility and initial efficacy of a prefilled online grocery shopping cart (i.e., default option) in promoting healthier grocery purchases in individuals with food insecurity. Fifty participants recruited from food pantries in New York in 2018 were randomized to review nutrition information before purchasing groceries online (n = 23) or modify a prefilled, nutritionally balanced online shopping cart (n = 27) based on a budget corresponding to Supplemental Nutrition Assistance Program benefits. Compared to nutrition education, the default shopping cart resulted in the purchase of significantly more ounces of whole grains (Mean Difference [Mdiff] = −4.05; 95% Confidence Interval [CI] = −6.14, −1.96; p < .001), cups of fruits (Mdiff = −1.51; 95% CI = −2.51, −0.59; p = .002) and vegetables (Mdiff = −2.21; 95% CI = −4.01, −0.41; p = .02), foods higher in fiber (mg; Mdiff = −15.65; 95% CI = −27.43, −3.87; p = .01), and lower in sodium (mg; Mdiff = 1642.66; 95% CI = 660.85, 2624.48; p = .002), cholesterol (mg; Mdiff = 463.86; 95% CI = 198.76, 728.96; p = .001), and grams of fat (Mdiff = 75.42; 95% CI = 42.81, 108.03; p < .001) and saturated fat (Mdiff = 26.20; 95% CI = 14.07, 38.34; p < .001). The use of a default online shopping cart appears to improve nutritional quality of food purchases in individuals facing financial constraints.

Does how you pay influence the share of healthy items that you Buy? Assessing differences in nutritional quality of food purchases by payment type

Shoppers that use cash as a form of payment are more likely to evaluate the necessity of an item they purchase than shoppers that pay with other forms of payment, such as credit cards. In this paper, we hypothesize that the use of cash may nudge shoppers to buy more healthful food items. We empirically evaluate whether the payment method affects the nutritional quality of food purchases. We also test whether the effect of payment type differs between food-at-home and food-away-from-home events. Specifically, we test whether shoppers purchase a higher share of nutritious food items when they pay with cash compared to when they use credit and debit cards. We use the National Household Food Acquisition and Purchase Survey (FoodAPS) data that tracks individual’s food purchases over one week. Using the Guiding Stars Program (GSP) algorithm to measure the nutritional quality of food items, we calculate the share of healthy items purchased at each event. We find that shoppers using cash purchase a higher share of healthy items than when they use credit or debit cards, and this nudging effect is primarily driven by food-away-from-home purchases.

Opticourses: promoting healthier food purchases at no additional cost in low-income households

Abstract Introduction Healthy diets are generally more expensive than unhealthy diets, explaining why socially disadvantaged individuals perceive food prices as a barrier to improve their diets. It is thus crucial to develop strategies enabling the achievement of good nutritional quality with a low budget, taking into account actual beliefs and expectations of the target population. A co-construction approach is thus recommended, involving participants at each step of the intervention to maximize its impact. Methods The “Opticourses” program was launched in 2010 with a feasibility study, followed by an intervention research in 2012-2014, in order to develop and evaluate a prevention program aiming at improving the nutritional quality of food purchases at no additional cost in a socioeconomically disadvantaged population. In order to implement activities tailored to the target population, participants were involved in the development of the protocol and the tools of the intervention and evaluation processes. Results Opticourses’s workshops (8 to 12 participants) include different activities displayed in four 2h sessions around real food purchases of participants, and games and exchanges aimed at promoting food and food choices of good nutritional quality for their price. The intervention research showed improvements in food purchasing behaviors of Opticourses participants. A transferability phase was conducted in 2015-2017. Since 2017, Opticourses is spreading in several regions of France, through training of professionals, in particular the courses organized by the Health Education Regional Committee (CRES) in the South of France. Discussion Bringing an original, concrete, co-constructed and scientifically based response to an everyday life problem is the main strength of the program. One important risk of failure for such prevention program is the underestimation of the requirements of the intervention research, in terms of time and human and budgetary resources. Key messages From a research point of view, getting access to new food purchasing data will allow a continuous refinement and innovation in the improvement of the diet for people with budgetary constraints. By focusing on food purchasing, a familiar activity that most adults feel able to handle, the Opticourses program is engaging and pragmatic, in accordance with health promotion principles.

