Implementing healthy food environment policies in New Zealand: nine years of inaction

Background The INFORMAS [International Network for Food and Obesity/Non-communicable Diseases (NCDs) Research, Monitoring and Action Support] Healthy Food Environment Policy Index (Food-EPI) was developed to evaluate the degree of implementation of widely recommended food environment policies by national governments against international best practice, and has been applied in New Zealand in 2014, 2017 and 2020. This paper outlines the 2020 Food-EPI process and compares policy implementation and recommendations with the 2014 and 2017 Food-EPI. Methods In March–April 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 “good practice” policy and infrastructure support indicators compared to international best practice, using an extensive evidence document verified by government officials. Experts then proposed and prioritized concrete actions needed to address the critical implementation gaps identified. Progress on policy implementation and recommendations made over the three Food-EPIs was compared. Results In 2020, 60% of the indicators were rated as having “low” or “very little, if any” implementation compared to international benchmarks: less progress than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. In 2020 the proposed actions were broader, reflecting the need for multisectoral action to improve the food environment, and the need for a mandatory approach in all policy areas. Conclusions There has been little to no progress in the past three terms of government (9 years) on the implementation of policies and infrastructure support for healthy food environments, with implementation overall regressing between 2017 and 2020. The proposed actions in 2020 have reflected a growing movement to locate nutrition within the wider context of planetary health and with recognition of the social determinants of health and nutrition, resulting in recommendations that will require the involvement of many government entities to overcome the existing policy inertia. The increase in food insecurity due to COVID-19 lockdowns may provide the impetus to stimulate action on food polices.

Food Culture in Youth Athletics: Exploration of the Beliefs in USA Stakeholders

Objectives. The present study examined beliefs surrounding food culture in youth athletics. Design. Qualitative research. Methods. Coaches (n = 62), parents (n = 161), and youth athletes (n = 40) in the USA completed questionnaires that explored aspects of the food environment of youth athletics, including practices related to food and beverage consumption and perspectives on the nutritional value of available foods and beverages. Results. Coaches, parents, and athletes all reported a high number of available foods and beverages, and were mixed both about whether these were healthy or unhealthy, and whether the availability of unhealthy foods and beverages was problematic. Conclusions. This study aimed to add to the literature an examination of multiple perspectives on the current food culture in youth athletics. Participant perspectives suggest that the food environment of youth sport may be an unhealthy mismatch with the physical, social, and psychological benefits of participation. Further research could aim to identify optimal environments for promoting health in youth sport. Limitations and additional directions for future research are discussed.

Nutrition Interventions Addressing Structural Racism: A Scoping Review

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care, and other settings. Nutrition education and nutrition-focused policy, systems, and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarize the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them to the “Getting to Equity in Obesity Prevention” framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing 6 databases—MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX, and ProQuest Dissertations & Theses. A total of 30 sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems, and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the “reduce deterrents” and “improve social and economic resources” aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

“What Do We Do For Snacks?”: The Perceived Role of Parks and Recreation Administrators in the Youth Sports Food Environment

Dietary intake is influenced by multiple systems, as highlighted in the Social- Ecological Model, including community influences like community programs. In this context, parks and recreation administrators may have a role in the types of snacks and beverages provided during youth sports. The current study focused on understanding park administrators’ experiences relative to the youth sports environment, including their responsibility and influence on the food environment. This was an exploratory qualitative case study conducted in Utah. Semi-structured interviews with parks and recreation administrators were completed via phone by a research assistant. A qualitative case study analysis was conducted by two researchers. In addition to the interviews, the websites of all the park and recreation sites were searched and phone calls were made to check physical locations for nutrition fliers/information. Three themes emerged through qualitative case study analysis. The first theme was the administrators’ role in the youth parks and recreation activities. The second theme was the administrators’ awareness of the food environment within youth sports. The final theme was the administrators’ role in influencing more nutritious snacks at these youth sporting activities. The results from this case study suggest that the parks and recreation administrators within Utah valued the importance of nutritional snacks and beverages within youth sporting activities and were supportive of the food environment improving. Several of the parks and recreation administrators in this study agreed that their further involvement (i.e., guidelines on snacks and beverages) in the youth sports food environment could improve the environment and better effect youth who are participating, thus enhancing opportunities to improve overall health and well-being. The results from this study show that administrators could bring awareness to youth sports nutrition and support guidelines for the types of snacks and beverages brought to youth sporting activities. Administrators could work with dietitians to develop information that would be appropriate to distribute to youth sports participants and parents. Providing information about what kinds of snacks to bring has the possibility to improve the conditions of the youth sports food environment. Additionally, consideration for policy changes in youth sports and recreation center facilities could be explored.

