Learn first, practice second approach to increase health professionals' nutrition-related knowledge, attitudes and self-efficacy.

Health professionals generally have positive attitudes towards the role of nutrition in medicine, but limited knowledge and low self-efficacy for incorporating it into routine care. To assess the effectiveness of a "learn first, practice second" intervention on the nutrition-related knowledge, attitudes, and self-efficacy of multidisciplinary health professionals, the present approach consisted of 16 weeks of online education and 2 weeks of cultural immersion in Tuscany, Italy. Data was captured via online surveys at Baseline, Post-education, Post-immersion, and Follow Up. Repeated measures ANOVA with irregular spacing was used, followed by Dunnett's or Cochran-Mantel-Haenszel testing. Results indicate significantly improved participant nutrition knowledge (nonzero correlation p = .0136, means score p = .0075) and self-efficacy (T0-T1 p < .0001, T0-T2 p < .0001, T0-T3 p = .0002), with differences in attitude trending towards significance (p = .0764). Findings from this study suggest that a combination of online education and hands on learning experiences can be beneficial for increasing health professionals' nutrition knowledge, confidence, and potentially attitude.

Relationships of Sleep Duration With Weight-Related Behaviors of U.S. College Students.

This study describes sleep behaviors of U.S. college students (N = 1,252; 18-24 years old; 59% female) and examines associations of sleep duration with weight-related behaviors. More than one quarter of participants slept < 7 hr/night and had mean Pittsburgh Sleep Quality Index (PSQI) scores indicating poor sleep quality. There were significant differences for all PSQI scales among sleep duration categories, < 7 hr (n = 344), 7-8 hr (n = 449), ≥ 8 hr (n = 459) sleep/night. Compared to those who slept ≥ 8 hr, those who slept < 8 hr had significantly more negative eating attitudes (2% higher), poorer internal regulation of food (4% lower), and greater binge eating (4% higher) scores. Findings advocate for health care professionals to evaluate sleep behaviors of college students during office visits and promote good sleep behaviors.

Vending machine assessment methodology. A systematic review.

The nutritional quality of food and beverage products sold in vending machines has been implicated as a contributing factor to the development of an obesogenic food environment. How comprehensive, reliable, and valid are the current assessment tools for vending machines to support or refute these claims? A systematic review was conducted to summarize, compare, and evaluate the current methodologies and available tools for vending machine assessment. A total of 24 relevant research studies published between 1981 and 2013 met inclusion criteria for this review. The methodological variables reviewed in this study include assessment tool type, study location, machine accessibility, product availability, healthfulness criteria, portion size, price, product promotion, and quality of scientific practice. There were wide variations in the depth of the assessment methodologies and product healthfulness criteria utilized among the reviewed studies. Of the reviewed studies, 39% evaluated machine accessibility, 91% evaluated product availability, 96% established healthfulness criteria, 70% evaluated portion size, 48% evaluated price, 52% evaluated product promotion, and 22% evaluated the quality of scientific practice. Of all reviewed articles, 87% reached conclusions that provided insight into the healthfulness of vended products and/or vending environment. Product healthfulness criteria and complexity for snack and beverage products was also found to be variable between the reviewed studies. These findings make it difficult to compare results between studies. A universal, valid, and reliable vending machine assessment tool that is comprehensive yet user-friendly is recommended.

Assessment of the dining environment on and near the campuses of fifteen post-secondary institutions.

