NUTRITION ENVIRONMENT MEASURES SURVEYWhat's New
NEMS News
We would like to share with others all of the exciting news and activities that relates to NEMS, whether it is a project update, a publication, grant funding, customizations, etc. Please send us an email at nems@zimbra.upenn.edu. Please click on the different categories below to learn more.
News from Us News from You Webinars Publications Project Updates
News From Us
A Tribute to Dr. 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:
Please join us in remembering this outstanding person and researcher.
NEMS Corner Store Tool (NEMS-CS)
Dr. Glanz and her research team have developed the NEMS-CS, specifically tailored for assessing corner stores. This tool is being used to assess corner stores in the Philadelphia area in conjunction with the Communities Putting Prevention To Work (CPPW) grant. They are collecting the data using PDAs with snapdragon software. If you are interested in seeing this tool, please contact us.
NEMS Perception Tool (NEMS-P)
Dr. Glanz and her research team are developing a tool to assess the perception of the nutrition environment. It is currently being pilot-tested. Stay tuned!
Built Environment Assessment Training Online Course
We have been developing a new online course for assessing the built environment for physical activity. The course will be an introduction into a few tools for assessing streetscapes, parks and trails. We hope to pilot-test the course in late fall. If you are interested in being a part of the pilot-testing, please send us an email at nems@zimbra.upenn.edu.
NEMS Online Training Wins Award!
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
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.
NEMS Vending Machine Tool (NEMS-V) Website 
Susan Klein and Carol Voss of Iowa State University Extension and Iowans Fit for Life Program received a grant from The Wellmark Foundation to develop a Nutrition Environment Measures Tool to assess the contents of vending machines (NEMS-V). Dr. Glanz and Margaret Clawson consulted on the development of the tool. The website has been launched. Please visit www.nems-v.com
On the website, you'll find a tutorial on how to use the tool and the healthy choices calculator and tips on how to take action to add some healthier options if needed.
They have received a second grant from The Wellmark Foundation to continue to build on NEMS-V. They will be assessing all the vending machines located in the buildings owned by the state of Iowa and work to get them to be filled with some healthier options, if the assessment shows it is needed. They also just handed out mini-grants to groups all over the state of Iowa that are interested in using any of the NEMS tools in their community or at their workplace.
Please go to webinars section to learn more about NEMS-V and their interesting work!
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.
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Webinars
Using NEMS-S in a Latino Neighborhood in Milwaukee, WI (about 45 minutes)
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.
The Chenango Health Network's the Restaurant Project (about 25 mins)
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
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
- If you'd like to view the webinar, click here.
- CMA tool and the scoring
NEMS-V: What is it and how it is changing Iowa and beyond!”
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.
- If you'd like to view the webinar, click here.
- If you'd like to go to the NEMS-V website, click here.
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.
- To view the webinar, please click here.
- A more detailed description of Omaha's work can be found here.
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.
- To view the webinar, please click here.
- To read a brief summary of their findings, click here.
- To view their sit-down assessment tool, click here.
- To view their quick service assessment tool, click here.
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.
- The webinar was recorded in two parts. To view the part one of the webinar, please click here. To view part two of the webinar, please click here.
- To view just the slides without the audio, click here.
- Jill and Sharon would appreciate any comments or feedback. Their emails are kirkpatricksi@mail.nih.gov and reedyj@mail.nih.gov
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.
NEMS-Related Publications
If you are going to publish a NEMS-Related publication, we strongly encourage you to include "NEMS" in the abstract, title or as a key word so that others can easily pull it up in a lit search.
2011
Dietary and built environment assessment in a Latino community
Khan S, Calloway SA, Maida T, Rakel DP. Dietary and built environment assessment in a Latino community. Am J Health Educ. 2012;43(2):74-82.
Abstract:
Background: Assessment of basic dietary intake and community nutrition environment is lacking and needed to improve health outcomes for the growing U.S. Latino community. Purpose: The dietary intake and community nutrition environment of a Latino population in the Midwest was evaluated. Methods: In a community clinic, Block Food Frequency Screeners in Spanish were administered to measure daily fruit, vegetable and fat intake. The community nutrition environment, specifically store outlets, was evaluated on the basis of availability, price and quality of foods using Nutrition Environment Measurement Surveys-Stores (NEM S-S). Results: The adult Latino community’s fruit, vegetable, and fat intake is considered “good,” except adult males exhibited a “fair” consumption of fat. NEMS-S revealed a good availability and quality of “healthy” food options in the stores, but reported higher prices, on average, for “healthy” options. Discussion: Dietary intake may reflect a community in transition from a predominantly Mexican to a standard American diet. Additional built environment assessment tools should be administered, and those that capture more of the diverse eating practices should be considered for future research, such as the NEMS-Texas survey which was developed for a predominantly Latino population in Texas. Translation to Health Education Practice: The study data are being used and adopted by other social service organizations and to inform health policy makers in Milwaukee. Future directives for research should include dietary assessments that include food items from diverse culinary traditions that more accurately capture dietary intake in United States urban settings. The newer Texas NEMS that includes all fruits and vegetables, may be better suited for urban populations nationally that may have access to fruits and vegetables from around the globe.
