Neighborhood disadvantage and the sales of unhealthy products: alcohol, tobacco and unhealthy snack food

Background Individuals may use unhealthy coping mechanisms such as alcohol, tobacco, and unhealthy snack consumption. The purpose of this study was to assess how neighborhood disadvantage is associated with sales of alcohol, tobacco, and unhealthy snacks at stores of a discount variety store chain. Methods Alcohol, tobacco, and unhealthy snack sales were measured monthly for 20 months, 2017–2018, in 16 discount variety stores in the United States. Mixed effects linear regressions adjusted for population size, with store-specific random effects, to examine the relationship of weekly unit sales with three outcome variables and neighborhood disadvantage, measured using the Area Deprivation Index (ADI). Results The discount variety stores were located in neighborhoods where the median ADI percentile was 87 [interquartile range 83,89], compared to the median ADI percentile of 50 for all US communities, indicating that the stores were located in substantially disadvantaged neighborhoods. For every 1% increase in ADI, weekly unit sales of unhealthy snack food increased by 43 [95% confidence interval, CI 28–57], and weekly unit sales of tobacco products increased by 11.5 [95% CI 5–18] per store. No significant relationship between neighborhood disadvantage and the weekly unit sales of alcohol products was identified. Conclusions The positive relationship between neighborhood disadvantage and the sale of tobacco and snack foods may help explain the pathway between neighborhood disadvantage and poor health outcomes. It would be useful for future research to examine how neighborhood disadvantage influences resident health-related behaviors.

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

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

Piece of Cake: Coping with COVID-19

To limit the spread of coronavirus disease 2019 (COVID-19), many individuals were instructed to stay at home, and teleworking became commonplace. Meanwhile, many others were laid off or worked reduced hours, and some front line workers were required to work longer hours. Concurrently, a surge in reports of “pandemic baking” suggested a cascade effect on eating behaviors, which may be an inadvertent strategy to cope with stress. We conducted an online survey of people living in Canada or the United States (N = 680) to assess how employment change may have been experienced as stressful and linked to a shift in food choices. Regression models suggested that reduced hours and being laid off were associated with greater stress appraisals, avoidant- and emotion-focused coping responses, and negative affect. In turn, negative affect was associated with eating to cope and unhealthy snack choices, like salty or sweet treats. Our study emphasizes that under stressful conditions, such as those experienced during the COVID-19 pandemic, some coping strategies may contribute to the greater vulnerability to downstream effects, particularly those relating to eating choices and nutritional balances.

Can Healthy Checkout Counters Improve Food Purchases? Two Real-Life Experiments in Dutch Supermarkets

Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9–2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3–3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0–3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7–1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1–1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.

Snacking Practices and Diet Choices Among College Students at a Large University in South Florida: A Cross-Sectional Survey

Objectives The college food environment plays an integral role in student dietary intake during the formative transition from adolescence to adulthood. During this time, students experience profound changes to their level of responsibility and autonomy while also establishing lifelong habits. These changes are of concern because obesity and chronic disease are the long term health consequences of poor patterns of eating, and yet research on this topic is sparse. This study aims to uncover the pattern of snack consumption and its influence on selecting healthier versions of snacks at a large Hispanic serving university in South Florida. Methods A cross-sectional survey was used to elicit self-reported snacking practices of college students via a web-based Qualtrics survey in the Spring of 2019. Statistical analysis using SPSS 25 included descriptive statistics and bivariate analysis performed to examine the frequency and percentages for dependent and independent variables. Logistic regression was run to determine the influence of the frequency and amount of unhealthy snack food consumption and choosing low-fat options. Results Of the 483 respondents (24% males), 93.4% reported consuming unhealthy snack foods at least once a week. Additionally, the pattern of snack consumption was 72% (383) chips and salty snacks, 65% (316) cookies, 64% (307) chocolate bars, and 58% (281) candies. The results also indicated that those who consumed unhealthy snacks more frequently were 1.85 times more likely to choose low-fat options than those who rarely consumed unhealthy snacks (AOR = 1.85, CI (1.04 – 3.30)). Conclusions These findings suggest that students are seeking healthier options even when snacking. As a responsible institution, the university can implement a snack policy that promotes a healthy diet and is in line with what students are seeking by offering more low-fat options. Funding Sources None.

How Are Community Socio-Economic Factors Associated with the Sales of Unhealthy Products: Alcohol, Tobacco and Unhealthy Snack Food in Low Income Communities

Objectives People under stress tend to use unhealthy coping mechanisms including using products like alcohol, tobacco and unhealthy snacks. The purpose of this study is to assess how measures of community socio-economic status, which may be proxies for community stress, are associated with the sales of unhealthy products (alcohol, tobacco, and unhealthy snacks) at a discount variety store chain. Specifically, we consider the following measures of community socio-economic status: population racial/ethnic composition, % of households on SNAP, % of households without a vehicle, walkability score and median community income. Methods Mixed effects linear regressions with random effects were used to examine the relationship between the weekly unit sales (per 1000 population) of three outcome variables (tobacco, alcohol, unhealthy snacks) and community socio-economic factors: % of households on SNAP, % of households without a vehicle, and median community income. Results The sales of alcohol, tobacco, and unhealthy snacks increased as the % of the population participating in SNAP increased. Other measures of community socio-economic status were not significantly (at 5% significance level) associated with tobacco or unhealthy snack sales. However, for alcohol sales, increases in: the median household income, walkability score and % of African American residents, were associated with a decrease in alcohol sales. Conclusions Low income neighborhoods frequently experience greater health burden compared to higher income neighborhoods. Understanding and quantifying the relationship between financial stress and unhealthy product consumption can help public health professionals intervene before chronic diseases manifest. Funding Sources Robert Woods Johnson Foundation.