OBJECTIVE: The present study evaluated the restaurant and dining venues on and near post-secondary campuses varying in institution size. DESIGN: The Nutrition Environment Measures Survey for Restaurants (NEMS-R) was modified to evaluate restaurants as fast food, sit down and fast casual; and campus dining venues as dining halls, student unions and snack bar/cafe´s. ANOVA with post hoc Tukey's B and T tests were used to distinguish differences between dining venues and associated institutions by size. SETTING: The study was conducted at fifteen US post-secondary institutions, 2009­2011. SUBJECTS: Data presented are from a sample of 175 restaurants and sixty-eight on-campus dining venues. RESULTS: There were minimal differences in dining halls by institution size, although medium-sized institutions as compared with small-sized institutions offered significantly more healthful side dish/salad bar items. Dining halls scored significantly higher than student unions or snack bar/cafe´s on healthful entre´es, side dish/salad bar and beverages offerings, but they also had the most barriers to healthful dietary habits (i.e. all-you-can-eat). No differences were found by restaurant type for NEMS-R scores for total restaurant dining environment or healthful entre´es and barriers. Snack bars had more healthful side dishes (P50?002) and fast-food restaurants had the highest level of facilitators (i.e. nutrition information; P50?002). CONCLUSIONS: Based on this evaluation in fifteen institutions, the full campus dining environment provides limited support for healthy eating and obesity prevention. The quality of campus dining environments can be improved via healthful offerings, providing nutrition information and other supports to facilitate healthy eating and prevent unwanted weight gain.

Sweet and salty. An assessment of the snacks and beverages sold in vending machines on US post-secondary institution campuses.

This study assessed the nutritional quality of snacks and beverages sold in vending machines. The contents of snack and beverage vending machines in 78 buildings on 11 US post-secondary education campuses were surveyed. Of the 2607 snack machine slots surveyed, the most common snacks vended were salty snacks (e.g., chips, pretzels) and sweets (i.e., candy and candy bars). The 1650 beverage machine slots assessed contained twice as many sugar-sweetened beverages as non-calorie-containing beverages. Only two institutions sold both milk and 100% juice in vending machines. The portion of snacks and beverages sold averaged more than 200 cal. Neither snacks nor beverages were nutrient dense. The majority of snacks were low in fiber and high in calories and fat and almost half were high in sugar. Most beverages were high in calories and sugar. This study's findings suggest that vending machines provide limited healthful choices. Findings from benchmark assessments of components of the food environment, like the vending options reported here, can provide valuable input to campus administrators, health services, food service, and students who want to establish campus policies to promote healthful eating.

Sneakers and spokes: an assessment of the walkability and bikeability of U.S. postsecondary institutions.

The purpose of the study described in this article was to assess the walkability and bikeability of 15 U.S. postsecondary education campuses. The Centers for Disease Control and Prevention's evidence-based Healthier Worksite Initiative Walkability Audit was modified to rate campus walking and biking path segments for path safety, quality, and comfort. Universities (n = 13) assessed an average of 44 path segments, which earned a mean score of 72.71 +/- 10.77 SD (possible range 0 to 100). Postsecondary technical schools (n = 2) assessed 20 path segments, which received an average score of 76.56 +/- 13.15. About 70% of path segments received a grade A or B, but almost 1 in 10 received a failing or poor support score for walking and biking. Nearly half or more campus environments scored significantly below an acceptable score on many path safety and quality criteria. Postsecondary education campuses that are supportive of walking and biking offer numerous benefits to the environment and people. Findings from environmental assessments like the data reported here can provide valuable input to campus planners.

Life of a vegetarian college student: Health, lifestyle, and environmental perceptions.

Objective To examine health behavior and environmental perception differences among vegetarian and nonvegetarian students. Participants: First-year university students (n = 1078) from eight United States universities. Methods: Data were obtained from base 2015 and followup 2016 assessments. Vegetarians and nonvegetarians were compared for anthropometrics, lifestyle behaviors, and campus environmental perceptions (CEPS). Results: Vegetarians had smaller waist circumference, lower systolic blood pressure, higher fruit and vegetable consumption, lower percentage of energy obtained from fat, and higher perceived stress. Vegetarians expressed a lower rating of perceptions of health policies on campus. Conclusion: A clear difference in indicators of physical health does not appear, however, vegetarian students show positive dietary patterns which can promote positive health outcomes. Further, vegetarians had lower perceptions of health policies on campus. Results can be used by administrators to ensure policies are in place to support health of students as currently vegetarian students see limitations in the environmental health policies.

Development of an Instrument Measuring Perceived Environmental Healthfulness: Behavior Environment Perception Survey (BEPS).