A Multilevel Assessment of Barriers to Adoption of Dietary Approaches to Stop Hypertension (DASH) among African Americans of Low Socioeconomic Status
Alain G. Bertoni, MD, MPH; Capri G. Foy, PhD, MS; Jaimie C. Hunter, MPH; Sara A. Quandt, PhD; Mara Z. Vitolins, DrPH, MPH; Melicia C. Whitt-Glover, PhD
Journal of Health Care for the Poor and Underserved 22 (2011): 1205–1220
Abstract:
Background: We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets.
Methods: Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS). Results. Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: 11.7, p.01, restaurants: 8.3, p.001) compared with majority White areas.
Conclusions: Interventions promoting
DASH among lower income AAs should reflect the food customs, economic concerns,
and food available in communities.
Assessment of Food Offerings and Marketing Strategies
in the Food-Service Venues at California Children’s Hospitals (in press, Academic Pediatrics)
Lenard I. Lesser, MD, MSHS; Dana E. Hunnes, RD, MPH; Phedellee Reyes, MPH;
LenoreArab,PhD;GeryW.Ryan, PhD; Robert.Brook,MD,ScD; DeborahA.Cohen,MD,MPH
Abstract:
OBJECTIVE: Marketing strategies and food offerings in hospital
cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at
the food-service venues in all 14 California children’s hospitals.
METHODS: We modified a widely-used tool to create the Nutritional
Environment Measures Survey for Cafeterias (NEMS-C)
by partnering with a hospital wellness committee. The NEMS-C
summarizes the number of healthy items offered, whether
calorie labeling is present, if there is signage promoting healthy
or unhealthy foods, pricing structure, and the presence of
unhealthy combination meals. The range of possible scores is
zero (unhealthy) to 37 (healthy). We directly observed the
food-service venues at all 14 tertiary care children’s hospitals
in California and scored them.
RESULTS: Inter-rater reliability showed 89% agreement on the
assessed items. For the 14 hospitals, the mean score was 19.1
(SD ¼ 4.2; range, 13–30). Analysis revealed that nearly all
hospitals offered diet drinks, low-fat milk, and fruit. Fewer
than one-third had nutrition information at the point of purchase
and 30% had signs promoting healthy eating. Most venues displayed
high calorie impulse items such as cookies and ice cream
at the registers. Seven percent (7%) of the 384 entrees served
were classified as healthy according to NEMS criteria.
CONCLUSIONS: Most children’s hospitals’ food venues
received a mid-range score, demonstrating there is considerable
room for improvement. Many inexpensive options are underused,
such as providing nutritional information, incorporating
signage that promotes healthy choices, and not presenting
unhealthy impulse items at the register.
Healthy food availability and the association with BMI in
Baltimore, Maryland
Casagrande, S.S., Franco, M., Gittelsohn, J., Zonderman, A.,
Evans, M., Kuczmarski, M., Gary-Webb, T. (2011) Public Health Nutrition 14 (6):1001-1007.
Abstract:
Objective: To study the association between the availability of healthy foods and
BMI by neighbourhood race and socio-economic status (SES).
Design: Trained staff collected demographic information, height, weight and 24 h
dietary recalls between 2004 and 2008. Healthy food availability was determined
in thirty-four census tracts of varying racial and SES composition using the
Nutrition Environment Measures Survey–Stores in 2007. Multilevel linear regression
was used to estimate associations between healthy food availability and BMI.
Setting: Baltimore City, Maryland, USA.
Subjects: Adults aged 30–64 years (n 2616) who participated in the Healthy Aging
in Neighborhoods of Diversity across the Life Span study.
Results: Among individuals living in predominantly white neighbourhoods, high
availability of healthy foods was associated with significantly higher BMI compared
with individuals living in neighbourhoods with low availability of healthy
food after adjustment for demographic variables (b53?22, P50?001). Associations
were attenuated but remained significant after controlling for dietary quality
(b52?81, P50?012).
