Public Health Population Determinants of Unhealthy Foods and Beverages
Rachel J. L. Prowse, Kim D. Raine
  • LAST MODIFIED: 27 April 2017
  • DOI: 10.1093/obo/9780199756797-0160


A population perspective on determinants of health behaviors, such as eating, seeks to understand how individuals interact with their environments. Features of environments that impact behavior range from local settings to broad cultural or political influences. Multiple conceptual frameworks (see especially the work of Laura Brennan, Karen Glanz, Mary Story, et al., in the Annual Review of Public Health and American Journal of Health) and narratives (a good example is Kim Raine’s Determinants of Healthy Eating in Canada: An Overview and Synthesis) may be useful in understanding the multidimensional nature of population determinants of eating (all works cited under General Overviews and Theoretical Frameworks). First, eating behavior can be impacted by different ecological levels (individual to collective/ environmental) (see Raine’s Determinants of Healthy Eating). Secondly, eating can be influenced by several types of environments (see Brennan, et al’s “Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity” in the Annual Review of Public Health). Third, the impact of environmental influences may vary depending on an individual’s perception of the environment and their life stage. Above all, each level and dimension is part of an interconnected, reinforcing system which can produce and reproduce eating behaviors, making it extremely complex to effectively intervene. At the individual level, factors such as physiological and psychological states, food preferences, and knowledge contribute to diets; however, individual factors are “necessary, but not sufficient to explain eating behavior” (p. S9). Collective environmental influences generate the context for our eating decisions by dictating what food is available, affordable, and acceptable to eat (see Raine 2005, cited under General Overviews and Theoretical Frameworks). Models of environmental determinants of (un)healthy eating have evolved over time to include five broad categories of collective influences on behavior: physical, economic, social, communication, and political (see Brennan). Organized by environment type, key resources are provided to explore population determinants of (un)healthy eating, the interaction between different environment types and the intersection of the individual and their environments. Any student, researcher, practitioner, or policymaker involved in areas relevant to public health nutrition (such as dietetics, geography, urban planning, business, economics, social assistance, job creation, food security, nutrition education, marketing, immigration, surveillance, or politics, to name a few) will find valuable references here. This article will impart knowledge on how to study, develop, implement, and monitor effective population interventions to improve diet. Compared to individual-level interventions, such as dietary counseling, population interventions can have a far-reaching impact by targeting distal determinants of diet and health. For example, this review provides a sample of population interventions (including how we design cities, distribute income, use food, and regulate industry) and indicates how policies and programs can be used at multiple levels to reduce unhealthy eating.

General Overviews and Theoretical Frameworks

Few overviews on population determinants for (un)healthy food and beverage consumption have been published. Those that exist provide a combination of evidence on individual and collective environmental factors impacting eating behavior. Sleddens, et al. 2015 provides an umbrella review of systematic reviews on the influences of youth diets, looking at four environments (physical, social, economic, political) as well as socio-cognitive factors. Mixed findings for environmental factors may reflect the immaturity and quantity of research available on the topic, as well as its complexity. Since healthy and unhealthy eating are not mutually exclusive behaviors, the determinants of healthy eating can provide insight into the same for unhealthy eating. Raine 2005 uses a population lens to explain why groups may or may not meet food and nutrition recommendations and why multilevel collective approaches will be effective in promoting healthy eating in populations. Three significant theoretical frameworks that depict the relationship between several determinants and food consumption include Glanz, et al. 2005; Brennan, et al. 2011; and Story, et al. 2008. All have been cited extensively and have been used to inform and explain research on population determinants of healthy and unhealthy eating. These frameworks share similarities in that each considers multiple environmental factors but differ in how these factors relate to one another, the individual, and eating behaviors. Glanz, et al. 2005 centers on features of the physical food environment that impact how individuals perceive their environment and their behaviors. Conversely, Brennan, et al. 2011 focuses on several different types and levels of environmental factors (physical, economic, social, and communication) situated within multiple political contexts. Bowen, et al. 2015 and Olstad, et al. 2014 are two examples where these theoretical frameworks have been used to research and evaluate interventions and actions. Story, et al. 2008 is a third framework that presents determinants using an ecological model where an individual is placed within multiple distal and proximal social, physical, and political environments.

  • Bowen, Deborah J., Wendy E. Barrington, and Shirley A. A. Beresford. 2015. Identifying the effects of environmental and policy change interventions on healthy eating. Annual Review of Public Health 36:289–306.