OBJECTIVE: To create a tool to measure college students' perception of the healthfulness of their environment. DESIGN: (1) Item generation, (2) cognitive interview testing and exploratory factor analysis, (3) item refinement/modification, (4) factor structure validation, and (5) criterion validation. SETTING: Ten college campuses. PARTICIPANTS: Time point 1 (n = 120 cognitive interviews; n = 922 factor analysis); time point 2 (n = 2,676), convenience sample of undergraduate students. MAIN OUTCOME MEASURES: Cognitive interviews and survey data were used to assess perceptions about the environment. ANALYSIS: Exploratory factor analysis, structural equation confirmatory factor analysis, correlations, and regressions. RESULTS: Item generation resulted in 93 items. Items were eliminated based on cognitive interviews, exploratory factor analysis of pilot data, and elimination of cross-loading or weak loading items. In confirmatory analyses, a 21-item, 5-factor structure was the best fit for the data (χ2 = 3,286.77, degrees of freedom = 189; comparative fit index = 0.840; root-mean-square error of approximation = 0.078). Environmental factors include physical activity (α = 0.68, 4 items), healthful eating (α = 0.86, 5 items), mental health (α = 0.85, 5 items), barriers to healthful eating (α = 0.70, 4 items), and peer influences (α = 0.73, 3 items). There were significant associations between scales and validation criteria (P < .05). CONCLUSIONS AND IMPLICATIONS: The Behavior Environment Perception Survey is a novel instrument measuring perceptions of the healthfulness of the campus environment. Strengths include a development process involving 10 different universities, strong psychometric properties, and breadth of constructs.

Food Insecurity Is Associated with Increased Risk of Obesity in US College Students.

BACKGROUND: Food insecurity affects millions of Americans and college students are especially vulnerable. Little is known about the relation of food insecurity with weight status and dietary intake during this critical phase of emerging adulthood. OBJECTIVES: We aimed to examine the sex-specific associations of food insecurity with obesity and dietary intake among college students. The study also explored these associations by meal plan (MP) enrollment. METHODS: This cross-sectional study included 683 second-year students at 8 universities in the United States. Food security status and dietary intake were assessed using the USDA Adult Food Security Survey and the Dietary Screener Questionnaire, respectively. On-site anthropometrics were measured by researchers. RESULTS: The prevalence of food insecurity at the universities ranged from 19.0% to 34.1% with a mean of 25.4% for the entire sample. Compared with high food security, marginal food security and food insecurity were associated with 3.16 (95% CI: 1.55, 6.46) and 5.13 (95% CI: 2.63, 10.00) times increased odds of obesity, respectively, exhibiting a dose-response relation. Food insecurity remained a significant predictor of obesity among both sexes after adjusting for sociodemographic variables. Food-insecure (FI) students had a significantly lower intake of fruits and vegetables and higher intake of added sugars than food-secure (FS) students. Obesity rate and added sugars consumption were higher among FI students with MPs than among FI students lacking MPs and FS students regardless of MP status. Among students with MPs, FS students had a higher intake of fruits and vegetables than FI students. CONCLUSIONS: Food insecurity was associated with obesity and poor dietary intake among both sexes. Although MP subsidies may be a reasoned approach to combat food insecurity, it should be coupled with efforts to assist students in making healthy food choices.Registered at clinicaltrials.gov as NCT02941497.

eB4CAST Approach Improves Science Communication With Stakeholders in a College-Based Health Program.

Communicating scientific results with community partners is often lacking in intervention programs, thus eB4CAST was developed to facilitate impact sharing. This article investigated using the eB4CAST dissemination tool to communicate impact from a campus-based obesity prevention program. Data from Get Fruved RCT university sites collected at baseline were used to generate eB4CAST reports. Experts (n = 13) and RCT sites (n = 15) were asked to provide feedback on eB4CAST reports based on appeal, understanding, and clarity. On all Likert items, participants rated above 7 on each (out of 10). Positive responses from open-ended questions included eB4CAST reports being clear, visually appealing, and aid in program understanding. Overall, eB4CAST was successful in relaying data and information for the Get Fruved program, thus a means for science communication that could be used in interventions. Utilizing infographics to report data and information is a feasible way to disseminate and communicate in a cost-effective, timely manner.

