Measurement of Nutrition Environments in Grocery Stores, Convenience Stores, and Restaurants in the Lower Mississippi Delta.

INTRODUCTION: The Lower Mississippi Delta is characterized by several factors associated with poor diet quality. Our objective was to measure local nutrition environments of pregnant women and their infants who participated in a nutrition and physical activity intervention to assess environmental exposures potentially influencing their dietary habits. METHODS: We measured the nutrition environments of 5 towns in which participants resided by using the Nutrition Environment Measures Survey for grocery stores, convenience stores, full-service restaurants, and fast food restaurants. We used general linear models to test for differences in ratio scores, calculated by dividing each food outlet score by the maximum score possible, among food outlet classes and subclasses. RESULTS: Mean total ratio scores (expressed as percentages) for the Nutrition Environment Measures Survey among 4 classes of food outlets were significantly different from one another except for convenience stores and full-service restaurants. On average, grocery stores (n = 11) had 54% of maximum points possible, followed by full-service restaurants (21%; n = 50), convenience stores (16%; n = 86), and fast food restaurants (8%; n = 119). We found no significant differences in mean total ratio scores among convenience store subclasses. For fast food restaurant subclasses, stand-alone restaurants (n = 81) had 19% of maximum points possible, significantly higher than grocery store delicatessens (6%; n = 8), corner stores that sold fast food (3%; n = 5), and gas stations that sold fast food (4%; n = 25). CONCLUSION: These 5 Lower Mississippi Delta towns scored low on nutrition environment measures associated with healthful eating. Behavioral interventions designed to bring about positive changes in dietary habits of rural residents are needed; however, effects may be minimal if environmental factors supportive of healthful eating are not available.

Quality of Meals Consumed by US Adults at Full-Service and Fast-Food Restaurants, 2003-2016: Persistent Low Quality and Widening Disparities.

BACKGROUND: Meals from full-service restaurants (FS) and fast-food restaurants (FF) are an integral part of US diets, but current levels and trends in consumption, healthfulness, and related sociodemographic disparities are not well characterized. OBJECTIVES: We aimed to assess patterns and nutritional quality (using validated American Heart Association [AHA] diet scores) of FS and FF meals consumed by US adults. METHODS: Serial cross-sectional investigation utilizing 24-h dietary recalls in survey-weighted, nationally representative samples of 35,015 adults aged ≥20 y from 7 NHANES cycles, 2003-2016. RESULTS: Between 2003 and 2016, American adults consumed ∼21 percent of energyfrom restaurants (FS: 8.5% in 2003-2004, 9.5% in 2015-2016, P-trend = 0.38; FF: 10.5%; 13.4%, P-trend = 0.31). Over this period, more FF meals were eaten for breakfast (from 4.4% to 7.6% of all breakfasts, P-trend <0.001), with no changes for lunch (15.2% to 15.3%) or dinner (14.6% to 14.4%). In 2015-2016, diet quality of both FS and FF were low, with mean AHA diet scores of 31.6 and 27.6 (out of 80). Between 2003 and 2016, diet quality of FF meals improved slightly, (the percentage with poor quality went from 74.6% to 69.8%; and with intermediate quality, from 25.4% to 30.2%; P-trend <0.001 each). Proportions of FS meals of poor (∼50%) and intermediate (∼50%) quality were stable over time, with <0.1% of consumed FS or FF meals meeting ideal quality. Disparities in FS meal quality persisted by race/ethnicity, obesity status, and education and worsened by income; whereas disparities in FF meal quality persisted by age, sex, and obesity status and worsened by race/ethnicity, education, and income. CONCLUSIONS: Between 2003 and 2016, FF and FS meals provided 1 in 5 calories for US adults. Modest improvements occurred in nutritional quality of FF, but not FS, meals consumed, and the average quality for both remained low with persistent or widening disparities. These findings highlight the need for strategies to improve the nutritional quality of US restaurant meals.