Conclusions: Contrary to expectations, there was a positive association between
the availability of healthy food and higher BMI among individuals living in predominantly
white neighbourhoods. This result could be due to individuals in
neighbourhoods with low healthy food availability travelling outside their
neighbourhood to obtain healthy food.
Implementing the Alberta Nutrition Guidelines for Children and Youth In a Recreational Facility
Olstad DL, Lieffers JRL, Raine KD, McCargar LJ. Implementing the Alberta Nutrition Guidelines for Children and Youth in a recreational facility. Canadian Journal of Dietetic Practice and Research 72(4):e212-e220, 2011.
Abstract
Purpose: In this mixed-methods case study, we explored factors
influencing the adoption and implementation of the Alberta
Nutrition Guidelines for Children and Youth within recreational
facilities, and assessed the impact of their implementation on
the food environment.
Methods: Qualitative data were generated via interviews,
observations, and document reviews. The quality of the food
environment was assessed using validated and newly developed
food environment assessment tools.
Results: Whereas few barriers existed in terms of adopting the
guidelines, implementing them proved much more challenging.
Implementation was impeded by concerns about the lack
of profitability of healthy items, time, and resource constraints.
Guidelines that do not restrict the availability of unhealthy options
are better accepted by stakeholders. Implementation of
the guidelines supported creation of a healthy food environment,
but the availability of healthy items remained very limited
within the concession (16%) and vending machines (20%), and
children continued to purchase primarily unhealthy items.
Conclusions: Findings suggest that children choose healthy
options insufficiently when unhealthy items are present. Thus,
although introducing the nutrition guidelines in a nonrestrictive
format may have been advantageous in some ways, they
should be strengthened over time so that they recommend near
or total elimination of unhealthy options.
Assessing the proximity of healthy food options and food deserts in a rural area in Maine
Teresa A. Hubley
Applied Geography 31 (2011) 1224e1231
Abstract: The purpose of the project described in this paper was to assess and describe the food environment
facing public assistance clients in a rural county in Maine. Using the concept of a “food desert” and an
objective tool for rating participating food outlets, the research team developed a spatial model of client
access to healthy foods. The final map shows that most rural residents are within acceptable distances of
well-rated stores, though these may not be supermarkets.
Store Type and Demographic Influence on the Availability and Price of Healthful Foods, Leon County, Florida, 2008
Leone AF, Rigby S, Betterley C, Park S, Kurtz H, Johnson MA, Lee JS.
Prev Chronic Dis 2011;8(6):A140. http://www.cdc.gov/pcd/issues/2011/nov/10_0231.htm.
Abstract:
Introduction The availability of healthful foods varies by neighborhood. We examined the availability and price of more healthful foods by store type, neighborhood income level, and racial composition in a community with high rates of diet-related illness and death.
Methods We used the modified Nutrition Environment Measures Survey in Stores to conduct this cross-sectional study in 2008. We surveyed 73 stores (29% supermarkets, 11% grocery stores, and 60% convenience stores) in Leon County, Florida. We analyzed the price and availability of foods defined by the 2005 Dietary Guidelines for Americans as “food groups to encourage.” We used descriptive statistics, t tests, analysis of variance, and χ2 tests in the analysis.
Results Measures of availability for all more healthful foods differed by store type (P < .001). Overall, supermarkets provided the lowest price for most fresh fruits and vegetables, low-fat milk, and whole-wheat bread. Availability of 10 of the 20 fruits and vegetables surveyed, shelf space devoted to low-fat milk, and varieties of whole-wheat bread differed by neighborhood income level (P < .05), but no trends were seen for the availability or price of more healthful foods by neighborhood racial composition.
Conclusions Store type affects the availability and price of more healthful foods. In particular, people without access to supermarkets may have limited ability to purchase healthful foods. Nutrition environment studies such as this one can be used to encourage improvements in neighborhoods that lack adequate access to affordable, healthful food, such as advocating for large retail stores, farmer’s markets, and community gardens in disadvantaged neighborhoods.
The Children’s Menu Assessment: Development, Evaluation, and Relevance of a Tool for Evaluating Children’s Menus
KRUKOWSKI, RA, EDDINGS, K; SMITH WEST, D.
J Am Diet Assoc. 2011;111:884-888.
Abstract: Restaurant foods represent a substantial portion of
children’s dietary intake, and consumption of foods
away from home has been shown to contribute to excess
adiposity. This descriptive study aimed to pilot-test
and establish the reliability of a standardized and comprehensive
assessment tool, the Children’s Menu Assessment,
for evaluating the restaurant food environment
for children. The tool is an expansion of the
Nutrition Environment Measures Survey-Restaurant.
