Who chooses "healthy" meals? An analysis of lunchtime meal quality in a workplace cafeteria.

BACKGROUND: The workplace can play an important role in shaping the eating behaviors of U.S. adults. Unfortunately, foods obtained in the workplace tend to be low in nutritional quality. Questions remain about the best way to approach the promotion of healthy food purchases among employees and to what extent health promotion activities should be tailored to the demographic characteristics of the employees. The purpose of this study was to (1) assess the nutritional quality of lunchtime meal purchases by employees in cafeterias of a large organization, (2) examine associations between lunchtime meal quality selection and the demographic characteristics of employees, and (3) determine the healthfulness of foods and beverages offered in the cafeterias of this organization. METHODS: A cross-sectional analysis was conducted using secondary data from a food labeling study implemented in three worksite cafeterias. Demographic data was collected via surveys and meal data was collected using a photo capture system for 378 participants. The Healthy Eating Index 2015 (HEI-2015) was used to determine meal quality and a total score for the menu of options available in the cafeterias during the study period. Summary statistics were generated, and the analysis of variance (ANOVA) was used to compare the HEI-2015 scores between groups. RESULTS: The mean HEI-2015 total score for the menu items offered (n = 1,229) in the cafeteria during the study period was 63.1 (SD = 1.83). The mean HEI-2015 score for individual lunchtime meal observations (n = 378) was 47.1 (SD = 6.8). In general, HEI-2015 total scores were higher for non-smokers, individuals who self-identified as Asian, had higher physical activity levels, scored higher on numeracy and literacy assessments, and reported higher education levels, incomes, and health status. CONCLUSIONS: The overall HEI-2015 scores indicate that the menu of options offered in the cafeterias and individual meal selections did not align with the Dietary Guidelines for Americans, and there were significant associations between average lunchtime meal quality scores and several demographic characteristics. These results suggest that healthy eating promotion activities in workplaces may need to be tailored to the demographic characteristics of the employees, and efforts to improve the food environment in the workplace could improve meal quality for all employees.

Comparisons of Four Diet Quality Indexes to Define Single Meal Healthfulness.

BACKGROUND: Many dietary indexes exist to evaluate nutrition quality, but few specifically assess the quality of a single meal. OBJECTIVE: Our aim was to compare 4 different diet quality indexes in their ability to assess the nutrition quality of single meals. DESIGN: This was a secondary analysis of data from the PACE (Effects of Physical Activity Calorie Expenditure) food labeling study (2015-2017). Data were collected in business cafeterias in North Carolina and included photos of lunch trays before consumption from an adult population and serving sizes of each food item. Additional nutrient analysis was conducted to compile macro- and micronutrient data for each food item, in addition to servings provided from each food group. MAIN OUTCOME MEASURES: The main outcome was individual meal nutrition quality. Data from the PACE study were used to calculate the scores of the following diet quality indexes: Healthy Eating Index 2015, Dietary Approaches to Stop Hypertension accordance score, Main Meal Quality Index, and Nutrient Rich Foods Index. STATISTICAL ANALYSIS PERFORMED: To score the meals, algorithms were created in SAS software, version 9.4, to combine individual foods and beverages into meals and calculate scores according to the individual index components. The total scores for each of the indexes were compared using Spearman correlation coefficients. RESULTS: A total of 8,070 observations or "meals" from 379 participants were scored for this study. The scores for each observation varied by index. The Spearman correlation coefficients between the indexes for the total score for all observations ranged from 0.26 to 0.68. The correlation coefficients did not change equally among the indexes when observations were excluded based on predefined criteria for what constitutes a meal. CONCLUSIONS: There is wide variability in scores of the 4 diet quality indexes analyzed in this study. In addition, the indexes show weak to moderate correlation, indicating that the appropriateness of the index will depend greatly on the study questions and objectives.

Assessing Preliminary Impact of the North Carolina Community Transformation Grant Project Farmers' Market Initiatives Among Rural Residents.