Peak expiratory flow rate and chronic respiratory symptoms among restaurant workers: a cross-sectional study from Thailand.

Background: Cooking smoke is a major source of indoor air pollution affecting millions of people worldwide. To date, there has been no epidemiological study to show the variation in health effects resulting from work at different kinds of restaurants in Thailand. This study determines lung function and chronic respiratory symptoms of workers in four types of eateries commonly found in Thailand. Methods: This is a cross-sectional study of 321 people working in four common types of restaurants in Thailand: 'tamsang' restaurants (from the Thai word ร้านอาหารตามสั่ง, a restaurant that makes a variety of foods to order) (170 people), papaya salad restaurants (51 people), noodle restaurants (50 people), and barbecue stalls (50 people).  The restaurant workers' demographic data as well as information on their working conditions was collected using a questionnaire administered in a face to face interview. Each worker's peak expiratory flow rate was measured using a portable peak flow meter. Results: This study found that working in a 'tamsang' restaurant is associated with a higher risk of poor lung function (OR = 2.59, 95% CI 1.33-5.06) and a higher prevalence of moderate dyspnea symptoms (OR = 3.79, 95% CI 1.63-8.79) compared to working in a papaya salad restaurant. The study also found that each of the following were associated with poor lung function and/or chronic respiratory symptoms: cooking with palm oil, having irritated teary eyes while cooking, cooking without a ventilation hood, long past experience working at restaurants, and working in a small cooking area (1-6 m 2). Conclusions: Work in different kinds of restaurants with variations in cooking methods and work conditions produces diverse effects on airway and lung function. Regulatory organizations should pay careful attention to protecting the health of restaurant workers, especially those working in 'tamsang' restaurants.

Socio-economic patterning of expenditures on 'out-of-home' food and non-alcoholic beverages by product and place of purchase in Britain.

While most food is consumed at home, food eaten out-of-home plays an important role in diets and it has been associated with higher energy intake and higher body weight. Beyond prepared meals, there is limited understanding of what foods people buy out-of-home and where they buy them from. This study analyses out-of-home food purchases by food groups and food outlet types, and estimates socio-economic differences in these expenditure patterns. We used a nationally representative product-level dataset of expenditures (n=2,734,987) on foods and non-alcoholic beverages for out-of-home consumption for 9,704 respondents in Great Britain (June 2015-December 2017). Population weighted estimates of per capita weekly expenditures and shares of expenditure were derived for four outlet types and eight food groups. We used linear multi-level modelling to determine differences in expenditure patterns by socio-economic status (SES) characterised via occupational social grade. Out-of-home purchases make up 25-39% of total food and beverage expenditures. Mid- and high-SES respondents spent nearly twice as much (£17.76 and £15.11 weekly), compared to low-SES respondents (£9.69) for out-ofhome food consumption. A third of expenditures across SES (36-37%) were spent in venues other than restaurants or fast-food and takeaway outlets. Meals accounted for 60% of expenditures, but a third was spent on beverages (10-12% non-alcoholic cold beverages, 17-18% hot beverages) and 9-10% on snacks. Mid- and low-SES respondents had a greater share of expenditure in takeaway and fast-food outlets, supermarkets and convenience stores, and on cold non-alcoholic beverages. Overall, low-SES respondents spent less on out-of-home foods but the share of this expenditure across different foods or outlets varied less. While restaurants, fast-food and takeaway outlets were a major source of out-of-home purchases, a significant proportion was spent in other outlets. Policies targeting out-of-home consumption should therefore consider the full range of foods as well as the diversity of places where they are sold.

Type and density of independent takeaway outlets: a geographical mapping study in a low socioeconomic ward, Manchester.

