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Background: Meals from full-service restaurants (FS) and fast-food restaurants (FF) are an integral part of US diets, but current levels and trends in consumption, healthfulness, and related sociodemographic disparities are not well characterized., Objectives: We aimed to assess patterns and nutritional quality (using validated American Heart Association [AHA] diet scores) of FS and FF meals consumed by US adults., Methods: Serial cross-sectional investigation utilizing 24-h dietary recalls in survey-weighted, nationally representative samples of 35,015 adults aged ≥20 y from 7 NHANES cycles, 2003-2016., Results: Between 2003 and 2016, American adults consumed ∼21 percent of energyfrom restaurants (FS: 8.5% in 2003-2004, 9.5% in 2015-2016, P-trend = 0.38; FF: 10.5%; 13.4%, P-trend = 0.31). Over this period, more FF meals were eaten for breakfast (from 4.4% to 7.6% of all breakfasts, P-trend <0.001), with no changes for lunch (15.2% to 15.3%) or dinner (14.6% to 14.4%). In 2015-2016, diet quality of both FS and FF were low, with mean AHA diet scores of 31.6 and 27.6 (out of 80). Between 2003 and 2016, diet quality of FF meals improved slightly, (the percentage with poor quality went from 74.6% to 69.8%; and with intermediate quality, from 25.4% to 30.2%; P-trend <0.001 each). Proportions of FS meals of poor (∼50%) and intermediate (∼50%) quality were stable over time, with <0.1% of consumed FS or FF meals meeting ideal quality. Disparities in FS meal quality persisted by race/ethnicity, obesity status, and education and worsened by income; whereas disparities in FF meal quality persisted by age, sex, and obesity status and worsened by race/ethnicity, education, and income., Conclusions: Between 2003 and 2016, FF and FS meals provided 1 in 5 calories for US adults. Modest improvements occurred in nutritional quality of FF, but not FS, meals consumed, and the average quality for both remained low with persistent or widening disparities. These findings highlight the need for strategies to improve the nutritional quality of US restaurant meals., (Copyright © The Author(s) 2020.)

Introduction: The Lower Mississippi Delta is characterized by several factors associated with poor diet quality. Our objective was to measure local nutrition environments of pregnant women and their infants who participated in a nutrition and physical activity intervention to assess environmental exposures potentially influencing their dietary habits., Methods: We measured the nutrition environments of 5 towns in which participants resided by using the Nutrition Environment Measures Survey for grocery stores, convenience stores, full-service restaurants, and fast food restaurants. We used general linear models to test for differences in ratio scores, calculated by dividing each food outlet score by the maximum score possible, among food outlet classes and subclasses., Results: Mean total ratio scores (expressed as percentages) for the Nutrition Environment Measures Survey among 4 classes of food outlets were significantly different from one another except for convenience stores and full-service restaurants. On average, grocery stores (n = 11) had 54% of maximum points possible, followed by full-service restaurants (21%; n = 50), convenience stores (16%; n = 86), and fast food restaurants (8%; n = 119). We found no significant differences in mean total ratio scores among convenience store subclasses. For fast food restaurant subclasses, stand-alone restaurants (n = 81) had 19% of maximum points possible, significantly higher than grocery store delicatessens (6%; n = 8), corner stores that sold fast food (3%; n = 5), and gas stations that sold fast food (4%; n = 25)., Conclusion: These 5 Lower Mississippi Delta towns scored low on nutrition environment measures associated with healthful eating. Behavioral interventions designed to bring about positive changes in dietary habits of rural residents are needed; however, effects may be minimal if environmental factors supportive of healthful eating are not available.

Background : Cooking smoke is a major source of indoor air pollution affecting millions of people worldwide. To date, there has been no epidemiological study to show the variation in health effects resulting from work at different kinds of restaurants in Thailand. This study determines lung function and chronic respiratory symptoms of workers in four types of eateries commonly found in Thailand. Methods : This is a cross-sectional study of 321 people working in four common types of restaurants in Thailand: 'tamsang' restaurants (from the Thai word ร้านอาหารตามสั่ง, a restaurant that makes a variety of foods to order) (170 people), papaya salad restaurants (51 people), noodle restaurants (50 people), and barbecue stalls (50 people).  The restaurant workers' demographic data as well as information on their working conditions was collected using a questionnaire administered in a face to face interview. Each worker's peak expiratory flow rate was measured using a portable peak flow meter. Results : This study found that working in a 'tamsang' restaurant is associated with a higher risk of poor lung function (OR = 2.59, 95% CI 1.33-5.06) and a higher prevalence of moderate dyspnea symptoms (OR = 3.79, 95% CI 1.63-8.79) compared to working in a papaya salad restaurant. The study also found that each of the following were associated with poor lung function and/or chronic respiratory symptoms: cooking with palm oil, having irritated teary eyes while cooking, cooking without a ventilation hood, long past experience working at restaurants, and working in a small cooking area (1-6 m 2 ). Conclusions : Work in different kinds of restaurants with variations in cooking methods and work conditions produces diverse effects on airway and lung function. Regulatory organizations should pay careful attention to protecting the health of restaurant workers, especially those working in 'tamsang' restaurants., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Juntarawijit C.)

While most food is consumed at home, food eaten out-of-home plays an important role in diets and it has been associated with higher energy intake and higher body weight. Beyond prepared meals, there is limited understanding of what foods people buy out-of-home and where they buy them from. This study analyses out-of-home food purchases by food groups and food outlet types, and estimates socio-economic differences in these expenditure patterns. We used a nationally representative product-level dataset of expenditures (n=2,734,987) on foods and non-alcoholic beverages for out-of-home consumption for 9,704 respondents in Great Britain (June 2015-December 2017). Population weighted estimates of per capita weekly expenditures and shares of expenditure were derived for four outlet types and eight food groups. We used linear multi-level modelling to determine differences in expenditure patterns by socio-economic status (SES) characterised via occupational social grade. Out-of-home purchases make up 25-39% of total food and beverage expenditures. Mid- and high-SES respondents spent nearly twice as much (£17.76 and £15.11 weekly), compared to low-SES respondents (£9.69) for out-ofhome food consumption. A third of expenditures across SES (36-37%) were spent in venues other than restaurants or fast-food and takeaway outlets. Meals accounted for 60% of expenditures, but a third was spent on beverages (10-12% non-alcoholic cold beverages, 17-18% hot beverages) and 9-10% on snacks. Mid- and low-SES respondents had a greater share of expenditure in takeaway and fast-food outlets, supermarkets and convenience stores, and on cold non-alcoholic beverages. Overall, low-SES respondents spent less on out-of-home foods but the share of this expenditure across different foods or outlets varied less. While restaurants, fast-food and takeaway outlets were a major source of out-of-home purchases, a significant proportion was spent in other outlets. Policies targeting out-of-home consumption should therefore consider the full range of foods as well as the diversity of places where they are sold., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The socioeconomic disparity in childhood and early adult obesity prevalence has been well characterised. Takeaway outlets may cluster in lower socioeconomic areas and their proximity to schools is of concern. This study aimed to map takeaway food outlets, characterise takeaway types and their proximity to educational institutions within a low socioeconomic ward in Manchester., Design: The Rusholme ward and a 2 km Euclidean buffer were included as the study area. Local authority Environmental Health data were used to map the takeaway outlets, using QGIS V.2.18.0 (OPENGIS.ch LLC, Einsiedeln, Switzerland). The types of takeaway outlets and major roads were included. Number of outlets within a 400 m Euclidean walking buffer of educational institutions were mapped., Setting: Rusholme, Manchester, UK., Results: Within the study area, 202 takeaway food outlets were identified and mapped as cluster points. Of these, 62.3% are located on major (A and B) roads, while the remaining outlets were located on minor roads. The majority (57.4%) of takeaway outlets sold similar items (fried chicken, burgers, pizzas, kebabs), with the remainder offering more diverse menus. Of the 53 schools, colleges and universities within the study area, 28 (52.8%) had 1-5 takeaway food outlets within 400 m, 9 (17.0%) had 6-10 outlets; 4 (7.5%) more than 11 outlets with 12 (22.6%) having zero outlets within 400 m., Conclusion: Within this low socioeconomic area, there was a high concentration of takeaway food outlets, predominantly along major roads and in easy walking distance of educational establishments with the majority offering similar foods. In addition, a high proportion of these outlets were in easy walking distance of educational establishments. Public health policy needs to consider the implications of current takeaway food outlets and not just the proliferation of these outlets with current planning laws., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey ( n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health.

