Soft drinks and premiums with children's meals marketed on the websites of the top restaurant chains worldwide.

OBJECTIVE: To assess the frequency with which soft drinks and premiums are available with children's meals marketed on the top restaurant chains' websites worldwide. DESIGN: Cross-sectional structured observational assessment of secondary information about top international restaurant chain children's meals. SETTING: Websites of top restaurant chains for 193 countries and five regions of the United Nations. PARTICIPANTS: Top restaurant chains (including McDonald's, Subway, Burger King and KFC) across 193 countries. Children's meal images and descriptions were reviewed to determine if the meal was marketed with a soft drink as a beverage option and whether the meal offered a premium. RESULTS: Children's meals were marketed online on restaurant websites by at least one of the four chains in a total of seventy eight of the 193 countries (40·4 %). Overall, 56·3 % of countries with any online children's meal marketing by the four chains included at least one chain that marketed soft drinks and 92·3 % marketed premiums with the meal. CONCLUSIONS: Every region in the world includes marketing of children's meals on the websites of the top restaurant chains. The high prevalence of premiums marketed online with children's meals is of concern. Similarly, with over 50 % of countries with online children's meal marketing having at least one chain that offers soft drinks as part of the meals, additional regulation and education may be warranted.

Foods and Beverages Available at SNAP-Authorized Drugstores in Sections of North Carolina.

OBJECTIVE: To assess healthy food availability in Supplemental Nutrition Assistance Program-authorized drugstores by store chain and neighborhood income level in 3 regions of North Carolina. DESIGN: Cross-sectional, descriptive study. SETTING: Twenty-five counties in North Carolina. PARTICIPANTS: A total of 108 drugstores (36 CVS Health, 36 Rite Aid, and 36 Walgreens). MAIN OUTCOME MEASURE(S): Fifty foods and beverages offered at drugstores, categorized as healthier and less healthy. ANALYSIS: Kruskal-Wallis tests were used to test differences in the availability of foods and beverages by chain and neighborhood income. RESULTS: Of the 50 foods/beverages observed, 11 were available at all drugstores. Three of the 36 (8%) healthier items were available at all stores (100% fruit juice, water, and high-fiber cereal) whereas 8 of the 14 less healthy items (57%) were available at all stores (chips, sports drinks, energy drinks, regular soda, diet soda, sugar-sweetened beverages, beer, and wine). Only 3% of drugstores offered fresh vegetables and 4% offered fresh fruits. Less than 20% offered frozen chicken or beef. For 36 healthier foods, 11 differed by chain (28%); for less healthy foods 2 of 14 differed by chain (7%). Foods and beverages offered did not vary by neighborhood income. CONCLUSIONS AND IMPLICATIONS: Although drugstores offer some healthier items, few offer fresh produce. As the drugstore industry changes, it is important for the nutrition community to study the impact of these changes on food purchasing behavior and ultimately health.

Partnering on the PRAISE Program: Putting Health Equity into Practice.

Purpose: The purpose of Preventive Health Education Resulting in Action Inspiring Success for Everyone (PRAISE) was to develop a community-driven program to encourage and support churches in sustainable health promotion and assessment efforts to improve African Americans' health knowledge and behaviors in Asheville, North Carolina. Methods: The PRAISE program provided technical support toward gaining recognition and an award for health promotion activities to 10 churches in year 1 and 5 additional churches in year 2. The Results-Based Accountability© (RBA) framework involved documentation of church health promotion activities and surveys of a convenience sample of congregants at nine churches before (presurvey, n=270) and after (postsurvey, n=241) the intervention. Differences in frequency of conduct of and participation in church health promotion activities and in congregant health knowledge and behaviors were assessed in 2015 and 2016. Results: Fourteen of the churches engaged in at least one health promotion activity and more than half offered healthier foods at gatherings, offered exercise opportunities, and held at least three health education activities. Seventy-two percent of congregants reported participating in at least one church health activity at postsurvey compared with 58% at presurvey. The proportion of congregants who had personal health knowledge and the proportion that rated their health as good or better were higher at postsurvey. Conclusion: Building on years of trust and collaboration among churches, local community organizations, and an academic partner, PRAISE in its first 2 years suggests that a community-driven approach can support health promotion and healthy behaviors, advancing health equity efforts.