A Multi-Year Examination of Gardening Experience and Fruit and Vegetable Intake During College.

Gardening has been positively associated with fruit and vegetable (FV) consumption based on short-term studies among children, but long-term data among adolescents and young adults are lacking. This investigation sought to elucidate the association between gardening experience and FV intake among college students over a two-year period. Students (N = 593) from eight universities were assessed at the end of their freshman (Y1) and sophomore (Y2) years during the springs of 2016 and 2017, respectively. At each time point, participants completed the NCI FV Screener and questions related to gardening experience and FV-related attitudes and behaviors. Students were then categorized into four groups based on gardening experience: Gardened only during the first or second year (Y1 only and Y2 only gardeners), gardened both years (Y1+Y2 gardeners), and non-gardeners. While both Y1 only and Y1+Y2 gardeners reported significantly higher FV intake relative to non-gardeners at Y1 (2.3 ± 0.9 and 2.6 ± 0.7 versus 1.9 ± 0.6 cup equivalents (CE)/day, respectively; p < 0.01), only Y1+Y2 gardeners differed from non-gardeners at Y2 (2.4 ± 0.6 versus 1.8 ± 0.5 CE/day; p < 0.001). Additionally, Y1+Y2 gardeners reported more frequent engagement of several FV-related behaviors, including shopping at farmers' markets, eating locally grown foods, and cooking from basic ingredients; and were five times more likely to have gardened during childhood (OR: 5.2, 95%, CI: 3.5-8.8; p < 0.001). Findings suggest that while isolated gardening experiences during college are associated with FV intake, reoccurring experience may be essential for sustained benefit.

Redesign, Field-Testing, and Validation of the Physical Activity Campus Environmental Supports (PACES) Audit.

This paper describes the redesign, field-testing, and convergent validity of a practical tool-Physical Activity Campus Environmental Supports (PACES) audit. Methods. The audit includes two parts: (1) PACES-Programs, which is comprised of questions regarding populations served, fees, programs (recreation/fitness classes and intramurals), proximity, adequacy of facilities, and marketing, and (2) PACES-Facilities, which is comprised of questions regarding built environment (aesthetics, bike racks, stairs, and universal design), recreation equipment, staff, amenities, and access. Each item criterion is specifically scored using a five-point, semantic-differential scale ranging from limited to extensive environmental support. A few questions utilize select all that apply for a summed score. PACES training, interrater reliability, and data collection are all accessible via an online portal. PACES was tested on 76 college campuses. Convergent validity was examined by comparing the PACES-Programs questions to Healthy Campus Initiatives-Programs questions (HCI-Programs) and comparing the PACES-Facilities questions to questions contained in the Physical Activity Resource Assessment (PARA) Instrument. Statistical analyses included Cronbach's alpha, ANOVA, latent profile analysis, and Spearman correlations. Results. The PACES-Programs audit includes 10 items for a potential total of 73 points (α = 0.72) and PACES-Facilities audit includes 15 items for a potential total of 77 points (α = 0.837). Most (77.8%) of the 153 facilities assessed scored in the most healthful range (20-42), which was mainly due to the extensiveness of the aerobic equipment/amenities and the competence/accessibility of staff. Significant differences in PACES-Total and PACES-Programs scores were associated with campus size and PACES-Facilities across regions. For the paired validation assessments, correlations were significant between PACES-Programs and HCI-Programs ((n=41) r=0.498, p < 0.001) and PACES-Facilities and PARA (n=29) for both features (r=0.417, p=0.024) and amenities (r=0.612, p < 0.001), indicating moderate convergent validity. Conclusion. The PACES audit is a valid, reliable tool for assessing the quality of recreation facilities and programs in a variety of college campus environments.

Cooking and Meal Planning as Predictors of Fruit and Vegetable Intake and BMI in First-Year College Students.

