Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profi... more Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profiling model (NPM) to the food supply in South Africa (SA) and compare its performance against existing NPM as an indication of suitability for use to underpin food policies targeted at discouraging consumption of products high in nutrients associated with poor health.Design:Cross-sectional analysis of the SA-packaged food supply comparing the CAM to three other NPM: SA Health and Nutrition Claims (SA HNC), Chilean Warning Octagon (CWO) 2019, and Pan-American Health Organisation (PAHO) NPM.Setting:The SA-packaged food supply based on products stocked by supermarkets in Cape Town, SA.Participants:Packaged foods and beverages (n 6474) available in 2018 were analysed.Results:Forty-nine per cent of products contained excessive amounts of nutrients of concern (considered non-compliant) according to the criteria of all four models. Only 10·9 % of products were not excessive in any nutrients of c...
China is facing a growing overweight problem in its adult population. This is a worrisome trend g... more China is facing a growing overweight problem in its adult population. This is a worrisome trend given its population size and the potential health care costs associated with nutrition-related non-communicable diseases. This trend has occurred together with changes in China's economic, social and physical environment. Hence, it is important to consider these factors in trying to understand what determined the changes in diet and physical activity, and thus the increases in weight. This dissertation first looks at how various dimensions of urbanization are associated with declines in physical activity. Second, it addresses how price and income changes might have contributed to dietary changes over time. Third, I apply a dynamic panel model to determine the degree to which physical activity and dietary choices affect weight change over time. I found that physical activity declines are strongly associated with greater availability of higher educational institutions, housing infrastr...
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened bever... more Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, polit...
Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling s... more Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of ( a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and ( b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improvepopulation health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and ...
Objectives COVID-19 has created a new normal, affecting food purchasing behaviors, moving a porti... more Objectives COVID-19 has created a new normal, affecting food purchasing behaviors, moving a portion of them online. It is unknown how these behavioral shifts may differ by sociodemographic characteristics and whether shifts may widen or diminish existing diet-related disparities. To fill these gaps, we use nationally-representative Consumer Panel survey data to examine shifts in online grocery shopping by sociodemographic characteristics. Methods The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen Homescan panel participants in March-April 2020 (n = 17,262 households (HH)). We describe survey-weighted HH sociodemographic characteristics and reasons for online shopping. Survey weighted-multivariable logistic regression was used to examine sociodemographic correlates of reported increases in online food shopping. Results One third (34%) of our survey-weighted sample said they shopped for groceries online more since COVID-19, and 60% of these HH reporte...
Policies that require front-of-package (FoP) nutrient warnings are becoming increasingly common a... more Policies that require front-of-package (FoP) nutrient warnings are becoming increasingly common across the globe as a strategy to discourage excess consumption of sugary drinks and ultra-processed food. However, a better understanding of the pathway through which FoP nutrient warnings work, as well as a review of how outcomes being measured in recent studies map onto this pathway, are needed in order to inform policy on the most effective FoP label design for reducing purchases of ultra-processed foods. This scoping review describes a conceptual model for how FoP nutrient warnings affect consumer behavior, examines which of these outcomes are currently being measured, and summarizes evidence from randomized controlled experiments. Twenty-two studies which experimentally tested nutrient warnings against a control label or other labeling systems were included for full-text review. Our conceptual model includes attention; comprehension, cognitive elaboration, and message acceptance; ne...
There are limited studies examining water consumption among individuals in hot climates. We asses... more There are limited studies examining water consumption among individuals in hot climates. We assessed the daily total water intake from plain water, other beverages, and food in a nationally representative sample of children and adolescents aged 6–18 years in the United Arab Emirates. Total water intake was compared against the recommendations of the Institute of Medicine and the European Food Safety Authority. Sociodemographic information, 24 h dietary recall, physical activity levels, and anthropometric data were collected from 527 participants. The mean ± SE of total water intake was 1778.4 ± 33.8 mL/day. Plain drinking water was the largest contributor to total water intake (51.6%), followed by food (27.3%). Sugar-sweetened beverages constituted 13.9% of water intake. The proportion of participants who met the Institute of Medicine recommendations ranged from 15% (males aged 14–18) to 25% (children aged 6–8). The proportion of participants who met the European Food Safety Authori...
