Nudging food choice in a prison setting: an investigation using food choice data.

BACKGROUND: The prison population presents complex health needs and is disproportionately affected by poor health, compared to the general population. Diet has a clear role in prisoner health, and the prison food environment within which food choices are made is relatively under-researched. The aim of this study was to examine whether food choices in a women's prison changed after the introduction of a new menu design by the catering team. METHODS: The adjusted menu design incorporated an emoticon (a smiley face) placed next to designated 'Healthy Choice' foods on the menu sheets, which were used to preselect meals. Data comprised all women's (n = 865) food choices (more than 115,000 selections) for a period of 8 weeks (with the new menu) as well as 8 weeks prior (baseline period). The study design was a pre-post intervention study, and food selection was examined using chi-square tests and binary logistic regression models. RESULTS: The selection of promoted foods overall significantly increased under the new menu design (with the emoticon nudge strategy) compared to baseline; the effect size, however, was small according to the usual guidelines (21.4% compared to 20% at baseline; χ2 (1) = 32.6, p < 0.001, φ = 0.02). Individuals were 11% more likely (p < 0.001) to select the promoted 'Healthy Choice' foods under the adjusted food choice architecture. A significant effect was found for lunch and evening meal - but not for desserts. A minority of individual food items that were promoted had significant positive changes in selection, and were 1.3-4 times as likely to be selected when emoticons had been introduced, compared to baseline. CONCLUSIONS: Further research is needed to examine the potential added benefit of multiple complementary nudge strategies, and the relevance of the preselection of foods in advance of consumption.

COVID-19 and the National Lockdown: How Food Choice and Dietary Habits Changed for Families in the United Kingdom.

COVID-19 changed the way families in the UK live, with as yet uncertain impacts to food choice and dietary habits. This study sought to explore food-related experiences and changes to behavior of families with children, during the pandemic. Semi-structured one-to-one interviews with parents (n = 20) and, separately, their children (n = 22; aged 8-10 years) were conducted. An inductive thematic approach was adopted for the data analysis, and four main themes emerged: commensality; elevated place of food in the home; snacking; and food shopping. Study findings highlighted several changes: some related to increased snacking and more takeaway food; others were more favorable, including spending more time together, increased home cooking, more efficient shopping practices and reduced food waste. Overall, an elevation of the place of food within the home was apparent, alongside enhanced food literacy, and some evidence of the relocalisation of food. This study contributes to the international literature on the impact of COVID-19 and national lockdowns on family lifestyle behaviors, specifically food choice and dietary habits; further research into the longer-term effects of COVID-19 on family food practices is required.

Adolescents' dietary behaviour: The interplay between home and school food environments.

In the UK, school food standards have looked to improve the nutritional profile of school food provision and the choices made; however, adolescents' choices tend to bias towards micronutrient poor and energy dense options. This study aimed to explore how adolescents make their school food choices, along with how they engage with their environments whilst selecting food. Seven focus group interviews took place with adolescents (n = 28; 13-14 years) in a secondary school in Northern England. Discussions with participants were audio-recorded, transcribed verbatim and then analysed using an inductive thematic approach. Six themes emerged from the data: (1) parents' and adolescents' roles in the home food environment, (2) burgeoning food autonomy, (3) school food choice factors, (4) social aspects of school food, (5) home versus school, (6) food knowledge & beliefs. Adolescents identified two distinct environments during the focus group discussions: the home and school environments. Adolescents juxtaposed the two, in terms of food provision, food choices, rules and customs surrounding food choice. This juxtaposition emerged as an indirect but important influence on adolescents' school food choices. The school and home environments both (in)directly influence adolescents' school food choices, which involve an integration of multiple, often conflicting influences. Adolescents may adopt a number of unhelpful dietary rationalisations as they try to manage and reconcile these influences. Consultation, together with consideration of relevant food choice models, is required to identify opportunities to influence adolescents' food choices at school.

Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites.