OBJECTIVES: The socioeconomic disparity in childhood and early adult obesity prevalence has been well characterised. Takeaway outlets may cluster in lower socioeconomic areas and their proximity to schools is of concern. This study aimed to map takeaway food outlets, characterise takeaway types and their proximity to educational institutions within a low socioeconomic ward in Manchester. DESIGN: The Rusholme ward and a 2 km Euclidean buffer were included as the study area. Local authority Environmental Health data were used to map the takeaway outlets, using QGIS V.2.18.0 (OPENGIS.ch LLC, Einsiedeln, Switzerland). The types of takeaway outlets and major roads were included. Number of outlets within a 400 m Euclidean walking buffer of educational institutions were mapped. SETTING: Rusholme, Manchester, UK. RESULTS: Within the study area, 202 takeaway food outlets were identified and mapped as cluster points. Of these, 62.3% are located on major (A and B) roads, while the remaining outlets were located on minor roads. The majority (57.4%) of takeaway outlets sold similar items (fried chicken, burgers, pizzas, kebabs), with the remainder offering more diverse menus. Of the 53 schools, colleges and universities within the study area, 28 (52.8%) had 1-5 takeaway food outlets within 400 m, 9 (17.0%) had 6-10 outlets; 4 (7.5%) more than 11 outlets with 12 (22.6%) having zero outlets within 400 m. CONCLUSION: Within this low socioeconomic area, there was a high concentration of takeaway food outlets, predominantly along major roads and in easy walking distance of educational establishments with the majority offering similar foods. In addition, a high proportion of these outlets were in easy walking distance of educational establishments. Public health policy needs to consider the implications of current takeaway food outlets and not just the proliferation of these outlets with current planning laws.

Categorização de um restaurante comercial na cidade de Santa Maria - RS / Category of a commercial restaurant in the city of Santa Maria - RS

O objetivo deste estudo foi realizar a auto-avaliação para a categorização de um serviço de alimentação, podendo classificar o mesmo segundo seu risco sanitário. Este artigo trata-se de um estudo de caso desenvolvido nos meses de outubro e novembro de 2018 em um restaurante comercial, no qual, aplicou-se a Lista de Avaliação, utilizada na categorização da Copa do Mundo FIFA/2014, para a auto-avaliação e futura categorização que acontecerá na cidade. Por conta das inadequações encontradas, o estabelecimento apresentou o selo de categoria C. Assim, mostrando que o local de estudo encontra-se dentros dos paramêtros de segurança sanitária, porem ainda é necessário corrigir algumas inadequações para a futura categorização final, podendo receber o selo de categoria A.

Relative Density of Away from Home Food Establishments and Food Spend for 24,047 Households in England: A Cross-Sectional Study.

Eating away from home is a risk factor for poor diet quality and obesity. With an ever-increasing proportion of household food spend directed toward eating out, the proliferation of these food establishments may contribute to their use, a potential precursor to less healthy food choices and low overall diet quality. However few studies are conducted at the national level and across a range of away from home food sources. The purpose of this study was to examine the association between the density of away from home food establishments (e.g., restaurants, fast food outlets and cafés) and household spend on away from home food within a nationally representative sample for England, UK. A cross-sectional analysis of data from Wave 1 of the UK Household Longitudinal Survey (n = 24,047 adults aged ≥19y) was conducted. Exposure was characterised as the density of away from home food establishments to all other food sources within 1 mile of the home, divided into quintiles (Q1 as lowest exposure and Q5 as highest exposure). The primary outcome included households with a high away from home equivalised monthly food spend (≥25% of total food spend). Logistic regression was used to estimate associations between away from home food establishment exposure and high away from home food spend. Away from home food establishment density was significantly associated with a greater odds of high monthly food spend (Q3: OR = 1.18, 95% CI = 1.07, 1.30; Q4: OR = 1.30, 95% CI = 1.18, 1.43; and Q5: OR = 1.52, 95% CI = 1.37, 1.68) with attenuation after controlling for known socioeconomic confounders (Q4: OR = 1.13, 95% CI = 1.02, 1.25; and Q5: OR = 1.16, 95% CI = 1.04, 1.30) compared to those least exposed (Q1). Those most exposed to away from home food establishments had a 16% greater odds of allocating more than 25% of household food spend on away from home food sources. This study provides one of the first analyses at the national level to examine the role of the local food environment in relation to household food spend, a potential precursor to diet quality and health.

