NEMS logo NUTRITION ENVIRONMENT MEASURES SURVEY

NEMS Applications

We would like to share with others all of the exciting applications of the NEMS tools and make this a useful webpage to other NEMS users.  We need your help in order to do that by letting us know about your NEMS projects and developments! Please keep us in the loop and send us an email at nems@zimbra.upenn.edu

Click on the links below to learn more.

 U.S. Projects and Applications         International Projects         Webinars           

Project Updates and Applications

NEMS-R          NEMS-S         Combo of NEMS

 

NEMS-R Projects and Applications

The New Elm Minnesota Project

The Minneapolis Heart Institute Foundation has been doing a variety of NEMS related work in New Elm, Minnesota over the last few years. Click here to see their poster of their convenience store program. They also have been doing an ambitious restaurant program: www.heartsbeatback.org/restaurant-program. Late 2013, they completed a follow-up NEMS-R assessment and are analyzing the results. Please go to the NEMS materials webpage if you would like to see their NEMS-R modifications.

The LiveWell EatWell Restaurant Challenge in Lawrence, KS (April 2013)

LiveWell Lawrence began the LiveWell EatWell Restaurant Challenge in late 2010. To date, 17 restaurants have accepted the challenge to offer healthy options for restaurant patrons. The program is managed and sustained by a WIC nutritionist at the Lawrence-Douglas County Health Department. The initiative rewards participating restaurants by promoting them and featuring their menu offerings in short stories posted on WellCommons, an award-winning community-journalism website that empowers local consumers and community health advocates reporting on and communicating about health and well-being issues that impact residents of Douglas County, Kansas.

To understand the relationship of food environments to eating and weight patterns, researchers need to examine accessibility of restaurants, but also factors that are believed to contribute to food choices in restaurants, including availability of more healthful foods, factors that facilitate or hinder healthful eating, pricing, and signage or promotion of healthful and unhealthful foods. As the program was originally designed, restaurants qualify for recognition by LiveWell required meeting several criteria including but not limited to the following: offering fresh, frozen or canned fruit; entrées prepared with lower-fat method (baked, steamed, poached, broiled or barbecued); offering smaller servings of entrées; offering lower fat or sugar free dessert options on menu; and providing a substitute for fried side dishes (e.g., side salad, vegetables, pasta salad or fresh fruit). This original program design is being modified as a result of an evaluation activity supported by the 2012-2013 CDRR grant. That activity resulted in the assessment of 56 Douglas County restaurants, including 17 that are currently participating in the LiveWell EatWell Restaurant Challenge. The assessment was completed using the nationally recognized Nutrition Environment Measures Survey for Restaurants (NEMS-R), which was recommended by the Dr. Anthony Randles, KDHE Physical Activity and Nutrition Program Manager. The NEMS-R assessment activity targeted current and prospective participants in the LiveWell EatWell Restaurant Challenge. As part of the 2012-2013 CDRR NEMS-R activity, a NEMS-R assessment report will be produced and provided to the 56 Douglas County restaurants evaluated in 2012. The analysis will summarize restaurant practices that facilitate or create barriers to healthful dining. The report will also identify opportunities for improvement in healthy dining.

Among EatWell restaurants, scores on the NEMS-R assessment ranged from a high of 17 to a low of 3 (excluding points allowable for kids’ menus, which not all participating restaurants had). Higher NEMS-R scores are associated with health promoting restaurant environments. 24% (4 of 17) of EatWell restaurants scored 10 or higher: Jason's Deli (17), Carlos O’Kelly’s (15), Applebee's (13) and Bambino's (10).

NEMS smart phone app related to NEMS-R scores developed for Cerro Gordo County in Iowa!  (Nov. 2013)

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The Cerro Gordo County Department of Public Health, located in north central Iowa, has been using the NEMS assessment tools for many years now. They have recently used the NEMS-R tool to assess every restaurant in the county in an effort to encourage restaurant managers to enhance their restaurant environment through healthy strategies. They have put together a book explaining the NEMS-R tool, the restaurant’s respective NEMS-R score, and highlighted a few strategies the restaurants could implement to improve their score and consequently provide a healthier eating environment for residents.  Click here to see the NEMS-R Strategy Guide for Improvement that they would like to distribute to the restaurant managers.