BACKGROUND: News websites are an essential source of medical news for the public. Many websites offer users the opportunity to leave comments, which may provide rich insights into public perspectives on health issues. With an established role in public health, fruit and vegetable (FV) consumption is central to the government's dietary guidelines. However, FV intake continues to fall short of government recommendations. OBJECTIVE: Using comments from news websites, this study aims to explore public perspectives on FV intake and related government dietary guidelines. METHODS: Data comprised 2696 web user comments generated in response to substantial media coverage for a meta-analysis examining FV consumption and the risk of all-cause mortality, cardiovascular disease, and total cancer. Using an inductive thematic approach, the data were analyzed and coded in an iterative process. RESULTS: Four overarching themes emerged: personal factors, rejection, lack of knowledge, and food landscape, each with component subthemes. The lack of clarity around government dietary health guidelines was apparent, and this, along with emergent personal factors, may hinder better consumption. Rejection was also evident, as was a quality versus quantity of life debate. CONCLUSIONS: There are gaps in the public's understanding of government guidelines, which may act as a constraint to better compliance. Further work should examine this issue and rejection and the possibility of public fatigue related to dietary health information and news. Similarly, future work should also explore targeted interventions with a specific emphasis on health literacy.

Food insecurity: Its prevalence and relationship to fruit and vegetable consumption.

BACKGROUND: Food insecurity in UK households is a substantial and growing concern. The present study identified those at risk of food insecurity and explored the relationship between food security and fruit and vegetable consumption. METHODS: Data were examined from the Food and You survey (2016) for a large representative sample (n = 3118) living in England, Wales and Northern Ireland. A 'Food Security Score' and a 'Food Changes Score' (relating to financially driven changes to food habits) were compiled and relationships with fruit and vegetable consumption were examined. RESULTS: The prevalence of marginal, low and very low food security was 12.6%, 5.4% and 2.8%, respectively. Significant correlations were observed between food security and fruit and vegetable consumption. Food security and food changes, independently, were significant predictors for fruit and vegetable consumption. With every unit increment in the Food Security Score (i.e., more food insecure), an 11% decrease in the odds of being a high fruit and vegetable consumer was evident. Likewise, the odds of being a high fruit and vegetable consumer decreases by 5% with every increment in the financially driven Food Changes Score. CONCLUSIONS: A notable proportion (more than one-fifth) experienced marginal, low or very low food security. Food insecurity and financially driven food changes were accompanied by decreases in the odds of being a high fruit and vegetable consumer. Findings underline the potential consequences of food insecurity, and point to further work aiming to examine other dietary implications, as well as strategies to mitigate against food insecurity and its detriment.

Breakfast on the go: Evaluating the nutritional content of supermarket products.

OBJECTIVES: Breakfast consumption on the go is becoming an established food habit; this has been accompanied by a growing number of related products. Given the limited research on these products and the growing trend in breakfast consumption away from home and on the go, the aim of this cross-sectional study was to survey and scrutinize the nutritional composition of breakfast on-the-go products available in the UK. METHODS: Field visits to supermarkets of the top seven grocery retailers (accounting for 88% of the UK market) were conducted in a large city in the UK. Breakfast on-the-go products (n = 128) were identified, and data (including price, energy, and nutrients) were collected. Products were categorized according to food format (i.e., breakfast biscuits, breakfast drinks, high-protein breakfast drinks, and porridge pots). Products were profiled according to front-of-pack nutrition labeling (i.e., low, medium, high) for fat, saturated fat, total sugars, and salt content. Nutrient content and profiles were examined across categories. RESULTS: Significant associations were revealed between product type and nutrient profiles for total fat, saturated fat, and salt. Total sugar content varied from 11.8 g per portion observed in biscuits to high-protein breakfast drinks, which contained almost double this level (20.0 g). Notably, six of ten breakfast on-the-go items (60.2%) were profiled as high for total sugars (according to front-of-pack criteria). Most items were medium in total fat (87.5%), low in saturated fat (61.7%), and low in salt (56.3%). CONCLUSIONS: Reformulation of breakfast on-the-go products, principally with respect to sugar content, is warranted. This is particularly relevant given the growing role of breakfast consumption on the go and ongoing developments in the sector as new product ranges and formats are introduced.

A nudge in the right direction: the role of food choice architecture in changing populations' diets.

Populations' diets typically fall short of recommendations. The implication of this on ill health and quality of life is well established, as are the subsequent health care costs. An area of growing interest within public health nutrition is food choice architecture; how a food choice is framed and its influence on subsequent food selection. In particular, there is an appeal to manipulating the choice architecture in order to nudge individuals' food choice. This review outlines the current understanding of food choice architecture, theoretical background to nudging and the evidence on the effectiveness of nudge strategies, as well as their design and implementation. Interventions emphasising the role of nudge strategies have investigated changes to the accessibility, availability and presentation of food and the use of prompts. Empirical studies have been conducted in laboratories, online and in real-world food settings, and with different populations. Evidence on the effectiveness of nudge strategies in shifting food choice is encouraging. Underpinning mechanisms, not yet fully explicated, are proposed to relate to salience, social norms and the principle of least effort. Emerging evidence points to areas for development including the effectiveness of choice architecture interventions with different and diverse populations, and the combined effect of multiple nudges. This, alongside further examination of theoretical mechanisms and guidance to engage and inspire across the breadth of food provision, is critical. In this way, the potential of choice architecture to effect meaningful change in populations' diets will be realised.