Objectives(i) To determine the current state of online grocery shopping, including individuals’ m... more Objectives(i) To determine the current state of online grocery shopping, including individuals’ motivations for shopping for groceries online and types of foods purchased; and (ii) to identify the potential promise and pitfalls that online grocery shopping may offer in relation to food and beverage purchases.DesignPubMed, ABI/INFORM and Google Scholar were searched to identify published research.SettingTo be included, studies must have been published between 2007 and 2017 in English, based in the USA or Europe (including the UK), and focused on: (i) motivations for online grocery shopping; (ii) the cognitive/psychosocial domain; and (iii) the community or neighbourhood food environment domain.SubjectsOur search yielded twenty-four relevant papers.ResultsFindings indicate that online grocery shopping can be a double-edged sword. While it has the potential to increase healthy choices via reduced unhealthy impulse purchases, nutrition labelling strategies, and as a method to overcome f...
ObjectiveTo estimate changes in taxed and untaxed beverages by volume of beverage purchased after... more ObjectiveTo estimate changes in taxed and untaxed beverages by volume of beverage purchased after a sugar-sweetened beverage (SSB) tax was introduced in 2014 in Mexico.DesignWe used household purchase data from January 2012 to December 2015. We first classified the sample into four groups based on pre-tax purchases of beverages: (i) higher purchases of taxed beverages and lower purchases of untaxed beverages (HTLU-unhealthier); (ii) higher purchases of both types of beverages (HTHU); (iii) lower purchases of taxed and untaxed beverages (LTLU); and (iv) lower purchases of taxed beverages and higher purchases of untaxed beverages (LTHU-healthier). Next, we estimated differences in purchases after the tax was implemented for each group compared with a counterfactual based on pre-tax trends using a fixed-effects model.SettingAreas with more than 50 000 residents in Mexico.ParticipantsHouseholds (n 6089).ResultsThe HTLU-unhealthier and HTHU groups had the largest absolute and relative re...
Background: The US Food and Drug Administration's updated nutrition labeling requirements will in... more Background: The US Food and Drug Administration's updated nutrition labeling requirements will include added sugars starting in July 2018, but no measure currently exists to identify the added sugar content of products and what it represents among purchases. Beverages are one of the first targets for reducing added sugar consumption, and hence are the focus here. Objective: Our goal was to estimate trends in added sugars in nonalcoholic packaged beverage products available in the United States and to estimate amounts of added sugars obtained from these beverages given the purchases of US households overall and by subpopulations. Design: On the basis of nutrition label data from multiple sources, we used a stepwise approach to derive the added sugar content of 160,713 beverage products recorded as purchased by US households in 2007-2012 (345,193 observations from 110,539 unique households). We estimated the amounts of added sugars obtained from packaged beverages US households reported buying in 2007-2008, 2009-2010, and 2011-2012, overall and by subpopulations based on household composition, race/ethnicity, and income. The key outcomes are added sugars in terms of per capita grams per day and the percentage of calories from packaged beverages. Results: Packaged beverages alone account for per capita consumption of 12 g/d of added sugars purchased by US households in 2007-2012, representing 32-48% of calories from packaged beverages. Whereas the absolute amount of added sugars from beverages has not changed meaningfully over time, the relative contribution of added sugars to calories from beverages has increased. Non-Hispanic black households and low-income households obtain both higher absolute and relative amounts of added sugars from beverages than non-Hispanic white households and high-income households (all P , 0.01). Conclusions: These results provide measures of added sugars from packaged beverages at both the product level and the population level in the United States and can be used for comparisons after the revised nutrition labels are implemented and for future monitoring.
International Journal of Behavioral Nutrition and Physical Activity, 2016
Background: To date no work has differentiated the effects of age, period, and cohort on physical... more Background: To date no work has differentiated the effects of age, period, and cohort on physical activity (PA) among Chinese adults, while also considering biological, behavioral, economic, and environmental factors over time. Methods: We used data from the China Health and Nutrition Survey (CHNS) between 1991 and 2011 (20 years). The outcomes of interest are metabolic equivalent of task (MET) hours per week from work and domestic activities. Age, individual characteristics, household size, asset ownership, urbanization were included as covariates. Analyses for adult (≥20y) males (n = 29,343) and females (n = 31,094) was conducted to explicitly assess differences in PA due to age vs period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages. Results: The mean age of the sample rose from 41.31 to 50.8 years and PA decreased from 427.75 ± 264.35 MET hours per week (MET-hr/wk) in 1991 to 245.99 ± 206.65 MET-hr/wk in 2011, with much steeper declines for women compared to men. For both genders, we found non-linear decreases in PA with age over time. Controlling for age effects, negative period effects on PA were observed in each survey year, and were substantial from 1993 to 2000 for males and from 1993 to 2011 for females. The interaction between survey year and age (P < 0.05) were observed from 2004 to 2011. Higher community urbanicity, vehicle ownership, TV and computer ownership, overweight and obese, higher education served as negative predictors. Bicycle ownership, bigger household size, non-professional jobs, being married and having more children (for women) were positive predictors of PA (P < 0.05). Furthermore, at any given age, individuals who were younger at baseline had higher mean PA compared with individuals older at baseline. Conclusion: This study followed a large cohort of adults over a significant portion of their lives. Strong age and secular trends were observed, resulting in an increasing number of participants who have or are likely to lower their PA levels. These trends suggest that tackling the rapid PA decline among its population is of high priority for China's public health outlook as its population ages and continues to experience significant economic and environmental changes.
