Erin Fitzharris University of Iowa-School of Public Health Susan Klein Iowa State University Extension Carol Voss Iowa Department of Public Health Fit for Life Program Summer 2008 1
The food environment has only recently been studied as an important contributor to the dietary decisions people make every day; decisions which ultimately impact both short- and long-term health outcomes. The built environment, or the surroundings we create for the places we live, work, shop, and so on, impacts the nutrition environment, which includes the external cues that influence one’s food choices and consumption (Sallis & Glanz, 2006). Generally, the nutrition environment in the majority of communities in the U.S. focuses on convenience, fast food, and large portion sizes and neglects fresh fruits and vegetables (2006). A nutrition environment conducive to healthy eating, where foods such as low-fat milk, fruits, vegetables, and whole grain bread are readily available at a local grocery or convenience store, is less likely to be found in lower-income communities (Frank et al., 2006; Glanz et al., 2007). Further, when healthy items are available, they are likely to cost more (Glanz et al., 2007). Therefore, one avenue for modifying eating behaviors is to change the nutrition environment in order to create an environment that is more conducive to healthy eating. A number of leading organizations in health and nutrition, including the World Health Organization, the Institute of Medicine, the International Obesity Task Force, and the Centers for Disease Control and Prevention, “have identified environmental and policy interventions as the most promising strategies for creating population-wide improvements in eating, physical activity, and weight status” (Glanz et al., 2005 p.330).
However, before environmental interventions are undertaken, the nutrition environment must first be quantitatively assessed in order to identify the primary areas on which to focus such interventions. One instrument developed to achieve this goal is the Nutrition Environment Measures Study (NEMS), which has been used to assess the nutrition environment of restaurants, grocery stores, and convenience stores (Glanz et al., 2007; Saelens et al., 2007). When assessing the
nutrition environment of restaurants, researchers looked at the following factors: availability of healthy foods, facilitators to healthful eating (i.e., nutrition information on the menu), barriers to healthy eating (i.e., menu discourages special requests), pricing (i.e., healthy entrees less expensive than regular entrees), and signage (i.e., highlighting of healthy options) (Saelens et al., 2007). This application of NEMS to fast-food and sit-down restaurants revealed that 21% of the sit-down restaurants and 36% of the fast-food restaurants assessed had healthy main dishes; however, of all the main dishes assessed in this study, less than 9% were considered healthy, indicating that diners have very limited, if any, healthy main dish choices when eating out (2007).
However, grocery stores, restaurants, and convenience stores are not the only avenues through which we purchase food; vending machines make food and beverages available in a variety of places where these items might not otherwise be purchased. In 2006, the locations of all vending machines in the U.S. could be broken down as follows: manufacturing facilities (33.8%), offices (23.5%), retail sites (10.7%), schools and colleges (9.6%), hospitals and nursing homes (7%), hotels and motels (4.4%), correctional facilities (3.3%), military bases (1.7%), and restaurants, bars, clubs (1.7%), with the remaining 4.4% of the vending machines’ locations categorized as ‘other’. Sales from all vending machines in 2006 totaled $22.54 billion (Maras, 2007). Much attention has been given to vending machines in schools in recent years; while schools are home to only a...