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Background: The amount of time children spend in child care (CC) each week has increased in recent years. As a result children consume a large proportion of their daily energy intake at CC facilities. The purpose of this study is to describe the baseline dietary practices and environment in preschool-aged children attending CC centers in Southwest Georgia before the implementation of a one-year policy implementation program. Methods: The data is the baseline data of a pilot study evaluating nutrition and physical activity wellness policy implementation in twenty four licensed CC in Georgia. Each CC provided a sample one week menu (three meals/day: breakfast, lunch and afternoon snacks). The energy and nutrient contents of 360 meals were analyzed using NutriKids. Food groups were assessed using a menu rubric. Menus were compared to the Dietary Reference Intakes and MyPyramid food group recommendations for children 3 to 5 years of age Results: Children were served a mean of 883 kcal at three meals. The menus content met the requirements for energy, macro-nutrients, vitamins A and C. However, the menus were high in saturated fat, and sodium content and did not meet the requirements for iron, fiber and calcium. The majority of the centers did not meet the requirements of the Food Guide Pyramid for pre-schoolers. With the exception of milk, children at all participating centers were served less than the recommended amounts for grains, vegetables, meat/beans and fresh fruits. Conclusions: Child care settings provide a unique opportunity to influence children's dietary behaviors and health. Our data suggests that children are not consuming recommended amounts of whole grains, fruits or vegetables while attending full-time childcare. Instead, children are consuming excessive amounts of added sugars from sweet snacks, sodium, and saturated fat from whole milk and high-fat or fried meats. We anticipate that by the end of the one-year implementation of the wellness policies, day-care centers in Southwest Georgia will be better equipped to improve the quality of food served to this population of children. Findings from this study and the policy recommendations that emerge could significantly impact efforts to provide healthier nutrition environments to children in child care centers.

With the passage of the Child Nutrition and WIC Reauthorization Act of 2004, all schools that participate in the National School Lunch Program are required to establish local wellness policies to address childhood obesity. In the state of Kentucky, Senate Bill 172 requires all elementary schools to adopt a local wellness policy addressing competitive foods, healthy choices, and daily physical activity. This study measured federal and state compliance among schools that responded to the 2008 Kentucky School Nutrition Survey. This study analyzed differences in the school nutrition environment among policies based on data from the 2002 and 2008 Kentucky School Nutrition surveys. The majority of school wellness policies were compliant with both federal and state guidelines. Significant differences in the school environment include a reduction in the availability of vending machines, decreased percentage of teachers using food as a reward, and increased use by teachers of non food items as a reward. Significant differences were not found among foods offered in vending machines, snack bars, and classroom parties. In 2008, elementary schools provided an average of 174 minutes of physical activity weekly, which is above the recommended guideline of 150 minutes per week.

abstract: "Globesity," as defined by the World Health Organization, describes obesity as a pandemic affecting at least 400 million people worldwide. The prevalence of obesity is higher among women than men; and in non-Hispanic black and Hispanic populations. Obesity has been significantly associated with increased all-cause mortality, and mortality from cardiovascular disease, obesity-related cancers, diabetes and kidney disease. Current strategies to curb obesity rates often use an ecological approach, suggesting three main factors: biological, behavioral, and environmental. This approach was used to develop four studies of obesity. The first study assessed dietary quality, using the Healthy Eating Index (HEI)-2005, among premenopausal Hispanic and non-Hispanic white women, and found that Hispanic women had lower total HEI-2005 scores, and lower scores for total vegetables, dark green and orange vegetables and legumes, and sodium. Markers of obesity were negatively correlated with total HEI-2005 scores. The second study examined the relationship between reported screen time and markers of obesity among premenopausal women and found