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News From Us

Built Environment Assessment Training Online Course Launched!- November 2012

We have developed a new online course for assessing the built environment for physical activity. The course is an introduction into a few tools for assessing streetscapes, parks and trails. If you would like to learn more about the course or register for it, please go to https://pabec.nursing.upenn.edu/. Please tell your colleagues about it as we really want others to be able to take advantage of these great free resources!

A Tribute to Dr. Paula Ford (Oct. 2011)paula ford

The NEMS team is very saddened to learn of the death of Dr. Paula Ford, an assistant professor in the Department of Public Health Sciences at the University of Texas at El Paso.  Dr. Ford passed away on October 8, 2011 after a lengthy battle with cancer.  Paula was a very special part of the NEMS community and she will be sorely missed in the public health world.  She attended our very first NEMS training in February 2006, then became a master trainer and assisted with a NEMS training in Austin, Texas.  Afterwards, Paula organized a NEMS training for interested parties in the state of Kansas, trained her own researchers and conducted many NEMS assessments in Western Kansas.  Below are selected articles by Dr. Ford:

Ford PB, Dzewaltowski DA. Neighborhood deprivation, supermarket availability, and BMI in low-income women: a multilevel analysis.  J Community Health. 2011 Oct;36(5):785-96.

Ford PB, Dzewaltowski DA. Limited supermarket availability is not associated with obesity risk among participants in the Kansas WIC Program.  Obesity (Silver Spring). 2010 Oct;18(10):1944-51. Epub 2010 Jan 7.

Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: three testable hypotheses. Nutr Rev. 2008 Apr;66(4):216-28. Review.

Please join us in remembering this outstanding person and researcher.

NEMS Online Training Wins Award! (2010)

The NEMS Online training has won the 2010 Best Practices in Distance Learning Programming - Bronze award from the United States Distance Learning Association (USDLA).  The award will be presented to the Center for Health Behavior Research and the developers, Centrax Corp. at the USDLA Annual International Awards Ceremony.

 

NEWS From You

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.

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. 

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.

The LiveWell EatWell Restaurant Challenge in Lawrence, KS

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-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.

Hospital Food/Beverage and Physical Activity Environment Scans

Researchers at the Centers for Disease Control and Prevention have been adapting a version of NEMS-R, NEMS-S and NEMS-V  to assess the nutrition environment in hospitals.  Collaborators on this project completed the Nutrition Environment Measures Survey  (NEMS) training, which includes didactics on the process of enumeration and fieldwork assessments of restaurants, grocery stores, and convenience stores. NEMS-Vending were also adapted to reflect components of the food/beverage and physical environments, respectively.

They intend to collaborate with hospitals across the country to conduct validity testing of these tools. The objectives of their project are 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.

If you are interested in learning more about this project, 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 which hopefully will be published soon, 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.

University of Alabama at Birmingham

Dr. Monica Baskin and her staff conducted store measure assessments in Birmingham. The ultimate goal of her study is to compare the cost and availability of fruits and vegetables in a variety of neighborhoods in Birmingham and try to detect any differences based on demographics such as race, income, etc.

University of Texas at El Paso

Paula Ford,  PhD while at Kansas State was awarded a grant from The Sunflower Foundation, a Kansas public health foundation, to evaluate rural food environments in western Kansas using the NEMS measures in conjunction with some other spatial and epidemiological analyses. She hopes to publish her results soon.

Cornell University

Leigh Gantner used the NEMS measures to examine the relationship of the food environment to early pregnancy weight and gestational weight gain in an 8 county area of rural upstate New York. Early pregnancy weight and gestational weight gain during pregnancy have been shown to be correlates of post partum weight retention, an increasingly recognized contributor to overweight and obesity in women. The analysis will help explain variation seen in early pregnancy weight and gestational weight gain, as well as contribute to a community-wide environmental intervention to promote healthy weights.


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