A large number of food policy councils (FPCs) exist in the United States, Canada, and Tribal Nati... more A large number of food policy councils (FPCs) exist in the United States, Canada, and Tribal Nations (N = 278), yet there are no tools designed to measure their members' perceptions of organizational capacity, social capital, and council effectiveness. Without such tools, it is challenging to determine best practices for FPCs and to measure change within and across councils over time. This study describes the development, testing, and findings from the Food Policy Council Self-Assessment Tool (FPC-SAT). The assessment measures council practices and council members' perceptions of the following concepts: leadership, breadth of active membership, council climate, formality of council structure, knowledge sharing, relationships, member empowerment, community context, synergy, and impacts on the food system. All 278 FPCs listed on the Food Policy Network's Online Directory were recruited to complete the FPC-SAT. Internal reliability (Cronbach's α) and inter-rater reliabi...
Understanding what influences where food outlets locate is important for mitigating disparities i... more Understanding what influences where food outlets locate is important for mitigating disparities in access to healthy food outlets. However, few studies have examined how neighborhood characteristics influence the neighborhood food environment over time, and whether these relationships differ by neighborhood-level income. Neighborhood-level data from four U.S. cities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA) from 1986, 1993, 1996, 2001, 2006, and 2011 were used with two-step econometric models to estimate longitudinal associations between neighborhood-level characteristics (z-scores) and the log-transformed count/km(2) (density) of food outlets within real estate-derived neighborhoods. Associations were examined with lagged neighborhood-level sociodemographics and lagged density of food outlets, with interaction terms for neighborhood-level income. Data were analyzed in 2016. Neighborhood-level income at earlier years was negatively associated with the current densi...
Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being ado... more Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake. Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015-29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented...
Racial/ethnic disparities in dietary quality persist among Americans, but it is unclear whether h... more Racial/ethnic disparities in dietary quality persist among Americans, but it is unclear whether highly processed foods or convenience foods contribute to these inequalities. We examined the independent associations of race/ethnicity with highly processed and ready-to-eat (RTE) food purchases among US households. We determined whether controlling for between-group differences in purchases of these products attenuated associations between race/ethnicity and the nutritional quality of purchases. The 2000-2012 Homescan Panel followed US households (n = 157,142) that scanned their consumer packaged goods (CPG) food and beverage purchases. By using repeated-measures regression models adjusted for sociodemographic characteristics, we examined time-varying associations of race/ethnicity with processed and convenience food purchases, expressed as a percentage of calories purchased. We estimated associations between race/ethnicity and saturated fat, sugar, or energy density of total purchases...
Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly bec... more Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries show that obesity among the poor is partly the result of an obesogenic built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level-2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level-1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2kg/m 2 increase in BMI for every additional convenience store and a 0.1kg/m 2 reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.