Sixty Percent of Foods Advertised in Grocery Store Flyers are Not In-line with Canada’s Food Guide

Purpose: To evaluate foods advertised in discount and premium grocery flyers for their alignment with Canada’s 2007 Food Guide (CFG) and assess if alignment differed by food category, season, page location, and price. Methods: Weekly flyers (n = 192) were collected from discount and premium grocery chains from each of 4 seasons. Health Canada’s Surveillance Tool was used to assess food items as in-line or not in-line with CFG. Results: Of 35 576 food items, 39.7% were in-line with CFG. There were no differences in proportions of foods not in-line in discount versus premium flyers (60.9% and 60.0%, respectively). Other Foods and Meat & Alternatives were advertised most (28.0% and 26.3%, respectively; P < 0.001). Milk & Alternatives were the least advertised food group (10.3%). Vegetables & Fruit (19.6%), Grains (21.6%), Milk & Alternatives (20.6%), and Meat & Alternatives (20.2%) were promoted least in Fall (P < 0.001). A higher proportion of foods advertised on middle pages were not in-line (61.0%) compared with front (56.6%) and back (58.8%) pages (P < 0.001). Not in-line foods were more expensive ($3.49, IQR = $2.82) than in-line foods ($3.28, IQR = $2.81; P < 0.001). Conclusions: While there was no difference in healthfulness of foods advertised in discount versus premium flyers, grocers advertised more foods not in-line with CFG. Government policies to improve the food environment should consider grocery flyers.

Exploring Barriers to Food Security Among Immigrants: A Critical Role for Public Health Nutrition

Upon moving to a new country and new food environment, 2 important public health issues may be experienced by immigrants as they adapt to their new country of residence, namely a higher prevalence of food insecurity and/or a decline in overall health over time postimmigration. Therefore, improving the food environment experienced by new migrants may be an effective strategy to reduce long-term health complications and improve well-being postimmigration. The aim of this paper is to discuss the potential barriers experienced by new immigrants in the access, availability, and utilization of familiar culturally appropriate foods and the subsequent impact on their food security status. Culturally appropriate foods are foods commonly consumed as part of cultural food traditions and are often staples within the diet; however, limited availability of and/or access to these foods can reduce food security. By understanding the barriers to food security and challenges that may be faced by immigrants and refugees, dietitians will be better equipped to assist these individuals in accessing culturally familiar foods and improve quality of life. In this capacity, dietitians can play a critical public health nutrition role by serving as a conduit for new immigrants to access community resources and navigate a new food environment.

Residential Food Environment, Household Wealth and Maternal Education Association to Preschoolers’ Consumption of Plant-Based Vitamin A-Rich Foods: The EAT Addis Survey in Addis Ababa

Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children’s diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children’s diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers’ consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.

Parental perceptions of the food environment and their influence on food decisions among low-income families: a rapid review of qualitative evidence

Background The food environment within and surrounding homes influences family dietary habits with socio-economic areas at a nutritional disadvantage. Families’ perception of the food environment and how it influences their food decisions is less clear. This rapid review aimed to synthesise qualitative evidence of parental perspectives of the food environment and their influence on food decisions among disadvantaged families. Method Qualitative and mixed-methods peer-reviewed journal articles published after 2000, that explored the perspectives of low-income parents in relation to their food environment and how this impacted food decisions for families with children aged 2-17 years, were included in this review. Embase, Scopus and PsycINFO were the databases chosen for this review. Search strategies included seven concepts related to family, food, perceptions, influences, environment, socio-economic status and study type. Two independent reviewers screened sixty-four studies. Thematic synthesis was employed. Results Two thousand one hundred and forty five results were identified through database searching and 1,650 were screened. Fourteen articles that originated from the US, Australia and the UK were included in this review. No articles were excluded following quality appraisal. Child preferences, financial and time constraints, and location and access to food outlets were barriers to accessing healthy food. Parental nutrition education and feeding approaches varied but positive outcomes from interventions to address these behaviours will be short-lived if inequities in health caused by poverty and access to affordable and healthy food are not addressed. The reliance on social support from families or government sources played an important role for families but are likely to be short-term solutions to health and nutritional inequities. Conclusions This qualitative evidence synthesis provides an insight into the perceptions of low-income parents on the factors influencing food decisions. Findings have implications for public health and the development of effective strategies to improve the dietary habits of children of disadvantaged families. Sustainable changes to dietary habits for families on low-income requires policy responses to low income, food access and to the high cost of healthy foods.

Identifying Opportunities for Strategic Policy Design to Address the Double Burden of Malnutrition through Healthier Retail Food: Protocol for South East Asia Obesogenic Food Environment (SEAOFE) Study

Effective policies that address both the supply and demand dimensions of access to affordable, healthy foods are required for tackling malnutrition in South East Asia. This paper presents the Protocol for the South East Asia Obesogenic Food Environment (SEAOFE) study, which is designed to analyze the retail food environment, consumers’ and retailers’ perspectives regarding the retail food environment, and existing policies influencing food retail in four countries in South East Asia in order to develop evidence-informed policy recommendations. This study was designed as a mixed-methods sequential explanatory approach. The country sites are Malaysia, Indonesia, the Philippines, and Thailand. The proposed study consists of four phases. Phase One describes the characteristics of the current retail food environment using literature and data review. Phase Two interprets consumer experience in the retail food environment in selected urban poor communities using a consumer-intercept survey. This phase also assesses the retail food environment by adapting an in-store audit tool previously validated in higher-income countries. Phase Three identifies factors influencing food retailer decisions, perceptions, and attitudes toward food retail policies using semi-structured interviews with selected retailers. Phase Four recommends changes in the retail food environment using policy analysis and semi-structured interviews with key stakeholders. For the analysis of the quantitative data, descriptive statistics and multiple regression will be used, and thematic analysis will be used to process the qualitative data. This study will engage stakeholders throughout the research process to ensure that the design and methods used are sensitive to the local context.