Examining the validity and utility of two secondary sources of food environment data against street audits in England.

BACKGROUND: Secondary data containing the locations of food outlets is increasingly used in nutrition and obesity research and policy. However, evidence evaluating these data is limited. This study validates two sources of secondary food environment data: Ordnance Survey Points of Interest data (POI) and food hygiene data from the Food Standards Agency (FSA), against street audits in England and appraises the utility of these data. METHODS: Audits were conducted across 52 Lower Super Output Areas in England. All streets within each Lower Super Output Area were covered to identify the name and street address of all food outlets therein. Audit-identified outlets were matched to outlets in the POI and FSA data to identify true positives (TP: outlets in both the audits and the POI/FSA data), false positives (FP: outlets in the POI/FSA data only) and false negatives (FN: outlets in the audits only). Agreement was assessed using positive predictive values (PPV: TP/(TP + FP)) and sensitivities (TP/(TP + FN)). Variations in sensitivities and PPVs across environment and outlet types were assessed using multi-level logistic regression. Proprietary classifications within the POI data were additionally used to classify outlets, and agreement between audit-derived and POI-derived classifications was assessed. RESULTS: Street audits identified 1172 outlets, compared to 1100 and 1082 for POI and FSA respectively. PPVs were statistically significantly higher for FSA (0.91, CI: 0.89-0.93) than for POI (0.86, CI: 0.84-0.88). However, sensitivity values were not different between the two datasets. Sensitivity and PPVs varied across outlet types for both datasets. Without accounting for this, POI had statistically significantly better PPVs in rural and affluent areas. After accounting for variability across outlet types, FSA had statistically significantly better sensitivity in rural areas and worse sensitivity in rural middle affluence areas (relative to deprived). Audit-derived and POI-derived classifications exhibited substantial agreement (p < 0.001; Kappa = 0.66, CI: 0.63-0.70). CONCLUSIONS: POI and FSA data have good agreement with street audits; although both datasets had geographic biases which may need to be accounted for in analyses. Use of POI proprietary classifications is an accurate method for classifying outlets, providing time savings compared to manual classification of outlets.

Food environments of young people: linking individual behaviour to environmental context.

Background: We aimed to identify and characterize the food environments from which young people obtain food and to explore associations between the type of food environment and food intakes. Methods: Young people (n = 86, mean age 17 years; combined data of two sequential pilot studies (collected in 2008-09) and a study conducted in 2011-12) recorded in 4-day self-complete food diaries what food they consumed and where food was sourced. Nutrient, fruit and vegetable intake was calculated according to the source of food, categorized using a food environment classification tool. Results: Over 4 days, respondents sourced food from an average of 4.3 different food environments. Home food was used daily and was more favourable in terms of nutrient profile than out-of-home food. Food sourced from specialist outlets, convenience stores and retail bakers had the highest energy density. Food from retail bakers and 'takeaway and fast food' outlets were the richest sources of fat while vending machines and convenience stores had the highest percentage of energy from sugar. Conclusions: This work provides details of 'where' young people obtain food and the nutritional consequences of choosing those food environments. While home food was a significant contributor to total dietary intake, food was obtained from a broad range of environments; particularly takeaway, fast food and education establishments.