Background: Secondary data containing the locations of food outlets is increasingly used in nutrition and obesity research and policy. However, evidence evaluating these data is limited. This study validates two sources of secondary food environment data: Ordnance Survey Points of Interest data (POI) and food hygiene data from the Food Standards Agency (FSA), against street audits in England and appraises the utility of these data., Methods: Audits were conducted across 52 Lower Super Output Areas in England. All streets within each Lower Super Output Area were covered to identify the name and street address of all food outlets therein. Audit-identified outlets were matched to outlets in the POI and FSA data to identify true positives (TP: outlets in both the audits and the POI/FSA data), false positives (FP: outlets in the POI/FSA data only) and false negatives (FN: outlets in the audits only). Agreement was assessed using positive predictive values (PPV: TP/(TP + FP)) and sensitivities (TP/(TP + FN)). Variations in sensitivities and PPVs across environment and outlet types were assessed using multi-level logistic regression. Proprietary classifications within the POI data were additionally used to classify outlets, and agreement between audit-derived and POI-derived classifications was assessed., Results: Street audits identified 1172 outlets, compared to 1100 and 1082 for POI and FSA respectively. PPVs were statistically significantly higher for FSA (0.91, CI: 0.89-0.93) than for POI (0.86, CI: 0.84-0.88). However, sensitivity values were not different between the two datasets. Sensitivity and PPVs varied across outlet types for both datasets. Without accounting for this, POI had statistically significantly better PPVs in rural and affluent areas. After accounting for variability across outlet types, FSA had statistically significantly better sensitivity in rural areas and worse sensitivity in rural middle affluence areas (relative to deprived). Audit-derived and POI-derived classifications exhibited substantial agreement (p < 0.001; Kappa = 0.66, CI: 0.63-0.70)., Conclusions: POI and FSA data have good agreement with street audits; although both datasets had geographic biases which may need to be accounted for in analyses. Use of POI proprietary classifications is an accurate method for classifying outlets, providing time savings compared to manual classification of outlets.

Background: We aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes., Methods: Young people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008-09) and a study conducted in 2011-12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool., Results: Over 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and 'takeaway and fast food' outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar., Conclusions: This work provides details of 'where' young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments., (© The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: To examine longitudinal pathways from multiple types of neighborhood restaurants and food stores to BMI, through dietary behaviors., Methods: We used data from participants (n=5114) in the United States-based Coronary Artery Risk Development in Young Adults study and a structural equation model to estimate longitudinal (1985-86 to 2005-06) pathways simultaneously from neighborhood fast food restaurants, sit-down restaurants, supermarkets, and convenience stores to BMI through dietary behaviors, controlling for socioeconomic status (SES) and physical activity., Results: Higher numbers of neighborhood fast food restaurants and lower numbers of sit-down restaurants were associated with higher consumption of an obesogenic fast food-type diet. The pathways from food stores to BMI through diet were inconsistent in magnitude and statistical significance., Conclusions: Efforts to decrease the numbers of neighborhood fast food restaurants and to increase the numbers of sit-down restaurant options could influence diet behaviors. Availability of neighborhood fast food and sit-down restaurants may play comparatively stronger roles than food stores in shaping dietary behaviors and BMI., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: Studies have shown that immigrants' acculturation is associated with numerous unhealthy behaviours. Yet, the role of environmental factors in modifying the effect of acculturation on health behaviours has received little attention. This study aims to create a more nuanced understanding of the health effects of acculturation by examining how neighbourhood immigrant composition modifies the association between individuals' eating patterns and acculturation., Methods: Cross-sectional Data from Los Angeles County Health Survey 2007 adult sample were linked to data on retail food establishments and US Census 2000 neighbourhood characteristics. Acculturation was measured by language spoken at home and years stayed in the US. Eating fast food more than once per week and eating zero serving of fruit or vegetables during the previous day were used as proxy indicators for unhealthy dietary behaviour. Multilevel logistic regression models were performed in the full sample and in the sample with only Latino adults., Results: Immigrants' lack of acculturation and living in a neighbourhood with a high percentage immigrants were associated with healthier dietary behaviour. We also identified that lack of acculturation conveyed a significantly stronger protective effect on regular fast-food consumption for immigrants living in neighbourhoods with higher percentage immigrants (OR: 0.34, 95% CI: 0.12 to 0.93)., Conclusions: Among immigrants in Los Angeles County, living in a neighbourhood with a high density of other immigrants attenuates the negative effects of acculturation on healthy eating behaviours. Healthy eating promotion efforts should build on this protective effect in outreach to acculturating immigrant communities., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: Interest has increased in understanding the types and healthfulness of restaurant foods for children, particularly in disadvantaged areas. The purpose of this community-based participatory research study was to describe the quality of restaurant food offered to children in a health-disparate region in Virginia and North Carolina and to determine if the availability of healthy foods differed by location (rural, urban) or by the predominant race (black, white, mixed race) of an area's population., Methods: Restaurants offering a children's menu in the 3 counties in Virginia and North Carolina that make up the Dan River Region were identified by using state health department records. Research assistants reviewed menus using the Children's Menu Assessment (CMA), a tool consisting of 29 scored items (possible score range, -4 to 21). Scores were calculated for each restaurant. We obtained information on the predominant race of the population at the block group level for all counties from 2010 US Census data., Results: For the 137 restaurants studied, mean CMA scores were low (mean, 1.6; standard deviation [SD], 2.7), ranging from -4 to 9 of 21 possible points. Scores were lowest for restaurants in the predominantly black block groups (mean, 0.2; SD, 0.4) and significantly different from the scores for restaurants in the predominantly white (mean, 1.4; SD, 1.6) and mixed-race block groups (mean, 2.6; SD, 2.4) (F = 4.3; P < .05)., Conclusion: Children's menus available in the Dan River Region lack healthy food options, particularly in predominantly black block groups. These study findings can contribute to regional efforts in policy development or environmental interventions for children's food quality by the community-based participatory research partnership and help local stakeholders to determine possible strategies and solutions for improving local food options for children.