Prevalence of Artificial Food Colors in Grocery Store Products Marketed to Children.

Artificial food colors (AFCs) in foods and beverages may be harmful to children. This study assesses the percentage of grocery store products marketed to children that contain AFCs, by category and company. The research team collected product and food-color information about 810 products in one grocery store in North Carolina in 2014. Overall, 350 products (43.2%) contained AFCs. The most common AFCs were Red 40 (29.8% of products), Blue 1 (24.2%), Yellow 5 (20.5%), and Yellow 6 (19.5%). Produce was the only category that did not have any AFCs. The highest percentage of products with AFCs was found in candies (96.3%), fruit-flavored snacks (94%), and drink mixes/powders (89.7%). Forty-one of the 66 companies marketed products containing AFCs. Given concerns about health effects of AFCs and high proportions of high-AFC categories, clinicians, parents, food companies, and the government can take steps to support children's healthy eating and development by reducing AFCs in children's diets.

Availability of Foods and Beverages in Supplemental Nutrition Assistance Program-Authorized Dollar Stores in a Region of North Carolina.

BACKGROUND: There are >25,000 Supplemental Nutrition Assistance Program (SNAP)-authorized dollar stores throughout the United States; many are located in lower-income neighborhoods and provide an accessible food and beverage source for area residents. OBJECTIVE: The purpose of this research was to determine the percent of food deserts within 16 counties in North Carolina that include a SNAP dollar store; examine the types of foods and beverages at SNAP dollar stores in these counties; test whether the foods and beverages offered vary by SNAP dollar store chain; and test whether the foods and beverages available differ by rural and urban location. DESIGN: This cross-sectional study used a combination of publicly available data and primary data to investigate the research questions. Secondary data sources were obtained from the US Department of Agriculture's SNAP retailer locator, the US Census, and the US Department of Agriculture's Food Access Research Atlas. Availability of foods and beverages was assessed among a sample of 90 SNAP dollar stores in 16 counties in southern and western sections of North Carolina. Data were collected in June 2014. RESULTS: About half (52%) of the food deserts in the research area included a SNAP dollar store. Most of the sampled stores sold healthier food staples, such as frozen meats, brown rice, 100% whole-wheat bread, and dried beans. None of the stores sold fresh fruits or vegetables. Some of the foods and beverages offered (eg, frozen fruit, frozen unseasoned vegetables, nonfat or low-fat milk, frozen ground beef) varied by SNAP dollar store chain. The foods and beverages offered did not differ by rural or urban county location. CONCLUSIONS: SNAP dollar stores offer a number of healthy food staples; however, they do not sell fresh fruits or vegetables. Further food environment research should include dollar stores.

Poor nutrition on the menu: children's meals at America's top chain restaurants.

BACKGROUND: We evaluated the nutritional quality of children's meals at chain restaurants, because children obtain about a third of their daily calories from away-from-home foods and studies show that restaurant foods are often higher in calories and lower in nutritional value than foods prepared at home. METHODS: We assessed the nutritional quality of children's meals at the 50 largest U.S. restaurant chains by visiting each chain's web site or calling the company. Eighteen of the chains did not have children's meals and 10 did not provide adequate nutrition information to be included in the study. The nutritional quality of each meal combination was evaluated against a set of nutrition standards based on key nutrition recommendations in the Dietary Guidelines for Americans. RESULTS: Of the 22 restaurants that had children's menus and available nutrition information, 99% of 1662 children's meal combinations were of poor nutritional quality. CONCLUSIONS: Restaurants should support healthier choices for children by reformulating existing menu items and adding new healthier items, posting calories on menus, and setting nutrition standards for marketing to children.

Nine out of 10 food advertisements shown during Saturday morning children's television programming are for foods high in fat, sodium, or added sugars, or low in nutrients.