To complement the NEMS-R Scores, they have released a Smart Phone App that utilizes NEMS-R scores in the county for public use when deciding where to dine throughout Cerro Gordo County. As restaurants improve, their scores will be updated. The public health department received funding through the Iowa Department of Public Health Community Transformation Grant.  Click here to view Powerpoint presentation.

To see the Android version, click here.

To see the Apple version, click here.

Chenango Health Network NEMS Assessment (Nov. 2011)

The Chenango Health Network who is the lead organization of a local health planning group conducted NEMS assessments of restaurants in their area in Chenango County in rural New York in late 2010. If you'd like to read about their results, click here.

After reviewing the results, the group members developed The Restaurant project which is an ecological approach to healthy eating, uses evidence-based chronic disease prevention strategies, builds on community strengths and resources and, uses a logic model which enables partners to assess and evaluate progress.  If you'd like to see their logic model, click here.

They launched The Restaurant Project which involves seven locally owned restaurants in different parts of this rural county. They have been working with the restaurants--adding and promoting healthy food choices and have started to promote these restaurants locally. These restaurants also have a strong community connection. The next step is to begin a broad community education campaign about eating out and ordering choices. They have been partnering with worksites/employers who have wellness activities underway.  Other restaurants would like to participate but due to funding and staffing, they will have to wait.

If you'd like to learn more about this project, you can contact Tina Utley Edwards, Executive Director of the Chenango Health Network at tina@chenangohealth.org

 

NEMS-S Projects and Applications

Example of Using NEMS as a Teaching Tool

John Hopkins Political Science Professor Adam Sheingate decided to use the NEMS-S tool with a summer class. Click here if you would like to read more about his class project.

Using NEMS-S to Study Food Access in Baton Rouge, LA.

Dr. Stephanie Broyles at the Pennington Biomedical Research Center in Baton Rouge, LA, received a grant from the American Heart Association to study children’s neighborhood food environments. Four data collectors used the NEMS-S program for tablets and visited over 550 food stores and produce markets in the parishes surrounding Baton Rouge. The data are being linked to other study data to investigate the impact of local food environments on a variety of health outcomes and behavior changes. The data have also been used to inform local food access policy within the East Baton Rouge Food Access Policy Commission’s findings and recommendations.

Presentation of NEMS-S Adaptation for Mexican Americans

Dr. Donna M. Winham presented the adaptation of the NEMS-S tool for the Mexican American population at the Experimental Biology Conference in April 2013 that she and Dr. Seline Szkupinski Quiroga collaborated on while at Arizona State University. The tool itself has not been publicly released but you can click here to view the slides on the adaptation.  Dr. Winham is the owner and principal consultant at Howell Research Associates, LLC www.howellresearch.org and can be contacted at dmwinham@howellresearch.org.

The New Elm Minnesota Project

The Minneapolis Heart Institute Foundation has been doing a variety of NEMS related work in New Elm, Minnesota over the last few years. Click here to see their poster of their convenience store program.

Seattle, WA (2010)

Graduate student Sara Coulter wrote her thesis on her NEMS-S data collected in a low-income racially diverse neighborhood in Seattle, WA.  To read the abstract of her results, please click here.  To read the entire thesis, click here.

Leon County, Florida (2010)

Angela Leone, a graduate student at UGA analyzed the NEMS data collected in Leon County, Florida.  To read the abstract of her results, please click here. You can also see her publication of the results on the publications webpage.

 

Combination of NEMS Tools Used

CDC and NPS Tools and Protocol for Evaluating National Parks

CDC and the National Park Service modified NEMS tools to evaluate the nutrition environments in the national parks. To see each setting's tool and protocol, click on each link below:

NEMS Project in Rural Arizona Town

The Arizona Area Health Education Center (AHEC) is funding a project using both the NEMS-S and NEMS-R in a rural Arizona town as part of a comprehensive assessment of the community nutrition environment.  The assessment combines data collected from surveys of members of a local coalition, community meetings, community surveys, secondary data, and the NEMS tools.  The goal is to establish baseline measures and identify policy or environmental-level interventions that could potentially improve the local community nutrition environment.  The assessment, including the NEMS project, is the preliminary research of a Mel and Enid Zuckerman College of Public Health, University of Arizona, doctoral student, Elizabeth Kizer, for a planned community based participatory research dissertation project.  Six local residents are participating in the NEMS project by volunteering their time to be trained as NEMS raters and perform surveys in every licensed store and restaurant in town (a total of 35 surveys).  A community action board will review the assessment, the NEMS data collected, and develop strategies to achieve policy or environmental-level change, which will guide this researcher and the local coalition, to improve the local food environment. 