Zoning and other land-use policies are a promising but controversial strategy to improve community food environments. To understand how these policies are debated, we searched existing databases and the Internet and analyzed news coverage and legal documentation of efforts to restrict fast-food restaurants in 77 US communities in 2001 to 2013. Policies intended to improve community health were most often proposed in urban, racially diverse communities; policies proposed in small towns or majority-White communities aimed to protect community aesthetics or local businesses. Health-focused policies were subject to more criticism than other policies and were generally less successful. Our findings could inform the work of advocates interested in employing land-use policies to improve the food environment in their own communities.

Objectives: We evaluated the impact of the New York City restaurant letter-grading program on restaurant hygiene, food safety practices, and public awareness., Methods: We analyzed data from 43,448 restaurants inspected between 2007 and 2013 to measure changes in inspection score and violation citations since program launch in July 2010. We used binomial regression to assess probability of scoring 0 to 13 points (A-range score). Two population-based random-digit-dial telephone surveys assessed public perceptions of the program., Results: After we controlled for repeated restaurant observations, season of inspection, and chain restaurant status, the probability of scoring 0 to 13 points on an unannounced inspection increased 35% (95% confidence interval [CI]=31%, 40%) 3 years after compared with 3 years before grading. There were notable improvements in compliance with some specific requirements, including having a certified kitchen manager on site and being pest-free. More than 91% (95% CI=88%, 94%) of New Yorkers approved of the program and 88% (95% CI=85%, 92%) considered grades in dining decisions in 2012., Conclusions: Restaurant letter grading in New York City has resulted in improved sanitary conditions on unannounced inspection, suggesting that the program is an effective regulatory tool.

Objectives: We examined population-level impact on customer awareness and use and explored potential disparities in outcomes regarding the King County, Washington, regulation requiring chain restaurants to provide calorie information., Methods: We analyzed 2008 to 2010 Behavioral Risk Factor Surveillance System data from 3132 English-speaking King County residents aged 18 years and older who reported eating at a regulated chain. We used regression models to assess changes in calorie information awareness and use from prepolicy to postpolicy implementation by customer demographics, health status, and restaurant type., Results: Calorie information awareness and use increased significantly from 2008 to 2010. Unadjusted analyses indicated that the proportion who saw and used calorie information tripled, from 8.1% to 24.8%. Fully adjusted analyses confirmed significant increases. After policy implementation, White, higher income, and obese respondents had greater odds of seeing calorie information. Women, higher income groups, and those eating at a fast-food versus a sit-down chain restaurant were more likely to use this information., Conclusions: Significant increases in calorie information awareness and use following regulation support the population-wide value of this policy. However, improvements varied across race, income, and gender.

Background: Children who eat fast food have poor diet and health outcomes. Fast food is heavily marketed to youth, and exposure to such marketing is associated with higher fast food consumption., Purpose: To examine the extent of child-directed marketing (CDM) inside and on the exterior of fast food restaurants., Methods: Data were collected from 6,716 fast food restaurants located in a nationally representative sample of public middle- and high-school enrollment areas in 2010, 2011, and 2012. CDM was defined as the presence of one or more of seven components inside or on the exterior of the restaurant. Analyses were conducted in 2014., Results: More than 20% of fast food restaurants used CDM inside or on their exterior. In multivariate analyses, fast food restaurants that were part of a chain, offered kids' meals, were located in middle- (compared to high)-income neighborhoods, and in rural (compared to urban) areas had significantly higher odds of using any CDM; chain restaurants and those located in majority black neighborhoods (compared to white) had significantly higher odds of having an indoor display of kids' meal toys. Compared to 2010, there was a significant decline in use of CDM in 2011, but the prevalence increased close to the 2010 level in 2012., Conclusions: CDM inside and on the exterior of fast food restaurants is prevalent in chain restaurants; majority black communities, rural areas, and middle-income communities are disproportionately exposed. The fast food industry should limit children's exposure to marketing that promotes unhealthy food choices., (Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare restaurant marketing by restaurant and neighborhood type., Methods: All restaurants (61=fast food, FF; 72=table service, TS) within an 800-meter radius of 13 public housing developments (HD) and 4 comparison neighborhoods were audited using the Restaurant Assessment Tool©2010. HD neighborhoods were lower income and higher minority than comparison neighborhoods with similar density and street connectivity., Results: Restaurants in HD neighborhoods had fewer healthy entrées than comparison neighborhoods. FF restaurants had cheaper beverages and more children's meals, supersize drinks, free prize with purchase, super-size items, special characters, and more items geared to driving than TS restaurants., Conclusions: Residents of lower socioeconomic neighborhoods may be differentially exposed to unhealthy food options.

Objectives: To assess TV fast food ad exposure in South Korea., Methods: We assessed time trends of targeted ratings (licensed from Nielsen Media Research Korea) by household income and education during 2004-2010., Results: Lower income groups saw more fast food TV ads during the study period. Exposure decreased in all income groups with a bigger income gap in 2010 than in 2004. The relative exposure to local fried chicken franchise TV ads surged from one fifth in 2004 to half of all TV fast food ads seen in 2010 in all socioeconomic status (SES)., Conclusions: Future studies should assess the link between TV fast ood ad exposure, an important contextual factor for individual food choices, and actual consumption.

We analyze, using an instrumental variable approach, the effect of the number of fast-food restaurants on school level obesity rates in Arkansas. Using distance to the nearest major highway as an instrument, our results suggest that exposure to fast-food restaurants can impact weight outcomes. Specifically, we find that the number of fast-food restaurants within a mile from the school can significantly affect school level obesity rates., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Issue Addressed: Whether improved alcohol management delivers additional benefits to clubs in the form of financial viability, expanded membership, increased spectators and greater capacity for competition., Methods: Measures were derived from 657 Australian community sporting clubs enrolled in the Good Sports program. The program assists clubs to manage alcohol through an accreditation process that sets minimum standards for regulatory compliance, club practices and policies. Measures were taken from survey information collected prior to Level 1 accreditation and at the third and final level of club accreditation., Results: Income was found to increase and reliance on alcohol as a funding source was found to diminish over time. Membership increased and was accelerated among females, young people and non-players. No changes in the number of junior and senior teams or players were found., Conclusions: Improved alcohol management can produce a range of benefits beyond responsible drinking patterns that add to club sustainability.

