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Background: Among adults and children consuming Western diets, beverages are significant sources of free sugars, saturated fats, excess calories, and alcohol, with relevance to chronic disease risk. The impact of recent healthy eating policies and beverage market evolutions on population-level consumption patterns in Canada is unknown. The current study examined trends in intake of a range of beverage types among a nationally-representative sample of Canadians, with stratification by socio-demographic characteristics.Methods: The 2004 (n = 34,775) and 2015 (n = 20,176) nutrition-focused cycles of the Canadian Community Health Surveys are cross-sectional surveys representative of the population of the 10 Canadian provinces. Based on a single multiple-pass 24-h dietary recall for each participant, fluids consumed as beverages were grouped into seven categories. Using linear regression, reported intake (volume, ml and energy, kcal) of each category was characterized over time and in relation to sex, age, ethnicity, income, body mass index (BMI), and province of residence.Results: In 2015, Canadians reported consuming an average of 1806 ml (275 kcal) fluids as beverages per day, including: plain water 867 ml (0 kcal); other unsweetened beverages, e.g. coffee, 364 ml (6 kcal); sugar-sweetened beverages (SSBs) 204 ml (99 kcal); plain milk 132 ml (64 kcal); alcoholic drinks 120 ml (71 kcal); 100% juice 74 ml (34 kcal); and diet or low calorie beverages 44 ml (2 kcal). Differential consumption was observed across socio-demographic groups, with high consumption of sugary drinks (i.e., SSBs and 100% juice) and alcohol across groups. From 2004 to 2015, the reported volumes of beverages consumed decreased by 10% (energy: - 24%). With adjustment for socio-demographic characteristics, there were significant changes (p < 0.001) over time in intake of: 100% juice - 40% (- 38%); plain milk - 37% (- 35%); SSBs - 26% (- 20%); diet or low calorie beverages (- 46%); and other unsweetened beverages - 11% (- 42%). The volume of plain water consumed increased by 10% (p < 0.0001). Intake of alcoholic (volume and energy) and diet or light beverages did not change significantly.Conclusions: Lower intake of beverages was reported by Canadians in 2015 versus 2004, with a shift towards plain water. Consumption of sugary drinks decreased, but these beverages continue to contribute substantially to Canadians' overall energy intake. The findings underscore the need for policies to further reduce the consumption of sugary and alcoholic beverages, as well as calories from beverages. [ABSTRACT FROM AUTHOR]

Background: Sugar taxes and front-of-package (FOP) nutrition labelling systems are strategies to address diet-related non-communicable diseases. However, there is relatively little experimental data on how these strategies influence consumer behavior and how they may interact. This study examined the relative impact of different sugar taxes and FOP labelling systems on beverage and snack food purchases. Methods: A total of 3584 Canadians 13 years and older participated in an experimental marketplace study using a 5 (FOP label condition) × 8 (tax condition) between-within group experiment. Participants received $5 and were presented with images of 20 beverages and 20 snack foods available for purchase. Participants were randomized to one of five FOP label conditions (no label; 'high in' warning; multiple traffic light; health star rating; nutrition grade) and completed eight within-subject purchasing tasks with different taxation conditions (beverages: no tax, 20% tax on sugar-sweetened beverages (SSBs), 20% tax on sugary drinks, tiered tax on SSBs, tiered tax on sugary drinks; snack foods: no tax, 20% tax on high-sugar foods, tiered tax on high-sugar foods). Upon conclusion, one of eight selections was randomly chosen for purchase, and participants received the product and any change. Results: Compared to those who saw no FOP label, participants who viewed the 'high in' symbol purchased less sugar (− 2.5 g), saturated fat (− 0.09 g), and calories (− 12.6 kcal) in the beverage purchasing tasks, and less sodium (− 13.5 mg) and calories (− 8.9 kcal) in the food tasks. All taxes resulted in substantial reductions in mean sugars (− 1.4 to − 4.7 g) and calories (− 5.3 to − 19.8 kcal) purchased, and in some cases, reductions in sodium (− 2.5 to − 6.6 mg) and saturated fat (− 0.03 to − 0.08 g). Taxes that included 100% fruit juice ('sugary drink' taxes) produced greater reductions in sugars and calories than those that did not. Conclusions: This study expands the evidence indicating the effectiveness of sugar taxation and FOP labelling strategies in promoting healthy food and beverage choices. The results emphasize the importance of applying taxes to 100% fruit juice to maximize policy impact, and suggest that nutrient-specific FOP 'high in' labels may be more effective than other common labelling systems at reducing consumption of targeted nutrients. [ABSTRACT FROM AUTHOR]

This study assessed test-retest reliability and relative validity of the Short Diet Questionnaire (SDQ) and usability of an online 24 h recall among 232 participants (62 years ± 9.1; 49.6% female) from the Canadian Longitudinal Study on Aging (CLSA). Participants were asked to complete four 24 h dietary recalls (24HRs) using the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada-2014), two SDQ administrations (prior to recalls one and four), and the System Usability Scale (SUS) for ASA24. For the SDQ administrations, Intraclass Correlation Coefficients ranged from 0.49 to 0.57 for nutrients and 0.35 to 0.72 for food groups. Mean intakes estimated from the SDQ were lower compared than those from the 24HRs. For nutrients, correlation coefficients were highest for fiber, calcium, and vitamin D (45–64 years: 0.59, 0.50, 0.51; >65 years: 0.29, 0.38, 0.49, p < 0.01); Kappas ranged from 0.14 to 0.37 in those 45–64 years and 0.17 to 0.32 in participants >65 years. Among the 70% who completed all recalls independently, the SUS indicated poor usability, though the majority reported feeling confident using ASA24. Overall, the SDQ captures intake with varying test-retest reliability and accuracy by nutrient and age. Further research is needed to inform use of a more comprehensive dietary measure in the CLSA. [ABSTRACT FROM AUTHOR]

There is currently considerable attention directed to identifying promising interventions to reduce consumption of sugars among populations around the world. A review of systematic reviews was conducted to identify gaps in the evidence on such interventions. Medline, EMBASE CINAHL, and the Cochrane Database of Systematic Reviews were searched to identify systematic reviews published in English from January 2005 to May 2017 and considering research on interventions to reduce sugar intake. Twelve systematic reviews that considered price changes, interventions to alter the food available within specific environments, and health promotion and education programs were examined. Each of the identified reviews focused on sugar-sweetened beverages (SSBs). The existing literature provides some promising indications in terms of the potential of interventions to reduce SSB consumption among populations. However, a common thread is the limited scope of available evidence, combined with the heterogeneity of methods and measures used in existing studies, which limits conclusions that can be reached regarding the effectiveness of interventions. Reviewed studies typically had limited follow-up periods, making it difficult to assess the sustainability of effects. Further, there is a lack of studies that address the complex context within which interventions are implemented and evaluated, and little is known about the cost-effectiveness of interventions. Identified gaps speak to the need for a more holistic approach to sources of sugars beyond SSBs, consensus on measures and methods, attention to the implementation of interventions in relation to context, and careful monitoring to identify intended and unintended consequences. [ABSTRACT FROM AUTHOR]

