Objectives: Home food environments are created when families stock their kitchens with food, which contributes to their dietary patterns and weight management. Native Hawaiians and Pacific Islanders (NPHIs) have a high prevalence of overweight and obesity. A description of their home food environment can help nurses understand NHPIs' dietary patterns. Our purpose was to describe NHPIs' home food environments by analyzing grocery store and restaurant receipts. Design and Sample: This descriptive study used analyzed qualitative and quantitative data from eight NHPI families, collected over an 8-week period. Measures: Grocery store and restaurant receipts were analyzed with descriptive statistics. Families' dietary patterns were studied with open-ended questions and compared to receipt data. Results: Food groups with the highest percent expenditures included combination foods (20%), protein foods (19%), and empty calorie food and drinks (11%). The lowest percent expenditures included fruits (8%), grains (7%), vegetables (7%), and dairy (6%). Families visited restaurants zero to 10 times (M = 2) per week. Conclusions: Results can help nurses address NHPIs' home food environment challenges by increasing their awareness of typical food purchases and helping NHPIs assess their own grocery and restaurant purchases and improve their own home food environments.

abstract: Individuals in urban low-income areas often do not have easy access to large grocery stores and supermarkets, and regularly shop at nearby small/corner stores. These stores stock an abundance of processed, energy-dense, nutrient poor foods, combined with few nutrient-dense products. A high concentration of small/corner stores is associated with poor diets by nearby residents. Interventions that target small food stores for increasing the availability and sale of healthy foods have been launched in many communities, and validated survey instruments have been developed to evaluate the effectiveness of the interventions. However, in-store surveys can take up to thirty minutes to conduct and require individual visits from investigators. Many projects assess the food environment in a large number of stores spread across broad geographical areas, making in-person evaluations infeasible and resource-prohibitive. The purpose of this study was to develop a valid and feasible short survey that could be used in-store or over the phone to capture the healthfulness of corner stores. An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct store audits of 230 corner stores in four New Jersey cities. Audit results were used in exploratory factor analysis and item response theory to develop a seven-item survey. The short survey was highly correlated with the full survey (r=0.79), and the short survey's classification of stores as healthy (top 20% of scores) versus unhealthy (bottom 80% of stores) matched NEMS-CS categorizations in 88% of cases. A second round of audits was conducted in 100 corner stores to confirm the validity of the seven-item survey and to test its feasibility as a phone audit tool. Complete phone responses were obtained from 86% of stores. Response matches indicated that store owners did not distinguish between 2% and low-fat milk, and tended to round up the fruit and vegetable count to five if they had fewer varieties. The seven-item short survey discriminates between healthy and unhealthy stores and is feasible for use as a phone audit tool. / Dissertation/Thesis / Doctoral Dissertation Physical Activity, Nutrition and Wellness 2015

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.

This study qualitatively explored how students, parents and school staff perceived the role that the school food environment played in student eating behaviour, how the Food and Nutrition Policy for Nova Scotia Public Schools impacted the food environment. This study looked at one public elementary school from Nova Scotia through a focus group with 6 grade five students, and individual interviews with 6 parents and 11 school staff members. Under the constructivist paradigm, the methodology chosen was social constructionism using constant comparative analysis. Significant themes that emerged from the data included: schools have a role in children’s eating habits; school culture is important for supporting a healthy food environment; and the food brought from home is the unhealthiest part of the school food environment. This research contributes to knowledge on the school’s impact on student eating behaviour, effectiveness of the policy, and the development of future research.

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In response to the rising prevalence of childhood overweight and obesity in Canada and around the world, the food environment has been recognized as one important determinant of health status. In order to fill some existing knowledge gaps in Canadian food environment research to better understand factors that may lead to health disparities, as well as to develop healthy public policies in response, this study characterized food environments in restaurants for children (10-13 years) living in Saskatoon, and examined their associations with neighbourhood socioeconomic characteristics. Specifically, using GIS-based techniques and a structured observation tool (NEMS-R), it examined community and consumer restaurant food environments by neighbourhoods categorized by distress level. The distribution of different restaurant types differs with respect to neighbourhood distress level. According to NEMS-R results, significant differences were found in the healthfulness of foods and beverages offered in restaurants by different categories. Restaurants within lower distress level neighbourhoods presented higher (more healthful) NEMS-R scores. However, the fast food environment for children was not significantly different according to their neighbourhood distress level.