Classificação dos restaurantes de Pelotas-RS, cadastrados no projeto-piloto de categorização de serviços de alimentação da Anvisa / Classification of restaurants in Pelotas-RS, registered in the pilot project of categorization of food services of Anvisa

Os serviços de alimentação estão cada vez mais presentes no cotidiano das pessoas, já que oferecem refeições de rápida aquisição e consumo. Por outro lado, cresce a preocupação com o fornecimento das refeições, tanto em relação à qualidade sensorial quanto à qualidade higienicossanitária. A fim de avaliar os procedimentos de boas práticas dos restaurantes Cadastrados no Projeto-Piloto de Categorização para a Copa Do Mundo (FIFA), na cidade de Pelotas/RS, no ano de 2014, foi realizado um estudo com os dados da Vigilância Sanitária do Município, do qual participaram 57 restaurantes, distribuídos entre a zona central e 6 bairros da cidade. Os estabelecimentos comerciais foram avaliados sobre as condições referentes aos procedimentos de Boas Práticas de Manipulação de Alimentos, por meio de um checklist composto por 51 itens. A aplicação desta ferramenta ocorreu em três momentos distintos. O primeiro foi o de auto-avaliação, o qual foi efetuado pelo responsável do local e os outros dois realizados pela pesquisadora e membros da Vigilância Sanitária do Município. Ao término das inspeções realizadas pela equipe, os dados foram tabulados em software desenvolvido para a categorização. No 1° ciclo verificaram-se problemas, sendo os mais frequentes relacionados ao controle integrado de vetores e pragas urbanas, matéria-prima, preparo do alimento, armazenamento e responsabilidade, documentação e registro. No 2° ciclo os problemas, na maioria dos restaurantes, apresentaram soluções e desta forma 52,6% dos estabelecimentos classificaram-se na melhor categoria, identificado como selo A. Concluiu-se que os estabelecimentos evoluíram de um ciclo para o outro, mas ainda precisam melhorar em alguns aspectos higienicossanitários.

The act of serving food is becoming even more recorrent in peoples' everyday life because they offer fast meals for consume. However, there has been growing an issue in regard of the supplying of those meals in the aspects of its sensorial and sanitary qualitivities. In order to evaluate the procedures of good practices involving registered restaurants in the Piloct Project of Categorization for the World Cup (FIFA), in the city of Pelotas/RS, in the year of 2014, a study with databases from Vigilância Sanitária from the city council was done, from which 57 restaurants localized nearby the central area and 6 neighborhoods in the city participated. The commercial estabelishments were evaluated in regard of their conditions in procedures of Boas Práticas de Manipulação de Alimentos through a checklist composed by 51 itens. The application of this tool took place during three distinct moments. The first one was self-evaluation, which was taken by the facility responsible and the other two moments taken by the researcher and members of Vigilância Sanitária from the city council. At the end of the inspections done by the team the data were put into a table using a software developed exclusively for its categorization. At the first cycle, it was verifyed frequent problems such as integral control of vetors and urban plages, raw material, food preparation, storing and responsibility, documentation and registration. At the second cycle, the most frequent problems, in its majority, from restaurants, solutions were presented and in this way, 52,6% of the facilities were classified into the best category by the seal A. It was concluded that the facilities have grown between cycles, but still need to work on their aspects of sanitary-hygiene.

Multiple pathways from the neighborhood food environment to increased body mass index through dietary behaviors: A structural equation-based analysis in the CARDIA study.

OBJECTIVES: To examine longitudinal pathways from multiple types of neighborhood restaurants and food stores to BMI, through dietary behaviors. METHODS: We used data from participants (n=5114) in the United States-based Coronary Artery Risk Development in Young Adults study and a structural equation model to estimate longitudinal (1985-86 to 2005-06) pathways simultaneously from neighborhood fast food restaurants, sit-down restaurants, supermarkets, and convenience stores to BMI through dietary behaviors, controlling for socioeconomic status (SES) and physical activity. RESULTS: Higher numbers of neighborhood fast food restaurants and lower numbers of sit-down restaurants were associated with higher consumption of an obesogenic fast food-type diet. The pathways from food stores to BMI through diet were inconsistent in magnitude and statistical significance. CONCLUSIONS: Efforts to decrease the numbers of neighborhood fast food restaurants and to increase the numbers of sit-down restaurant options could influence diet behaviors. Availability of neighborhood fast food and sit-down restaurants may play comparatively stronger roles than food stores in shaping dietary behaviors and BMI.