Parents are typically relied upon to report young children’s dietary intake. However, there has been limited research assessing the accuracy of such reports captured using novel dietary assessment tools. The purpose of the current study was to assess the validity of the web-based Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada) for capturing dietary intake among children aged two-five years (n = 40), using parental proxy reporting. The study was conducted in a daycare setting, allowing for standardization of foods and drinks offered and direct observation of intake. Parental-reported intake was compared to true intake for lunch and dinner, as well as an afternoon snack, on a single day. Each eating occasion, including plate waste, was unobtrusively documented. Parents were not present for lunch or the afternoon snack, but joined their children at the daycare centre for the dinner meal. The following day, parents reported their children’s intake from the previous 24-h period using ASA24-Canada. For the eating occasions assessed, parents reported exact or close matches for 79.2% (82.3% for lunch, 81.2% for the snack, and 77.4% for dinner) of the foods and beverages truly consumed by children. Estimates of intake for energy and macronutrients examined (carbohydrates, fat, and protein) based on parental reports were higher than those based on true (observed) intake. Our findings suggest that parents are able to report what their preschool children eat and drink relatively accurately. However, the accuracy of portion size estimates is low. Strategies to enhance portion size reporting are needed to improve parental proxy reporting. [ABSTRACT FROM AUTHOR]

To inform strategies to improve the dietary intakes of populations, robust evaluations of interventions are required. This paper is drawn from a workshop held at the International Society of Behavioral Nutrition and Physical Activity 2017 Annual Meeting, and highlights considerations and research priorities relevant to measuring dietary outcomes within intervention studies. Self-reported dietary data are typically relied upon in such studies, and it is recognized that these data are affected by random and systematic error. Additionally, differential error between intervention and comparison groups or pre- and post-intervention can be elicited by the intervention itself, for example, by creating greater awareness of eating or drinking occasions or the desire to appear compliant. Differential reporting can render the results of trials incorrect or inconclusive by leading to biased estimates and reduced statistical power. The development of strategies to address intervention-related biases requires developing a better understanding of the situations and population groups in which interventions are likely to elicit differential reporting and the extent of the bias. Also needed are efforts to expand the feasibility and applications of biomarkers to address intervention-related biases. In the meantime, researchers are encouraged to consider the potential for differential biases in dietary reporting in a given study, to choose tools carefully and take steps to minimize and/or measure factors such as social desirability biases that might contribute to differential reporting, and to consider the implications of differential reporting for study results. [ABSTRACT FROM AUTHOR]

Background: The contribution of beverages to overall diet is of increasing interest to researchers and policymakers, particularly in terms of consumption of drinks high in added sugars; however, few tools to assess beverage intake have been developed and evaluated. This study aimed to evaluate the relative validity of a new online Beverage Frequency Questionnaire (BFQ) among young adults in Canada.Methods: A cross-sectional relative validation study was conducted among young adults aged 16-30 years (n = 50). Participants completed a 17-item BFQ, a 7-day food record (7dFR), and a single-item measure of sugary drink intake. Pearson correlations and paired t-tests were used to evaluate correlation and agreement between the measures for 17 individual beverage categories, total drink consumption, total alcoholic beverage consumption, and two definitions of drinks with excess sugars. Cognitive interviews were conducted to examine participant interpretation and comprehensiveness of the BFQ.Results: Estimates of beverage intake based on the BFQ and the 7dFR were highly correlated, specifically for the total number and volume of beverages consumed, total alcoholic beverage consumption, sugary drink intake, and each of the 17 beverage categories with 3 exceptions: coffee or tea with sugar or cream, specialty coffees, and hard alcohol with caloric mix. Paired t-tests between the BFQ and the 7dFR indicated that the average reported volume was significantly different only for sweetened fruit drinks. The single-item measure of sugary beverage intake was not significantly correlated with the 7dFR. Cognitive interviewing demonstrated high comprehension levels, and confirmed the appropriateness of the BFQ beverage categories and sizes.Conclusions: Overall, the results suggest that the BFQ performed well relative to a 7dFR and had high usability among this study population, indicating its promise for collecting population-level data on beverage intake, including sugar-sweetened beverages, which are known indicators of diet and health. [ABSTRACT FROM AUTHOR]

For the first time since its introduction, the 2019 Canada's Food Guide (2019-CFG) highlighted specific guidance on eating practices, i.e., recommendations on where, when, why, and how to eat. The Canadian Eating Practices Screener / Questionnaire court canadien sur les pratiques alimentaires was developed to assess eating practices based on the 2019-CFG healthy eating recommendations. The objective of this cross-sectional study was to assess the construct validity and reliability of the Canadian Eating Practices Screener. From July to December 2021, adults (n = 154) aged 18–65 years completed a sociodemographic questionnaire and the screener. Construct validity was assessed by examining variability in screener scores, by comparing screener scores among subgroups with hypothesized differences in eating practices, and by examining the correlation between screener scores and fruit and vegetable intake. Reliability, i.e., internal consistency, was assessed by calculating Cronbach's coefficient alpha. Screener item scores were summed to provide a total score ranging from 21 to 105. The mean screener score was 76 (SD = 8.4; maximum, 105), ranging from 53 (1st percentile) to 92 (99th percentile). Differences in total scores in hypothesized directions were observed by age (p = 0.006), perceived income adequacy (p = 0.09), educational attainment (p = 0.002), and smoking status (p = 0.09), but not by gender or health literacy level. The correlation between screener scores and fruit and vegetable intake was 0.29 (p = 0.002). The Cronbach's coefficient alpha was 0.79, suggesting acceptable to high internal consistency. Study findings provide preliminary evidence of the screener's construct validity and reliability, supporting its use to assess eating practices based on the 2019-CFG healthy eating recommendations. [ABSTRACT FROM AUTHOR]

In 2019, Health Canada released a new iteration of Canada's Food Guide (2019-CFG), which, for the first time, highlighted recommendations regarding eating practices, i.e., guidance on where, when, why, and how to eat. The objective of this study was to develop a brief self-administered screener to assess eating practices recommended in the 2019-CFG among adults aged 18–65 years. Development of the screener items was informed by a review of existing tools and mapping of items onto 2019-CFG recommendations. Face and content validity were assessed with experts in public health nutrition and/or dietary assessment (n = 16) and individuals from Government of Canada (n = 14). Cognitive interviews were conducted with English-speaking (n = 16) and French-speaking (n = 16) adults living in Canada to assess face validity and understanding of the screener items. While some modifications were identified to improve relevance or clarity, overall, the screener items were found to be relevant, well-constructed, and clearly worded. This comprehensive process resulted in the Canadian Eating Practices Screener/Questionnaire court canadien sur les pratiques alimentaires, which includes 21 items that assess eating practices recommended in the 2019-CFG. This screener can facilitate monitoring and surveillance efforts of the 2019-CFG eating practices as well as research exploring how these practices are associated with various health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Two studies were conducted to evaluate the National Cancer Institute (NCI)'s web-based Automated Self-Administered 24-hour Recall (ASA24) system, which was developed to facilitate the collection of 24-hour dietary recalls in largescale research. Hypothesis: Energy, nutrient and food group estimates, response rates, and preferences are comparable between ASA24 and USDA's interviewer-administered Automated Multiple-Pass Method (AMPM). Methods: Study 1 assessed the response rates and data collected using ASA24 compared to AMPM. About 1200 participants were recruited from three integrated health systems using quota sampling to ensure representation of a range of ages and race/ethnicity groups. Participants were asked to complete two 24HRs, 4-7 weeks apart, and randomized into four study groups: 1) two ASA24s; 2) two AMPMs; 3) ASA24 first and AMPM second; and 4) AMPM first and ASA24 second. Study 2 assessed the validity of ASA24 compared to AMPM in a one-day feeding study. Eighty-one participants visited a study center to consume three meals from a buffet. All containers were unobtrusively weighed before and after each participant served him/herself; plate waste was also weighed. The next day, participants returned to the center to complete either ASA24 or AMPM. Results: Study 1: Almost all enrolled participants (95%) completed at least one recall and 80% completed two; response rates did not differ by recall mode. Estimated intakes of energy, nutrients and food groups were comparable for ASA24 and AMPM; for example, energy, 2132 vs. 2126 kcal; fat, 84.9 vs. 82.8 g; saturated fatty acids, 27.9 vs. 26.9 g; fiber, 18.4 vs. 18.4 g; and fruits and vegetables, 3.0 vs. 3.1 cup equivalents. Of participants randomized to complete one ASA24 and one AMPM, a greater percentage preferred ASA24. Study 2: The examination of foods and drinks reported showed that exact or close matches were recalled for 76.9% of items truly consumed among ASA24 respondents compared to 82.5% among AMPM respondents. Far matches were reported for 3.1% of items consumed among ASA24 respondents compared to 0.7% for AMPM. The proportions of foods or drinks consumed but not reported (exclusions) were 20.4% and 16.8% for ASA24 and AMPM, respectively. Median differences between reported and true intakes for energy, nutrient and most food groups were not significantly different between ASA24 and AMPM. Conclusion: ASA24 performs well relative to traditional interviewer-administered recalls and is feasible for use in large-scale research. The tool, which offers significant savings over interviewer-administered recalls, is publicly available from NCI and has been used in over 800 studies to collect over 113,000 dietary recalls. The tool is currently being updated to run on mobile applications. [ABSTRACT FROM AUTHOR]