    DOI: 10.1146/annurev-publhealth-032013-182516Save Citation »Export Citation » Share Citation »

    Utilizes the Glanz, et al. 2005 framework to explore the evidence on existing and potential interventions on influences of diet. Examples of intervention reviewed at each level of the framework: government policies (assistance programs, menu labeling, food taxation), information (marketing to children), food environment settings (organizations, neighborhoods, retail outlets), and the perceived nutrition environment.

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  • Brennan, Laura, Sarah Castro, Ross C. Brownson, Julie Claus, and C. Tracy Orleans. 2011. Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity. Annual Review of Public Health 32:199–223.

    DOI: 10.1146/annurev-publhealth-031210-101206Save Citation »Export Citation » Share Citation »

    Positing poor diet as a cause of childhood obesity, this article breaks down the types of environments (physical, economic, social, communication) and situates them within local, regional, and national policy contexts as determinants of diet. Useful to understand how political features at various levels influence each environment type and to inform multilevel practical interventions or research.

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  • Glanz, Karen, James F. Sallis, Brian E. Saelens, and Lawrence D. Frank. 2005. Healthy nutrition environments: Concepts and measures. American Journal of Health Promotion 9.5: 330–333.

    DOI: 10.4278/0890-1171-19.5.330Save Citation »Export Citation » Share Citation »

    Original framework describing how individual eating behavior is influenced by features of various food environments (retail areas, communities, home, work, and school), as well as information and media and government policies. Considers how individuals, their attitudes and beliefs, and environmental factors interact to produce behavior. Can inform food environment interventions and research.

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  • Olstad, Dana L., Kim D. Raine, and Candace I. J. Nykiforuk. 2014. Development of a report card on healthy food environments for children in Canada. Preventive Medicine 69:287–295.

    DOI: 10.1016/j.ypmed.2014.10.023Save Citation »Export Citation » Share Citation »

    Operationalizes the Brennan, et al. 2011 environmental framework to explore how environments, interventions, and policies in Alberta, Canada, support or create barriers for healthy eating and healthy weights in children. Explores using expert rankings of the quality of environments based on achievement of a priori indicators and benchmarks. Emphasizes healthy eating promotion through a “whole society” approach.

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  • Raine, Kim. 2005. Determinants of healthy eating in Canada: An overview and synthesis. Canadian Journal of Public Health 96.S3: S8–S14.

    DOI: 10.17269/cjph.96.1499Save Citation »Export Citation » Share Citation »

    Emphasizes collective determinants of eating, such as environmental and policy contexts and how individual factors interact with contextual factors. Gives several examples within each category of determinants. Highlights need for population health promotion approach to nutrition. Clear overview for anyone new to population nutrition.

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  • Sleddens, Ester, Willemieke Kroeze, and Leonie F. M. Kohl, et al. 2015. Determinants of dietary behavior among youth: An umbrella review. International Journal of Behavioral Nutrition & Physical Activity 12:1–22.

    DOI: 10.1186/s12966-015-0164-xSave Citation »Export Citation » Share Citation »

    Review of systematic reviews that assesses influences at individual and environmental levels and interactions between the two on the eating habits of youth. Useful starting point to find systematic reviews on a specific influence or aspect of diet. Highlights concerns with available research on this topic.

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  • Story, Mary, Karen M. Kaphingst, Ramona Robinson-O’Brien, and Karen Glanz. 2008. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health 29:253–272.

    DOI: 10.1146/annurev.publhealth.29.020907.090926Save Citation »Export Citation » Share Citation »

    Ecological framework of the determinants of diet that includes nested levels of influence: personal characteristics, social factors, features within settings (schools, work, communities, stores) and broad policy, program, and societal factors. Highlights that individuals are surrounded by multiple environmental factors influencing their food choices.

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The Physical Environment

The physical environment influences food choice and eating behavior through food accessibility and availability (Raine 2005, cited under General Overviews and Theoretical Frameworks). The physical food environment can be modified in local-level settings such as schools, stores, or neighborhoods. For example, schools may implement “junk” food bans, thereby decreasing availability of unhealthy choices. Stores or restaurants may sell only large portion sizes, encouraging overconsumption. Macro-level policies can be used to create supportive physical environments; for example, agriculture policies may protect food production, thus influencing the availability of healthy food, while urban zoning policies may place restrictions on the number and types of food retail or food service operations, thus limiting access to unhealthy foods (Raine 2005, cited under General Overviews and Theoretical Frameworks). Physical features are one of the most studied areas of food environments. This section includes an assortment of resources that provide an introduction to the current evidence on how physical environments impact diet. It includes three systematic reviews on the impact of food access on diet (Reviews on the Physical Environment). It also includes a collection of resources that explore the physical features of home, schools, and communities, as well as how individuals interact with the same and how other environmental features (social, economic) blend with physical environments to produce behavior (see Physical Environment Features). Finally, the section concludes with an examination of various debates on this topic, weighing the concepts of “food deserts” (poor access to healthy food) and “food swamps” (easy access to unhealthy food), objective and perceived environmental factors, and local versus global influences (see Debates Surrounding the Physical Environment).