Exploring the directionality in the relationship between descriptive and injunctive parental and peer norms and snacking behavior in a three-year-cross-lagged study

Background. People’s eating behavior is assumed to be influenced by what other people do (perceived descriptive norms) and what others approve of (perceived injunctive norms). It has been suggested that adolescents are more susceptible to peer norms than parental norms, because they experience a strong need for group acceptance that leads to conforming to peer group norms. The current study examined changes in snacking behavior and four types of social norms (i.e., parental and peer descriptive and injunctive norms) that promoted fruit and vegetable intake among adolescents. This study was the first to examine whether snacking behavior also influenced norm perceptions by testing the directionality of these associations.Methods. The study consisted of 819 participants (M [SD] age = 11.19 [1.36]; 46.1% boys), collected at three time points (T1 = 2016, T2 = 2017 and T3 = 2018) during the MyMovez project. Self-reported frequency of snack consumption, perceived parental and peer descriptive and injunctive norms were assessed. The primary analysis consisted of a series of cross-lagged autoregressive models specified in a structural equation modeling framework. Results. Model comparisons testing the descriptive and injunctive norms in separate models and in an additional combined model revealed evidence for bi-directional associations between norms and snacking behavior. Descriptive peer and parent norms were not found to have an effect on subsequent snacking behaviors. Perceived injunctive parental norms were positively associated with healthy snack food intake and negatively associated with unhealthy snack intake (forward direction). Injunctive peer norms were negatively associated with healthy snack food intake. In addition, higher unhealthy snack food intake was negatively associated with the perception of descriptive and injunctive parental norms one year later (reversed direction). We did not find peer norms to be more closely associated with changes in snacking behaviors compared to parental norms. Conclusions. Parents expecting their children to snack healthy had a positive influence on healthy snacking behavior whereas only acting as a healthy role model did not. Future research should address the possible interaction between descriptive and injunctive norms. Research should also take into account the bi-directional relations between eating behaviors and normative perceptions.

Exploring the directionality in the relationship between descriptive and injunctive parental and peer norms and snacking behavior in a three-year-cross-lagged study.

Background. People’s eating behavior is assumed to be influenced by what other people do (perceived descriptive norms) and what others approve of (perceived injunctive norms). It has been suggested that adolescents are more susceptible to peer norms than parental norms, because they experience a strong need for group acceptance that leads to conforming to peer group norms. The current study examined changes in snacking behavior and four types of social norms (i.e., parental and peer descriptive and injunctive norms) that promoted fruit and vegetable intake among adolescents. This study was the first to examine whether snacking behavior also influenced norm perceptions by testing the directionality of these associations.Methods. The study consisted of 819 participants (M [SD] age = 11.19 [1.36]; 46.1% boys), collected at three time points (T1 = 2016, T2 = 2017 and T3 = 2018) during the MyMovez project. Self-reported frequency of snack consumption, perceived parental and peer descriptive and injunctive norms were assessed. The primary analysis consisted of a series of cross-lagged autoregressive models specified in a structural equation modeling framework. Results. Model comparisons testing the descriptive and injunctive norms in separate models and in an additional combined model revealed evidence for bi-directional associations between norms and snacking behavior. Descriptive peer and parent norms were not found to have an effect on subsequent snacking behaviors. Perceived injunctive parental norms were positively associated with healthy snack food intake and negatively associated with unhealthy snack intake (forward direction). Injunctive peer norms were negatively associated with healthy snack food intake. In addition, higher unhealthy snack food intake was negatively associated with the perception of descriptive and injunctive parental norms one year later (reversed direction). We did not find peer norms to be more closely associated with changes in snacking behaviors compared to parental norms. Conclusions. Parents expecting their children to snack healthy had a positive influence on healthy snacking behavior whereas only acting as a healthy role model did not. Future research should address the possible interaction between descriptive and injunctive norms. Research should also take into account the bi-directional relations between eating behaviors and normative perceptions.

Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children’s Healthy and Unhealthy Snacking: The ToyBox Study

This study investigated parental influences on preschool children’s healthy and unhealthy snacking in relation to child obesity in a large cross-sectional multinational sample. Parents and 3–5 year-old child dyads (n = 5185) in a kindergarten-based study provided extensive sociodemographic, dietary practice and food intake data. Parental feeding practices that were derived from questionnaires were examined for associations with child healthy and unhealthy snacking in adjusted multilevel models, including child estimated energy expenditure, parental education, and nutritional knowledge. Parental healthy and unhealthy snacking was respectively associated with their children’s snacking (both p < 0.0001). Making healthy snacks available to their children was specifically associated with greater child healthy snack intake (p < 0.0001). Conversely, practices that were related to unhealthy snacking, i.e., being permissive about unhealthy snacking and acceding to child demands for unhealthy snacks, were associated with greater consumption of unhealthy snacks by children, but also less intake of healthy snacks (all p < 0.0001). Parents having more education and greater nutritional knowledge of snack food recommendations had children who ate more healthy snacks (all p < 0.0001) and fewer unhealthy snacks (p = 0.002, p < 0.0001, respectively). In the adjusted models, child obesity was not related to healthy or unhealthy snack intake in these young children. The findings support interventions that address parental practices and distinguish between healthy and unhealthy snacking to influence young children’s dietary patterns.