Lack of healthy food options on children's menus of restaurants in the health-disparate Dan River region of Virginia and North Carolina, 2013.

INTRODUCTION: Interest has increased in understanding the types and healthfulness of restaurant foods for children, particularly in disadvantaged areas. The purpose of this community-based participatory research study was to describe the quality of restaurant food offered to children in a health-disparate region in Virginia and North Carolina and to determine if the availability of healthy foods differed by location (rural, urban) or by the predominant race (black, white, mixed race) of an area's population. METHODS: Restaurants offering a children's menu in the 3 counties in Virginia and North Carolina that make up the Dan River Region were identified by using state health department records. Research assistants reviewed menus using the Children's Menu Assessment (CMA), a tool consisting of 29 scored items (possible score range, -4 to 21). Scores were calculated for each restaurant. We obtained information on the predominant race of the population at the block group level for all counties from 2010 US Census data. RESULTS: For the 137 restaurants studied, mean CMA scores were low (mean, 1.6; standard deviation [SD], 2.7), ranging from -4 to 9 of 21 possible points. Scores were lowest for restaurants in the predominantly black block groups (mean, 0.2; SD, 0.4) and significantly different from the scores for restaurants in the predominantly white (mean, 1.4; SD, 1.6) and mixed-race block groups (mean, 2.6; SD, 2.4) (F = 4.3; P < .05). CONCLUSION: Children's menus available in the Dan River Region lack healthy food options, particularly in predominantly black block groups. These study findings can contribute to regional efforts in policy development or environmental interventions for children's food quality by the community-based participatory research partnership and help local stakeholders to determine possible strategies and solutions for improving local food options for children.

Does neighbourhood composition modify the association between acculturation and unhealthy dietary behaviours?

OBJECTIVE: Studies have shown that immigrants' acculturation is associated with numerous unhealthy behaviours. Yet, the role of environmental factors in modifying the effect of acculturation on health behaviours has received little attention. This study aims to create a more nuanced understanding of the health effects of acculturation by examining how neighbourhood immigrant composition modifies the association between individuals' eating patterns and acculturation. METHODS: Cross-sectional Data from Los Angeles County Health Survey 2007 adult sample were linked to data on retail food establishments and US Census 2000 neighbourhood characteristics. Acculturation was measured by language spoken at home and years stayed in the US. Eating fast food more than once per week and eating zero serving of fruit or vegetables during the previous day were used as proxy indicators for unhealthy dietary behaviour. Multilevel logistic regression models were performed in the full sample and in the sample with only Latino adults. RESULTS: Immigrants' lack of acculturation and living in a neighbourhood with a high percentage immigrants were associated with healthier dietary behaviour. We also identified that lack of acculturation conveyed a significantly stronger protective effect on regular fast-food consumption for immigrants living in neighbourhoods with higher percentage immigrants (OR: 0.34, 95% CI: 0.12 to 0.93). CONCLUSIONS: Among immigrants in Los Angeles County, living in a neighbourhood with a high density of other immigrants attenuates the negative effects of acculturation on healthy eating behaviours. Healthy eating promotion efforts should build on this protective effect in outreach to acculturating immigrant communities.

Impact of a letter-grade program on restaurant sanitary conditions and diner behavior in New York City.

