Public Health Nutrition最新文献

Objective: The Supplemental Nutrition Assistance Program (SNAP) Online Purchasing Pilot (OPP) authorised the use of SNAP benefits online in Maryland in May 2020. We assessed shopping behaviour and intentions associated with uptake and intended future use of online grocery shopping during and after COVID-19 among SNAP-eligible households.

Design: In this mixed-methods study, participants completed a survey on online grocery shopping, and a purposefully sampled subset participated in focus groups or in-depth interviews between November 2020 and March 2021.

Setting: Predominantly urban households in Maryland.

Participants: Primary shoppers of SNAP-eligible households with young children (n 310).

Results: Most participants reported first shopping for groceries online after the OPP was implemented (57 %). Families who purchased groceries in-store less frequently were less likely to report ever buying groceries online (rate ratio (RR): 0·66, 95 % CI 0·46, 0·93) compared with weekly grocery shoppers. Shoppers who intended to purchase more groceries online in the next 6 months were more likely to have online shopping experience, although this differed by timing of online grocery service adoption. Participants reported more negative attitudes towards in-store grocery shopping during the pandemic than prior to its onset and cited COVID-19 as a motivator for ordering groceries online in focus groups. Most participants who had shopped online planned to continue after the pandemic (79 %).

Conclusions: Most participants who shopped online started during the COVID-19 pandemic and considered the pandemic a key motivator. Findings suggest that low-income households will continue to shop online, affirming the need for policies that promote equitable access to healthy food online.

Objective: To investigate the relationship between maternal age and nutritional status, and test associations between maternal nutritional status and child mortality with a focus on maternal obesity.

Design: Secondary analysis of data from nationally representative cross-sectional sample of women of reproductive ages (15-49 years) and their children under 5 years. The outcome variable for maternal nutritional status was BMI, classified into underweight (BMI < 18·50 kg/m²), normal weight (18·50-24·99 kg/m²), overweight (25·0-29·9 kg/m²) and obesity (>=30·0 kg/m²). Child mortality was captured with five binary variables measuring the risk of dying in specific age intervals (neonatal, post-neonatal, infant, childhood and under-five mortality).

Setting: The most recent Demographic and Health Surveys from Democratic Republic of Congo (DRC).

Participants: The final samples consisted of 7892 women of reproductive ages (15-49 years) and 19 003 children aged 0-59 months.

Results: The prevalence of obesity was estimated at 3·4 %; it increased with maternal age. Furthermore, obesity unevenly affected provinces in the Democratic Republic of the Congo: Kinshasa, South Kivu, North Kivu and Maniema were most affected. Finally, maternal obesity showed mixed effects on child mortality.

Conclusion: The prevalence of obesity is still low; however, provinces are unevenly affected. Therefore, interventions and programmes to improve nutrition should incorporate geographical disparities to tackle adverse child outcomes associated with maternal obesity, to limit negative consequences of maternal obesity, including non-communicable diseases which might be a strong impediment to reach Sustainable Development Goals (SDG) 2 and 3.

Objective: To examine the proportion of products offered by leading food brands in Canada that are 'unhealthy' according to Health Canada's (HC) nutrient profile model for proposed restrictions on food marketing to children (M2K-NPM).

Design: Nutritional information for products offered by top brands was sourced from the University of Toronto FLIP and Menu-FLIP 2020 databases, respectively. HC's M2K-NPM, which includes thresholds for Na, total sugars and saturated fat, was applied to products.

Setting: Canada.

Participants: Overall, 1385 products from top breakfast cereal (n 15 brands, n 222 products), beverage (n 21 brands, n 769 products) and yogurt (n 10 brands, n 394 products) brands, and 3153 menu items from seventeen chain restaurants in Canada were assessed (n 60 unique brands overall).

Results: For 42 % of brands (n 21), 100 % of their products exceeded ≥1 nutrient threshold(s), with ≥50 % of the products offered by twenty-three brands (46 %) exceeding two thresholds. Specifically, one or more nutrient thresholds were exceeded by ≥50 % of the products offered by 14/15 breakfast cereal brands, 18/21 beverage brands, all ten yogurt brands and all seventeen restaurant brands. Notably, 100·0 % of the products offered by ten breakfast cereal, six beverage, two yogurt and three restaurant brands exceeded ≥1 threshold(s).