Consumption of ready-to-eat (RTE) salads has increased worldwide. Consequently, the number of outbreaks caused by food-borne pathogens, including diarrheagenic E. coli pathotypes (DEPs), associated with the consumption of RTE-salads has increased. DEPs include enterotoxigenic (ETEC), typical and atypical enteropathogenic (tEPEC, aEPEC), enteroinvasive (EIEC), enteroaggregative (EAEC), diffuse adherent (DAEC) and Shiga toxin-producing (STEC) E. coli. In less-developed areas of the world, fresh crops continue to be irrigated with untreated sewage water. The aims of this study were to evaluate the microbiological quality and prevalence of DEPs in RTE-salads of raw vegetables, purchased from restaurants at Pachuca-City, Hidalgo, Mexico, where most locally consumed vegetables are irrigated with untreated sewage water. A total of 130 salads were purchased from restaurants of three categories: A) national chain restaurants and B) local restaurants, both with the H distinctive (a recognition that the Secretary of Tourism grants to restaurants that manage supplies with high levels of hygiene); and C) local small inexpensive restaurants without H distinctive. A total of 6 restaurants were included, 2 per category (A(1-2), B(1-2), C(1-2)). Each sample was tested for the presence of faecal coliforms (FC) and E. coli by standard procedures. E. coli strains were further characterized for the presence of DEPs loci by two multiplex polymerase chain reactions. Among the 130 salad samples 99% (129) were contaminated with FC; 85% (110/129) harboured E. coli and 7% (8/110) DEPs. The amount of positive salad samples for FC and E. coli was similar between restaurants and categories. The FC mean (571 FC/g) of all samples was significantly higher (p<0.001) than the E. coli mean (63 E. coli/g). A weak correlation of 7.7% (r(2)=0.077, p=0.003) between median FC and E. coli MPN (most probable number) per sample was found. Of the 8 salad samples contaminated with DEPs, 2 were spinach salads from restaurant A(2) and 3 were (Mixed salad) samples from each C restaurant. Three samples harboured non-O157 STEC strains, 2 EIEC, 1 ETEC and 2 samples had non-O157 STEC and EIEC strains, simultaneously. A significant difference (p=0.008) between the prevalence of E. coli vs. DEPs was observed. Independently of the restaurants' overall hygienic status, most RTE-salads had a poor microbiological quality and some harboured DEPs that have been associated with illness in Mexico. Health authorities should focus on implementing DEPs screening in raw vegetables and enforcing the legislation that forbids irrigation with untreated sewage water of both root and leafy vegetables., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Eating outside of the home environment on a frequent basis has been associated with weight gain. Food choices when eating out are usually high in energy content, which contributes to excessive energy intake; however, the available data on out-of-home eating and obesity are far from conclusive. This systematic review assesses the association between out-of-home eating and body weight in adults over 18 years of age. The literature databases searched included Medline, Embase, Lilacs, The Cochrane Library, and the ISI Web of Knowledge. The review includes a comprehensive quality assessment of all included observational studies, 20 cross-sectional studies, and 8 prospective cohort studies. All but one of the prospective cohort studies and about half of the cross-sectional analyses found a positive association between out-of-home eating and body weight. However, many methodological differences among the studies were found, such as the definition of out-of-home eating and its assessment, which limits comparisons. The results of the present analysis suggest that in future studies fast-food restaurants and other out-of-home dining venues should be analyzed separately, assessments based on a single 24-h recall should be avoided, and controls for at-home choices (which were not included in any of the studies reviewed) are necessary to evaluate this association., (© 2012 International Life Sciences Institute.)

PURPOSE. Assessing food environments often requires using commercially available data. Disparate methods used for classifying food outlets in these databases call for creating a classification approach using common definitions. A systematic strategy for reclassifying food stores and restaurants, as they appear in commercial databases, into categories that differentiate the availability of healthy options is described here. DESIGN AND SETTING. Commercially available data on food outlets including names, addresses, North American Industry Classification System codes, and associated characteristics was obtained for five New Jersey communities. ANALYSIS. A reclassification methodology was developed using criteria and definitions from the literature to categorize food outlets based on availability of healthy options. Information in the database was supplemented by systematic Internet and key word searches, and from phone calls to food outlets. RESULTS. The methodology resulted in 622 supermarket/grocery stores, 183 convenience stores, and 148 specialty stores in the original data to be reclassified into 58 supermarkets, 30 grocery stores, 692 convenience stores, and 115 specialty stores. Outlets from the original list of 1485 full-service restaurants and 506 limited-service restaurants were reclassified as 563 full-service restaurants and 1247 limited-service restaurants. Reclassification resulted in less than one-seventh the number of supermarkets and grocery stores, more than three times the number of convenience stores, and twice as many limited-service restaurants-a much less healthy profile than the one generated by using exclusively the commercial databases. CONCLUSION. An explicit and replicable strategy is proposed for reclassifying food outlets in commercial databases into categories that differentiate on the basis of healthy food availability. The intent is to contribute towards building a consensus among researchers on definitions used in public health research for characterizing different types of food outlets.

Background: Young adults report frequent away-from-home eating; however, little is known regarding what types of restaurants are patronized or whether associations with dietary intake and weight status differ according to restaurant type., Objective: This cross-sectional study in a diverse sample of young adults examines sociodemographic differences in the frequency of eating at different types of fast-food and full-service (server brings food to table) restaurants. In addition, this study examines whether associations between away-from-home eating, dietary intake, and weight status differ according to restaurant type., Design: There were 1,030 men and 1,257 women (mean age=25.3 years) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). Participants were members of a longitudinal cohort who completed baseline surveys at schools in Minneapolis/St Paul, MN, and completed the EAT-III surveys online or by mail in 2008-2009., Main Outcome Measures: Height, weight, and usual dietary intake were self-reported., Statistical Analyses Performed: Regression models adjusted for sociodemographic characteristics were used to examine associations between frequency of restaurant use, dietary intake, and weight status., Results: More frequent use of fast-food restaurants that primarily served burgers and french fries was associated with higher risk for overweight/obesity; higher intake of total energy, sugar-sweetened beverages, and fat; and with lower intake of healthful foods and key nutrients. For example, those who reported burger-and-fries restaurant use on three or more occasions per week consumed nearly one additional sugar-sweetened beverage per day compared to those who reported burger-and-fries restaurant use on less than one occasion per week. More frequent use of fast-food restaurants that primarily served sandwiches/subs was related to a few markers of poorer diet quality, but unrelated to weight status. More frequent use of full-service restaurants was also unrelated to weight status and related to higher intake of vegetables., Conclusions: There may be a need for interventions to promote healthier food choices among young adults who report frequent burger-and-fries restaurant use., (Copyright © 2011 American Dietetic Association. Published by Elsevier Inc. All rights reserved.)

Reliable and valid measures of local food environments are needed to more fully understand the relationship between these environments and health and identify potential intervention points to improve access to, and the availability of, healthy foods. These measures also inform policy making, including the zoning of food outlets and food labelling/information requirements. A literature review was undertaken using health, behavioural and social sciences, nutrition and public health databases and grey literature, to determine available information on the measurement of local food environments. Included articles were those measuring aspects of food environments published from 2000 to 2010. A range of tools and methods are available to measure different components of food environments. Those focusing on community nutrition environments record the number, type and location of food outlets. The tools that focus on the consumer nutrition environment incorporate other factors, such as available food and beverage products, their price and quality, and any promotions or information to prompt consumers to make purchasing decisions. A summary and critique of these measures are provided., (Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.)