Hospital Food/Beverage and Physical Activity Environment Scans

Dr. Belay is hopeful that the scan will be released this spring 2014.

Researchers at the Centers for Disease Control and Prevention have adapted a version of NEMS-R, NEMS-S and NEMS-V  to assess the nutrition environment in hospitals. 

They collaborated with hospitals across the country to conduct validity testing of these tools. The objectives of their project were to adapt a food & beverage retail environment assessment tool for hospitals and to disseminate these tools such that hospitals can increase knowledge about and monitor healthy hospital environments. To read the published article in Preventing Chronic Disease, click here.

If you are interested in learning more about the tool for your own use, please contact Dr. Brook Belay at hup1@cdc.gov.

NEMS Tool for Assessing the Nutrition Environment on College Campuses

Fifteen post-secondary institutions assessed their near and on-campus eating environment using NEMS-S and NEMS-R tools modified by Dr. Tanya Horacek from Syracuse University. In the study, Dr. Horacek concluded that a college campus provides an eating environment with an array of dining and shopping venues,­­­­ most of which are not consistent with dietary recommendations for good health and obesity prevention. The findings of this study provide evidence in support of campus initiatives to evaluate and improve the quality of their own and surrounding eating environments.

The modifications made to NEMS-R to assess Campus Dining venues included the addition of a detailed evaluation of salad bars, vegetarian options, non-dairy milk alternatives, and cereals.  NEMS-S was expanded to evaluate canned and frozen fruits and vegetables (F/V), other ground lean meats, vegetarian (meat alternative) products, and the cereal (by fiber criteria).

NEMS-R.Campus Dining and protocol.

If you'd like to access all of Dr. Horacek's customization materials, please go to the NEMS materials webpage.  Also, please go to the publications page, to view Dr. Horacek's published articles on the project.

NEMS-Related Video from NEMS User

Sarah Moen, a student in Wisconsin who worked on a NEMS project over the summer of 2011, created a video of her NEMS experience.  To see her video, click here.

 

For more information about any of these projects, please send an email to nems@zimbra.upenn.edu

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International Projects

NEMS Project in Guatemala

Towards the development of a Nutrition Environment Measures Survey in Stores (NEMS-S) tool to measure the Guatemalan food environment

With greater availability of ultra-processed foods and the transition away from subsistence agriculture, Guatemala is undergoing a nutrition transition. Whereby, with a greater availability of energy-dense, inexpensive foods high in fats and sugars, there is a greater consumption of these foods; this has often been associated with obesity. Amongst Guatemalan women aged 15-49 y, overweight and obesity have increased from rates of 34% to 59% between 1995-2008 (Kanter et al. 2013). To be able to conduct studies to assess associations between individual level diet, health, and socio-demographic data and food environment measures between urban and rural areas, respectively, in Guatemala, valid and reliable food environment measures are necessary.

To develop an appropriate NEMS-S tool for Guatemala, it was important to first pilot test the original NEMS-S in Guatemala in its verbatim, original form. This work is a collaboration between the Institute of Nutrition of Central America and Panama, specifically the INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), and CeSSIAM, Center for Studies on Sensory Impairment, Aging, and Metabolism, both located in Guatemala City, Guatemala. Two certified NEMS-S raters pilot tested the original NEMS-S on two separate occasions in four different supermarkets in Zone 3 of Quetzaltenango (Xela), Guatemala, the second largest city in Guatemala. We found that the original NEMS-S had both high inter-rater and test-test reliability. However, measurement validity varied by food item. Based on a subjective analysis regarding how easy raters could fill out the original NEMS-S, it performed very good for fruits and vegetables; good for juice, bread, chips, and cereal; but poor for lean meat, milk, frozen dinners, hot dogs, diet soda, and baked goods. Based on these results and Guatemalan dietary survey data, we have begun a process to design a modified NEMS-S tool for Guatemala; and are in the process of testing this tool. Ultimately, we plan to conduct studies that assess the relationship between individual level data and food environment measures between urban and rural areas of Guatemala with survey instruments of equal reliability, but adapted to the food-offering realities of the Western Highlands.