Conclusions: Most products offered by top food brands in Canada exceeded HC's M2K-NPM thresholds. Nonetheless, these brands could still be marketed under the proposed regulations, which exclude brand marketing (i.e. promotions without an identifiable product) despite its contribution to marketing power. These findings reinforce the need for Canada and other countries to include brand marketing in M2K policies.

Objective: The public health nutrition workforce is well placed to contribute to bold climate action; however, tertiary educators are seeking practical examples of how to adequately prepare our future workforce. This study examines the responses of university students engaged in a co-designed planetary health education workshop as part of their public health nutrition training.

Design: A mixed-methods approach was used to collect and interpret student responses to four interactive tasks facilitated during an in-person workshop. Data were analysed using statistical tests, frequency counting and content analysis.

Setting: The intervention was co-designed by students (n 5) and an educator over a 4-week period as part of a larger multi-disciplinary study at an Australian university.

Participants: The workshop engaged nutrition and dietetics students (n 44) enrolled in public health nutrition coursework.

Results: Students reported an increase in self-perceived knowledge about planetary health as a concept and how they can promote it within their future professional roles. Students' descriptions of what planetary health means to them were focused on humans' role in protecting and preserving the ecosystem, the responsible and sustainable use of natural resources and a need to sustain a healthy life for future generations. Students prioritised the values of 'collaboration' and 'respect' as being critical to guide personal and professional practice to promote planetary health.

Conclusions: This study demonstrated that incorporating planetary health curricula designed by, and for, university students could be a feasible and effective way to prepare the future public health nutrition workforce to address planetary health challenges.

Objective: The Baby-Friendly Hospital Initiative (BFHI) designation is known to increase breast-feeding rates in the USA. However, less is known about barriers and facilitators to breast-feeding support practices in BFHI hospitals and how they differ from non-BFHI hospitals. We examined what barriers and facilitators are perceived to affect breast-feeding practices among BFHI and non-BFHI hospital administrators and further explored factors that presented challenges to the adoption and continuation of breast-feeding support practices.

Design: Cross-sectional study was conducted. We measured whether hospitals were implementing 12 breast-feeding support practices and identified barriers and facilitators to the practices. The survey questionnaire included both structured and open-ended questions.

Setting: This study included hospital administrators from both BFHI and non-BFHI hospitals from all regions of the USA to help elucidate potential differences.

Participants: A stratified random sample of 50 % of BFHI and 50 % of non-BFHI hospitals was obtained. The final sample size included 113 BFHI and 177 non-BFHI hospital administrators.

Results: Low interest among mothers was reported as the most significant barrier to providing breast-feeding support among all administrators. Non-BFHI hospital administrators were more likely to report cost, nursing staff and physician resistance and hospital infrastructure as barriers to initiating practices. In-person training was cited as the most important facilitator among both groups.

Conclusions: Strengthening prenatal education for mothers and trainings for administrative and nursing staff and physicians is warranted in BFHI and non-BFHI hospitals. Staff management and hospital infrastructure need to be improved particularly in non-BFHI hospitals to provide adequate breast-feeding support for mothers.

Objective: The creation of a healthy food environment is highly dependent on the policies that governments choose to implement. The objective of this study is to compare the level of implementation of current public policies aimed at creating healthy food environments in Burkina Faso with international good practice indicators.

Design: This evaluation was carried out using the Food-EPI tool. The tool has two components (policy and infrastructure support), thirteen domains and fifty-six good practice indicators adapted to the Burkina Faso context.

Setting: Burkina Faso.

Participants: Expert evaluators divided into two groups: the group of independent experts from universities, NGO and civil society and the group of experts from various government sectors.

Results: Among the fifty-six indicators, it was assessed the level of implementation as 'high' for six indicators, 'medium' for twenty-four indicators, 'low' for twenty-two indicators and 'very low' for four indicators. High implementation level indicators include strong and visible political support, targets on exclusive breastfeeding and complementary feeding, strong and visible political support for actions to combat all forms of malnutrition, monitoring of exclusive breastfeeding and complementary feeding indicators, monitoring of promotion and growth surveillance programmes and coordination mechanism (national, state and local government). The indicators on menu labelling, reducing taxes on healthy foods, increasing taxes on unhealthy foods and dietary guidelines are the indicators with a 'very low' level of implementation in Burkina Faso.