The U.S. Department of Agriculture estimates that one in nine U.S. households is "food insecure": unable to purchase sufficient, or healthy food. Public policy advocates and politicians have pointed to the prevailing federal minimum wage as a culprit, labeling it a "starvation wage." This study examines whether and to what extent increases to the minimum wage have improved the quantity and nutritional quality of food purchased by minimum wage earners, and what implications these potential changes in consumer behavior have for marketers. The authors show that households likely to be earning the minimum wage increase their calories purchased in response to minimum wage increases, and that these gains are predominantly found among households purchasing the least amount of food prior to the minimum wage rising. Although the authors do not find evidence that the average household improves the nutritional content of calories purchased, they do find evidence that the least healthy households (as measured by past purchases) buy more healthy foods in response to rising minimum wages. Overall, the findings suggest that higher minimum wages may not only help households afford more calories but also encourage some households to purchase more healthy calories. In addition, the authors find an increased openness among minimum wage households to purchasing new grocery items. This openness to trying previously unpurchased products offers promotion and product line planning opportunities to manufacturers. It also offers retailers with a nutrition-friendly brand image an opportunity to nudge consumers toward purchasing more healthy foods. [ABSTRACT FROM AUTHOR]

The objective of this project was to develop a brief self-administered dietary screener, in English and French, to rapidly assess alignment of adults' dietary intake with the 2019 Canada's Food Guide healthy food choices recommendations. In consultation with Health Canada and external advisors (n = 15), guiding principles were defined. Existing screeners were scanned, and the healthy food choices recommendations were mapped to inform questions and response options. Cognitive interviews were conducted in English (n = 17) and French (n = 16) with adults aged 18–65 years from April to June 2021 to assess understanding of questions and face validity; recruitment emphasized variation in sociodemographic characteristics. Face and content validity were assessed with experts in nutrition, surveillance, and public health (n = 13 English, 3 French) from April to May 2021. The testing indicated that the screener was well understood overall but informed refinements to improve comprehension of the questions and their alignment with the healthy food choices recommendations. The resulting Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires includes 16 questions to rapidly assess alignment of intake with the 2019 Canada's Food Guide healthy food choices recommendations, including healthy foods and foods to limit, in situations in which comprehensive dietary assessment is not feasible. The Canadian Food Intake Screener was developed to rapidly assess alignment of adults' dietary intake over the past month with the Food Guide's healthy food choices recommendations. The screener was developed and evaluated through an iterative process that included three rounds of cognitive interviews in each of English and French, along with ongoing feedback from external advisors and face and content validity testing with a separate panel of content experts. The 16-question screener is intended for use with adults, aged 18–65 years, with marginal and higher health literacy in research and surveillance contexts in which comprehensive dietary assessment is not possible. [ABSTRACT FROM AUTHOR]

The Canadian Food Intake Screener/Questionnaire court canadien sur les apports alimentaires was developed to rapidly assess alignment of adults' dietary intake over the past month with the 2019 Canada's Food Guide's healthy food choices recommendations. From July to December 2021, adults (n = 154) aged 18–65 years completed the screener and up to two 24 h dietary recalls. The screener scoring system was aligned with the Healthy Eating Food Index-2019 (HEFI-2019), to the extent possible. Analysis of variance compared screener scores among subgroups with known differences in diet quality. Using the recall data, the National Cancer Institute multivariate method was used to model HEFI-2019 components, with the screener score as a covariate, and the correlation coefficient between screener and total HEFI-2019 scores was estimated. The mean screener score was 35 points (SD = 4.7; maximum 65), ranging from 26 (1st percentile) to 45 (99th percentile). Differences in scores in hypothesized directions were evident by gender identity (p = 0.06), perceived income adequacy (p = 0.07), education (p = 0.02), and smoking status (p = 0.003). The correlation between screener and HEFI-2019 scores was 0.53 (SE = 0.12). The screener's moderate construct validity supports its use for rapid assessment of alignment of adults' intake with the healthy food choices recommendations when comprehensive dietary assessment is not possible. The Canadian Food Intake Screener was developed to rapidly assess alignment of dietary intake with the Canada's Food Guide-2019 healthy food choices recommendations. Scoring is aligned with the Healthy Eating Food Index-2019 to the extent possible. Among a sample of adults, reasonable variation in screener scores was noted, mean screener scores differed between some subgroups with known differences in diet quality, and a moderate correlation between screener scores and total Healthy Eating Food Index-2019 scores based on repeat 24 h dietary recalls was observed. The Canadian Food Intake Screener has moderate construct validity for rapid assessment of overall alignment of adults' dietary intake with the Canada's Food Guide-2019 healthy food choices recommendations. [ABSTRACT FROM AUTHOR]

Objective: Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction. Design: Randomised controlled trial. Setting: Web-based intervention for young adults living in Australia. Participants: 18–24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire. Results: Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme. Conclusion: Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods. [ABSTRACT FROM AUTHOR]

Recent studies have established the important contribution of food consumption to climate change, but the environmental implications of Canadians′ dietary choices have not been studied in this regard. In this study, dietary intake data for 10,000 residents of Ontario, Canada were used to identify dietary patterns and estimate the Global Warming Potential (GWP) of food consumption and waste. Cluster analysis was used to identify seven dietary patterns (DP): vegan, vegetarian, pescatarian, omnivorous, and diets excluding red meat, beef and pork. Calorie-adjusted food baskets were formulated based on the most commonly consumed food items for each DP. Life cycle assessment was used to estimate GWP for each basket from farm operations, processing, distribution, to household processes (cooking, storage, food waste). The findings suggest that Ontario residents prefer DPs rich in animal products (particularly beef) that have very high GWP. Further, reducing food waste could reduce GWP by up to 8%. Though methods differ across studies and comparisons must be made carefully, available estimates of diet-related GWP from the US and UK are consistently higher than values in this study. Efforts are needed to standardize methods to facilitate a more cohesive body of evidence on the relevance of dietary choices and food waste to climate change. [ABSTRACT FROM AUTHOR]

We estimate nutrient intake from diet and total sources including dietary supplements (DS), and dietary quality of low‐income U.S. older adults (60+ years) using the 2007–2016 National Health and Nutrition Examination Survey. We apply the National Cancer Institute method to determine usual/habitual nutrient intake distributions. Our results reveal that low‐income older adults have poor nutrient intake and dietary quality. DS use reduces the risk of nutrient inadequacy but is not associated with statistically significantly better dietary quality. Future policies that would change access to nutrients through DS should consider the current DS contributions to nutrient intake among the low‐income, older population. [ABSTRACT FROM AUTHOR]