"That's His Choice Not Mine!" Parents' Perspectives on Providing a Packed Lunch for Their Children in Primary School.

OBJECTIVE: To examine factors influencing parents' selection of packed lunches over a school lunch, their choices in food preparation, and the role of children within these. DESIGN: A qualitative approach using semistructured focus group and individual interviews. SETTING: Four primary schools in a UK local authority. PARTICIPANTS: Twenty parents providing a packed lunch for their children (aged 5-11 years). ANALYSIS: An inductive thematic approach was used to identify categories and themes. The researchers maintained rigor in the data analysis through internal discussion and review until consensus was reached. RESULTS: Children emerged as active decision makers exerting substantial power particularly in the initial decision to have a packed lunch, and then in influencing the lunch's contents. The packed lunch could be a source of anxiety for some parents; however, ultimately parents' attitudes and perceptions revolved around the key requirement that the lunch was eaten. Providing a packed lunch was a means of achieving this. CONCLUSIONS: This study highlights children's growing authority over everyday food decisions. Further research is needed to explore children's perceptions of their role in food provision. The study's findings have implications for school food, nutrition education, and school-based interventions. Frameworks that look to improve children's nutrition in this area should reflect children's growing status as food decision makers and consider how this can be employed to support and sustain positive changes.

Preparing and sharing food: a quantitative analysis of a primary school-based food intervention.

Background: Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention. Methods: The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174). Results: Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident. Conclusions: The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.

Adolescents' beverage choice at school and the impact on sugar intake.

BACKGROUND/OBJECTIVES: To examine students' beverage choice in school, with reference to its contribution to students' intake of non-milk extrinsic (NME) sugars. SUBJECTS/METHODS: Beverage and food selection data for students aged 11-18 years (n=2461) were collected from two large secondary schools in England, for a continuous period of 145 (school A) and 125 (school B) school days. Descriptive analysis followed by cluster analysis of the beverage data were performed separately for each school. RESULTS: More than a third of all items selected by students were beverages, and juice-based beverages were students' most popular choice (school A, 38.6%; school B, 35.2%). Mean NME sugars derived from beverages alone was high (school A, 16.7 g/student-day; school B, 12.9 g/student-day). Based on beverage purchases, six clusters of students were identified at each school (school A: 'juice-based', 'assorted', 'water', 'cartoned flavoured milk', 'bottled flavoured milk', 'high volume juice-based'; school B: 'assorted', 'water with juice-based', 'sparkling juice/juice-based', 'water', 'high volume water', 'high volume juice-based'). Both schools included 'high volume juice-based' clusters with the highest NME sugar means from beverages (school A, 28.6 g/student-day; school B, 24.4 g/student-day), and 'water' clusters with the lowest. A hierarchy in NME sugars was found according to cluster; students in the 'high volume juice-based' cluster returned significantly higher levels of NME sugars than students in other clusters. CONCLUSIONS: This study reveals the contribution that school beverages combined with students' beverage choice behaviour is making to students' NME sugar intake. These findings inform school food initiatives, and more generally public health policy around adolescents' dietary intake.

A qualitative study of a food intervention in a primary school: Pupils as agents of change.

This study explored the impact of a school-based kitchen project at a large inner London school. Timetabled kitchen classroom sessions (90 min every fortnight) were held with all 7-9 year old pupils. Semi-structured focus group discussions (with 76 pupils, 16 parents) and interviews (with headteachers, catering managers and specialist staff) were conducted at the intervention school and a matched control school. Categories and concepts were derived using a grounded theory approach. Data analysis provided three main categories each with their related concepts: Pupil factors (enthusiasm and enjoyment of cooking, trying new foods, food knowledge and awareness, producing something tangible); School factors (learning and curriculum links, resource implications and external pressures) and Home factors (take home effects, confidence in cooking and self-esteem, parents' difficulties cooking at home with children). Children's engagement and the opportunity to cook supported increased food awareness, skills and food confidence. In the grounded theory that emerged, take home effects beyond the school gate dominate, as children act as agents of change and influence cooking and food choice at home. These short term outcomes have the potential to lead to longer term outcomes including changing eating behaviour and diet.