Conclusions: The general results showed that there is a clear need for further improvements in policy and infrastructure support to promote healthy food environments.

Objective: The adoption of policies promoting healthier restaurant food environments is contingent on their acceptability. Limited evidence exists regarding individual characteristics associated with restaurant food environment policy acceptability, especially health-related characteristics. This study examined associations between health characteristics and restaurant food environment policy acceptability among urban Canadians.

Design: Links between health characteristics and complete agreement levels with selected policies were examined using data in the cross-sectional Targeting Healthy Eating and Physical Activity survey study, that is, a large pan-Canadian study on policy acceptability. For each policy, several logistic multilevel regression analyses were conducted.

Setting: Canada's seventeen most populated census metropolitan areas.

Participants: Urban Canadian adults responded to the survey (n 27 162).

Results: Body mass index was not associated with acceptability after adjustments for other health and sociodemographic characteristics were made. Across all policies and analyses, those reporting excellent or very good health statuses were more likely to be in complete agreement with targeted policies than those with good health statuses. For selected policies and analyses, those reporting poor health statuses were also more likely to be in complete agreement than those describing their health status as good. For all policies and analyses, both those consuming restaurant-prepared foods daily and those never consuming these foods were more likely to be in complete agreement than those consuming these foods once per week.

Conclusions: More research is needed to explain discrepancies in acceptability according to health characteristics. Bringing this study's findings to the attention of policymakers may help build momentum for policy enactment.

Objective: To identify patterns of food taxes acceptability among French adults and to investigate population characteristics associated with them.

Design: Cross-sectional data from the NutriNet-Santé e-cohort. Participants completed an ad hoc web-based questionnaire to test patterns of hypothetical food taxes acceptability (i.e. overall perception combined with reasons for supporting or not) on eight food types: fatty foods, salty foods, sugary foods, fatty and salty foods, fatty and sugary products, meat products, foods/beverages with unfavourable front-of-pack nutrition label and 'ultra-processed foods'. Sociodemographic and anthropometric characteristics and dietary intakes (24-h records) were self-reported. Latent class analysis was used to identify patterns of food taxes acceptability.

Setting: NutriNet-Santé prospective cohort study.

Participants: Adults (n 27 900) engaged in the French NutriNet-Santé e-cohort.

Results: The percentage of participants in favour of taxes ranged from 11·5 % for fatty products to 78·0 % for ultra-processed foods. Identified patterns were (1) 'Support all food taxes' (16·9 %), (2) 'Support all but meat and fatty products taxes' (28·9 %), (3) 'Against all but UPF, Nutri-Score and salty products taxes' (26·5 %), (4) 'Against all food taxes' (8·6 %) and (5) 'No opinion' (19·1 %). Pattern 4 had higher proportions of participants with low socio-economic status, BMI above 30 kg/m² and who had consumption of foods targeted by the tax above the median.

Conclusions: Results provide strategic information for policymakers responsible for designing food taxes and may help identify determinants of support for or opposition to food taxes in relation to individual or social characteristics or products taxed.

Objective: In response to increasing hypertension rates, South Africa implemented a regulation which set a maximum total sodium content for certain packaged food categories. We assess changes in reported sodium intake among 18-39 year old adults living in one township in the Western Cape as a result of the implementation of the regulation in 2016.

Design: By linking one set of 24 hour dietary recall data to two versions of the South Africa Food Composition Database which reflect the pre-regulation and post-regulation periods, we calculated changes in sodium intake due to reformulation of food products, not behavior change. We statistically tested differences in mean consumption in this sample with paired t-tests.

Setting: Langa, Western Cape, South Africa.

Participants: Surveyed participants were residents of Langa between 18-39 years old (n=2,148).

Results: Before and after the implementation of the regulation there was a statistically significant decrease in the estimated sodium intake among adults of 189.4 mg (137.5, 241.4; p=0.00). Reported sodium from cured meat (such as Russians) and certain types of soup powder, cereals, and salted peanuts had a 9 to 33 percent lower calculated sodium consumption.

Conclusions: Our conclusions show that independent of any behavioral changes on the part of consumers, it is possible to lower sodium intake by using regulations to induce food manufacturers to lower the sodium levels in their products. As countries explore similar regulatory strategies, this work can add to that body of evidence to inform policies to improve the food system.