Reviews on the Physical Environment

Three systematic reviews summarize the available research (usually cross-sectional studies): Caspi, et al. 2012; Engler-Stringer, et al. 2014; and Williams, et al. 2014. Each demonstrates that the physical food environment can be investigated or measured in several ways to understand how physical features impact eating behavior and diet quality. Both Caspi, et al. 2012 and Engler-Stringer, et al. 2014 provide broad overviews of the state of knowledge of the impact of physical food environment factors on dietary intake/eating behavior and explore differences in research methods to explain variability in findings. While Caspi, et al. 2012 included studies with adults and children, Engler-Stringer, et al. 2014 focuses her investigation by selecting only studies that evaluated impacts on children aged 5–18 years. Interestingly, Caspi, et al. 2012 found evidence that perceived access to food was more consistently associated with food intake than objectively measured access. Caspi, et al. 2012 also concluded that relationships observed between the exposure and outcome did not appear to depend on the quality of study methods used. Similarly, Engler-Stringer, et al. 2014 found that the majority of studies reviewed revealed at least one positive association with diet even though inconsistent methods were applied across the studies. Finally, Williams, et al. 2014 fills a gap by specifically focusing on studies evaluating food environments located around schools. Although her findings were mixed, Williams, et al. 2014 explains that failing to consider other physical or environmental factors that impact students’ food choices before, during, and after school and examining only the presence of retail food stores or restaurants around a school limits her conclusions.

  • Caspi, Caitlin E., Glorian Sorensen, S. V. Subramanian, and Ichiro Kawachi. 2012. The local food environment and diet: A systematic review. Health & Place 18.5: 1172–1187.

    DOI: 10.1016/j.healthplace.2012.05.006Save Citation »Export Citation » Share Citation »

    Synthesis of impact of physical environment characteristics on dietary intake. Focuses on food availability and accessibility but also reviews economic and social aspects. Provides insight into how different measurement techniques impact findings. A good introduction for graduate students or new researchers to the state of evidence, methodological considerations, and needed research.

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  • Engler-Stringer, Rachel, Ha Le, Angela Gerrard, and Nazeem Muhajarine. 2014. The community and consumer food environment and children’s diet: A systematic review. BioMed Central Public Health 14.1: 1271–1291.

    DOI: 10.1186/1471-2458-14-522Save Citation »Export Citation » Share Citation »

    Comprehensive account of state of evidence on how retail and neighborhood features impact the types of foods children consume and their overall diet quality. Outlines which environmental features have been most consistently associated with children’s diet. Useful for graduate students or novice researchers interested in understanding environmental influences on children’s food intake.

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  • Williams, J., P. Scarborough, A. Matthews, et al. 2014. A systematic review of the influence of the retail food environment around schools on obesity-related outcomes. Obesity Reviews 15.5: 359–374.

    DOI: 10.1111/obr.12142Save Citation »Export Citation » Share Citation »

    Focused review evaluated the impact of food store/restaurant proximity to schools on children’s food purchasing, diet, and weight. Unhealthy food access increased intake in half of the correlations reported, but few were statistically significant. Despite mixed findings, re-conceptualizes how food environments can impact children and youth by examining the school community environment.

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Physical Environment Features