abstract: Chronic diseases are the leading causes of death in the United States. Dietary behaviors influence the risk of developing multiple chronic diseases. The U.S. population consumes too few fruits and vegetables and too much sugar sweetened beverages (SSB) and fast food. The Social Ecological Model (SEM) was created as a framework for health promotion interventions. The SEM organizes factors that can influence health into five layers: intrapersonal factors, interpersonal processes, institutional/organizational factors, community factors, and public policy. Each layer can influence dietary behaviors and other layers. This work aims to understand how the community layer, represented by the food environment, moderates the association of two other layers and dietary behaviors: the interpersonal layer, represented by receiving health care provider’s (HCP) advice to lose weight, and the policy layer, represented by participation in the Supplemental Nutrition Assistance Program (SNAP), and a policy change within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Participant data were obtained from a household telephone survey of 2,211 adults in four cities in New Jersey from two cross-sectional panels in 2009-10 and 2014. Community food data were purchased and classified according to previously established protocol. Interaction and stratified analyses determined the differences in the association between HCP advice, SNAP participation, and time (for WIC participants) and eating behaviors by the food environment. Interaction and stratified analyses revealed that HCP advice was associated with a decrease in SSB consumption when participants lived near a small grocery store, or far from a supermarket, limited service restaurant (LSR), or convenience store. SNAP participation was associated with a higher SSB consumption when respondents lived close to a small grocery store, supermarket, and LSR. There were no differences in fruit and vegetable consumption between two time points among WIC participants, or by food outlet. The food environment, part of the community layer of SEM, moderated the relationship between the interpersonal layer and dietary behaviors and the policy layer and dietary behaviors. The association between HCP advice and dietary behaviors and SNAP participation and dietary behaviors were both influenced by the food environment in which participants lived. / Dissertation/Thesis / Doctoral Dissertation Nutrition 2017

Background: Consumption of sugary drinks (SD) among children is a prevalent public health issue that is exacerbated by the powerful marketing of such beverages to youth. Methods: A secondary analysis of the International Food Policy Survey Youth Wave 2019 was conducted to assess the impact of self-reported exposure to SD marketing within the past 30 days or SD brand advertisements on youth brand preference and brand recall overall, by country, and by age group. Ordinal, multinomial, and binary logistic regression were used to examine these associations. Results: Youth brand preference and recall were positively associated with self-reported exposure to general and brand-specific SD marketing within and across all countries. Both children and adolescents were similarly impacted by SD marketing. Soft drinks, sports drinks, and fruit juice brands were most commonly recalled by youth. Conclusion: Global marketing policies should consider older children and adolescents to adequately protect and support child health.

The local food environment plays an important role in the health of adolescents, especially in rural areas. Often, rural areas lack the accessibility and availability of healthy food choices, making a healthy lifestyle difficult to achieve. This study presents a cross-sectional survey of rural adolescents in 8 counties in Kentucky and North Carolina to determine the association between food store choice, body mass index (BMI), and key dietary outcomes. Although BMI had no association with food store choice, those who infrequently shopped at gas stations, convenience stores, and fast food restaurants consumed significantly less added sugar (p < 0.05) than those who shopped at those stores more regularly. Increasing the availability and accessibility of food venues with healthy food options such as supermarkets may decrease added sugar intake among rural adolescents.

abstract: Determining the factors associated with the availability of healthy and unhealthy foods in the household may help in understanding the varying complexities that contribute to obesity among children and help design interventions to impact children's food consumption behaviors. This study examined factors that are associated with the availability of healthy and unhealthy foods in children's home food environments (HFE). Data was collected from a random-digit-dial telephone survey of 1708 households, with at least one child between 3-18 years of age, located in five low-income New Jersey cities. HFE was assessed based on responses to a set of six items that measured availability of specific healthy and unhealthy foods in the respondent's home. These items contributed to construction of three HFE scales used as dependent variables in these analyses: healthy HFE, unhealthy HFE, and a ratio of healthy to unhealthy foods in the HFE. Independent variables included household socio-demographics, parental perceptions of their own weight and diet health, frequency of family meals, proximity to food outlets, and perception of access to healthy foods in the neighborhood food environment. Significant differences were observed in the HFE by race and ethnicity, with Non-Hispanic black children having fewer healthy foods and Non-Hispanic white children having more unhealthy food items available at home. Parents who reported being overweight or obese had a healthier HFE and those perceiving their own eating as healthy had more healthy and less unhealthy foods in the household. Food-secure households had more unhealthy compared to healthy foods at home. Households located farther from a supermarket had a greater number of unhealthy food items and a lower healthy/unhealthy food availability ratio. Parental perception of better access to fruits and vegetables and low-fat foods was associated with availability of a greater number of healthy food items at home. Overall, the HFE varied by parental and demographic characteristics, parental perceptions about the food environment and the actual features of the built neighborhood food environment. / Dissertation/Thesis / M.S. Nutrition 2012