Since the late 1970s, China's role in the global economy and its exposure to other cultures, ideo... more Since the late 1970s, China's role in the global economy and its exposure to other cultures, ideologies via the media, education, business investments and technology has burgeoned at an amazing speed, especially in the urban cities. At the same time, the performance of the Chinese economy since 1978 has been unprecedented for such as vast country, growing at an annual rate of around 10% between 1980 and 1990. Economic reform in China can be categorized under rural and urban reforms. In the rural areas, the abolition of communes and the introduction of the Household Responsibility System (HRS) were two of the major changes in the rural areas. Communes were important political and economic bodies that fulfilled most local government functions (such as police, justice, education, welfare and social services), and held a monopoly on economic functions (such as assignment of production plans, allocation of procurement quotas, and control over leadership of the teams). This meant that the commune determined how incomes were allocated, as well as restrictions on the size and use of private plots, and non-agricultural production. The abolition of the communes was intended to separate the communes' governmental functions from their economic functions. This resulted in an increase in the control of the ordinary farm family over its affairs as to what and how much to produce 3. In particular, farmers had less restrictions on performing on non-agricultural activities. Meanwhile, the HRS, which lowered the state quota, increased the state procurement price and allowed greater freedom and possibility for rural households to produce and sell beyond the state quota, was almost fully in place by 1984. The reported improvement in grain production with the introduction of the HRS was remarkable. In 1977, total grain production in the villages was 35,000 kilograms, but by 1986, it reached 265,000 kilograms 4 .
How beverage taxes might influence purchases of foods and beverages among households with prescho... more How beverage taxes might influence purchases of foods and beverages among households with preschool children is unclear. Thus, we examined the relation between beverage taxes and food and beverage purchases among US households with a child 2-5 y of age. We examined how a potential tax on sugar-sweetened beverages (SSBs), or SSBs and >1% fat and/or high-sugar milk, would influence household food and beverage purchases among US households with a preschool child. We aimed to identify the lowest tax rate associated with meaningful changes in purchases. We used household food and beverage purchase data from households with a single child who participated in the 2009-2012 Nielsen Homescan Panel. A 2-part, multilevel panel model was used to examine the relation between beverage prices and food and beverage purchases. Logistic regression was used in the first part of the model to estimate the probability of a food/beverage being purchased, whereas the second part of the model used log-li...
This study developed a method to estimate added sugar content in consumer packaged goods (CPG) th... more This study developed a method to estimate added sugar content in consumer packaged goods (CPG) that can keep pace with the dynamic food system. A team including registered dietitians, a food scientist and programmers developed a batch-mode ingredient matching and linear programming (LP) approach to estimate the amount of each ingredient needed in a given product to produce a nutrient profile similar to that reported on its nutrition facts label (NFL). Added sugar content was estimated for 7021 products available in 2007-08 that contain sugar from ten beverage categories. Of these, flavored waters had the lowest added sugar amounts (4.3g/100g), while sweetened dairy and dairy alternative beverages had the smallest percentage of added sugars (65.6% of Total Sugars; 33.8% of Calories). Estimation validity was determined by comparing LP estimated values to NFL values, as well as in a small validation study. LP estimates appeared reasonable compared to NFL values for calories, carbohydrates and total sugars, and performed well in the validation test; however, further work is needed to obtain more definitive conclusions on the accuracy of added sugar estimates in CPGs. As nutrition labeling regulations evolve, this approach can be adapted to test for potential product-specific, category-level, and population-level implications.
Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profi... more Objective:This study aimed to apply the newly developed Chile Adjusted Model (CAM) nutrient profiling model (NPM) to the food supply in South Africa (SA) and compare its performance against existing NPM as an indication of suitability for use to underpin food policies targeted at discouraging consumption of products high in nutrients associated with poor health.Design:Cross-sectional analysis of the SA-packaged food supply comparing the CAM to three other NPM: SA Health and Nutrition Claims (SA HNC), Chilean Warning Octagon (CWO) 2019, and Pan-American Health Organisation (PAHO) NPM.Setting:The SA-packaged food supply based on products stocked by supermarkets in Cape Town, SA.Participants:Packaged foods and beverages (n 6474) available in 2018 were analysed.Results:Forty-nine per cent of products contained excessive amounts of nutrients of concern (considered non-compliant) according to the criteria of all four models. Only 10·9 % of products were not excessive in any nutrients of c...
China is facing a growing overweight problem in its adult population. This is a worrisome trend g... more China is facing a growing overweight problem in its adult population. This is a worrisome trend given its population size and the potential health care costs associated with nutrition-related non-communicable diseases. This trend has occurred together with changes in China's economic, social and physical environment. Hence, it is important to consider these factors in trying to understand what determined the changes in diet and physical activity, and thus the increases in weight. This dissertation first looks at how various dimensions of urbanization are associated with declines in physical activity. Second, it addresses how price and income changes might have contributed to dietary changes over time. Third, I apply a dynamic panel model to determine the degree to which physical activity and dietary choices affect weight change over time. I found that physical activity declines are strongly associated with greater availability of higher educational institutions, housing infrastr...
Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened bever... more Evidence showing the effectiveness of policies to reduce the consumption of sugar-sweetened beverages (SSBs) is growing. SSBs are one of the largest sources of added sugar in the diet and are linked to multiple adverse health conditions. This review presents a framework illustrating the various types of policies that have been used to reduce SSB exposure and consumption; policies are organized into four categories (financial, information, defaults, and availability) and take into consideration crosscutting policy considerations (feasibility, impact, and equity). Next, for each category, we describe a specific example and provide evidence of impact. Finally, we discuss crosscutting policy considerations, the challenge of choosing among the various policy options, and important areas for future research. Notably, no single policy will reduce SSB consumption to healthy levels, so an integrated policy approach that adapts to changing market and consumption trends; evolving social, polit...
Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling s... more Countries worldwide have implemented mandatory or voluntary front-of-package nutrition labeling systems. We provide a narrative review of ( a) real-world evaluations of front-of-package nutrition labels that analyze objective sales data and ( b) studies that objectively assess product reformulation in response to a front-of-package nutrition label implementation. We argue that there is sufficient scientific evidence to recommend that governments implement mandatory front-of-package nutrition labeling systems to improvepopulation health. We also present a conceptual framework to describe front-of-package label influence and provide recommendations for the optimal label design, emphasizing that labeling systems should be highly visible and salient, be simple and easy to understand, leverage automatic associations, and integrate informational and emotional messaging. The existing research suggests that Guideline Daily Amount labels should be avoided and that the Health Star Rating and ...
Objectives COVID-19 has created a new normal, affecting food purchasing behaviors, moving a porti... more Objectives COVID-19 has created a new normal, affecting food purchasing behaviors, moving a portion of them online. It is unknown how these behavioral shifts may differ by sociodemographic characteristics and whether shifts may widen or diminish existing diet-related disparities. To fill these gaps, we use nationally-representative Consumer Panel survey data to examine shifts in online grocery shopping by sociodemographic characteristics. Methods The Nielsen COVID-19 Shopper Behavior Survey was administered to a subset of Nielsen Homescan panel participants in March-April 2020 (n = 17,262 households (HH)). We describe survey-weighted HH sociodemographic characteristics and reasons for online shopping. Survey weighted-multivariable logistic regression was used to examine sociodemographic correlates of reported increases in online food shopping. Results One third (34%) of our survey-weighted sample said they shopped for groceries online more since COVID-19, and 60% of these HH reporte...
Policies that require front-of-package (FoP) nutrient warnings are becoming increasingly common a... more Policies that require front-of-package (FoP) nutrient warnings are becoming increasingly common across the globe as a strategy to discourage excess consumption of sugary drinks and ultra-processed food. However, a better understanding of the pathway through which FoP nutrient warnings work, as well as a review of how outcomes being measured in recent studies map onto this pathway, are needed in order to inform policy on the most effective FoP label design for reducing purchases of ultra-processed foods. This scoping review describes a conceptual model for how FoP nutrient warnings affect consumer behavior, examines which of these outcomes are currently being measured, and summarizes evidence from randomized controlled experiments. Twenty-two studies which experimentally tested nutrient warnings against a control label or other labeling systems were included for full-text review. Our conceptual model includes attention; comprehension, cognitive elaboration, and message acceptance; ne...
There are limited studies examining water consumption among individuals in hot climates. We asses... more There are limited studies examining water consumption among individuals in hot climates. We assessed the daily total water intake from plain water, other beverages, and food in a nationally representative sample of children and adolescents aged 6–18 years in the United Arab Emirates. Total water intake was compared against the recommendations of the Institute of Medicine and the European Food Safety Authority. Sociodemographic information, 24 h dietary recall, physical activity levels, and anthropometric data were collected from 527 participants. The mean ± SE of total water intake was 1778.4 ± 33.8 mL/day. Plain drinking water was the largest contributor to total water intake (51.6%), followed by food (27.3%). Sugar-sweetened beverages constituted 13.9% of water intake. The proportion of participants who met the Institute of Medicine recommendations ranged from 15% (males aged 14–18) to 25% (children aged 6–8). The proportion of participants who met the European Food Safety Authori...