Objectives: This article examines the relationships between structural poverty (the proportion of people in a county living at < or =130% of the federal poverty level [FPL]), urban sprawl, and three types of restaurants (grouped as fast food, chain full service, and independent full service) in explaining body mass index (BMI) of individuals., Methods: Relationships were tested with two-tiered hierarchical models. Individual-level data, including the outcome variable of calculated BMI, were from the 2005, 2006, and 2007 California Behavioral Risk Factor Surveillance Survey (n = 14,205). County-level data (n = 33) were compiled from three sources. The 2000 U.S. Census provided the proportion of county residents living at < or = 130% of FPL and county demographic descriptors. The sprawl index used came from the Smart Growth America Project. Fast-food, full-service chain, and full-service independently owned restaurants as proportions of the total retail food environment were constructed from a commercially available market research database from 2004., Results: In the analysis, county-level demographic characteristics lost significance and poverty had a consistent, robust association on BMI (p < 0.001). Sprawl demonstrated an additional, complementary association to county poverty (p < 0.001). Independent restaurants had a large, negative association to BMI (p < 0.001). The coefficients for chain and fast-food restaurants were large and positive (p < or = 0.001), indicating that as the proportion of these restaurants in a county increases, so does BMI., Conclusions: This study demonstrates the important role of county poverty and urban sprawl toward understanding environmental influences on BMI. Using three categories of restaurants demonstrates different associations of full-service chain and independent restaurants, which are often combined in other research.

Objectives: To quantify the concentration of respirable particles equal to or smaller than 2.5μm (PM(2.5)) as a marker of second-hand smoke (SHS) exposure in a sample of hospitality venues in Barcelona 2 years after the Spanish smoking law came into effect., Methods: We performed a cross-sectional descriptive study from October to December 2007. The study population consisted of 40 hospitality venues in Barcelona selected by a random route sampling, with representation of the different types of smoking regulation included in the law (smoking allowed, smoking ban and venues with smoking areas). SHS levels were quantified by measuring PM(2.5) concentrations, which were measured using a laser photometer (Side Pack AM 510 Personal Aerosol Monitor). The measurements were carried out for 5 minutes outside the venue and for 30 minutes inside the venue. In addition, observational variables related to the characteristics of the venue and signs of tobacco consumption were recorded., Results: The concentration of PM(2.5) in venues where smoking was still allowed was five times higher than that in venues where smoking was banned (182μg/m(3) and 34μg/m(3), respectively) and exceeded the concentration established by the US Environmental Protection Agency (EPA) as harmful (35μg/m(3)). However, in venues where smoking was banned, the concentration was lower than the EPA standard and there were no significant differences with the outdoor PM(2.5) concentration., Conclusions: Two years after the introduction of the Spanish smoking law, SHS exposure in venues where smoking was allowed was q still very high, representing a significant health risk for hospitality workers., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Smoking bans in bars and restaurants have been shown to improve worker health and reduce hospital admissions for acute myocardial infarction. Several studies have also reported improved indoor air quality, although these studies generally used single visits before and after a ban for a convenience sample of venues., Purpose: The primary objective of this study was to provide detailed time-of-day and day-of-week secondhand smoke-exposure data for representative bars and restaurants in Minnesota., Methods: This study improved on previous approaches by using a statistically representative sample of three venue types (drinking places, limited-service restaurants, and full-service restaurants), conducting repeat visits to the same venue prior to the ban, and matching the day of week and time of day for the before- and after-ban monitoring. The repeat visits included laser photometer fine particulate (PM₂.₅) concentration measurements, lit cigarette counts, and customer counts for 19 drinking places, eight limited-service restaurants, and 35 full-service restaurants in the Minneapolis/St. Paul metropolitan area. The more rigorous design of this study provides improved confidence in the findings and reduces the likelihood of systematic bias., Results: The median reduction in PM₂.₅ was greater than 95% for all three venue types. Examination of data from repeated visits shows that making only one pre-ban visit to each venue would greatly increase the range of computed percentage reductions and lower the statistical power of pre-post tests. Variations in PM₂.₅ concentrations were found based on time of day and day of week when monitoring occurred., Conclusions: These comprehensive measurements confirm that smoking bans provide significant reductions in SHS constituents, protecting customers and workers from PM₂.₅ in bars and restaurants., (Copyright © 2010 American Journal of Preventive Medicine. All rights reserved.)

Background: Development of accurate and sensitive methods to characterize the food environment is needed. Thus, we examined convergent and criterion validity of 2 retail food environment data sources and then examined differences in predictive validity between 3 ways of measuring the rural and urban food environment., Methods: Ten counties were selected in each of 3 North Carolina regions (n = 30). Number of fast-food restaurants and chain supermarkets were calculated using 2 data sources. Convergent validity was percent agreement between the 2 sources. Criterion validity was percent agreement between each source and the most accurate venue count. Predictive validity of food environment measures (Retail Food Environment Index, fast-food restaurants/capita, and supermarkets/capita) was calculated by associations with county-level mean-weighted body mass index (BMI)., Results: Percent agreement for fast-food restaurants ranged from 50% to 100% (mean = 87%) and for supermarkets ranged from 58% to 100% (mean = 89%). The 2 data sources had similar percent agreement with the most accurate count. Retail Food Environment Index was positively associated with BMI, while fast-food restaurants per capita were negatively associated with BMI., Conclusions: Our results lend support to studies using both food environment data sources examined.

The aims were to: develop a food environment classification tool and to test the acceptability and validity of three secondary sources of food environment data within a defined urban area of Newcastle-Upon-Tyne, using a field validation method. A 21 point (with 77 sub-categories) classification tool was developed. The fieldwork recorded 617 establishments selling food and/or food products. The sensitivity analysis of the secondary sources against fieldwork for the Newcastle City Council data was good (83.6%), while Yell.com and the Yellow Pages were low (51.2% and 50.9%, respectively). To improve the quality of secondary data, multiple sources should be used in order to achieve a realistic picture of the foodscape., (2010 Elsevier Ltd. All rights reserved.)