that total screen time, TV, and computer use were positively associated with markers of obesity. Waist/height ratio, fat mass index, and leptin concentrations were significantly lower among those who reported the lowest screen time versus the moderate and high screen time categories. The third study examined the relationship between screen time and dietary intake and found no significant differences in absolute dietary intake by screen time category. The fourth study was designed to test a brief face-to-face healthy shopping intervention to determine whether food purchases of participants who received the intervention differed from those in the control group; and whether purchases differed by socioeconomic position. Participants in the intervention group purchased more servings of fruit when compared to the control group. High-income participants purchased more servings of dark green/deep yellow vegetables compared to those in the low-income group. Among those who received the intervention, low-income participants purchased foods of lower energy density, and middle-income participants purchased food of higher fat density. The findings of these studies support policy changes to address increasing access and availability of fruits and vegetables, and support guidelines to limit screen time among adults. / Dissertation/Thesis / Ph.D. Nursing and Healthcare Innovation 2010

Introduction: Unhealthy diets are significant contributors to chronic diseases. Variations in CVD rates across ethnicities in Canada could be attributable to diverse dietary habits and nutrition environmental influences. The extent to which individuals’ food environment perceptions influence dietary intake is also understudied. Methods: This cross-sectional study, utilizing data from 7,077 of the 10,100 adults in the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, assessed associations of elements of the nutrition environment (food prices, advertisements, and availability) and ethnicity with dietary intakes. Results: Self-reported intakes of carbohydrates, junk foods, meat, and cholesterol varied significantly across Asians and White Europeans (p<0.0001). Rural/urban differences were also observed in carbohydrate, fat, protein, cholesterol, vegetable, meat, and sweet drink intakes (p<0.0001), excluding junk foods, and fruits. Interestingly, while individuals' perceptions of their food environment did not correlate with objective measures of the same environment, a 1$ increase in vegetable prices was significantly associated with a decrease in vegetable consumption by 0.0078 In(servings/day) (p= 0.0233), after adjusting for rural/urban living, ethnicity and BMI. No associations were found between fruits, meat, bread, eggs, cola, chocolate, poultry, rice, and milk prices and respective intakes. No association was also found between fruit/vegetable availability and consumption; nor between junk foods, sweet drinks and fruit/vegetable ads and consumption. Notably, alcohol advertisement was associated with alcohol intake. Discussion/Conclusion: The price-inelastic nature of foods like milk and eggs due to their perceived essentiality, implies the superimposing effects of other factors on consumption aside, price. While food advertisements undoubtedly impact eating behaviours, their influence might be subtle considering factors like price which could pose barriers to healthy eating. These findings emphasize the intricate interplay between prices, availability, advertisement, and other factors and dietary choices. Policymakers, food industries, and health advocates can leverage these insights to create healthier food environments for improved health. / Thesis / Master of Science (MSc) / Unhealthy diets are significant contributors to chronic diseases. Diverse influences from the nutrition environment also impact consumption. To better inform public health strategies promoting healthy eating, it is imperative to ascertain whether modifying the food environment of individuals would be more effective in transforming their eating behaviours. This cross-sectional study, utilizing data from 7,077 adults from the CAHHM cohort, assessed the influence of elements of the nutrition environment and ethnicity on dietary intake. Differences in carbohydrate, junk food, meat, and cholesterol intake were found among Asians and White Europeans. Carbohydrate, fat, protein, vegetable, meat, and sweet drink intakes varied between rural and urban settings. Increased vegetable prices were associated with reduced consumption, while food advertisements were not associated with dietary intake. This study shows that the costs of healthy foods impact dietary choices more than advertisements. Policymakers can utilize these findings to promote healthy food environments in Canada.