OBJECTIVE: Using the Social Determinants of Health as the study's theoretical underpinning, the authors examined the impact of the North Carolina Community Transformation Grant Project farmers' market initiatives on changes in awareness and use of farmers' markets, and fruit and vegetable consumption. METHODS: During the farmers' market season, the researchers conducted a random digit-dial telephone survey among residents in 3 rural North Carolina counties to examine changes in farmers' market awareness, shopping, and fruit and vegetable consumption. They examined change over 1 year using t tests, chi-square tests, and propensity score matching. RESULTS: In 1 county there were increases in farmers' market shopping and fruit and vegetable consumption, and in 1 county there were decreases in farmers' market shopping and fruit and vegetable consumption. CONCLUSIONS AND IMPLICATIONS: The impact of farmers' market initiatives may be affected by county-specific socioeconomic contexts.

Disparities in healthy food zoning, farmers' market availability, and fruit and vegetable consumption among North Carolina residents.

BACKGROUND: Context and purpose of the study. To examine (1) associations between county-level zoning to support farmers' market placement and county-level farmers' market availability, rural/urban designation, percent African American residents, and percent of residents living below poverty and (2) individual-level associations between zoning to support farmers' markets; fruit and vegetable consumption and body mass index (BMI) among a random sample of residents of six North Carolina (NC) counties. METHODS: Zoning ordinances were scored to indicate supportiveness for healthy food outlets. Number of farmers' markets (per capita) was obtained from the NC-Community Transformation Grant Project Fruit and Vegetable Outlet Inventory (2013). County-level census data on rural/urban status, percent African American, and percent poverty were obtained. For data on farmers' market shopping, fruit and vegetable consumption, and BMI, trained interviewers conducted a random digit dial telephone survey of residents of six NC counties (3 urban and 3 rural). Pearson correlation coefficients and multilevel linear regression models were used to examine county-level and individual-level associations between zoning supportiveness, farmers' market availability, and fruit and vegetable consumption and BMI. RESULTS: At the county-level, healthier food zoning was greater in more urban areas and areas with less poverty. At the individual-level, self-reported fruit and vegetable consumption was associated with healthier food zoning. CONCLUSIONS: Disparities in zoning to promote healthy eating should be further examined, and future studies should assess whether amending zoning ordinances will lead to greater availability of healthy foods and changes in dietary behavior and health outcomes.

Farmers' market shopping and dietary behaviours among Supplemental Nutrition Assistance Program participants.

OBJECTIVE: Because farmers' markets include a variety of fruits and vegetables, shopping at farmers' markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers' market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers' markets and associations between shopping at farmers' markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI. DESIGN: Cross-sectional analyses of associations between farmers' market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI. SETTING: Department of Social Services, Pitt County, eastern North Carolina, USA. SUBJECTS: Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey. RESULTS: Barriers to shopping at farmers' markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers' market shopping was associated with awareness of farmers' markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers' market shopping (estimate =1·06 (se 0·32), P=0·001). CONCLUSIONS: Our study is one of the first to examine SNAP participants' farmers' market shopping, distance to farmers' markets and dietary behaviours. Barriers to shopping at farmers' markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants' use of farmers' markets, ultimately improving diet quality in this high-risk group.

Implementation of California state school competitive food and beverage standards.

BACKGROUND: Competitive foods and beverages are available on most US school campuses. States and school districts are adopting nutrition standards to regulate these products, but few studies have reported on the extent to which schools are able to adhere to competitive regulations. The purpose of this study was to describe the extent to which schools in disadvantaged communities were able to implement California competitive food and beverage standards. METHODS: Data on the competitive foods (n = 1019) and beverages (n = 572) offered for sale on 19 school campuses were collected in 2005 and 2008. Descriptive statistics were generated on overall adherence rates to school nutrition standards and adherence rates by venue and school level. Logistic regression models tested predictors of adherence by continuous and categorical variables (eg, venue, item selling price). RESULTS: Data show an increase from 2005 to 2008 in average adherence to the California standards. Several predictors had statistically significant associations with adherence or nonadherence. Adherence was higher for competitive foods sold in school stores than foods sold in vending machines. Higher selling price was associated with lower adherence. Competitive foods classified as entrees were more likely to adhere than snack items, and larger total size (in fluid ounces) beverages were associated with higher adherence. CONCLUSIONS: Schools have begun to implement competitive food and beverage policies. However, school environments, particularly in secondary schools, are not 100% compliant with school nutrition standards. These findings can inform policymakers and school officials about the feasibility of implementing competitive food standards in schools.