The market for local food has grown considerably over the course of thirty years. At the same time, even robust local food systems may reproduce injustices that have long marred corporatized food systems. In this paper, we explore the relationship of environmental justice to local food systems by asking two questions. First, are farmers markets (FMs) more likely to be found in wealthier, whiter communities? Second, are FMs providing people who are not members of socially privileged groups with an opportunity to buy food grown in accordance with organic principles? Drawing on survey data from FMs in New Jersey, we find that, although community demographics are strongly associated with FM location, social privilege is not associated with where organic farmers sell produce, once the lens of analysis is narrowed to just communities with an FM. But although food grown without agricultural chemicals is widely available at FMs in the study area, organic farmers who accept payment via WIC or SNAP are not more likely to sell at FMs in lower-income communities, and fewer organic farmers than non-organic farmers accept payment via WIC or SNAP. The presence of organic farmers at FMs in a wide range of communities suggests that expanding access to locally sourced fruits and vegetables may be able to play a small but not insignificant role in reducing exposure to agricultural chemicals. However, organic food would be more accessible at FMs in low-income communities if more organic farmers participated in nutrition assistance programmes like WIC and SNAP. [ABSTRACT FROM AUTHOR]

Most children and young people (CYP) worldwide are classified as inactive because they fail to meet the World Health Organisation recommendations for physical activity. Online interventions that use devices like exergames, smartphones, social media, and wearables have the potential to improve physical activity engagement because of their extensive reach and opportunities for learning and use across contexts. The objectives of this systematic review were to update the evidence-base on online physical activity interventions for CYP since 2015, analyse the outcomes associated with online interventions across physical, cognitive, social and affective domains, and assess the mechanisms (i.e. pedagogical strategies) of online interventions that resulted in outcomes related to physical activity. A systematic search of the literature was conducted across 4 databases (MEDLINE, PudMed, EBSCO and EMBASE) using key words related to online interventions, physical activity and CYP. The inclusion criteria were: CYP aged 5–18 years in the general population; use of an online-based medium to deliver an intervention related to physical activity; outcomes related to changes to physical activity, and in physical, cognitive, social and affective domains; and quantitative, qualitative and mixed methods studies. A modified version of the Quality Assessment Tool for Studies with Diverse Designs was used to assess study quality. A mixed methods approach was used to analyse and synthesise all evidence. 26 papers were identified as meeting the inclusion criteria, including randomised control trials (n=8), non-randomised interventions (n=12), observational studies (n=3) and qualitative papers (n=3). The target population of most studies was children (<12 years) where data collection mostly took place in a school setting, in elementary schools, and in physical education lessons. The interventions reported on positive changes to CYP's physical activity behaviours, through increases in physical activity levels and emotions, attitudes and motivations toward physical activity. Gamification and personalisation were the main mechanisms of online interventions that elicited positive changes in behaviours. The studies in this review provide a convincing rationale for the use of online interventions to support CYP's engagement with physical activity, due to the positive effects on physical and affective outcomes. New evidence is provided on the key mechanisms of online interventions (gamification and personalised learning) and the contexts in which online interventions are likely to be effective (elementary school PE) that can be used by health and education practitioners, organisations, policy makers and/or researchers to reach and engage CYP in physical activity. This study had some limitations that mainly relate to variation in study design, over-reliance of self-reported measures, and sample characteristics, that prevented comparative analysis. Registration number: PROPSERO; CRD42020215597. [ABSTRACT FROM AUTHOR]

Background Children ages 6 to 17 years can accurately assess their own food insecurity, whereas parents are inaccurate reporters of their children's experiences of food insecurity. No globally applicable scale to assess the food insecurity of children has been developed and validated. Objectives We aimed to develop a globally applicable, experience-based measure of child and adolescent food insecurity and establish the validity and cross-contextual equivalence of the measure. Methods The 10-item Child Food Insecurity Experiences Scale (CFIES) was based on items previously validated from questionnaires from the United States, Venezuela, and Lebanon. Cognitive interviews were conducted to check understanding of the items. The questionnaire then was administered in 15 surveys in 13 countries. Other items in each survey that assessed the household socioeconomic status, household food security, or child psychological functioning were selected as criterion variables to compare to the scores from the CFIES. To investigate accuracy (i.e., criterion validity), linear regression estimated the associations of the CFIES scores with the criterion variables. To investigate the cross-contextual equivalence (i.e., measurement invariance), the alignment method was used based on classical measurement theory. Results Across the 15 surveys, the mean scale scores for the CFIES ranged from 1.65 to 5.86 (possible range of 0 to 20) and the Cronbach alpha ranged from 0.88 to 0.94. The variance explained by a 1-factor model ranged from 0.92 to 0.99. Accuracy was demonstrated by expected associations with criterion variables. The percentages of equivalent thresholds and loadings across the 15 surveys were 28.0 and 5.33, respectively, for a total percentage of nonequivalent thresholds and loadings of 16.7, well below the guideline of <25%. That is, 83.3% of thresholds and loadings were equivalent across these surveys. Conclusions The CFIES provides a globally applicable, valid, and cross-contextually equivalent measure of the experiences of food insecurity of school-aged children and adolescents, as reported by them. [ABSTRACT FROM AUTHOR]

Background: Menu labelling, and more specifically calorie labelling, has been posited as an intervention to improve nutrition literacy and the healthfulness of consumers' food purchases. However, there is some concern calorie labelling may unintentionally trigger or exacerbate disordered eating among vulnerable persons. The purpose of this research was to explore young adults' experiences with labelling, with a focus on its implications for their relationships with food.Methods: Individual semi-structured interviews were conducted with participants from a campus-based menu labelling study. Interview data were inductively coded using thematic analysis and supported by survey data assessing disordered eating, body esteem, and related constructs.Results: The sample consisted of 13 participants (10 women, 3 men), most of whom perceived themselves as "about the right weight" (62%). Four key themes included: (1) participants' support of and skepticism about labelling interventions, (2) the identification of knowledge and autonomy as mechanisms of labelling interventions, (3) the role of the individual's and others' relationships with food in experiences with labelling, and (4) disordered eating and dieting as lenses that shape experiences with interventions. Participants' perceptions of and experiences with calorie labels were shaped by gender, body esteem, and disordered eating risk.Conclusions: The results provide insight into the complexity of young adults' interactions with labelling interventions and context for future research exploring the unintended consequences of public health nutrition interventions. [ABSTRACT FROM AUTHOR]

To investigate associations between eating behavior constructs (social eating, perceived competence, habit automaticity, self-determined motivation) and diet quality among young adults. Cross-sectional analysis. Young adults (n = 1,005; mean age, 21.7 ± 2.0 years; 85% female) enrolled in the Advice, Ideas, and Motivation for My Eating (Aim4Me) study. Four eating behavior measures collected via online surveys: Social Eating Scale, Perceived Competence in Healthy Eating Scale, Self-Report Behavioral Automaticity Index, and Regulation of Eating Behaviors scales. Diet quality was assessed using the Australian Recommended Food Score (ARFS) and percentage energy from energy-dense, nutrient-poor (EDNP) foods. Multivariate linear regression investigating associations between eating behavior measures (independent variables) and ARFS and EDNP foods (dependent variables), adjusting for sociodemographic and lifestyle confounders. Greater perceived competence in healthy eating and behavioral automaticity for consuming healthy foods, limiting EDNP food intake, and higher intrinsic motivation, integrated regulation, and identified regulation of eating behaviors were associated with higher ARFS and lower percentage energy EDNP foods (P < 0.001). Greater self-reported social influence on eating behaviors was associated with higher ARFS (P = 0.01). Higher amotivation was associated with greater % energy from EDNP foods (P < 0.001). Perceived competence, habit automaticity, and self-determined motivation are determinants of diet quality in young adults. These findings support the development of interventions that promote healthy eating habits by focusing on eating behavior constructs and evaluating their use in improving diet quality. [ABSTRACT FROM AUTHOR]