Objectives(i) To determine the current state of online grocery shopping, including individuals’ m... more Objectives(i) To determine the current state of online grocery shopping, including individuals’ motivations for shopping for groceries online and types of foods purchased; and (ii) to identify the potential promise and pitfalls that online grocery shopping may offer in relation to food and beverage purchases.DesignPubMed, ABI/INFORM and Google Scholar were searched to identify published research.SettingTo be included, studies must have been published between 2007 and 2017 in English, based in the USA or Europe (including the UK), and focused on: (i) motivations for online grocery shopping; (ii) the cognitive/psychosocial domain; and (iii) the community or neighbourhood food environment domain.SubjectsOur search yielded twenty-four relevant papers.ResultsFindings indicate that online grocery shopping can be a double-edged sword. While it has the potential to increase healthy choices via reduced unhealthy impulse purchases, nutrition labelling strategies, and as a method to overcome f...
ObjectiveTo estimate changes in taxed and untaxed beverages by volume of beverage purchased after... more ObjectiveTo estimate changes in taxed and untaxed beverages by volume of beverage purchased after a sugar-sweetened beverage (SSB) tax was introduced in 2014 in Mexico.DesignWe used household purchase data from January 2012 to December 2015. We first classified the sample into four groups based on pre-tax purchases of beverages: (i) higher purchases of taxed beverages and lower purchases of untaxed beverages (HTLU-unhealthier); (ii) higher purchases of both types of beverages (HTHU); (iii) lower purchases of taxed and untaxed beverages (LTLU); and (iv) lower purchases of taxed beverages and higher purchases of untaxed beverages (LTHU-healthier). Next, we estimated differences in purchases after the tax was implemented for each group compared with a counterfactual based on pre-tax trends using a fixed-effects model.SettingAreas with more than 50 000 residents in Mexico.ParticipantsHouseholds (n 6089).ResultsThe HTLU-unhealthier and HTHU groups had the largest absolute and relative re...
Background: The US Food and Drug Administration's updated nutrition labeling requirements will in... more Background: The US Food and Drug Administration's updated nutrition labeling requirements will include added sugars starting in July 2018, but no measure currently exists to identify the added sugar content of products and what it represents among purchases. Beverages are one of the first targets for reducing added sugar consumption, and hence are the focus here. Objective: Our goal was to estimate trends in added sugars in nonalcoholic packaged beverage products available in the United States and to estimate amounts of added sugars obtained from these beverages given the purchases of US households overall and by subpopulations. Design: On the basis of nutrition label data from multiple sources, we used a stepwise approach to derive the added sugar content of 160,713 beverage products recorded as purchased by US households in 2007-2012 (345,193 observations from 110,539 unique households). We estimated the amounts of added sugars obtained from packaged beverages US households reported buying in 2007-2008, 2009-2010, and 2011-2012, overall and by subpopulations based on household composition, race/ethnicity, and income. The key outcomes are added sugars in terms of per capita grams per day and the percentage of calories from packaged beverages. Results: Packaged beverages alone account for per capita consumption of 12 g/d of added sugars purchased by US households in 2007-2012, representing 32-48% of calories from packaged beverages. Whereas the absolute amount of added sugars from beverages has not changed meaningfully over time, the relative contribution of added sugars to calories from beverages has increased. Non-Hispanic black households and low-income households obtain both higher absolute and relative amounts of added sugars from beverages than non-Hispanic white households and high-income households (all P , 0.01). Conclusions: These results provide measures of added sugars from packaged beverages at both the product level and the population level in the United States and can be used for comparisons after the revised nutrition labels are implemented and for future monitoring.
International Journal of Behavioral Nutrition and Physical Activity, 2016
Background: To date no work has differentiated the effects of age, period, and cohort on physical... more Background: To date no work has differentiated the effects of age, period, and cohort on physical activity (PA) among Chinese adults, while also considering biological, behavioral, economic, and environmental factors over time. Methods: We used data from the China Health and Nutrition Survey (CHNS) between 1991 and 2011 (20 years). The outcomes of interest are metabolic equivalent of task (MET) hours per week from work and domestic activities. Age, individual characteristics, household size, asset ownership, urbanization were included as covariates. Analyses for adult (≥20y) males (n = 29,343) and females (n = 31,094) was conducted to explicitly assess differences in PA due to age vs period effects, and implicitly assess differences by cohorts due to the period-specific experiences across individuals of varying ages. Results: The mean age of the sample rose from 41.31 to 50.8 years and PA decreased from 427.75 ± 264.35 MET hours per week (MET-hr/wk) in 1991 to 245.99 ± 206.65 MET-hr/wk in 2011, with much steeper declines for women compared to men. For both genders, we found non-linear decreases in PA with age over time. Controlling for age effects, negative period effects on PA were observed in each survey year, and were substantial from 1993 to 2000 for males and from 1993 to 2011 for females. The interaction between survey year and age (P < 0.05) were observed from 2004 to 2011. Higher community urbanicity, vehicle ownership, TV and computer ownership, overweight and obese, higher education served as negative predictors. Bicycle ownership, bigger household size, non-professional jobs, being married and having more children (for women) were positive predictors of PA (P < 0.05). Furthermore, at any given age, individuals who were younger at baseline had higher mean PA compared with individuals older at baseline. Conclusion: This study followed a large cohort of adults over a significant portion of their lives. Strong age and secular trends were observed, resulting in an increasing number of participants who have or are likely to lower their PA levels. These trends suggest that tackling the rapid PA decline among its population is of high priority for China's public health outlook as its population ages and continues to experience significant economic and environmental changes.