In 2009-2010, a randomly selected sample of 130 local
and chain restaurants were chosen from within 20
miles of Little Rock, AR, to examine the availability of
children’s menus and to conduct initial calibration of
the Children’s Menu Assessment tool (final sample:
n=46). Independent raters completed the Children’s
Menu Assessment in order to determine inter-rater
reliability. Test–retest reliability was also examined.
Inter-rater reliability was high: percent agreement was
97% and Spearman correlation was 0.90. Test–retest
was also high: percent agreement was 91% and Spearman
correlation was 0.96. Mean Children’s Menu Assessment
completion time was 14 minutes, 56 seconds
-10 minutes, 21 seconds. Analysis of Children’s
Menu Assessment findings revealed that few healthier
options were available on children’s menus, and most
menus did not provide parents with information for
making healthy choices, including nutrition information
or identification of healthier options. The Children’s
Menu Assessment tool allows for comprehensive,
rapid measurement of the restaurant food environment
for children with high inter-rater reliability. This tool
has the potential to contribute to public health efforts to develop and evaluate targeted environmental interventions
and/or policy changes regarding restaurant
foods.
Click here to see the tool.
2010
Individual and environmental correlates of dietary fat intake in rural
communities: A structural equation model analysis
April K.Hermstad, Deanne W.Swan, MichelleC.Kegler, J.K.Barnette, KarenGlanz
Social Science & Medicine 71 (2010) 93-101.
Abstract:
Total dietary fat and saturated fat intake are associated with obesity, elevated cholesterol, an dheart
disease.This study tested a group structural equation model to explore differences in the relative influence of individual, social ,and physical environment factors on dietary fat intake amongst adults aged 40-70 years. Participants from four rural Georgia,U.S.,counties (n = 527) completed a cross-
sectional survey that included questions about eating patterns and individual and social influences on
healthy eating. Observational measures of nutrition environments in stores and restaurants in these
counties also were completed. Models for both women and men found significant positive relationships
between self-efficacy for healthy eating and perceived nutrition environments and family support for
healthy eating. The association between self-efficacy for eating a low-fa tdiet and frequency of eating out
and grocery shopping was negative for both genders. The home nutrition environment was associated with dietary fat intake for women but not men. The results indicate that the influence of individual and
environmental factors on dietary fat intake differs for men and women, with the home environment
playing a larger role for women in rural communities.
Texas nutrition environment assessment of retail food stores (TxNEA-S): development and evaluation
Christian T Gloria* and Mary A Steinhardt
Public Health Nutrition: 13(11), 1764–1772.
Abstract:
Objective: Current nutrition environment instruments are typically designed to
measure a small number of healthy foods based on national trends. They lack the
depth to accurately measure the unique dietary choices of subpopulations, such
as Texas consumers whose food preferences are influenced by Hispanic/Latino
culture. Thus the purposes of the present study were to: (i) develop a comprehensive
observational tool to measure the availability of healthy foods from retail
stores in Texas; and (ii) conduct a pilot test to examine the tool’s reliability, as
well as differences in the availability of healthy foods in stores between high- and
low-income neighbourhoods.
Design: Grocery and convenience stores were assessed for availability of healthy
foods. Reliability was calculated using percentage agreement, and differences
in availability were examined using 2 (store type) 3 2 (neighbourhood income)
ANOVA.
Setting: One high-income and one low-income neighbourhood in Austin, Texas.
Subjects: A sample of thirty-eight stores comprising twenty-five convenience
stores and thirteen grocery stores.
Results: The low-income neighbourhood had 324% more convenience stores and
56% fewer grocery stores than the high-income neighbourhood. High inter-rater
(mean50?95) and test–retest reliability (mean50?92) and a significant interaction
(P50?028) between store type and neighbourhood income were found.