Food reformulation and nutritional quality of food consumption: an analysis based on households panel data in France

Background/objectivesWe aimed to quantify the contribution of food reformulation to changes in the nutritional quality of consumers’ food purchases, and compare it with the impact of substitutions made by consumers.Subjects/methodsUsing a brand-specific data set in France, we considered the changes in the nutrient content of food products in four food sectors over a 3-year period. These data were matched with data on consumers’ purchases to estimate the change in the nutritional quality of consumers’ purchases. This change was divided into three components: the reformulation of food products, the launching of new products and the consumers’ substitutions between products. Key nutrients were selected for each food group: breakfast cereals (sugar, fats, SFA, fiber, and sodium), biscuits and cakes (sugar, fats, SFA, and fiber), potato chips (fats, SFA, and sodium) and soft drinks (sugar).ResultsProduct reformulation initiatives have improved existing products for most food group-nutrient pairs. In particular, the contribution of food reformulation to the change in nutritional quality of food purchases was strong in potato chips (the sales-weighted mean SFA and sodium contents decreased by 31.4% to 52.1% and 6.7% to 11.1%, respectively), and breakfast cereals (the sales-weighted mean sodium content decreased by 7.3% to 9.7%). Regarding the launching of new products, the results were ambiguous. Consumers’ substitutions between food items were not generally associated to an improvement in the nutritional quality of the food purchases.ConclusionsPolicies aiming to promote food reformulation may have greater impact than those promoting changes in consumer behavior.

Consumers' Response to an On-Shelf Nutrition Labelling System in Supermarkets: Evidence to Inform Policy and Practice.

Providing a nutrition rating system on the front of food packages or on retail shelf tags has been proposed as a policy strategy for supporting healthier food choices. Guiding Stars is an on-shelf nutrition labelling system that scores foods in a supermarket based on nutritional quality; scores are then translated into ratings of 0 to 3 stars. It is consistent with evidence-informed recommendations for well-designed labels, except for not labelling 0-star products. The largest supermarket retailer in Canada rolled out the Guiding Stars system in supermarkets across Ontario, Canada. The aim of our study was to examine the extent to which consumers respond to an on-shelf nutrition labelling system in supermarkets to inform current and future nutrition labelling policies and practices. Capitalizing on a natural experiment, we conducted a quasi-experimental study across 3 supermarket banners (or "chains") in Ontario, one of which implemented the Guiding Stars system in 2012. We used aggregated supermarket transaction data to test the effect of Guiding Stars on the nutritional quality of food purchases in intervention supermarkets relative to control supermarkets. We also conducted exit surveys among 783 randomly selected shoppers from intervention and control supermarkets to assess consumer awareness, understanding, trust, and self-reported use of the labelling system. Relative to control supermarkets, shoppers in intervention supermarkets made small but significant shifts toward purchasing foods with higher nutritional ratings; however, shifts varied in direction and magnitude across food categories. These shifts translated into foods being purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. We also found increases in the number of products per transaction, price per product purchased, and total revenues. Results of the exit surveys indicate a modest proportion of consumers were aware of, understood, and trusted Guiding Stars in intervention supermarkets, and a small proportion of consumers reported using this system when making purchasing decisions. However, 47% of shoppers exposed to Guiding Stars were confused when asked to interpret the meaning of a 0-star product that does not display a rating on the shelf tag. This study demonstrates support for policies promoting on-shelf nutrition labels designed according to evidence-informed principles, but policymakers should move forward with caution when investing in such systems until research has confirmed optimal label design, clarified the mechanisms through which dietary intake is improved, and assessed associations with nutrition-related health outcomes.

Household food security: Perceptions, behavior and nutritional quality of food purchases

Food security is an encompassing concept that includes several dimensions: sufficiency, acceptability, safety, stability and nutritional quality. Lately, diverse studies discuss how much objective and subjective indicators are able to characterize some of the above-mentioned dimensions. This has opened the door to some apparent contradictions between different food security measurements that reflect perception (through specific surveys) and behavior (expenditure data).This article aims to extend the food security debate, focusing on the dimension of nutritional quality and classifying food products as healthy or unhealthy, in addition to computing their calorie value. Using a nationally representative database of nearly 6700 households in Mexico, we found that food-secure households (55% of the total sample) purchase an overall food basket that is 0.7 items less diverse, spend $85 Mexican pesos per week more, and show no significant difference in terms of purchased kcals compared to food-insecure households. After controlling for confounding factors, we found that food-secure households purchase a wider variety of healthy food items (and a smaller variety of unhealthy food items), spend more money on food, and purchase more calories in healthy food items compared to food-insecure households. Therefore, with this article, we enhance the relevance of the nutritional quality of food purchases in the food security debate.