Researchers have noted large spatial variations in rates of food insecurity. But little research exists on why this is so and the impacts it has on rural families. Drawing on a mixed-methods longitudinal study with 124 poor and working-class households in North Carolina, we analyze the processes that shape lower-income rural families' access to food. We trace the narratives of three families whose stories are emblematic of themes from the larger data set to illumine how space and context influence families' experiences across the life course. As the caregivers in our study navigated how to feed their families, living in a rural area shaped the resources and often precarious forms of support that they drew on from their social networks, local communities, and the state. [ABSTRACT FROM AUTHOR]

Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender. [ABSTRACT FROM AUTHOR]

Background: The public health benefits of sugar-sweetened beverage (SSB) taxes often rely on, among other things, changes to consumer purchases. Thus, perceived cost of SSBs and signalling effects—via awareness of the tax—may impact the effectiveness of SSB taxes on consumer purchases. Objective: The study sought to examine perceived cost of SSBs, tax awareness, and changes in beverage purchasing over time and across four countries with and without SSB taxes. Methods: The study used data from the 2017, 2018 and 2019 waves of the International Food Policy Study. Annual cross-sectional online surveys were conducted in Australia, Mexico, UK and US, which captured perceived cost of SSBs relative to non-SSBs in all countries (with Australia as a no-tax comparator), and measures of tax awareness and participants' reported changes in beverage purchasing in response to SSB taxes in Mexico (tax implemented in 2014), UK (tax implemented in 2018) and US (subnational taxes since 2015). Logistic regression models evaluated the measures across years and socio-demographic groups. Results: Perceived cost of SSBs relative to non-SSBs was higher in Mexico (all three years) and the UK (2018 and 2019 following tax implementation) than Australia and the US. Tax awareness was higher in UK than Mexico, and decreased over time among Mexican respondents. Patterns of reported beverage purchasing changes in response to the tax were similar across Mexico, UK and US, with the largest changes reported by Mexican respondents. Respondents with characteristics corresponding to lower socioeconomic status were less likely to be aware of an SSB tax, but more likely to perceive SSBs to cost more than non-SSBs and report changes in purchasing in response to the tax, where there was one. Conclusions: This study suggests that in countries where a national SSB tax was present (Mexico, UK), perceived cost of SSBs and tax awareness were higher compared to countries with no SSB tax (Australia) or subnational SSB taxes (US), respectively, and suggests that perceived cost and tax awareness represent distinct constructs. Improving the 'signalling effect' of existing SSB taxes may be warranted, particularly in tax settings where consumer behaviour change is a policy objective. [ABSTRACT FROM AUTHOR]

Background: Information specialists conducting searches for systematic reviews need to consider key questions around which and how many sources to search. This is particularly important for public health topics where evidence may be found in diverse sources. Objectives: The objective of this review is to give an overview of recent studies on information retrieval guidance and methods that could be applied to public health evidence and used to guide future searches. Methods: A literature search was performed in core databases and supplemented by browsing health information journals and citation searching. Results were sifted and reviewed. Results: Seventy‐two papers were found and grouped into themes covering sources and search techniques. Public health topics were poorly covered in this literature. Discussion: Many researchers follow the recommendations to search multiple databases. The review topic influences decisions about sources. Additional sources covering grey literature eliminate bias but are time‐consuming and difficult to search systematically. Public health searching is complex, often requiring searches in multidisciplinary sources and using additional methods. Conclusions: Search planning is advisable to enable decisions about which and how many sources to search. This could improve with more work on modelling search scenarios, particularly in public health topics, to examine where publications were found and guide future research. [ABSTRACT FROM AUTHOR]

This study aims to showcase the adaptability evaluation of human settlements in Chengdu with the use of 3S technology. Chengdu was selected as the research object; natural eco-environmental factors such as terrain fluctuations, temperature and humidity, vegetation type, land use, and vegetation cover were analyzed, together with human disturbance factors such as traffic and gross domestic product (GDP); and the index weights were calculated by analytic hierarchy process (AHP). The evaluation model of Chengdu's residential environment adaptability was constructed based on the analysis carried out by the 3S technology: projection transformation, remote sensing interpretation, information extraction, and analysis. The results of the analysis reflected the zoning and spatial distribution characteristics of Chengdu's residential environment adaptability, and show that (1) the adaptability index of Chengdu's human settlement environment is between 15.98 and 76.75, and the suitability of human settlement environment is seen gradually decreasing from the middle, where it is the highest, when moving to the west and to the east of Chengdu; (2) according to the present situation, the suitability index can be divided into high-grade suitable areas, relatively high-grade suitable areas, moderately suitable areas, and low suitable areas; (3) the correlation between the spatial distribution of Chengdu population and each index factor is as follows: per capita GDP > topographic relief > temperature and humidity > vegetation coverage > traffic network density > land use > hydrological factors; (4) there is a good correlation between Chengdu's human settlements suitability index and the present population density grid layer, and its correlation coefficient is 0.7326; and (5) the leading impact indicators of human settlements are different in different regions. The results show that the natural environmental conditions in Chengdu are superior and that the ecological environmental quality is relatively stable, but the human settlement suitability index is relatively low in the southeast and Longmenshan areas of Chengdu. [ABSTRACT FROM AUTHOR]

Background: Dietary inequities in childhood may shape dietary and health inequities across the life course. Quantifying the magnitude and direction of trends in absolute and relative gaps and gradients in diet quality according to multiple indicators of socioeconomic position (SEP) can inform strategies to narrow these inequities.Objectives: We examined trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among a nationally representative sample of children in Canada.Methods: Data from children (aged 2-17 y; n = 18,670) who participated in the cross-sectional Canadian Community Health Survey-Nutrition in 2004 or 2015 were analyzed. SEP was based on total household income, household educational attainment, and neighborhood deprivation. Dietary intake data from 1 interviewer-administered 24-h dietary recall were used to derive a Healthy Eating Index-2015 (HEI-2015) score for each participant as a measure of diet quality. Inequities in diet quality were quantified using 4 indices: absolute and relative gaps (between highest and lowest SEP) and absolute (Slope Index of Inequality) and relative gradients (Relative Index of Inequality). Overall and age-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015.Results: Although mean HEI-2015 total scores improved from 52.3 to 57.3 (maximum 100 points; P < 0.001), absolute and relative gaps and gradients in diet quality remained mostly stable for all 3 SEP indicators. However, among children aged 6-11 y, absolute and relative gradients in diet quality according to household educational attainment and neighborhood deprivation widened.Conclusions: The diet quality of children in Canada was poor and inequitably patterned in 2004 and 2015. Although mean diet quality improved between 2004 and 2015, absolute and relative gaps and gradients in diet quality persisted, with some evidence of widening absolute and relative gradients among 6- to 11-y-olds. [ABSTRACT FROM AUTHOR]