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Webinars

Using NEMS-S in a Latino Neighborhood in Milwaukee, WI (about 45 minutes) (2012)

Stephanie Calloway and Tatiana Maida of CORE/El Centro in Milwaukee, WI trained some promotoras to collect NEMS-S data. Learn about their project and results in this webinar. If you would like to contact them to learn more, email Stephanie at stephaniec@core-elcentro.org.

If you'd like to view the webinar, click here.  If you would like to read more in-depth about their project, please go to the publications page.

The Chenango Health Network's the Restaurant Project              (about 25 mins) (2012)

The Chenango Health Network based in Norwich, NY conducted NEMS-R assessments almost two years ago. Based on the results, they along with their collaborators designed The Restaurant Project, an intervention with some of the restaurants. Chris McAvoy, the program coordinator would like to share more details about their project and their successes in this webinar on March 2, 2012.

If you'd like to view the webinar, click here.

The Children's Menu Assessment (CMA) Tool and how it is being used to track policy change in California (2012)

On January 31, 2012, Becca Krukowski, PhD, University of Arkansas for Medical Sciences and Jennifer Otten, PhD, RD, Stanford Prevention Research Center presented on the use and scoring of the Children's Menu Assessment tool and how the tool is being used to track the impacts of toy giveaway legislation in California.

Background: The Children's Menu Assessment tool was adapted from the NEMS-R, to focus attention on restaurant children's menus. This tutorial will provide training on the use of the tool, how to score it and an example of how it is being used in the field to track the impacts of California's toy giveaway legislation - legislation prohibiting restaurants from distributing toy giveaways with meals, foods, and beverages not meeting minimal nutrition criteria. The tool and the instructions are attached and can also be found at: https://riskfactor.cancer.gov/mfe/instruments/krukowski-childrens-lunch-dinner-menu-assessment

NEMS-V: What is it and how it is changing Iowa and beyond!” (2012)

On January 26, 2012, Carol Voss of the Iowa Department of Public Health and Susan Klein of Iowans Fit for Life presented on Iowa's experiences in using the NEMS vending machine assessment tool and its website development and how their project is leading to policy and environmental change in Iowa. If you'd like to contact Carol and Susan with questions, their emails are carol.voss@idph.iowa.gov  and susanklein50@gmail.com.

Omaha's use of NEMS-S for their WIC Poject (March 12, 2010)

During the March 12, 2010 State Nutrition Environment Workgroup webinar, Mary Baluff, MS, RD, LMNT, Chief of the Community and Health Nutrition Services from the Douglas County Health Department in Omaha, NE, presented on a community specific tool that was developed by the DCHD to better understand the adequacy of the retail food network and its capacity system to meet the demands of the new WIC food packages.

Assessing Kid's Menus in Restaurants in Thurston County, Washington (April 16, 2010)

Making a Better Choice for Kids:  What Restaurants Have to Offer

Washington State University Extension partnered with Thurston County Public Health and Social Services to investigate the availability of healthier children’s menu options at restaurants.  An adapted Nutrition Environment Measures Survey (NEMS) was used to assess availability of healthier entrees, sides, and beverages listed on children’s menus.  All but nineteen potentially eligible restaurants in Thurston County, Washington were visited. After pre-testing and revising, surveys were completed by trained surveyors.  A total of 129 quick service and 161 sit down restaurants were visited between April-May 2008.  A children’s menu was present at 187 or 64% of all restaurants.  Menu text, meal names, and food items were sometimes ambiguous or difficult to read.   Zena Edwards, WSU Thurston County Extension Food Safety & Nutrition faculty will share lessons learned for conducting this type of assessment and plans for use of the data. 

NCI's Measures of the Food Environment Web-based Compilation(June 4, 2010)

https://riskfactor.cancer.gov/mfe

Jill Reedy and Sharon Kirkpatrick will provide an overview of NCI's Measures of the Food Environment web-based compilation, which includes citations for peer-reviewed research encompassing the measurement of food environments, as well as many of the instruments used in the research.  The compilation currently includes articles (and associated instruments) published since 1990 related to food environments in stores, restaurants, schools, and worksites, and is being expanded to include measures of the home food environment.

 

To be a webinar speaker or to be added to the contact list for information on future webinars, email us at: nems@zimbra.upenn.edu.

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