Unlabelled: This study investigated the contribution of sources and establishment characteristics, on the exposure to fine particulate matter (PM(2.5)) in the non-smoking sections of bars, cafes, and restaurants in central Zurich. PM(2.5)-exposure was determined with a nephelometer. A random sample of hospitality establishments was investigated on all weekdays, from morning until midnight. Each visit lasted 30 min. Numbers of smokers and other sources, such as candles and cooking processes, were recorded, as were seats, open windows, and open doors. Ambient air pollution data were obtained from public authorities. Data were analysed using robust MM regression. Over 14 warm, sunny days, 102 establishments were measured. Average establishment PM(2.5) concentrations were 64.7 microg/m(3) (s.d. = 73.2 microg/m(3), 30-min maximum 452.2 microg/m(3)). PM(2.5) was significantly associated with the number of smokers, percentage of seats occupied by smokers, and outdoor PM. Each smoker increased PM(2.5) on average by 15 microg/m(3). No associations were found with other sources, open doors or open windows. Bars had more smoking guests and showed significantly higher concentrations than restaurants and cafes. Smokers were the most important PM(2.5)-source in hospitality establishments, while outdoor PM defined the baseline. Concentrations are expected to be even higher during colder, unpleasant times of the year., Practical Implications: Smokers and ambient air pollution are the most important sources of fine airborne particulate matter (PM(2.5)) in the non-smoking sections of bars, restaurants, and cafes. Other sources do not significantly contribute to PM(2.5)-levels, while opening doors and windows is not an efficient means of removing pollutants. First, this demonstrates the impact that even a few smokers can have in affecting particle levels. Second, it implies that creating non-smoking sections, and using natural ventilation, is not sufficient to bring PM(2.5) to levels that imply no harm for employees and non-smoking clients.

Objective: To test the moderating role of the extent of fast-food restaurants in one's immediate environment in the association between mastery and metabolic risk. Higher sense of mastery (perceived control over one's circumstances) has been associated with better metabolic outcomes. Mastery may be instrumental in resisting unhealthful environmental food cues when these become ubiquitous, resulting in a greater health impact of mastery., Methods: Blood samples were obtained from 344 individuals (50% men), aged 18 to 57 years (mean, 34.9 years), sampled from seven census tracts representing the spectrum of census tract-level socioeconomic status and language (French/English) in Montreal. Risk factors based on standards for high-density lipoprotein and total cholesterol, waist circumference, body mass index, triglycerides, and glycated hemoglobin were summed to obtain a cumulative metabolic risk score. Mastery was self-reported, using a validated scale. The proportion of restaurants classified as fast-food within 500 m of participants' residences was determined, using a geographic information system. Main and interactive effects were tested with Poisson regression, accounting for clustering of observations and participants' age, gender, education, and income., Results: Mastery interacted with fast-food exposure in relation to metabolic risk (p = .03). Higher mastery was significantly associated with lower metabolic risk for participants surrounded by a high proportion of fast food (relative risk, 0.80; 95% confidence interval, 0.76-0.84; p < .0001), but not for those living in areas with low proportion of fast-food restaurants (relative risk, 0.94; 95% confidence interval, 0.82-1.08; p = .37)., Conclusions: A positive relationship between mastery and lower metabolic risk was most apparent in environments with higher fast-food exposure.

Objectives: To describe the actual presence of smoking in restaurant and hospitality premises after the smoking prevention act banning smoking in workplaces came into force in 2006, with wide exemptions in this sector., Methods: We performed an observational, descriptive study in Barcelona (Catalonia, Spain) in 2008 based on cluster sampling, with 1130 premises. The results were stratified by premise type., Results: Up to 85.7% of food shops allowing consumption within their premises (bakeries, pastry shops...) ban smoking, as well as 85% of fast food establishments. Among restaurants, 40% are smoke-free or have separate smoking areas. Bar-cafés and café-restaurants (the most abundant premises) usually allow smoking. There are more smoke-free options in central districts and in shopping malls., Conclusions: Up to 75.4% of all premises allow smoking freely. These results show the limitations of the law., (Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Outside of the United States, evidence for associations between exposure to fast-food establishments and risk for obesity among adults is limited and equivocal. The purposes of this study were to investigate whether the relative availability of different types of food retailers around people's homes was associated with obesity among adults in Edmonton, Canada, and if this association varied as a function of distance between food locations and people's homes., Methods: Data from a population health survey of 2900 adults (18 years or older) conducted in 2002 was linked with geographic measures of access to food retailers. Based upon a ratio of the number of fast-food restaurants and convenience stores to supermarkets and specialty food stores, a Retail Food Environment Index (RFEI) was calculated for 800 m and 1600 m buffers around people's homes. In a series of logistic regressions, associations between the RFEI and the level of obesity among adults were examined., Results: The median RFEI for adults in Edmonton was 4.00 within an 800 m buffer around their residence and 6.46 within a 1600 m buffer around their residence. Approximately 14% of the respondents were classified as being obese. The odds of a resident being obese were significantly lower (OR = 0.75, 95%CI 0.59 - 0.95) if they lived in an area with the lowest RFEI (below 3.0) in comparison to the highest RFEI (5.0 and above). These associations existed regardless of the covariates included in the model. No significant associations were observed between RFEI within a 1600 m buffer of the home and obesity., Conclusion: The lower the ratio of fast-food restaurants and convenience stores to grocery stores and produce vendors near people's homes, the lower the odds of being obese. Thus the proximity of the obesogenic environment to individuals appears to be an important factor in their risk for obesity.

Purpose: Examine variation in obesity among older adults relative to the joint influences of density of neighborhood fast food outlets and residents' behavioral, psychosocial, and sociodemographic characteristics., Design: Cross-sectional and multilevel design., Setting: Census block groups, used as a proxy for neighborhoods, within the metropolitan region's Urban Growth Boundary in Portland, Oregon., Subjects: A total of 1221 residents (mean age, 65 years) recruited randomly from 120 neighborhoods (48% response rate)., Measures: A geographic information system-based measure of fast food restaurant density across 120 neighborhoods was created. Residents within the sampled neighborhoods were assessed with respect to their body mass indices (BMI), frequency of visits to local fast food restaurants, fried food consumption, levels of physical activity, self-efficacy of eating fruits and vegetables, household income, and race/ethnicity., Analyses: Multilevel logistic regression analyses., Results: Significant associations were found between resident-level individual characteristics and the likelihood of being obese (BMI > or = 30) for neighborhoods with a high-density of fast food restaurants in comparison with those with a low density: odds ratios for obesity, 95% confidence intervals (CI), were 1.878 (CI, 1.006-3.496) for weekly visits to local fast food restaurants; 1.792 (CI, 1.006-3.190) for not meeting physical activity recommendations; 1.212 (CI, 1.057-1.391) for low confidence in eating healthy food; and 8.057 (CI, 1.705-38.086) for non-Hispanic black residents., Conclusion: Increased density of neighborhood fast food outlets was associated with unhealthy lifestyles, poorer psychosocial profiles, and increased risk of obesity among older adults.