Evidence suggests that combining tools that gather short- and long-term dietary data may be the optimal approach for the assessment of diet–disease associations in epidemiologic studies. Online technology can reduce the associated burdens for researchers and participants, but feasibility must be demonstrated in real-world settings before wide-scale implementation. The objective of this study was to determine the feasibility and acceptability of combining web-based tools (the Automated Self-Administered 24-hour Dietary Assessment Tool [ASA24-2016] and the past-year Diet History Questionnaire II [DHQ-II]) in a subset of participants in Alberta's Tomorrow Project, a prospective cohort. For this feasibility study, invitations were mailed to 550 randomly selected individuals enrolled in Alberta's Tomorrow Project. Consented participants (n = 331) were asked to complete a brief sociodemographic and health questionnaire, four ASA24-2016 recalls, the DHQ-II, and an evaluation survey. The study was conducted from March 2016 to December 2016 in Alberta, Canada. The majority of participants, mean age (SD) = 57.4 (9.8) years, were women (70.7%), urban residents (85.5%), and nonsmokers (95.7%). Primary outcomes were number of ASA24-2016 recalls completed, response rate of DHQ-II completion, and time to complete each assessment. The Wilcoxon signed rank sum test was used to assess differences in completion time. One-third (n = 102) of consenting participants did not complete any ASA24-2016 recalls. The primary reason to withdraw from the feasibility study was a lack of time. Among consenting participants, 51.9% (n = 172), 41.1% (n = 136), and 36.5% (n = 121) completed at least two ASA24-2016 recalls, the DHQ-II, and at least two ASA24-2016 recalls plus the DHQ-II, respectively. Median (25th to 75th percentile) completion times for participants who completed all recalls were 39 minutes (25 to 53 minutes) for the first ASA24-2016 recall and 60 minutes (40 to 90 minutes) for the DHQ-II. Findings indicate combining multiple ASA24-2016 recalls and the DHQ-II is feasible in this subset of Alberta's Tomorrow Project participants. However, optimal response rates may be contingent on providing participant support. Completion may also be sensitive to timing and frequency of recall administration. [ABSTRACT FROM AUTHOR]

Efforts to lose, gain, or maintain weight are prevalent among youth and young adults, but little is known about the relationship between weight management efforts and dietary quality. Attempts to manage weight are typically driven by weight perceptions, which may also uniquely affect overall diet. The objective was to explore sex-stratified associations between weight management efforts and perceptions with dietary quality among youth and young adults. Cross-sectional online survey data were drawn from Wave 1 (2016) of the Canada Food Study. Youth and young adults (n = 3,000), aged 16 to 30 years, were recruited from community settings in five Canadian cities and completed the online survey. The analytic sample consisted of 2,040 participants. The Healthy Eating Index-2015 (HEI-2015) was used to characterize dietary quality among participants who completed a 24-hour recall. Respondents reported their weight change efforts over the past year and their weight perception. Sex-stratified multiple linear regression analyses were conducted to investigate relationships between each of weight management efforts and perceptions, separately, and dietary quality, controlling for known covariates. The HEI-2015 mean score was 52 of 100 possible points. Nearly one quarter of male and female respondents reported not trying to do anything about their weight, whereas 16% reported trying to maintain, 28% and 5% trying to gain, and 33% and 55% trying to lose weight, respectively. Most respondents (63% of males and 66% of females) perceived their weight as just about right. Among males, trying to gain or maintain weight were each significantly associated with higher HEI-2015 mean scores compared with not trying to manage weight (P <.01 and <.001, respectively), whereas this relationship existed only for weight maintenance among female respondents (P <.01). Weight perceptions and HEI-2015 mean scores were not significantly related. Efforts to manage weight, which are commonplace among youth and young adults, are associated with dietary quality. Future behavioral research may provide insights into strategies used by youth to manage weight, guiding interventions that recognize links among weight-related behaviors, dietary quality, and other determinants of health. [ABSTRACT FROM AUTHOR]

Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) is a self-administered web-based tool designed to collect detailed dietary data at low cost in observational studies. The objectives of this study were to describe, overall and by demographic groups, the performance and feasibility of ASA24-2011 recalls and compare Healthy Eating Index-2015 (HEI-2015) total and component scores to 4-day food records (4DFRs) and food frequency questionnaires (FFQs). Over 12 months, participants completed up to 6 ASA24 recalls, 2 web-based FFQs, and 2 unweighed paper-and-pencil 4DFRs. Up to 3 attempts were made to obtain each ASA24 recall. Participants were administered doubly-labeled water to provide a measure of total energy expenditure and collected two 24-hour urine samples to assess concentrations of nitrogen, sodium, and potassium. From January through September 2012, 1,110 adult members of AARP, 50 to 74 years of age, were recruited from the Pittsburgh, PA, area to participate in the Interactive Diet and Activity Tracking in AARP (IDATA) study. After excluding 33 participants who had not completed any dietary assessments, 531 men and 546 women remained. Response rates, nutrient intakes compared to recovery biomarkers across each ASA24 administration day, and HEI-2015 total and component scores were measured. Means, medians, standard deviations, interquartile ranges, and HEI-2015 total and component scores computed using a multivariate measurement error model are presented. Ninety-one percent of men and 86% of women completed 3 ASA24 recalls. Approximately three-quarters completed 5 or more, higher than the completion rates for 2 4DFRs and 2 FFQs. Approximately, three-quarters of men and 70% of women completed ASA24 on the first attempt; 1 in 5 completed it on the second. Completion rates varied slightly by age and body mass index. Median time to complete ASA24-2011 (current version: ASA24-2020) declined with subsequent recalls from 55 to 41 minutes in men and from 58 to 42 minutes in women and was lowest in those younger than 60 years. Mean nutrient intakes were similar across recalls. For each recording day, energy intakes estimated by ASA24 were lower than energy expenditure. Reported intakes for protein, potassium, and sodium were closer to recovery biomarkers for women, but not for men. Geometric means of reported intakes of these nutrients did not systematically vary across ASA24 administrations, but differences between reported intakes and biomarkers differed by nutrient. Of 100 possible points, HEI-2015 total scores were nearly identical for 4DFRs and ASA24 recalls and higher for FFQs (men: 61, 60, and 68; women: 64, 64, and 72, respectively). ASA24, a freely available dietary assessment tool for use in large-scale nutrition research, was found to be highly feasible. Similar to previously reported data for nutrient intakes, HEI-2015 total and component scores for ASA24 recalls were comparable to those for 4DFRs, but not FFQs. ClinicalTrials.gov identifier: NCT03268577 (http://www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Objective: African Americans (AAs) experience greater prevalence of cardiovascular disease (CVD) compared to other ethnic/racial groups. Low-grade chronic inflammation (often quantified by serum C-reactive protein CRP) is a well-documented risk factor for CVD. A healthy diet is plentiful in antioxidant nutrients and is associated with a lower inflammatory status and CVD risk. Our objective was to examine the relationship between dietary intake of antioxidants (carotenoids, vitamins A, C, E, and selenium) and serum CRP concentrations in mid-life and older AAs, while controlling for confounders. Methods: Data were from the baseline phase of a longitudinal church-based intervention study to reduce CVD risk in AAs. Anthropometrics were measured in a standard manner. Fasting serum samples were analyzed with ELISA for CRP. Multiple-pass 24-hour dietary recalls were used to assess intake; self-reported questionnaires were used to collect demographics. Statistical analyses were performed using SPSS Statistics 21 with the level of significance set at p < 0.05. Results: A total of n = 73 participants (n = 51 females) were included in the analyses. The females and males, respectively were 58.9 ± 10.3 and 59.4 ± 9.7 years old, with BMI of 34.6 ± 8.3 and 35.6 ± 9.3 kg/m2 (Mean ± SD). The mean serum CRP was above 0.6 mg/dL, although slightly lower in males. Males consumed more energy (kcal) and met RDA for selenium, whereas females met RDA for vitamin C. Both groups met RDA for vitamin A. All other dietary variables fell below the RDA or had no RDA established. Results from the binary logistic regression did not show significant association between dietary antioxidants and serum CRP in males or females. However, among females, for every unit increase in BMI, there was a 15% increase in serum CRP (OR = 1.15, p = 0.04). Conclusions: Our study does not support the inverse relationship between antioxidants intake and CRP, but does support the evidence for obesity-induced inflammation and suggests the association can be applied to AA women. [ABSTRACT FROM AUTHOR]