The objective was to determine if cooking skills and meal planning behaviors are associated with greater fruit and vegetable intake and lower body mass index (BMI) in first-year college students who are at risk for excessive weight gain. A cross-sectional analysis was conducted using baseline data from a multi-state research project aimed at preventing weight gain in first-year college students. Cooking type, frequency and confidence, self-instruction for healthful mealtime behavior intention, self-regulation of healthful mealtime behavior, and cup equivalents of fruits and vegetables (FV) were measured using validated surveys. BMI was calculated from measured height and weight. First-year students (n = 1108) considered at risk for weight gain from eight universities completed baseline assessments within the first month of entering college. Multiple linear regression was used to determine associations among independent variables of cooking patterns, meal planning behaviors, and dependent variables of fruit and vegetable intake and BMI, after controlling for the influence of sex. Cooking more frequently, cooking with greater skills, and practicing meal planning behaviors are associated with greater fruit and vegetable intake and lower BMI in first-year college students. Interventions aimed at improving health in college students may be enhanced by incorporating cooking and meal planning components.

Development and Validation of the Vending Evaluation for Nutrient-Density (VEND)ing Audit.

Background: This paper describes the development and validation of the Vending Evaluation for Nutrient-Density (VEND)ing audit to comprehensively evaluate vended products based upon healthfulness, price and promotion, and machine accessibility. Methods: A novel vending nutrient-density score was created to determine the healthfulness of vended snack/beverage products. Field tested in United States colleges, VENDing audit (∑nutrient-density + 10 × % healthy products) and Support sub-scores (price + promotion + accessibility) were calculated for snack/beverage machines. Higher scores indicate more healthful vending options and supports for choosing healthfully. Nutrition Environment Measures Survey-Vending (NEMS-V) was used to validate the nutrient-density score for a sub-sample of machines. Sensitivity and specificity were computed by comparing the number of healthy snacks/beverages determined by NEMS-V and the VENDing nutrient-density scores. Results: Researchers conducted the VENDing audit on 228 snack/beverage vending machines at 9 universities within the United States and used both VENDing and NEMS-V on 33 snack and 52 beverage vending machines. Mean VENDing audit scores were 4.5 ± 2.0 (2.6, 3.4) and 2.6 ± 2.0 (0, 12) for snack/beverage machines, respectively. The number of products considered healthy assessed with both the VENDing nutrient-density scores and the NEMS-V were positively correlated for beverages (r = 0.687, p < 0.001) and snacks (r = 0.366, p < 0.05). The sensitivity was excellent for beverages (0.83) and moderate for snacks (0.69); while the specificity was moderate for both beverages (0.66) and snacks (0.50). Conclusions: The VENDing audit uses unique, valid, and reliable nutrient-density scoring to evaluate snacks/beverages along a continuum of healthful criteria and comprehensively evaluates the full vending environment.

Development and Validation of the Policies, Opportunities, Initiatives and Notable Topics (POINTS) Audit for Campuses and Worksites.

Background: Workplace or campus wellness/obesity-prevention policies and initiatives can improve health. Research tools to assess worksite or campus policies/initiatives are scarce. Thus, the aim of this research is to develop and validate the policies, opportunities, initiatives, and notable topics (POINTS) audit. Methods: POINTS was developed and refined via expert review, pilot-testing, and field testing. Trained researchers completed a web-based review from a student-focus or employee-focus regarding 34 health-promoting topics for colleges. Each topic was evaluated on a 0⁻2 scale: 0 = no policy/initiative, 1 = initiatives, 2 = written policy. When a written policy was detected, additional policy support questions (administered, monitored, reviewed) were completed. Results: Cronbach's Alpha for the student-focused POINTS audit was α = 0.787 (34 items, possible points = 65), and for the employee-focused POINTS audit was α = 0.807 (26 items, possible points = 50). A total of 115 student-focused and 33 employee-focused audits were completed. Although there was little evidence of policy presence beyond stimulant standards (smoking and alcohol), there were extensive examples of health initiatives. The student-focused POINTS audit was validated using the Healthier Campus Initiative's survey. Conclusions: POINTS is a web-based audit tool that is valid and useful for pre-assessment, advocacy, benchmarking, and tracking policies for health and well-being for students (campus) and employees (worksite).

