nutrition environment assessment methods

ASSESSING THE PHILADELPHIA NUTRITION ENVIRONMENT: IN-STORE MARKETING AND NEMS Alison Leung and Gabriela Abrishamian-Garcia Mentor: Karen Glanz, PhD., MPH.

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OUTLINE

Overview of nutrition environments

In-Store Marketing Perceived Nutrition

Environment Measurement Survey (NEMS-P)

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NUTRITION ENVIRONMENTS [GLANZ, SALLIS, SAELENS & FRANK 2005]

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IN-STORE MARKETING PROJECT

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Funded by the Robert Wood Johnson Foundation

PROJECT OVERVIEW Led by Penn, Temple and the Food

Trust

Assess promotion and placement of healthy versus unhealthy foods

Promotion: signage, shopper marketing Placement: location of products in the store,

placement on shelves, store layout, etc

Collaborate with supermarkets

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AIMS

Design and conduct a pilot study to evaluate the impact of low-cost in-store marketing strategies on their ability to:

1) Decrease the sale of empty calories from energy-dense, low-nutrient child-relevant foods

2) Increase the sale of healthy children’s foods 3) Be profitable, or at minimum cost neutral, to

retailers and manufacturers

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“Simply Inseparable” Cross-promotion of milk and Oreos

SIGNIFICANCE Address the childhood obesity epidemic

Change healthy food marketing at grocery stores

Fill gaps in research

Lack of in-store marketing research on children Lack of representation of diverse population groups

(race/ethnicity, income, education) Limited research on consumer behavior/health in real-life

settings

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METHODS Phase 1: Formative research and measurement

development Winter 2010: Secure cooperation of grocery chains Spring 2011: Analyze sales data June 2011: Conduct focus groups Fall 2010-Summer 2011: Develop Grocery Marketing

Environment Assessment tool (GMEA) Phase 2: Pilot intervention studies

Begin September 2011: Implement intervention (4-6 months) Throughout intervention: Intercept surveys

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PHASE 1 INTERVENTIONS: HEALTHY RETAIL SOLUTIONS

Results of focus group and sales data Fresh Grocer and Shop Rite Change signage Change product placement Place call-out signs on shelves Conduct taste-testing Target products

Milk Cereal Frozen Dinners Beverages

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GROCERY MARKETING ENVIRONMENT ASSESSMENT (GMEA)

Need a feasible measure of 4 P’s for

in-store retail environments

Measures 8 product categories Notes available products in high-

impact areas Proportion of unhealthy vs. healthy

food Records check out aisle environment

Create composite scores to prompt

and evaluate change

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Example of an “Island” of produce

MY ROLE

Test GMEA tool and begin collecting data

Assist with focus groups Create GMEA data

dictionary

11 Collecting data in a corner store

PRELIMINARY OBSERVATIONS

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LESSONS LEARNED Changes to the grocery store environment are

crucial Complexity of factors that affect food purchases Importance of collaboration between different

stakeholders

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NUTRITION ENVIRONMENT MEASUREMENT SURVEY - PERCEIVED (NEMS-P)

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Funded by Abramson Cancer Center PA Tobacco Settlement Fund

OBJECTIVES Primary Objective

Develop and validate a standardized measure of perceived nutrition environment

Secondary Objectives Evaluate whether observed nutrition environment

and perceived nutrition environment are independent Evaluate the additive mediators of the relationship

between self-reported nutrition environments and eating behaviors

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METHODS Phase 1: Measure Development and Pilot Study

• Draft Measure • Internal Review • External Review to Assess Face & Content Validity • Pilot Testing

• Phase 2: Main Measurement Study • Ascertainment of measure reliability • Ascertainment of measure validity

• Phase 3: Dissemination of Results

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STUDY LOCATIONS

• Target Area 1: Low Socioeconomic Status Area • North Philadelphia

Predominantly small corner stores & poor access to supermarkets • West Philadelphia

Main food outlets are small corner stores & fast food restaurants

• Target Area 2: Higher Socioeconomic Status Area • Chestnut Hill Area

Characterized by produce markets, small gourmet food shops and moderate access to larger supermarkets

• Wynnewood Area Characterized by access to produce markets and large supermarkets

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MAIN MEASUREMENT

Recruitment began in November 2010

Participants were asked to complete the survey 2 different times, 2-3 weeks apart.

Surveys could be completed in-person or through the mail.

Evaluated using the Nutrition Environment Measures Survey (NEMS)

Trained staff are collecting NEMS for a sample of the restaurants and stores

A portion of the restaurants and stores are being double rated for inter-rater reliability

Measuring the Perceived Nutrition Environment

Measuring the Observed Nutrition Environment

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NUTRITION ENVIRONMENT MEASUREMENT SURVEY-STORES AND CORNER STORE (NEMS-S AND NEMS-CS)

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11 measures Milk Fruit

Frozen and Canned Fruit

Vegetables Frozen and Canned

Vegetables Ground Beef Hot Dogs Frozen Dinners Baked Goods Beverages Bread Chips and Snacks Cereal

Measures… Price Availability Quality

Produce section of convenience store in West Philadelphia

NUTRITION ENVIRONMENT MEASURES SURVEY (NEMS)

Restaurants (NEMS-R) Stores (NEMS-S)

Data collected with paper survey Data collected with PDA survey

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DATA COLLECTION

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CURRENT STATUS NEMS-S data

collection Data cleaning Data analysis

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MY ROLE

Scanned surveys Data collection using NEMS-S Compiled survey comments for

review

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LESSONS LEARNED Process of data management Creating a tool to assess nutrition environments

is difficult given the wide variation in store types.

Research is a continuous process in which changes and improvements are made along the way.

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PRELIMINARY FINDINGS FROM NEMS-P

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NEMS-P SAMPLE

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Gender Frequency Percent

Female 153 69.2 Male 64 29.0 Missing 4 1.8 Total 221 100.0

Age

N Minimum Maximum Mean Std. Deviation

Age 216 20 65 45.11 11.067

IMPORTANCE OF PUBLIC TRANSPORTATION WHEN SHOPPING FOR FOOD

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IMPORTANCE OF BUYING FOOD NEAR HOME

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IMPORTANCE OF COST WHEN SHOPPING FOR FOOD

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IMPORTANCE OF CONVENIENCE WHEN EATING OUT AT A RESTAURANT

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IMPORTANCE OF WEIGHT CONTROL WHEN EATING OUT AT A RESTAURANT

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SPECIAL THANKS Dr. Karen Glanz Erica Cavanaugh Erica Davis Sarah Green Olivia Hamilton Marcia Commins Diana Chan Kate Volpicelli Luke Bingaman Bryan Kim Lissy Madden Joanne Levy 32

QUESTIONS/COMMENTS?

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