El incremento de la prevalencia de sobrepeso y obesidad durante los últimos años ha aumentado el interés por conocer sus determinantes y a contemplar el entorno como un componente clave en el desarrollo de exceso de peso, constituyendo lo que se conoce como entorno o ambiente obesogénico. Este término se define como la influencia que tienen los entornos para promover el exceso de peso en la población, facilitando conductas más sedentarias y/o una alimentación no saludable. Se trata de un concepto complejo sobre el que se han desarrollado varios modelos para conceptualizarlo, y explicar cómo influye en el comportamiento individual de las personas. Además, para caracterizarlo se establecen diferencias entre el entorno alimentario y el entorno construido. Para conocer cómo el entorno influye en el desarrollo de obesidad, habría que profundizar en cuáles son los factores concretos que lo constituyen y de qué manera intervienen en el comportamiento de la población, con el fin de poder modificar dichos ambientes. Para ello, existen diversos estudios que han utilizado instrumentos de recolección de datos para identificar y operacionalizar de forma rigurosa y objetiva a todos y cada uno de los factores que lo conforman. La presente tesis tiene como objetivo general analizar el entorno obesogénico alimentario desde una perspectiva teórica y mediante la implementación de herramientas de medición en España, a través de la consecución de cuatro objetivos específicos. Para ello, el primer objetivo es desarrollar un marco conceptual del entorno obesogénico alimentario para el contexto español. El segundo objetivo consiste en realizar una revisión de los instrumentos de recogida de datos sobre entorno obesogénico en adultos. Los objetivos 3 y 4, se basan en adaptar y evaluar culturalmente los instrumentos “Perceived Nutrition Environment Measurement Survey” (NEMS-P) y “Nutrition Environment Measurement Survey in Stores” (NEMS-S) al contexto español, respectivamente. Los diferentes aspectos tratados en la presente tesis ofrecen una revisión teórica mediante el marco conceptual desarrollado y una revisión mediante un Scoping review a nivel mundial donde se contemplan las herramientas de recogida de datos sobre entorno alimentario y construido en adultos. El marco conceptual ha contribuido a tener una mejor comprensión de qué características específicas del entorno alimentario en el contexto español pueden ser más relevantes para la salud de la población. En la revisión, se encontraron 92 instrumentos: 46 que miden el entorno alimentario, 42 el construido y 4 que miden ambos. Con esto se facilita el conocimiento sobre qué instrumentos existen hasta la fecha, sus características y utilidades, haciendo más sencilla la selección de una o varias de ellas para futuras investigaciones. Asimismo, la presente tesis también ha adaptado al contexto español dos instrumentos de medición del entorno alimentario (percibido y de venta de alimentos). Los resultados obtenidos en la adaptación del instrumento NEMS-P-MED muestran que es válido, y en ciertos ítems fiable (el coeficiente de alfa de Cronbach's presenta un rango entre 0,6 y 0,9), y útil para evaluar las percepciones del entorno alimentario del hogar, tiendas de alimentos y restaurantes. Por otro lado, los datos obtenidos en la adaptación del instrumento NEMS-S-MED muestran que los porcentajes de acuerdo fueron casi perfectos en la fiabilidad inter-observador y intra-observador, y los estadísticos kappa también fueron muy altos (mediana κ=1,00 para la fiabilidad inter-observador; κ=0,92 para la fiabilidad intra-observador). Asimismo, la herramienta NEMS-S-MED es capaz de discriminar entre los tipos de tiendas y las zonas de censo de diferente nivel socioeconómico. Además, mediante la combinación de ambos instrumentos, NEMS-S-MED y NEMS-P-MED, se logrará tener una comprensión completa de los entornos alimentarios en tiendas de alimentos, tanto de la percepción como de forma directa. Como conclusión, cabe destacar que numerosos instrumentos han sido desarrollados para caracterizar el entorno obesogénico, la mayoría de ellos desarrollados en países anglosajones (Estados Unidos, Australia). El instrumento NEMS-P-MED es útil y válido para evaluar el entorno alimentario percibido en el contexto español. El instrumento NEMS-S-MED es una herramienta fiable para evaluar el entorno alimentario de tiendas de alimentos en un contexto español. Finalmente, la utilización de un enfoque de investigación de métodos mixtos, combinando ambos instrumentos, facilitaría la comprensión de los principales determinantes contextuales del entorno con el fin de diseñar intervenciones de salud pública eficaces para mejorar el entorno alimentario y reducir las cifras de exceso de peso de la población.