Analysis of contact mechanics in McKee-farrar metal-on-metal hip implants.

Contact mechanics analysis for a typical McKee-Farrar metal-on-metal hip implant was carried out in this study. The finite element method was used to predict the contact area and the contact pressure distribution at the bearing surfaces. The study investigated the effects of the cement and underlying bone, the geometrical parameters such as the radial clearance between the acetabular cup and the femoral head, and the acetabular cup thickness, as well as other geometrical features on the acetabular cup such as lip and studs. For all the cases considered, the predicted contact pressure distribution was found to be significantly different from that based upon the classical Hertz contact theory, with the maximum value being away from the centre of the contact region. The lip on the cup was found to have a negligible effect on the predicted contact pressure distribution. The presence of the studs on the outside of the cup caused a significant increase in the local contact pressure distribution, and a slight decrease in the contact region. Reasonably good agreement of the predicted contact pressure distribution was found between a three-dimensional anatomical model and a simple two-dimensional axisymmetric model. The interfacial boundary condition between the acetabular cup and the underlying cement, modelled as perfectly fixed or perfectly unbonded, had a negligible effect on the predicted contact parameters. For a given radial clearance of 0.079 mm, the decrease in the thickness of the acetabular cup from 4.5 to 1.5 mm resulted in an increase in the contact half angle from 15 degrees to 26 degrees, and a decrease in the maximum contact pressure from 55 to 20 MPa. For a given acetabular cup thickness of 1.5 mm, a decrease in the radial clearance from 0.158 to 0.0395 mm led to an increase in the contact half-angle from 20 degrees to 30 degrees, and a decrease in the maximum contact pressure from 30 to 10 MPa. For zero clearance, although the contact pressure was significantly reduced over most of the contact area, the whole acetabular cup came into contact with the femoral head, leading to stress concentration at the edge of the cup. Design optimization of the geometrical parameters, in terms of the acetabular cup thickness and the radial clearance, is important, not only to minimize the contact stress at the bearing surfaces, but also to avoid equatorial and edge contact.

The influence of the restoration-tooth interface in light cured composite restorations: a finite element analysis.

This study examines the early shrinkage behaviour of dental composite resins, and in particular the interfacial stresses around the margins of a composite restoration. The development of stresses at the restoration-tooth interface can have a detrimental effect on the longevity of a restoration. The influence of this interface on the stress system generated in the tooth was examined using finite element analysis. The restoration-tooth interface was simulated using spring elements of varying spring constants (k = 1, 10(2), 10(4), 10(10) N/mm). Interfacial stresses varied from -0.15 to 0.42 MPa for a spring constant of 1 N/mm, and from -19 to 68 MPa for a spring constant of 10(10) N/mm. Correlations between stiffness at the restoration-tooth interface and higher shrinkage stresses due to restricted shrinkage were found. Interfacial failure at the upper and lower regions of the interface, as well as cuspal movements of the order of 2 microm were predicated for the model of the highest spring constant, 10(10) N/mm. The restoration-tooth interface modelled by the spring elements was seen to have a conclusive effect on the ensuing stress system, as well as the longevity of the restoration.

Polymerization shrinkage of dental composite resins.

Aesthetic materials have always been a priority for the restoration of anterior teeth; increasingly, they have also gained prominence in the restoration of posterior teeth. This has been due to their advantages as an alternative to amalgam. Their drawbacks however, can include poor marginal adaptation, postoperative sensitivity and cuspal movement. These are particularly associated with the polymerization shrinkage accompanying the placement of composite resins. Consequently, a variety of methods have been used for determining the polymerization shrinkage. These range from dilatometer methods, specific gravity methods and deflecting disc systems to optical methods. In this work a unique method for the qualitative analysis of polymerization shrinkage was undertaken. This method utilized a miniature transducer and provided details of the shrinkage from within the material. The results indicated movement of material towards the initiating light, followed by a return movement away from it. The study was expanded to incorporate clinical aspects, whereby the composite resin was in direct contact with dental tissue, as in a restoration. Tests were performed with surface-treated cavity moulds, as in restoration placement, and without surface treatment. Results indicated that the shrinkage was highly dependent upon the region under investigation, as well as on the state of the surface.