OBJECTIVES: We evaluated the impact of the New York City restaurant letter-grading program on restaurant hygiene, food safety practices, and public awareness. METHODS: We analyzed data from 43,448 restaurants inspected between 2007 and 2013 to measure changes in inspection score and violation citations since program launch in July 2010. We used binomial regression to assess probability of scoring 0 to 13 points (A-range score). Two population-based random-digit-dial telephone surveys assessed public perceptions of the program. RESULTS: After we controlled for repeated restaurant observations, season of inspection, and chain restaurant status, the probability of scoring 0 to 13 points on an unannounced inspection increased 35% (95% confidence interval [CI]=31%, 40%) 3 years after compared with 3 years before grading. There were notable improvements in compliance with some specific requirements, including having a certified kitchen manager on site and being pest-free. More than 91% (95% CI=88%, 94%) of New Yorkers approved of the program and 88% (95% CI=85%, 92%) considered grades in dining decisions in 2012. CONCLUSIONS: Restaurant letter grading in New York City has resulted in improved sanitary conditions on unannounced inspection, suggesting that the program is an effective regulatory tool.

Changes in awareness and use of calorie information after mandatory menu labeling in restaurants in King County, Washington.

OBJECTIVES: We examined population-level impact on customer awareness and use and explored potential disparities in outcomes regarding the King County, Washington, regulation requiring chain restaurants to provide calorie information. METHODS: We analyzed 2008 to 2010 Behavioral Risk Factor Surveillance System data from 3132 English-speaking King County residents aged 18 years and older who reported eating at a regulated chain. We used regression models to assess changes in calorie information awareness and use from prepolicy to postpolicy implementation by customer demographics, health status, and restaurant type. RESULTS: Calorie information awareness and use increased significantly from 2008 to 2010. Unadjusted analyses indicated that the proportion who saw and used calorie information tripled, from 8.1% to 24.8%. Fully adjusted analyses confirmed significant increases. After policy implementation, White, higher income, and obese respondents had greater odds of seeing calorie information. Women, higher income groups, and those eating at a fast-food versus a sit-down chain restaurant were more likely to use this information. CONCLUSIONS: Significant increases in calorie information awareness and use following regulation support the population-wide value of this policy. However, improvements varied across race, income, and gender.

Fast-food fights: news coverage of local efforts to improve food environments through land-use regulations, 2001-2013. [corrected].

Zoning and other land-use policies are a promising but controversial strategy to improve community food environments. To understand how these policies are debated, we searched existing databases and the Internet and analyzed news coverage and legal documentation of efforts to restrict fast-food restaurants in 77 US communities in 2001 to 2013. Policies intended to improve community health were most often proposed in urban, racially diverse communities; policies proposed in small towns or majority-White communities aimed to protect community aesthetics or local businesses. Health-focused policies were subject to more criticism than other policies and were generally less successful. Our findings could inform the work of advocates interested in employing land-use policies to improve the food environment in their own communities.

Child-directed marketing inside and on the exterior of fast food restaurants.

BACKGROUND: Children who eat fast food have poor diet and health outcomes. Fast food is heavily marketed to youth, and exposure to such marketing is associated with higher fast food consumption. PURPOSE: To examine the extent of child-directed marketing (CDM) inside and on the exterior of fast food restaurants. METHODS: Data were collected from 6,716 fast food restaurants located in a nationally representative sample of public middle- and high-school enrollment areas in 2010, 2011, and 2012. CDM was defined as the presence of one or more of seven components inside or on the exterior of the restaurant. Analyses were conducted in 2014. RESULTS: More than 20% of fast food restaurants used CDM inside or on their exterior. In multivariate analyses, fast food restaurants that were part of a chain, offered kids' meals, were located in middle- (compared to high)-income neighborhoods, and in rural (compared to urban) areas had significantly higher odds of using any CDM; chain restaurants and those located in majority black neighborhoods (compared to white) had significantly higher odds of having an indoor display of kids' meal toys. Compared to 2010, there was a significant decline in use of CDM in 2011, but the prevalence increased close to the 2010 level in 2012. CONCLUSIONS: CDM inside and on the exterior of fast food restaurants is prevalent in chain restaurants; majority black communities, rural areas, and middle-income communities are disproportionately exposed. The fast food industry should limit children's exposure to marketing that promotes unhealthy food choices.

