Lisa A. Sutherland

Guiding Stars: the effect of a nutrition navigation program on consumer purchases at the supermarket

BACKGROUND To improve diet quality and overall population health, the need to develop nutritional rating systems that are comprehensive in scope and easy for the consumer to understand and use at the point-of-purchase has emerged. OBJECTIVE Our aim was to examine the effect of a comprehensive storewide supermarket point-of-purchase nutrition navigation intervention by using a shelf-label 3-tiered star icon on consumer food and beverage choices and their associated nutritional quality. DESIGN By using a natural experiment design, purchasing data from 2006 to 2008 were obtained from a Northeast supermarket chain with 168 stores located in northern New England and New York and examined at preimplementation and at 1- and 2-y follow-up periods. RESULTS The nutrition navigation system studied showed significant changes in food purchasing immediately after implementation, and these changes continued to be significant 1 and 2 y later. When the same 8-mo period (January-August) each year was compared, in 2006, 24.50% of items purchased earned a star rating; this proportion increased to 24.98% (P < 0.001) and 25.89% (P < 0.0001) at the 1- and 2-y follow-up periods, respectively. For a 4-wk period, 1 y after program implementation, consumers purchased significantly more ready-to-eat cereals with stars (eg, less added sugars and more dietary fiber) and fewer no-star, high-sugar, low-fiber cereals. CONCLUSION Increasing rates of obesity and declining diet quality for Americans strongly support the need for effective supermarket point-of-purchase programs, such as the Guiding Stars nutrition navigation program, that provide clear, concise, and simplified nutrition information to guide consumer food and beverage choices.

Unraveling the web: an evaluation of the content quality, usability, and readability of nutrition web sites.

OBJECTIVE To determine the content quality, general readability, and usability characteristics of consumer nutrition information on the World Wide Web. DESIGN Almost 500 Web sites were identified for evaluation through 2 different approaches. Of these, 150 were included for further evaluation. Each site was rated on a 27-item tool covering content quality, readability, and usability. ANALYSIS Summary statistics, means, ranges, and standard deviation were calculated for each study variable. The statistical significance of differences between item means by search strategy was determined using Students t tests. RESULTS Web sites identified using popular search engines scored significantly lower for content quality (P < .0001), were easier to navigate (P < .001), had better overall adherence to usability standards (P < .0001), and had lower reading levels compared with those sites identified using a government Web portal. CONCLUSIONS AND IMPLICATIONS Nutrition Web sites obtained using popular search engines may be aesthetically appealing and easy to use, but they often provide inaccurate nutrition information. As consumers increasingly turn to the World Wide Web for nutrition advice and education, it is imperative that the needs of diverse user populations be identified and addressed. Future nutrition education research should build on these findings by creating strategies that help users find reliable user-friendly gateways to accurate nutrition information on the Internet.

Development and implementation of the guiding stars nutrition guidance program.

Purpose. To describe the collaborative process between a grocery retailer and a panel of nutrition experts used to develop a nutrition guidance system (Guiding Stars) that evaluates the nutrient profile of all edible products in the supermarket, and to report the results of the food and beverage ratings. Design. A collaboration between a private retailer and members of the scientific community that led to the development of a scoring algorithm used to evaluate the nutritional quality of foods and beverages. Setting/Subjects. Northeast supermarkets (n = 160). Measures. Food and beverage nutrition ratings and distribution of stars across different grocery categories. Analysis. Descriptive statistics for rating distributions were computed. T-tests were conducted to assess differences in mean nutrient values between foods with zero versus three stars or a dichotomized variable representing all foods with one to three stars. Results. All edible grocery items (n = 27,466) were evaluated, with 23.6% earning at least one star. Items receiving at least one star had lower mean levels of sodium, saturated fat, and sugars and higher amounts of fiber than products not earning stars. Conclusion. The Guiding Stars system rates edible products without regard to brand or manufacturer, and provides consumers with a simple tool to quickly identify more nutritious choices while shopping. The low percentage of products qualifying for stars reflects poorly on the food choices available to Americans.