Global growth of "big box" stores and the potential impact on human health and nutrition.

Despite a large body of literature on the food environment, little is known about the role of supercenters in human nutrition and health. The objectives of this review are to examine what is currently known about the association between supercenters, nutrition, and obesity, to identify how supercenters may affect disparities in food access and nutritional quality of food purchases, and to document the rapid rise of supercenters as a source of food purchases in the United States. A case study of Wal-Mart, the largest food retailer in the United States, is presented that demonstrates the major and increasing role of supercenters as a source of packaged food purchases in the United States, particularly among low-income households, as well as the role of supercenters in supplying key nutrients. Taken together, this review and case study highlight the dominant role of supercenters in the US diet and the need to better understand how supercenters can be leveraged to improve the nutritional quality of what consumers buy and eat.

Can an On-Shelf Nutrition Labelling System Improve the Nutritional Quality of Food Purchases in Supermarkets?

Can an On-Shelf Nutrition Labelling System Improve the Nutritional Quality of Food Purchases in Supermarkets?

Socioeconomic Factors and Their Relation to Eating Habits in Two Communities in Nova Scotia, Canada

Household food purchases and hence consumption are representative of household education, income, employment, and health. This study compares 2 communities in Nova Scotia, Canada: Glace Bay, located east of Sydney on Cape Breton Island, and King's County, west of Halifax. Glace Bay fares less well in the previous 4 categories and, consequently, it was hypothesized that Glace Bay would also rank lower in terms of nutritional quality of food purchases and their consumption compared to King's County. Questionnaires regarding socioeconomic conditions and food consumption patterns were completed by households in both communities. Glace Bay residents consumed similar levels of meat and dairy but lower levels of fresh and canned fruits and vegetables compared to King's County. Glace Bay also had a higher consumption of eggs, bread, carbonated beverages, and french fries and purchased fewer organic foods. It is concluded that lower levels of the 4 factors in Glace Bay contribute to these poorer food intakes and to some indicators of health. Action is required to improve nutrition in Glace Bay.

The Influence of Taxes and Subsidies on Energy Purchased in an Experimental Purchasing Study

There is limited research on how taxes and subsidies would influence the energy and nutritional quality of food purchases. Using an experimental analogue purchasing task, we examined the effects of increasing the price of high-calorie-for-nutrient foods or reducing the price of low-calorie-for-nutrient foods by 12.5% and 25% on mothers’ purchases of 68 common foods and drinks. Taxing less healthy foods with low nutrient density reduced energy (caloric) intake, while reducing the proportion of fat and increasing the proportion of protein purchased. Subsidizing more healthful foods with high nutrient density increased energy intake, without changing the macronutrient profile of foods purchased. These results favor taxes as a way to reduce caloric intake.

An examination of income-related disparities in the nutritional quality of food selections among Canadian households from 1986–2001

Socio-economic disparities in nutrition have been documented in numerous countries, and have been linked to health inequalities. Social and economic policy changes occurring over the last several years have resulted in growing levels of income inequality in many countries. However, the extent to which these temporal changes have affected nutrition disparities is largely unknown. Our research examined income-related disparities in the nutritional quality of food selections among Canadian households from 1986 to 2001. Data from the 1986, 1992, 1996 and 2001 Family Food Expenditure surveys were pooled together ( n=35 048). The relationships between household income and the nutritional quality of food purchases (considering nutrients both as absolute amounts and adjusted for energy, and total energy density) were estimated using general linear models, including tests of significance for differences across the survey years. Results revealed significant positive relationships between income and most nutrients, which persisted over time, and for some nutrients grew stronger. One exception was folate, where the positive relationship between income and folate (independent of energy) was no longer apparent in 2001; this could be attributed to the mandatory fortification of some cereal grain products with folic acid, which came into effect in 1998, resulting in greater availability of folate from grain products. There was also a significant negative relationship between income and total energy density (ratio of food energy to food weight), which persisted across the survey years. At a time of growing income inequality and worsening problems of poverty, food policy makers need to pay attention to the potential for policy interventions to exacerbate or improve nutrition disparities.