Óleos e gorduras: utilização no processo produtivo de restaurantes comerciais de Porto Alegre / Oils and fats: use in the production process of commercial restaurants in Porto Alegre, Brazil

In this study, we aimed to identify the types of oils and fats used in the production process of meals and investigate practices to control immersion frying in commercial restaurants. Sixty-two managers of commercial restaurants in the municipality of Porto Alegre, state of Rio Grande do Sul, Brazil were interviewed between February and April 2012. The main results showed that soybean oil (91.9%) was the most often used, followed by hydrogenated vegetable fat (35.5%), in the restaurants surveyed. As to immersion frying practices, at the establishments where managers were trained in nutrition, hydrogenated vegetable fat was less used (p<0.05). It is worth mentioning the importance of having vocational education as a tool to promote better practices in using oils and fat to produce healthy food. It is clearly necessary to have specific legislation involving the production processes and sale of meals in accordance with the policies adopted by the World Health Organization (WHO).

El objetivo del estudio fue identificar los tipos de aceites y grasas utilizados en el proceso productivo de comidas, así como investigar las prácticas en el control de las frituras de inmersión de restaurantes comerciales. Se entrevistó, entre febrero y abril de 2012, a 62 gerentes de restaurantes comerciales de la ciudad de Porto Alegre, RS. Entre los principales resultados, se destaca el aceite de soja (91,9%) como el más utilizado, seguido por la grasa vegetal hidrogenada (35,5%) en los restaurantes que participaron de la encuesta. En lo que se refiere a las prácticas de las frituras de inmersión, en aquellos establecimientos en los que el gestor poseía formación en nutrición, hubo una menor prevalencia del uso de la grasa vegetal hidrogenada (p<0,05). Se destaca la importancia de la educación profesional como herramienta promotora de mejores prácticas en la utilización de aceites y grasas para la producción de alimentos sanos y se observa la necesidad de legislaciones específicas en lo que se refiere a los procesos productivos y a la comercialización de comidas que estén en consonancia con las políticas adoptadas por la Organización Mundial de la Salud.

O objetivo do estudo foi identificar os tipos de óleos e gorduras utilizados no processo produtivo de refeições, bem como investigar as práticas no controle das frituras de imersão de restaurantes comerciais. Foram entrevistados, entre fevereiro e abril de 2012, 62 gerentes de restaurantes comerciais do município de Porto Alegre, RS. Dentre os principais resultados, destaca-se o óleo de soja (91,9%) como o mais utilizado, seguido pela gordura vegetal hidrogenada (35,5%), nos restaurantes pesquisados. Em relação às práticas das frituras de imersão, nos estabelecimentos em que o gestor possuía formação em nutrição, houve menor prevalência do uso da gordura vegetal hidrogenada (p<0,05). Destaca-se a importância da educação profissionalizante como ferramenta promotora de melhores práticas na utilização de óleos e gorduras para produção de alimentos saudáveis e percebe-se a necessidade de legislações específicas relacionadas aos processos produtivos e à comercialização de refeições que sejam consoantes às políticas adotadas pela Organização Mundial de Saúde.

Heterogeneity in TV fast food advertisement exposure in South Korea.

OBJECTIVES: To assess TV fast food ad exposure in South Korea. METHODS: We assessed time trends of targeted ratings (licensed from Nielsen Media Research Korea) by household income and education during 2004-2010. RESULTS: Lower income groups saw more fast food TV ads during the study period. Exposure decreased in all income groups with a bigger income gap in 2010 than in 2004. The relative exposure to local fried chicken franchise TV ads surged from one fifth in 2004 to half of all TV fast food ads seen in 2010 in all socioeconomic status (SES). CONCLUSIONS: Future studies should assess the link between TV fast ood ad exposure, an important contextual factor for individual food choices, and actual consumption.