Background: Food prepared away from home has become increasingly popular to U.S. families, and may contribute to obesity. Sales have been dominated by fast food outlets, where meals are purchased for dining away from home or in the home. Although national chain affiliated fast-food outlets are considered the main source for fast food, fast foods are increasingly available in convenience stores and supermarkets/grocery stores. In rural areas, these nontraditional fast-food outlets may provide most of the opportunities for procurement of fast foods., Methods: Using all traditional and nontraditional fast-food outlets identified in six counties in rural Texas, the type and number of regular and healthier menu options were surveyed using on-site observation in all food venues that were primarily fast food, supermarket/grocery store, and convenience store and compared with 2005 Dietary Guidelines., Results: Traditional fast-food outlets represented 84 (41%) of the 205 opportunities for procurement of fast food; 109 (53.2%) were convenience stores and 12 (5.8%) supermarkets/grocery stores. Although a similar variety of regular breakfast and lunch/dinner entrées were available in traditional fast-food outlets and convenience stores, the variety of healthier breakfast and lunch/dinner entrées was significantly greater in fast food outlets. Compared with convenience stores, supermarkets/grocery stores provided a greater variety of regular and healthier entrées and lunch/dinner side dishes., Conclusion: Convenience stores and supermarkets/grocery stores more than double the potential access to fast foods in this rural area than traditional fast-food outlets alone; however, traditional fast food outlets offer greater opportunity for healthier fast food options than convenience stores. A complete picture of fast food environment and the availability of healthier fast food options are essential to understand environmental influences on diet and health outcomes, and identify potential targets for intervention.

Purpose: To explore the relationship between the placement of fast-food outlets and neighborhood-level socioeconomic variables by determining if indicators of lower socioeconomic status were predictive of exposure to fast food., Design: A descriptive analysis of the fast-food environment in a Canadian urban center, using secondary analysis of census data and Geographic Information Systems technology., Setting: Edmonton, Alberta, Canada., Measures: Neighborhoods were classified as High, Medium, or Low Access based on the number of fast-food opportunities available to them. Neighborhood-level socioeconomic data (income, education, employment, immigration status, and housing tenure) from the 2001 Statistics Canada federal census were obtained., Analysis: A discriminant function analysis was used to determine if any association existed between neighborhood demographic characteristics and accessibility of fast-food outlets., Results: Significant differences were found between the three levels of fast-food accessibility across the socioeconomic variables, with successively greater percentages of unemployment, low income, and renters in neighborhoods with increasingly greater access to fast-food restaurants. A high score on several of these variables was predictive of greater access to fast-food restaurants., Conclusion: Although a causal inference is not possible, these results suggest that the distribution of fast-food outlets relative to neighborhood-level socioeconomic status requires further attention in the process of explaining the increased rates of obesity observed in relatively deprived populations.

Background: Empiric studies find that contextual factors affect individual weight status over and above individual socioeconomic characteristics. Given increasing levels of obesity, researchers are examining how the food environment contributes to unhealthy weight status. An important change to this environment is the increasing availability of away-from-home eating establishments such as restaurants., Methods: This study analyzed the relationship between the restaurant environment and weight status across counties in the United States. Individual data from the 2002-2006 Behavioral Risk Factor Surveillance System (N=714,054) were linked with restaurant data from the 2002 U.S. Economic Census. Fast-food and full-service restaurant density, along with restaurant mix (the ratio of fast-food to full-service restaurants), were assessed., Results: Fast-food restaurant density and a higher ratio of fast-food to full-service restaurants were associated with higher individual-level weight status (BMI and the risk of being obese). In contrast, a higher density of full-service restaurants was associated with lower weight status., Conclusions: Area-level restaurant mix emerged as an important correlate of weight status, with components of the restaurant environment exhibiting differential associations. Hence, it is the availability of fast-food relative to other away-from-home choices that appears salient for unhealthy weight outcomes. Areas with a high density of full-service restaurants were indicative of a more healthful eating environment, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. Future prospective studies are required to delineate causal pathways.

Background: Parallel to the rising obesity epidemic, food consumption patterns and household expenditures show a marked upward trend in total energy intake derived from away-from-home sources., Methods: This study conducted cross-sectional multivariate analyses to examine associations between local-area racial, ethnic, and income characteristics and the availability of full-service and fast-food restaurants. Based on a U.S. national census of 28,050 ZIP codes that cover a population of 280,675,874 people, restaurant outlet data were linked to 2000 Census Bureau data based on ZIP code tabulation areas and analyses were undertaken using negative binomial count models and ordinary least squares regression analyses., Results: Study results showed that higher- versus lower-income, predominantly black and racially mixed versus predominantly white and Hispanic versus non-Hispanic neighborhoods had fewer available full-service and fast-food restaurants. Near-low- and middle-income neighborhoods had the highest number of available restaurants with 1.24 and 1.22 times number of full-service restaurants and 1.34 and 1.28 times the number of fast-food restaurants compared to high-income neighborhoods. Predominantly black neighborhoods were found to have 58.2% and 59.3% of the number of full-service and fast-food restaurants available in predominantly white neighborhoods. No statistically significant differences were found in the relative availability of fast-food versus full-service restaurants by income, race, or ethnicity in the national sample used. However, across urban areas, near-low-, middle-, and near-high- versus high-income neighborhoods and predominantly black versus white neighborhoods were found to have moderately higher proportions of fast-food among total restaurants., Conclusions: In urban areas, higher proportions of available fast-food restaurants out of total restaurants in predominantly black versus predominantly white neighborhoods may contribute to racial differences in obesity rates.

Purpose: The rapid increase in obesity over the past two decades suggests that behavioral and environmental influences, including poor nutrition and physical inactivity, are fueling what is now widely recognized as a public health crisis. Yet, limited research has been conducted to examine how environmental factors, such as neighborhood-level characteristics, may be associated with increased risk for obesity., Methods: Community-level risk associated with childhood obesity was examined in East Los Angeles, a community with one of the highest rates of childhood obesity in Los Angeles by triangulating: 1) spatial data for the number and location of food establishments relative to the location of schools; 2) observations regarding the availability and quality of fruits and vegetables in local grocery stores; and 3) observations regarding the quality and utilization of local parks., Results: The findings revealed that there were 190 food outlets in the study community, of which 93 (49%) were fast-food restaurants. Of the fast-food restaurants, 63% were within walking distance of a school. In contrast, there were 62 grocery stores, of which only 18% sold fresh fruits and/or vegetables of good quality. Of the stores that did sell fruits and/or vegetables, only four were within walking distance of a school. Although well maintained, the five parks in this community accounted for only 37.28 acres, or 0.543 acres per 1000 residents., Conclusions: These findings suggest that children have easy access to fast food, and limited access to both healthy food options and parks in which to engage in physical fitness activities. This was particularly true in areas around schools. The implications for these findings with regards to policy-related prevention and future research are discussed.

Objective: Childhood and adolescent obesity is an increasing public health problem. Fast food consumption has been linked to obesity. The purpose of this study is to determine adolescent calorie and fat consumption patterns at different types of restaurants., Method: Study subjects (104 adolescents) were asked to order a dinner meal from 10 restaurant menus with an estimate of how much they would actually consume. A paired T-test was used to compare the calories and fat values for each restaurant vs. McDonald's., Results: Mean calories/fat (g) ordered at each restaurant were: California Pizza Kitchen (CPK).: 1284/70, Chili's (Ch). 1333/62, Denny's (Den): 1226/61, McDonald's (MD): 1016/45, Outback Steakhouse (OS): 1656/93, Panda Express (PE): 873/29, Red Lobster (RL): 1016/49, Stuart Anderson's (SA). 1058/52, Taco Bell (TB): 800/34, Wendy's (Wen): 879/32. Calorie/fat content of the ordered items were significantly higher at CPK, Ch, Den, and OS compared to McDonald's. RL and SA were not significantly different from MD. Calorie/fat content of the ordered items were significantly lower at PE, TB and Wen compared with McDonald's., Conclusion: More calories/fat were ordered at many sit down restaurants compared to McDonald's. The lowest calories/fat were ordered at other fast food restaurants (Taco Bell, Wendy's and Panda Express).