More than Fast Food: Development of a Story Map to Compare Adolescent Perceptions and Observations of Their Food Environments and Related Food Behaviors.

The purpose of this convergent, multiphase, mixed methods study was to better understand the perceptions of adolescents' food environments and related food behaviors using grounded visualization and story mapping. Adolescents from one high school (13⁻16 years) in the southeastern United States were evaluated via data from health behavior surveys (n = 75), school environment maps, focus groups (n = 5 groups), and Photovoice (n = 6) from October 2016 to April 2017. Data from each phase were integrated using grounded visualization and new themes were identified (n = 7). A story map using ArcGIS Online was developed from data integration, depicting the newly identified themes. Participants failed to meet national recommendations for fruit and vegetable intake (2.71 cups). Focus group and Photovoice findings indicated the need for convenience food items in all environments. The story map is an online, interactive dissemination of information, with five maps, embedded quotes from focus groups, narrative passages with data interpretation, pictures to highlight themes, and a comparison of the participants' food environments. Story mapping and qualitative geographic information systems (GIS) approaches may be useful when depicting adolescent food environments and related food behaviors. Further research is needed when evaluating story maps and how individuals can be trained to create their own maps.

Food Choice Priorities Change Over Time and Predict Dietary Intake at the End of the First Year of College Among Students in the U.S.

This study assessed food choice priorities (FCP) and associations with consumption of fruits and vegetables (FV), fiber, added sugars from non-beverage sources, and sugar-sweetened beverages (SSB) among college students. Freshmen from eight U.S. universities (N = 1149) completed the Food Choice Priorities Survey, designed for college students to provide a way to determine the factors of greatest importance regarding food choices, and the NCI Dietary Screener Questionnaire. Changes in FCP and dietary intake from fall 2015 to spring 2016 were assessed. Multiple regression models examined associations between FCP and log-transformed dietary intake, controlling for sex, age, race, and BMI. Participant characteristics and FCP associations were also assessed. FCP importance changed across the freshmen year and significantly predicted dietary intake. The most important FCP were price, busy daily life and preferences, and healthy aesthetic. Students who endorsed healthy aesthetic factors (health, effect on physical appearance, freshness/quality/in season) as important for food choice, consumed more FV and fiber and less added sugar and SSB. Busy daily life and preferences (taste, convenience, routine, ability to feel full) predicted lower FV, higher added sugar, and higher SSB consumption. Price predicted lower FV, higher SSB, and more added sugar while the advertising environment was positively associated with SSB intake. FCP and demographic factors explained between 2%⁻17% of the variance in dietary intake across models. The strongest relationship was between healthy aesthetic factors and SSB (B = -0.37, p < 0.01). Self-rated importance of factors influencing food choice are related to dietary intake among students. Interventions that shift identified FCP may positively impact students' diet quality especially considering that some FCP increase in importance across the first year of college.

Path Analysis of Campus Walkability/Bikeability and College Students' Physical Activity Attitudes, Behaviors, and Body Mass Index.

PURPOSE: The purpose of this study was to assess the relationship between the walkability/bikeability of college campuses and students' body mass index (BMI) with student physical activity (PA) attitudes and behaviors as potential mediators. DESIGN: Cross-sectional. SETTING: Thirteen university campuses. PARTICIPANTS: A total of 1384 student participants. MEASURES: Walkability/bikeability environmental score (ES): 12-item audit assessed an average of 44 path segments per campus. Students were measured for height and weight and completed online surveys. Physical activity stage of change/behavior intentions were assessed using the transtheoretical model. The Cognitive Behavioral Physical Activity Questionnaire assessed outcome expectations, self-regulation, and personal barriers. International Physical Activity Questionnaire assessed walking-, moderate-, and vigorous-intensity PA. ANALYSIS: Descriptive statistics, zero-order correlations, and path analysis with maximum likelihood estimation. RESULTS: The overall model fit was good with χ2 of 171.388 ( df = 18), P < .001, comparative fit index value of .95, and a root mean square of approximation of .079. After controlling for gender, there was a direct negative association between walkability/bikeability ES and BMI (ß = -.085) and positive association between personal barriers and BMI (ß = .134). Walkability/bikeability ES was positively associated with walking-intensity PA (ß = .010). Self-regulation was positively associated with moderate-intensity PA (ß = .213), which, in turn, was negatively associated with BMI (ß = -.057). CONCLUSIONS: The ease of walking and biking on a campus was related to college students' walking behavior and their BMI. Students' PA behavioral intentions were associated with moderate PA and lower BMI. These results provide evidence to focus on policies and structural supports for walkable/bikeable environments to supplement and enhance interventions encouraging individual behavior change for PA and weight management.