Conclusions: The TxNEA-S tool includes 106 healthy food items, such as fruits,
vegetables, dairy, proteins and grains. The tool is reliable and face validity is
affirmed by the Texas Department of Health. Grocery stores have more healthy
foods than convenience stores, and high-income
Neighborhood Impact on Healthy Food Availability and Pricing in Food Stores.Krukowski RA, West DS, Harvey-Berino J, Elaine Prewitt T. J Community Health. 2010 Feb 3. Availability and price of healthy foods in food stores has the potential to influence purchasing patterns, dietary intake, and weight status of individuals. This study examined whether demographic factors of the store neighborhood or store size have an impact on the availability and price of healthy foods in sample of grocery stores and supermarkets. The Nutrition Environment Measures Study-Store (NEMS-S) instrument, a standardized observational survey, was utilized to evaluate food stores (N = 42) in a multi-site (Vermont and Arkansas) study in 2008. Census data associated with store census tract (median household income and proportion African-American) were used to characterize store neighborhood and number of cash registers was used to quantify store size. Median household income was significantly associated with the NEMS healthy food availability score (r = 0.36, P < 0.05); neither racial composition (r = -0.23, P = 0.14) nor store size (r = 0.27, P = 0.09) were significantly related to the Availability score. Larger store size (r = 0.40, P < 0.01) was significantly associated with the NEMS-S Price scores, indicating more favorable prices for healthier items; neither racial composition nor median household income were significantly related to the Price score (P's > 0.05). Even among supermarkets, healthier foods are less available in certain neighborhoods, although, when available, the quality of healthier options did not differ, suggesting that targeting availability may offer promise for policy initiatives. Furthermore, increasing access to larger stores that can offer lower prices for healthier foods may provide another avenue for enhancing food environments to lower disease risk. |
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2008
Availability And Prices Of Foods Across Stores And Neighborhoods: The Case Of New Haven, Connecticut
Andreyeva, T., Blumenthal, D., Schwartz, M., Long, M., Brownell, K.(2008) Availability And Prices Of Foods Across Stores And Neighborhoods: The Case Of New Haven, Connecticut. Health Affairs, 27(5):1381-1388.
Abstract: Two studies compared food availability and prices in large and small stores across neighborhoods of varying income levels in New Haven, Connecticut. The findings suggest that supermarket access in lower-income neighborhoods has improved since 1971, and average food prices are comparable across income areas. Despite this progress, stores in lower-income neighborhoods (compared to those in higher-income neighborhoods) stock fewer healthier varieties of foods and have fresh produce of much lower quality. Policies are needed not only to improve access to supermarkets, but also to ensure that stores in lower-income neighborhoods provide high-quality produce and healthier versions of popular foods.
Type and Cost of Foods Sold in Baltimore Neighborhoods:
Impact on Dietary Intake and Cardiovascular Risk
Franco,M., Diez Roux, A., Glass, T., Caballero, B., Brancati, F. (2008) Neighborhood Characteristics and Availability of Healthy Foods in Baltimore. American Journal of Preventive Medicine, 35(6): 561-567.
Abstract - Background
Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition.
Methods
A cross-sectional study was conducted in 2006 to determine differences in the availability of healthy foods across 159 contiguous neighborhoods (census tracts) in Baltimore City and Baltimore County and in the 226 food stores within them. A healthy food availability index (HFAI) was determined for each store, using a validated instrument ranging from 0 points to 27 points. Neighborhood healthy food availability was summarized by the mean HFAI for the stores within the neighborhood. Descriptive analyses and multilevel models were used to examine associations of store type and neighborhood characteristics with healthy food availability.
Results
Forty-three percent of predominantly black neighborhoods and 46% of lower-income neighborhoods were in the lowest tertile of healthy food availability versus 4% and 13%, respectively, in predominantly white and higher-income neighborhoods (p<0.001). Mean differences in HFAI comparing predominantly black neighborhoods to white ones, and lower-income neighborhoods to higher-income neighborhoods, were -7.6 and -8.1, respectively. Supermarkets in predominantly black and lower-income neighborhoods had lower HFAI scores than supermarkets in predominantly white and higher-income neighborhoods (mean differences -3.7 and -4.9, respectively). Regression analyses showed that both store type and neighborhood characteristics were independently associated with the HFAI score.
Conclusions
Predominantly black and lower-income neighborhoods have a lower availability of healthy foods than white and higher-income neighborhoods due to the differential placement of types of stores as well as differential offerings of healthy foods within similar stores. These differences may contribute to racial and economic health disparities.
Project Updates
Working with Local Restaurants in New Ulm, Minnesota (2011)
The Minneapolis Heart Institute Foundation has been doing some exciting work. First, they conducted a NEMS assessment of the nutrition community in New Ulm, Minnesota. Based on the results, they created a report for restaurants using NEMS data. Now, they are working with them to try to modify their menus. Here is a link to more information on their website: http://www.heartsbeatback.org/restaurant-program
For their next steps, they are hoping to begin work in the next few months on a baseline assessment of the entire community (restaurants, grocery stores and convenience stores). Also, they had a poster on the convenience store program at the American Dietetic Association meeting this past September in San Diego. Click here to view the poster.
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
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 above in the publications.
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.
Past NEMS Project Updates
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.
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.
For more information about any of these projects, please send an email to nems@zimbra.upenn.edu