Prevalence of Food and Beverage Brands in Movies: 1996–2005

OBJECTIVE: The objective of this study was to describe food and beverage brand placements in a large representative sample of popular movies. METHODS: We identified and coded brand placements for foods, beverages, and food retail establishments in the top 20 US box office movie hits for each year from 1996 to 2005. We also coded general movie characteristics (Motion Picture Association of America rating, run time, genre, and information about major characters). We summarized the number and types of food, beverage, and food retail establishment brands by movie characteristics and also identified manufacturers that are associated with each of the brands. RESULTS: Of the 200 movies coded, 138 (69%) contained at least 1 food, beverage, or food retail establishment brand. Movies rated PG-13 and R were significantly more likely to have brand placements compared with movies in other rating categories. Comedies, action/adventures, and horror films had more brand placements than other genres. We did not detect a significant difference in the number of movies with brand placements or mean number of placements per movie by year of movie release. A total of 1180 brand placements were identified and verified, including 427 food, 425 beverage, and 328 food retail establishment brand placements. Candy/confections (26%) and salty snacks (21%) were the most prevalent food brands, sugar-sweetened beverages (76%) were the most prevalent beverage brands, and fast food composed two thirds of the food retail establishment brand placements. CONCLUSIONS: Food, beverage, and food retail establishment brands are frequently portrayed in movies, and most of the brand placements are for energy-dense, nutrient-poor foods or product lines. Movies are a potent source of advertising to children, which has been largely overlooked.

Giving the wrong impression: food and beverage brand impressions delivered to youth through popular movies

BACKGROUND Marketing on television showcases less-healthful options, with emerging research suggesting movies promote similar products. Given the obesity epidemic, understanding advertising to youth should be a public health imperative. The objective of this study was to estimate youth impressions to food and beverages delivered through movies. METHODS Impressions were calculated by dividing US receipts annually into average movie ticket prices, then multiplying this by the number of brand appearances. Examination by ratings, product types and ages were conducted by Spearman rank correlation coefficient tests. RESULTS Youth in the USA saw over 3 billion food, beverage or food-retail establishment (FRE) impressions on average, annually from 1996 to 2005. Those aged 12-18 viewed over half of all impressions, with PG-13-rated movies containing 61.5% of impressions. There were no significant trends in brand appearances by food, beverage or FRE impressions over the decade, although there was a decreasing trend in R-rated impressions for both foods (P< 0.01) and beverages (P< 0.01), but not FREs (P= 0.08). CONCLUSIONS Movies promote billions of food and beverage impressions annually to youth. Given the public health crisis of obesity, future research should further investigate these trends, as well as the potential association of these unhealthy exposures in youth.

Nutrition Professionals in Cyberspace: Getting Wired for the New Millennium

In all of the challenges the Internet poses, there are many exciting opportunities for nutrition professionals. The Internet is creating job possibilities and new opportunities for better communication with clients. It also provides a medium for innovative resource development and creative new programs to influence consumers, a need stated by The American Dietetic Associations position paper on nutrition education for the public (7). However, this information revolution require good communication, scholarly discussions, advocacy for quality, and rigorous evaluation by nutrition professionals to meet the challenges put forth.

New technologies and their influence on existing interventions

Contents: Preface. Introductory Remarks. Part I: What Is Treatment Adherence? H.B. Bosworth, Introduction. H.B. Bosworth, C.I. Voils, Theoretical Models to Understand Treatment Adherence. Part II: Factors Influencing Treatment Adherence. K.L. Dominick, M. Morey, Physical Function/Exercise and Adherence. W.S. Yancy, J. Boan, Adherence to Diet Recommendations. L.A. Bastain, S.L. Molner, L.J. Fish, C.M. McBride, Smoking Cessation and Adherence. H.B. Bosworth, Medication Treatment Adherence. S. Zinn, Patient Adherence in Rehabilitation. Part III: Treatment Adherence in Special Populations. J. Cheng, E.C. Walter, Nonadherence in Pediatrics. J. Gonzalez, J.W. Williams, Jr., The Effects of Clinical Depression and Depressive Symptoms on Treatment Adherence. P.S. Calhoun, M. Butterfield, Treatment Adherence Among Individuals With Severe Mental Illness. S.C. Alexander, B. Sleath, C.E. Golin, C.T. Kalinowski, Provider-Patient Communication and Treatment Adherence. M. Weinberger, T. Salz, Physician Adherence to Clinical- Practice Guidelines. Part IV: Methodological Issues and Treatment Adherence. A. Ammerman, M. Tajik, Treatment Adherence at the Community Level: Moving Toward Mutuality and Participatory Action. C. Van Houtven, M. Weinberger, T. Carey, Implications of Nonadherence for Economic Evaluation and Health Policy. K. Anstrom, A. Allen, K. Weinfurt, Estimating Causal Effects in Randomized Studies With Imperfect Adherence: Conceptual and Statistical Foundations. D.B. Matchar, M.B. Patwardhan, G.P. Samsa, Improving Adherence With Clinical Guidelines. C. Skinner, S. Korbin, M. Campbell, L. Sutherland, New Technologies and Their Influence on Existing Interventions. H.B. Bosworth, M. Weinberger, E.Z. Oddone, Conclusion.