Multilevel Structural Equation Modeling of Students' Dietary Intentions/Behaviors, BMI, and the Healthfulness of Convenience Stores.

BACKGROUND: When dietary behaviors are habitual, intentions are low, and environmental cues, such as the consumer food environment, might guide behavior. How might intentions to eat healthily and ultimately actual dietary behaviors, be influenced by the consumer food environment (including the availability and affordability of healthy foods) in convenience stores? This study will determine pathways between the healthfulness of convenience stores and college students' dietary intentions/behaviors, and body mass index (BMI). METHODS: Through multilevel structural equation modeling, a comparison was made of students' healthful meal intentions (HMI); intake (fruits/vegetables, %kcal/fat, sugar-sweetened beverages (SSBs) and whole-grains); and measured BMI; as well as the healthfulness of convenience stores (fruits/vegetables availability/quality, healthy food availability/affordability). Data was collected on 1401 students and 41 convenience stores across 13 US college campuses. RESULTS: Controlling for gender, HMI was negatively associated with SSBs (ß = -0.859) and %kcal/fat (ß = -1.057) and positively with whole-grains (ß = 0.186) and fruits/vegetables intake (ß = 0.267); %Kcal/fat was positively (ß = 0.098) and fruits/vegetables intake (ß = -0.055) negatively associated with BMI. Campus level, fruits/vegetables availability were positively associated to HMI (ß = 0.214, ß = 0.129) and directly/negatively to BMI (ß = -2.657, ß = -1.124). CONCLUSIONS: HMI modifies dietary behaviors, with energy from fat and fruit/vegetable intake the most predictive of weight. Availability of fruit/vegetables in convenience stores make it easier for young adults to eat well.

Development and Validation of a Simple Convenience Store SHELF Audit.

Background This paper describes the development, reliability, and convergent validity of a practical tool-the Convenience Store Supportive Healthy Environment for Life-Promoting Food (SHELF) Audit. Methods Audit items included: a variety of fresh, processed, and frozen fruits and vegetables; low-fat dairy products; healthy staples and frozen meals; healthy food incentive programs; items sold in check-out areas; portion/cup sizes; and pricing. Each audit item was scored using a five-point semantic-differential scale (1 = provides little or no support for healthful foods to 5 = provides high support for healthful foods). Convergent validity was examined by comparing the SHELF audit to Ghirardelli et al. and Laska et al. store audits. Statistical analysis included: Factor analysis, ANOVA, and Spearman correlations. Results SHELF included three factors: a Fruits/Vegetables scale (eight items, α = 0.79; total potential points = 34); a Healthy Foods scale (four items, α = 0.72; total potential points = 16); and a Supports scale (four items, α = 0.685; total potential points = 16). Only 6% of the 124 convenience stores assessed scored in the most healthful range (46⁻66). The assessed drug stores (n = 15) scored higher than convenience stores (n = 81) on the Healthy Foods and Supports scales but not the Fruits/Vegetables scale. The SHELF sub-scores were highly correlated with other audit tools indicating convergent validity. Conclusion The SHELF convenience store audit is a valid, reliable tool for assessing the degree to which convenience stores support healthfulness regarding Fruits/Vegetables, Healthy Foods, and Supports for choosing healthy.