In the United States, almost one in six households with children cannot access adequate food for a healthy and active lifestyle. Although food insecurity disproportionately affects lower-income households, it remains unclear why some lower-income families are more vulnerable to food insecurity than others. Household unsecured debt, such as debt incurred from credit cards and medical bills, may be an unexplored financial constraint associated with food insecurity. Using data from the 2014 Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID), I assess whether unsecured debt, by amount and type of debt, is associated with food insecurity among lower-income households with children (N=1,319). Results indicate that medical debt increases odds of household food insecurity even after accounting for key sociodemographic and economic risk factors, while no relationship exists between other forms of unsecured debt and food insecurity. Moreover, although liquid assets decrease the risk of household food insecurity and attenuate the harmful effects associated with unpaid medical bills, few households have enough liquid assets to mitigate the risks associated with medical debt. Efforts to prevent medical debt may be essential for eliminating food insecurity among lower-income households with children. [ABSTRACT FROM AUTHOR]

Background: Sociodemographic characteristics are associated with the dietary patterns of populations. However, the direction of the association is not consistent among countries: it is contingent on the nutritional transition phase, level of economic development, cultural contexts and both the social and health policies prevailing in each country. The objective of this study was to identify the trends in dietary patterns observed in 2006, 2012 and 2016 among Mexican adults by sociodemographic characteristic.Methods: To determine and compare dietary patterns, we performed a secondary analysis of dietary and sociodemographic data for adults 20-59 years old. Data were drawn from the 2006 and 2012 National Health and Nutrition Surveys (ENSANUTs) together with the 2016 Half-Way National Health and Nutrition Survey (ENSANUTMC). To estimate the dietary patterns, we used an adapted version of the Healthy Eating Index-2015 (HEI-2015) and a quantile-based regression model to compare the HEI medians by sociodemographic characteristic.Results: From 2006 to 2016, the quality of the diet of Mexican adults scored under 50 points on a scale of 0 to 100, markedly below the maximum scores for the majority of HEI-2015 components. Diet quality varied according to age, sex, socioeconomic status (SES), area (urban/rural) and region of residence, with the highest quality observed among older individuals (within the 40-59 age group), women, people of lower SES and residents of rural areas, particularly in southern Mexico. Although this trend remained constant overall throughout 2006, 2012 and 2016, specific HEI-2015 components showed an opposite trend by sociodemographic strata.Conclusion: The diet quality of Mexican adults was suboptimal from 2006 to 2016, with notorious disparities persisting over time among sociodemographic strata. Our results can serve as a basis for formulating recommendations on ways to improve the population diet, where those components diverging the most from adequate scores could be highlighted in public-health messages. [ABSTRACT FROM AUTHOR]

This paper considers the role of marketing in building intercultural relations in superdiverse, post-colonial societies, using post-apartheid South Africa as a case study. Drawing on neo-institutional theory, we analyze South African advertising campaigns to determine how marketing brokers intercultural relations by legitimizing social meanings conveyed through nation-building ideologies and consumers' lived experiences. We examine whether marketing outputs align with stages of Rainbow Nation-building strategies and types of consumers' lived experiences of South Africa's superdiversity. We then derive a conceptualization of intercultural marketing, which we characterize as an approach focused on brokering meanings of convivial intercultural engagement and collective development of societal welfare goals. We contribute to macromarketing theory, directing attention to the important brokering role marketing has, in bridging conceptions of reconciliatory social development held by public policy makers and by societies' populations. By conceptualizing intercultural marketing, its goals and tools, we contribute to multiculturally-sensitive marketing research and practice advancement. [ABSTRACT FROM AUTHOR]

Background: Dieting is a risk factor of both eating disorders and obesity. The aim was to examine time trends of dieting in Swedish adolescents, and explore how dieting and body weight dissatisfaction are related to self-reported health, wellbeing and health behaviours.Methods: Analyses of cross-sectional Swedish data from HBSC (Health Behaviour in School-aged Children) surveys 1994-2014. In total, about 30,000 girls and boys in the age of 11, 13 and 15 years participated. Data was collected by using classroom administered questionnaires in 5th, 7th and 9th grade. Logistic regressions was used to analyse secular trends of dieting, and how dieting and body dissatisfaction were associated with self-reported overall health, health behaviours, BMI and various physical, psychological and social aspects of health in 2014.Results: Dieting increased from 1994 to 2014 in both girls and boys in all age groups, and in 2014, the prevalence was 14% in girls and 8% in boys. The prevalence of body satisfaction was 65% respectively 69%. Body weight dissatisfaction and dieting were present in all body weight classes and were associated with self-reported poor health and many other negative health aspects. In comparison with the participants that were satisfied with their body weight the odds ratio (95% CI) for self-reported poor health was 3.4 (2.6-4.4) in dieters, 4.9 (3.8-6.4) in participants who perceived a need to lose weight and 2.1 (1.5-2.8) in those who perceived a need to gain weight, when adjusting for age, sex and body weight class.Conclusions: When promoting health among school age children body weight dissatisfaction and dieting ought to be considered. Furthermore, it is important to support girls and boys in all weight classes to reach and maintain a healthy body image and weight. [ABSTRACT FROM AUTHOR]

Quantitative research depends on using measures to collect data that are valid (ie, reflect well the phenomena of interest) and perform equivalently across contexts. Demonstrating validity and cross-context equivalence requires specifically designed studies, but many such studies have problems that have limited their usefulness. This article explains validity and cross-context equivalence of measures (and important related concepts) and clarifies how to establish them. Validation is the process of determining whether a measure or indicator is suitable for providing useful analytical measurement for a given purpose and context. Cross-context equivalence means that a measure performs comparably across contexts. Four types of equivalence are construct, item, measurement, and scalar. Establishing validity and cross-context equivalence requires representing mathematically the errors (ie, imprecision, undependability, and inaccuracy) of a measure and using appropriate statistical methods to quantify these errors. Studies aiming to provide evidence about the validity of a measure need to clarify the purpose and context for use of that measure. Choose one of the two conceptual systems for validation; obtain data to establish the extent to which the measure is well constructed, reliable, and accurate; and use analytic methods beyond simple correlations to provide a basis for making reasoned judgment about whether the measure provides useful analytic measurement for the particular purpose(s) and context. Establishing accuracy of a measure requires having available other measures known to be accurate as comparators; in the case that no other measure understood to be more accurate is available, then the study will be able to establish agreement rather than validity. [ABSTRACT FROM AUTHOR]

In the last decade, a massive body of research on food insecurity and health among women has emerged in various disciplines, including nursing, social work, psychology, and health geography. This article deploys an intersectional lens to identify successful coping mechanisms and the development of resilience in women living in poverty, linking food insecurity with geography, coping strategies, and health. A review of the literature reveals that, despite increasing interest in the health implications of food insecurity across multiple health and social disciplines, little is known about women's food insecurity in different geographical contexts. This study addresses this gap in knowledge by exploring women's experiences of food insecurity and the perceived impacts on their physical and mental health in the city of Greater Sudbury in Northern Ontario and the city of London in Southern Ontario, Canada. A purposive sampling technique was used to recruit twenty women from sites where services are provided to poor and/or homeless women. Individual semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. The transcripts were subjected to thematic analysis using NVIVO 11 software. The themes that emerged are congruent with the selected theoretical framework (intersectionality). The key themes identified include food and financial hardship (e.g., food availability, accessibility, and quality; food prices; income and rent), motherhood (e.g., feeding children first), resourcefulness (e.g., food skipping and food stretching) and health perception (e.g., physical health, mental health). The study's findings have implications for the development of strengths-based and community-based interventions targeting women experiencing food insecurity. [ABSTRACT FROM AUTHOR]

