Christina Black

Dietary inequalities: what is the evidence for the effect of the neighbourhood food environment?

This review summarises the evidence for inequalities in community and consumer nutrition environments from ten previous review articles, and also assesses the evidence for the effect of the community and consumer nutrition environments on dietary intake. There is evidence for inequalities in food access in the US but trends are less apparent in other developed countries. There is a trend for greater access and availability to healthy and less healthy foods relating to better and poorer dietary outcomes respectively. Trends for price show that higher prices of healthy foods are associated with better dietary outcomes. More nuanced measures of the food environment, including multidimensional and individualised approaches, would enhance the state of the evidence and help inform future interventions.

The Southampton Initiative for Health: A complex intervention to improve the diets and increase the physical activity levels of women from disadvantaged communities

The Southampton Initiative for Health is a training intervention with Sure Start Children’s Centre staff designed to improve the diets and physical activity levels of women of childbearing age. Training aims to help staff to support women in making changes to their lifestyles by improving three skills: reflection on current practice; asking ‘open discovery’ questions; and goal-setting. The impact of the training on staff practice is being assessed. A before and after non-randomized controlled trial is being used to evaluate the effectiveness and cost-effectiveness of the intervention in improving women’s diets and increasing their physical activity levels.

'Making every contact count': Evaluation of the impact of an intervention to train health and social care practitioners in skills to support health behaviour change.

A total of 148 health and social care practitioners were trained in skills to support behaviour change: creating opportunities to discuss health behaviours, using open discovery questions, listening, reflecting and goal-setting. At three time points post-training, use of the skills was evaluated and compared with use of skills by untrained practitioners. Trained practitioners demonstrated significantly greater use of these client-centred skills to support behaviour change compared to their untrained peers up to 1 year post-training. Because it uses existing services to deliver support for behaviour change, this training intervention has the potential to improve public health at relatively low cost.

Measuring the healthfulness of food retail stores: variations by store type and neighbourhood deprivation

BackgroundThe consumer nutrition environment has been conceptualised as in-store environmental factors that influence food shopping habits. More healthful in-store environments could be characterised as those which promote healthful food choices such as selling good quality healthy foods or placing them in prominent locations to prompt purchasing. Research measuring the full-range of in-store environmental factors concurrently is limited.PurposeTo develop a summary score of ‘healthfulness’ composed of nine in-store factors that influence food shopping behaviour, and to assess this score by store type and neighbourhood deprivation.MethodsA cross-sectional survey of 601 retail food stores, including supermarkets, grocery stores and convenience stores, was completed in Hampshire, United Kingdom between July 2010 and June 2011. The survey measured nine variables (variety, price, quality, promotions, shelf placement, store placement, nutrition information, healthier alternatives and single fruit sale) to assess the healthfulness of retail food stores on seven healthy and five less healthy foods that are markers of diet quality. Four steps were completed to create nine individual variable scores and another three to create an overall score of healthfulness for each store.ResultsAnalysis of variance showed strong evidence of a difference in overall healthfulness by store type (p < 0.001). Large and premium supermarkets offered the most healthful shopping environments for consumers. Discount supermarkets, ‘world’, convenience and petrol stores offered less healthful environments to consumers however there was variation across the healthfulness spectrum. No relationship between overall healthfulness and neighbourhood deprivation was observed (p = 0.1).ConclusionsA new composite measure of nine variables that can influence food choices was developed to provide an overall assessment of the healthfulness of retail food stores. This composite score could be useful in future research to measure the relationship between main food store and quality of diet, and to evaluate the effects of multi-component food environment interventions.

The effect of a behaviour change intervention on the diets and physical activity levels of women attending Sure Start Children's Centres: results from a complex public health intervention.

Objectives The UK governments response to the obesity epidemic calls for action in communities to improve peoples health behaviour. This study evaluated the effects of a community intervention on dietary quality and levels of physical activity of women from disadvantaged backgrounds. Design Non-randomised controlled evaluation of a complex public health intervention. Participants 527 women attending Sure Start Childrens Centres (SSCC) in Southampton (intervention) and 495 women attending SSCCs in Gosport and Havant (control). Intervention Training SSCC staff in behaviour change skills that would empower women to change their health behaviours. Outcomes Main outcomes dietary quality and physical activity. Intermediate outcomes self-efficacy and sense of control. Results 1-year post-training, intervention staff used skills to support behaviour change significantly more than control staff. There were statistically significant reductions of 0.1 SD in the dietary quality of all women between baseline and follow-up and reductions in self-efficacy and sense of control. The decline in self-efficacy and control was significantly smaller in women in the intervention group than in women in the control group (adjusted differences in self-efficacy and control, respectively, 0.26 (95% CI 0.001 to 0.50) and 0.35 (0.05 to 0.65)). A lower decline in control was associated with higher levels of exposure in women in the intervention group. There was a statistically significant improvement in physical activity in the intervention group, with 22.9% of women reporting the highest level of physical activity compared with 12.4% at baseline, and a smaller improvement in the control group. The difference in change in physical activity level between the groups was not statistically significant (adjusted difference 1.02 (0.74 to 1.41)). Conclusions While the intervention did not improve womens diets and physical activity levels, it had a protective effect on intermediate factors—control and self-efficacy—suggesting that a more prolonged exposure to the intervention might improve health behaviour. Further evaluation in a more controlled setting is justified.

Low levels of food involvement and negative affect reduce the quality of diet in women of lower educational attainment

BACKGROUND Women of lower educational attainment tend to have poorer quality diets and lower food involvement (an indicator of the priority given to food) than women of higher educational attainment. The present study reports a study of the role of food involvement in the relationship between educational attainment and quality of diet in young women. METHODS The first phase uses six focus group discussions (n = 28) to explore the function of food involvement in shaping the food choices of women of lower and higher educational attainment with young children. The second phase is a survey that examines the relationship between educational attainment and quality of diet in women, and explores the role of mediating factors identified by the focus group discussions. RESULTS The focus groups suggested that lower food involvement in women of lower educational attainment might be associated with negative affect (i.e. an observable expression of negative emotion), and that this might mean that they did not place a high priority on eating a good quality diet. In support of this hypothesis, the survey of 1010 UK women found that 14% of the effect of educational attainment on food involvement was mediated through the womans affect (P ≤ 0.001), and that 9% of the effect of educational attainment on quality of diet was mediated through food involvement (P ≤ 0.001). CONCLUSIONS Women who leave school with fewer qualifications may have poorer quality diets than women with more qualifications because they tend to have a lower level of food involvement, partly attributed to a more negative affect. Interventions to improve womens mood may benefit their quality of diet.

Variety and quality of healthy foods differ according to neighbourhood deprivation

This study addresses a gap in the food environment literature by investigating spatial differences in the inter relationship of price, variety and quality of food in southern England. We conducted a survey of all grocery stores (n=195) in the city of Southampton, UK, and ranked neighbourhoods according to national quintiles of deprivation. We found no difference in availability or cheapest price across neighbourhoods. However, the poorest neighbourhoods had less variety of healthy products and poorer quality fruit and vegetables than more affluent neighbourhoods. Dietary inequalities may be exacerbated by differences in the variety and quality of healthy foods sold locally; these factors may influence whether or not consumers purchase healthy foods.