Background: Although obesity and poor dietary habits are complex multifactorial problems, away-from-home food has been identified as one likely and important contributor. Restaurants provide a growing and substantial portion of the average American's diet, yet the Nutrition Labeling and Education Act (NLEA), which went into effect in 1994, explicitly exempts restaurants from most labeling requirements. Thus, this study examined the availability of nutrition information from the largest chain restaurants in the United States., Methods: Between January and August 2004, we surveyed the 300 largest chain restaurants by telephone, e-mail, or examining company websites (response rate was 96%). The top chains, as ranked by revenue, were selected based on 2002 ratings in Restaurants and Institutions., Results: Fifty-four percent of the 287 largest chain restaurants made some nutrition information available. Forty-four percent had nutrition information for the majority of their standard menu items. We found no significant differences in the availability of nutrition information based on the size of the restaurant chain. Of those restaurants with nutrition information, 86% provided information on the company website., Conclusions: The number of restaurants providing nutrition information has increased over the last 10 years. However, making informed and healthful food choices is hampered by the absence of nutrition information at many restaurants. Given the growing and significant role that away-from-home foods play in Americans' diets, the Surgeon General and the National Academies' Institute of Medicine recommend that nutrition information be available to customers at restaurants, and state legislatures and the U.S. Congress are beginning to address the issue.

Background: The UK government proposed introducing partial smokefree legislation for England with exemptions for pubs and bars that do not prepare and serve food. We set out to test the hypothesis that pubs from more deprived areas and non food-serving pubs have higher levels of particulate air pollution., Methods: We conducted a cross sectional study in four mainly urban areas of the North West of England. We recruited a stratified random sample of 64 pubs divided into four groups based on whether their local population was affluent or deprived (using a UK area based deprivation measure), and whether or not they served food. The timing of air quality monitoring stratified to ensure similar distribution of monitoring by day of the week and time of evening between groups. We used a portable air quality monitor to collect fine particle (PM2.5) levels over a minimum of 30 minutes in areas where smoking was allowed,, and calculated mean time-time weighted average PM2.5 levels., Results: Mean PM2.5 was 285.5 microg/m3 (95% CI 212.7 to 358.3). Mean levels in the four groups were: affluent food-serving pubs (n = 16) 188.1 microg/m3 (95%CI 128.1 to 248.1); affluent non food-serving (n = 16) 186.8 microg/m3 (95%CI 118.9 to 254.3); deprived food-serving (n = 17) 399.4 microg/m3 (95%CI 177.7 to 621.2); and deprived non food-serving (n = 15) 365.7 microg/m3 (195.6 to 535.7). Levels were higher in pubs in deprived communities: mean 383.6 microg/m3 (95% CI 249.2 to 518.0) vs 187.4 microg/m3 (144.8 to 229.9); geometric mean 245.2 microg/m3 vs 151.2 microg/m3 (p = 0.03). There was little difference in particulate levels between food and non food-serving pubs., Conclusion: This study adds to the evidence that the UK government's proposals for partial smokefree legislation in England would offer the least protection to the most heavily exposed group--bar workers and customers in non food-serving pubs in deprived areas. The results suggest these proposals would work against the UK government's stated aim to reduce health inequalities.

Objectives: We examined the concentration of fast food restaurants in areas proximal to schools to characterize school neighborhood food environments., Methods: We used geocoded databases of restaurant and school addresses to examine locational patterns of fast-food restaurants and kindergartens and primary and secondary schools in Chicago. We used the bivariate K function statistical method to quantify the degree of clustering (spatial dependence) of fast-food restaurants around school locations., Results: The median distance from any school in Chicago to the nearest fast-food restaurant was 0.52 km, a distance that an adult can walk in little more than 5 minutes, and 78% of schools had at least 1 fast-food restaurant within 800 m. Fast-food restaurants were statistically significantly clustered in areas within a short walking distance from schools, with an estimated 3 to 4 times as many fast-food restaurants within 1.5 km from schools than would be expected if the restaurants were distributed throughout the city in a way unrelated to school locations., Conclusions: Fast-food restaurants are concentrated within a short walking distance from schools, exposing children to poor-quality food environments in their school neighborhoods.

This paper describes a case study of a neighborhood pub in British Columbia, Canada. This case study is an examination of three common pub occupations-bartending, waitressing and cooking (n = 17). The aims of this study are to determine the biomechanical loads of job tasks identified as physically demanding for the three occupations analyzed, to assess the potential risk of musculoskeletal injury in these job tasks, and to recommend injury prevention measures. Risk of musculoskeletal injury was assessed with four validated methods (RULA, NIOSH lifting equation, Shoaf pulling model, 3D Static Strength prediction program). Tasks commonly and frequently performed were observed to pose some risk to the working populations and require investigation and changes soon as indicated by the upper extremity and low-back assessment procedures used. Mean combined compression at the lumbrosacral disc in common tasks have been demonstrated to exceed the action limit described by NIOSH. Ligament strain was observed to reach as high as 18% at the lumbosacral joint.

Background: The UK government claims that between 10 and 30% of pubs and bars will be exempt from proposed legislation to achieve smokefree enclosed public places across England. This arises from the contentious inclusion that pubs and bars that do not prepare and serve food and private members clubs, will be able to allow smoking. We aimed to survey pubs and bars across the North West of England to assess smoking policies and the proportion and variations by deprivation level of venues preparing and serving food., Methods: We carried out a telephone survey of 1150 pubs and bars in 14 local authorities across the North West of England. The main data items were current smoking policy, food preparation and serving status, and intention to change food serving and smoking status in the event of implementation of the proposed English partial smokefree legislation., Results: 29 pubs and bars (2.5%) were totally smoke-free, 500 (44%) had partial smoking restrictions, and 615 (54%) allowed smoking throughout. Venues situated in the most deprived quintiles (4 and 5) of deprivation were more likely to allow unrestricted smoking (62% vs 33% for venues in quintiles 1 and 2). The proportion of pubs and bars not preparing and serving food on the premises was 44% (95% CI 42 to 46%), and ranged from 21% in pubs and bars in deprivation quintile 1 to 63% in quintile 5., Conclusion: The proportion of pubs and bars which do not serve food was far higher than the 10-30% suggested by the UK government. The proportion of pubs allowing unrestricted smoking and of non-food venues was higher in more disadvantaged areas, suggesting that the proposed UK government policy of exempting pubs in England which do not serve food from smokefree legislation will exacerbate inequalities in smoking and health.