A 2005 review by the Institute of Medicine of the National Academies concluded that food marketing influences children's food preferences, consumption, and health. Given the powerful influence of marketing on children's diets, this cross-sectional study examined the types of foods, the nutritional quality of those foods, and the marketing techniques and messages used in food advertising during Saturday morning children's television programming. During 27.5 hours of programming in May 2005, 49% of advertisements shown were for food (281 food advertisements out of 572 total advertisements). The most commonly advertised food categories were ready-to-eat breakfast cereal and cereal bars (27% of all food advertisements), restaurants (19% of food advertisements), and snack foods (18% of food advertisements). Ninety-one percent of food advertisements were for foods or beverages high in fat, sodium, or added sugars or were low in nutrients. Cartoon characters were used in 74% of food advertisements, and toy or other giveaways were used in 26% of food advertisements. About half of food advertisements contained health/nutrition or physical activity messages and 86% of food advertisements contained emotional appeals. This study provides food and nutrition professionals with information about the amount and types of food children are encouraged to eat during Saturday morning television programming. The findings can help food and nutrition professionals counsel children about healthful eating and/or develop programs or policies to balance those advertisements with healthful eating messages.

Nickelodeon markets nutrition-poor foods to children.

BACKGROUND: While many factors contribute to childhood obesity and children's poor diets, food marketing affects children's food choices, preferences, their diets, and their health. The purpose of this study was to assess the nutritional quality of the foods marketed by one of the largest companies that markets food to children, Nickelodeon. METHODS: In fall 2005, the nutritional quality of foods advertised via Nickelodeon media and with Nickelodeon characters was assessed. The cross-sectional sample included food ads on the Nickelodeon television station and in Nickelodeon magazine, product packages with Nickelodeon characters found in one large urban grocery store, and meals at restaurants with promotions tied to Nickelodeon programs or characters. RESULTS: Of 168 television food ads, 148 (88%) were for foods of poor nutritional quality. Of 21 magazine food ads, 16 (76%) were for foods of poor nutritional quality. Fifteen grocery store products were identified with Nickelodeon characters on the packaging; nine (60%) were foods of poor nutritional quality. In addition, of the 48 possible children's meal combinations at restaurants with promotional offers tied to Nickelodeon programs, 45 (94%) were of poor nutritional quality. CONCLUSIONS: Through its food marketing, the Nickelodeon entertainment company influences the diets of millions of American children. Unfortunately, eight of ten foods, beverages, and restaurant meals advertised on Nickelodeon's television station, in its magazine, or tied to its characters are of poor nutritional quality. Rather than undermining parents' efforts to feed their children healthfully, Nickelodeon should support parents by setting nutrition standards and marketing to children only foods that meet those standards.

Exploring stress and coping among urban African American adolescents: the Shifting the Lens study.

INTRODUCTION: Stress can have a significant effect on an adolescent's long-term physical and mental well-being. An understanding of the role of unmanaged stress during early adolescence is critical for the prevention of chronic diseases such as depression. The purpose of the Shifting the Lens study was to explore perceptions of stress, sources of social support, and use of coping strategies among urban African American ninth graders. METHODS: A youth-driven, mixed-method approach was used to assess teens' perceptions of stress. During the 2001-2002 school year, teen participants (N = 26) from East Baltimore, Md, completed questionnaires, audio journals, pile-sort activities, and personal social support network maps. RESULTS: In contrast with existing literature that emphasizes the influence of violence and neighborhood factors on stress among teens, teens prioritized other sources of stress, particularly from school, friends, and family. For support, they relied on different individuals, depending on the source of the stress--friends for romantic relationship stress and family for job, school, and family stress. Sex differences in the coping styles of the participating teens were found. Girls reported more frequent use of support-seeking and active coping strategies than boys. CONCLUSION: The use of multiple data collection strategies to explore stress uniquely contributes to our understanding of how one group of teens perceives and copes with stress. Future research should explore stress from the youth perspective in communities that are similar to East Baltimore, Md. In addition, programmatic recommendations include the need for sex-specific stress management activities and education about youth stress for adults. Community participatory translation interventions based on study findings, such as a youth-produced video and a resource guide for youth service providers, were implemented.