Immigrant health assimilation is often framed as a linear, individualistic process. Yet new assimilation theory and structural theories of health behavior imply variation in health assimilation as immigrants and their families interact with different US social institutions throughout the day. We test this idea by analyzing how two indicators of dietary assimilation-food acculturation and healthy eating-vary throughout the day as Mexican children in immigrant households consume food in different institutional settings. Using individual fixed-effects models and data from the National Health and Nutrition Examination Survey, we find that Mexican children in immigrant households (N = 2,337) engage in "dietary code-switching," eating more acculturated but not necessarily less healthy food in schools and more acculturated but less healthy food in restaurants compared to homes. Findings advance theory and knowledge about how social institutions condition dietary assimilation in particular and health assimilation more broadly. [ABSTRACT FROM AUTHOR]

Developing the evidence base for health promotion can be challenging because interventions often have to target competing determinants of health, including social, structural, environmental and political determinants; all of which are difficult to measure and thus evaluate. Drawing on a case study of food insecurity, which refers to inadequate access to food due to financial constraints, we illustrate the challenges faced by community-based organizations in collecting data to form an evidence base for the development and evaluation of collective programmes aimed at addressing food insecurity. Interviews were conducted with members of a multi-stakeholder coalition (n  = 22 interviewees; n  = 10 organizations) who collectively work to address food insecurity in their community through a range of community-based programmes and services. Member organizations also provided a list of measures currently used to inform programme and service development and evaluation. Data were collected in a city in Southern Ontario, Canada between May and September 2015. Participants identified four barriers to collecting data: Organizational needs and philosophies; concerns surrounding clientele wellbeing and dignity; issues of feasibility; and restrictive requirements imposed by funding bodies. Participants also discussed their previous successes in collecting meaningful data for identifying impact. Our results point to the challenge of generating data suitable for developing and evaluating programmes aimed at broader determinants of health, while maintaining the primary goal of meeting clients' needs. Documenting change at intermediate- and macro-levels would provide evidence for the collective effectiveness of current programmes and services offered. However, appropriate resources need to be invested to allow for scientific evaluation. [ABSTRACT FROM AUTHOR]

Past research on immigrant health frequently finds that the duration of time lived in the United States is associated with the erosion of immigrants' health advantages. However, the timing of U.S. migration during the life course is rarely explored. We draw from developmental and sociological perspectives to theorize how migration during childhood may be related to healthy eating among adult immigrants from Mexico. We test these ideas with a mechanism-based age-period-cohort model to disentangle age, age at arrival, and duration of residence. Results show that immigrants who arrived during preschool ages (2-5 years) and school ages (6-11 years) have less healthy diets than adult arrivals (25+ years). After accounting for age at arrival, duration of residence is positively related to healthy eating. Overall, the findings highlight the need to focus more research and policy interventions on child immigrants, who may be particularly susceptible to adopting unhealthy American behaviors during sensitive periods of childhood. [ABSTRACT FROM AUTHOR]

In the United States, more than 1 in 5 households with children are unable to access and provide adequate food for a healthy, active lifestyle. We argue that the contribution of local context for food insecurity risk has largely been overlooked in favor of focusing on individual family characteristics, and that this is problematic given that mitigating food insecurity may be a communal process. We examine the relevance of neighborhood contributors to food insecurity among children, utilizing geocoded and nationally-representative data from the ECLS-K: 2010-2011 kindergarten cohort. We find little evidence that neighborhood socioeconomic, food retail, or social services characteristics directly impact food insecurity risk. However, our results reveal that family and neighborhood socioeconomic characteristics combine to impact food insecurity in ways consistent with a disadvantage paradox. As neighborhood concentrated disadvantage increases, higher-SES families’ risk of food insecurity increases, but lower-SES families’ risk decreases. This paradox is not explained by a higher concentration of social service organizations in more disadvantaged neighborhoods, and we theorize that impoverished families with children may share information and resources in disadvantaged communities to avoid food insecurity. [ABSTRACT FROM AUTHOR]

This article examines the associations among food insecurity, financial shocks, and financial coping strategies among elementary school students' households in Wisconsin using a survey of parents. Volatility in income and expenses are predictive of households' ability to meet food needs, and parents who have experienced large or volatile expenses report more difficulty in shielding child(ren) from food hardships. Food insecurity is characterized by a continuum of financial adaptations-ranging from relying on savings, borrowing from family and friends, and increased work effort in conjunction with marginal food security, and progressing toward use of potentially inferior forms of credit such as payday and pawn loans at the more severe end of the food insecurity spectrum. In addition to income-focused coping strategies, survey respondents report food-specific coping strategies. Overall, the results suggest that food security and financial security interventions may work in concert and may benefit from greater coordination. [ABSTRACT FROM AUTHOR]

This study examines food insecurity among children of participants in a federally funded savings program in the United States, the Individual Development Account ( IDA) program. We measure child food insecurity of savings program families by using the eight questions of the Current Population Survey's Food Security Supplement. About 39.4% of savings program families report food insecurity. No differences in children's food hardship between current and past program participants were identified. Examining predictors, propensity to plan for money tend to be associated with higher odds of children's food insecurity. By contrast, frugal behavior, lower material deprivation, and higher subjective well-being tend to reduce the odds of children's food insecurity. Findings also confirm previous literature on the association of alternative financial services and higher food insecurity among children. [ABSTRACT FROM AUTHOR]

This study aims to showcase the adaptability evaluation of human settlements in Chengdu with the use of 3S technology. Chengdu was selected as the research object; natural eco-environmental factors such as terrain fluctuations, temperature and humidity, vegetation type, land use, and vegetation cover were analyzed, together with human disturbance factors such as traffic and gross domestic product (GDP); and the index weights were calculated by analytic hierarchy process (AHP). The evaluation model of Chengdu's residential environment adaptability was constructed based on the analysis carried out by the 3S technology: projection transformation, remote sensing interpretation, information extraction, and analysis. The results of the analysis reflected the zoning and spatial distribution characteristics of Chengdu's residential environment adaptability, and show that (1) the adaptability index of Chengdu's human settlement environment is between 15.98 and 76.75, and the suitability of human settlement environment is seen gradually decreasing from the middle, where it is the highest, when moving to the west and to the east of Chengdu; (2) according to the present situation, the suitability index can be divided into high-grade suitable areas, relatively high-grade suitable areas, moderately suitable areas, and low suitable areas; (3) the correlation between the spatial distribution of Chengdu population and each index factor is as follows: per capita GDP > topographic relief > temperature and humidity > vegetation coverage > traffic network density > land use > hydrological factors; (4) there is a good correlation between Chengdu's human settlements suitability index and the present population density grid layer, and its correlation coefficient is 0.7326; and (5) the leading impact indicators of human settlements are different in different regions. The results show that the natural environmental conditions in Chengdu are superior and that the ecological environmental quality is relatively stable, but the human settlement suitability index is relatively low in the southeast and Longmenshan areas of Chengdu., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A retrospective study of kids' meals purchased at Walt Disney World was conducted to determine acceptance rates for healthy sides and beverages. Purchase data from all 145 Walt Disney World restaurants were analyzed using a log-linear model and a Poisson regression. Across all restaurants, 47.9% and 66.3% of guests accepted healthy default sides and beverages, respectively. Acceptance rates of sides and beverages were higher at quick-service restaurants (49.4% and 67.8%, respectively) compared to table-service restaurants (40.3% and 45.6%, respectively). The healthy defaults reduced calories (21.4%), fat (43.9%), and sodium (43.4%) for kids' meal sides and beverages. This study contributes by examining the use of kids' meal healthy defaults in quick-service and table-service restaurant formats at the world's largest theme park, a previously unstudied setting, and by providing the largest ever healthy default data set. The results suggest that healthy defaults can shift food and beverage selection patterns toward healthier options. [ABSTRACT FROM AUTHOR]

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People whom the author would like to thank for their assistance in the creation of the journal "Nutrients" are mentioned.