A large number of food policy councils (FPCs) exist in the United States, Canada, and Tribal Nati... more A large number of food policy councils (FPCs) exist in the United States, Canada, and Tribal Nations (N = 278), yet there are no tools designed to measure their members' perceptions of organizational capacity, social capital, and council effectiveness. Without such tools, it is challenging to determine best practices for FPCs and to measure change within and across councils over time. This study describes the development, testing, and findings from the Food Policy Council Self-Assessment Tool (FPC-SAT). The assessment measures council practices and council members' perceptions of the following concepts: leadership, breadth of active membership, council climate, formality of council structure, knowledge sharing, relationships, member empowerment, community context, synergy, and impacts on the food system. All 278 FPCs listed on the Food Policy Network's Online Directory were recruited to complete the FPC-SAT. Internal reliability (Cronbach's α) and inter-rater reliabi...
Understanding what influences where food outlets locate is important for mitigating disparities i... more Understanding what influences where food outlets locate is important for mitigating disparities in access to healthy food outlets. However, few studies have examined how neighborhood characteristics influence the neighborhood food environment over time, and whether these relationships differ by neighborhood-level income. Neighborhood-level data from four U.S. cities (Birmingham, AL; Chicago, IL; Minneapolis, MN; Oakland, CA) from 1986, 1993, 1996, 2001, 2006, and 2011 were used with two-step econometric models to estimate longitudinal associations between neighborhood-level characteristics (z-scores) and the log-transformed count/km(2) (density) of food outlets within real estate-derived neighborhoods. Associations were examined with lagged neighborhood-level sociodemographics and lagged density of food outlets, with interaction terms for neighborhood-level income. Data were analyzed in 2016. Neighborhood-level income at earlier years was negatively associated with the current densi...
Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being ado... more Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake. Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015-29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented...
Racial/ethnic disparities in dietary quality persist among Americans, but it is unclear whether h... more Racial/ethnic disparities in dietary quality persist among Americans, but it is unclear whether highly processed foods or convenience foods contribute to these inequalities. We examined the independent associations of race/ethnicity with highly processed and ready-to-eat (RTE) food purchases among US households. We determined whether controlling for between-group differences in purchases of these products attenuated associations between race/ethnicity and the nutritional quality of purchases. The 2000-2012 Homescan Panel followed US households (n = 157,142) that scanned their consumer packaged goods (CPG) food and beverage purchases. By using repeated-measures regression models adjusted for sociodemographic characteristics, we examined time-varying associations of race/ethnicity with processed and convenience food purchases, expressed as a percentage of calories purchased. We estimated associations between race/ethnicity and saturated fat, sugar, or energy density of total purchases...
Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly bec... more Obesity in the sub-Saharan Africa region has been portrayed as a problem of affluence, partly because obesity has been found to be more common in urban areas and among the rich. Recent findings, however, reveal rising prevalence among the poor particularly the urban poor. A growing body of literature mostly in Western countries show that obesity among the poor is partly the result of an obesogenic built environment. Such studies are lacking in the African context. This study examines the characteristics of the local food environment in an urban poor setting in Accra, Ghana and further investigates the associated risk of obesity for residents. Data on the local food environment was collected using geographic positioning system (GPS) technology. The body mass indices (BMI) of females (15-49 years) and males (15-59 years) were calculated from measured weight and height. Data on the socio-demographic characteristics and lifestyle behaviors of respondents was also collected through a household survey. Spatial analysis tools were used to examine the characteristics of the local food environment while the influence of the food environment on BMI was examined using a two-level multilevel model. The measures of the food environment constituted the level-2 factors while individual socio-demographic characteristics and lifestyle behaviors constituted the level-1 factors. The local food environment in the study communities is suggestive of an obesogenic food environment characterized by an abundance of out-of-home cooked foods, convenience stores and limited fruits and vegetables options. The results of the multilevel analysis reveal a 0.2kg/m 2 increase in BMI for every additional convenience store and a 0.1kg/m 2 reduction in BMI for every out-of-home cooked food place available in the study area after controlling for individual socio-demographic characteristics, lifestyle behaviors and community characteristics. The findings of this study indicate that the local food environment in urban poor Accra is associated with increased risk of obesity through providing access to convenience stores. In order to reduce the risk of obesity in these urban poor communities, there is the need to regulate the availability of and access to convenience stores while also encouraging healthier offerings in convenience stores.
Since the late 1970s, China's role in the global economy and its exposure to other cultures, ideo... more Since the late 1970s, China's role in the global economy and its exposure to other cultures, ideologies via the media, education, business investments and technology has burgeoned at an amazing speed, especially in the urban cities. At the same time, the performance of the Chinese economy since 1978 has been unprecedented for such as vast country, growing at an annual rate of around 10% between 1980 and 1990. Economic reform in China can be categorized under rural and urban reforms. In the rural areas, the abolition of communes and the introduction of the Household Responsibility System (HRS) were two of the major changes in the rural areas. Communes were important political and economic bodies that fulfilled most local government functions (such as police, justice, education, welfare and social services), and held a monopoly on economic functions (such as assignment of production plans, allocation of procurement quotas, and control over leadership of the teams). This meant that the commune determined how incomes were allocated, as well as restrictions on the size and use of private plots, and non-agricultural production. The abolition of the communes was intended to separate the communes' governmental functions from their economic functions. This resulted in an increase in the control of the ordinary farm family over its affairs as to what and how much to produce 3. In particular, farmers had less restrictions on performing on non-agricultural activities. Meanwhile, the HRS, which lowered the state quota, increased the state procurement price and allowed greater freedom and possibility for rural households to produce and sell beyond the state quota, was almost fully in place by 1984. The reported improvement in grain production with the introduction of the HRS was remarkable. In 1977, total grain production in the villages was 35,000 kilograms, but by 1986, it reached 265,000 kilograms 4 .
How beverage taxes might influence purchases of foods and beverages among households with prescho... more How beverage taxes might influence purchases of foods and beverages among households with preschool children is unclear. Thus, we examined the relation between beverage taxes and food and beverage purchases among US households with a child 2-5 y of age. We examined how a potential tax on sugar-sweetened beverages (SSBs), or SSBs and >1% fat and/or high-sugar milk, would influence household food and beverage purchases among US households with a preschool child. We aimed to identify the lowest tax rate associated with meaningful changes in purchases. We used household food and beverage purchase data from households with a single child who participated in the 2009-2012 Nielsen Homescan Panel. A 2-part, multilevel panel model was used to examine the relation between beverage prices and food and beverage purchases. Logistic regression was used in the first part of the model to estimate the probability of a food/beverage being purchased, whereas the second part of the model used log-li...
This study developed a method to estimate added sugar content in consumer packaged goods (CPG) th... more This study developed a method to estimate added sugar content in consumer packaged goods (CPG) that can keep pace with the dynamic food system. A team including registered dietitians, a food scientist and programmers developed a batch-mode ingredient matching and linear programming (LP) approach to estimate the amount of each ingredient needed in a given product to produce a nutrient profile similar to that reported on its nutrition facts label (NFL). Added sugar content was estimated for 7021 products available in 2007-08 that contain sugar from ten beverage categories. Of these, flavored waters had the lowest added sugar amounts (4.3g/100g), while sweetened dairy and dairy alternative beverages had the smallest percentage of added sugars (65.6% of Total Sugars; 33.8% of Calories). Estimation validity was determined by comparing LP estimated values to NFL values, as well as in a small validation study. LP estimates appeared reasonable compared to NFL values for calories, carbohydrates and total sugars, and performed well in the validation test; however, further work is needed to obtain more definitive conclusions on the accuracy of added sugar estimates in CPGs. As nutrition labeling regulations evolve, this approach can be adapted to test for potential product-specific, category-level, and population-level implications.
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Papers by Shu Wen Ng