Physical determinants of population diets include features located within and around local settings, such as the home, school, or work. The studies below examine multiple features of physical environments in these settings and their relationship with diet. The research on food stores and restaurants is diverse and complex. Measurement issues are a recurrent theme. Minaker, et al. 2009 assesses features within and around restaurants on a university campus as a means to develop a valid food environment assessment tool. Her findings help to reveal some complexities of researching food retailers and suggest that it may be shortsighted to assume certain types of retailers are healthy or unhealthy. Researchers from the University of Pennsylvania (Karen Glanz) have led the development and evaluation of the Nutrition Environment Measures Survey (NEMS), an observational assessment tool with several adaptations to guide food environment research and interventions. Sanchez-Flack, et al. 2016 reports on certain features of small grocery stores in the United States that influence food purchasing behaviors in Latino customers from the perspective of the manager. School environment is a promising area for intervention (See Brennan, et al. 2014, cited under Types of Policy Interventions). Briefel, et al. 2009 provides insight into what school environmental factors are associated with student food intake from a cross-sectional study of US schools. Welker, et al. 2016 reflects on how school food environments have or have not supported healthy weights in students in the 21st century. Looking at the home environment, van Ansem, et al. 2014 specifically evaluated the impact of physical and economic factors on children’s snack and sugar-sweetened beverage intake, including access to said products within the home. The community nutrition environment, the space between the home, school, and food stores and restaurants, is another food environment. Community-level food access is evaluated by Zenk, et al. 2014 and Skidmore, et al. 2010. Zenk, et al. 2014 uses research methods that evaluate perceived access to food at a particular time point as a determinant of unhealthy snack food consumption. Skidmore, et al. 2010 uses objective geographic mapping of proximity and density of food stores in a cross-sectional analysis of their association with children’s eating habits.

  • Briefel, Ronette R., Mary Kay Crepinsek, Charlotte Cabili, Ander Wilson, and Philip M. Gleason. 2009. School food environments and practices affect dietary behaviors of US public school children. Journal of the American Dietetic Association 09.2S: S91–S107.

    DOI: 10.1016/j.jada.2008.10.059Save Citation »Export Citation » Share Citation »

    Surveys 287 public schools in the United States to identify school features associated with intake of sugar-sweetened beverages, energy-dense nutrient-poor foods, and fruits and vegetables. Introduces readers to a breadth of school related factors within the physical environment, as well as the political (school policies), and communication (nutrition education) environments.

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  • Minaker, Leia M., Kim D. Raine, and Sean B. Cash. 2009. Measuring the food service environment: Development and implementation of assessment tools. Canadian Journal of Public Health 100.6: 421–425.

    DOI: 10.17269/cjph.100.2094Save Citation »Export Citation » Share Citation »

    Although the study does not measure food and beverage intake from consumers, provides a detailed account of environmental features within communities and retailers that were believed to be associated with eating behavior (see General Overviews and Theoretical Frameworks). Includes a rare validity analysis of the assessment tool.

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  • Nutrition Environment Measures Survey.

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    Online collection of the Nutrition Environment Measures Survey (NEMS) tools for restaurants, stores, vending machines among others. Provides publications from development and evaluation of the tools as well as other research conducted with NEMS tools or adapted versions. Critical resource for researchers or practitioners working on settings-based environmental influences of nutrition.

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  • Sanchez-Flack, Jennifer C., Barbara Baquero, Laura A. Linnan, Joel Gittelsohn, Julie L. Pickrel, and Guadalupe X. Ayala. 2016. What influences Latino grocery shopping behavior? Perspectives on the small food store environment from managers and employees in San Diego, California. Ecology of Food & Nutrition 55.2: 163–181.

    DOI: 10.1080/03670244.2015.1112282Save Citation »Export Citation » Share Citation »

    Qualitatively investigates factors that influence grocery shopping. Although food purchasing was not measured, findings can guide in-store interventions for certain cultural communities, especially those who shop at smaller community stores. Provides an example of how individual factors intersect with the environment.

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  • Skidmore, Paula, Ailsa Welch, and Esther van Sluijs, et al. 2010. Impact of neighborhood food environment on food consumption in children aged 9–10 years in the UK SPEEDY (Sport, Physical Activity and Eating Behavior: Environmental Determinants in Young People) Study. Public Health Nutrition 13.7: 1022–1030

    DOI: 10.1017/S1368980009992035Save Citation »Export Citation » Share Citation »

    An example of a study investigating community nutrition environments and children’s diets. Findings show that there are indeterminate associations between proximity and density of supermarkets and convenience stores with diet, but some changes in diet may be contrary to expectations. Demonstrates that a single store type may have multiple (and opposing) impacts on diet.

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  • van Ansem, Wilke J. C., Frank J. van Lenthe, Carola T. M. Schrijvers, Gerda Rodenburg, and Dike van de Mheen. 2014. Socio-economic inequalities in children’s snack consumption and sugar-sweetened beverage consumption: The contribution of home environmental factors. British Journal of Nutrition 112.3: 467–476.

    DOI: 10.1017/S0007114514001007Save Citation »Export Citation » Share Citation »

    Home availability of foods and beverages is one independent variable evaluated in this cross-sectional analysis of determinants of children’s food choices. Also includes social (parenting practices) and economic (education and income) factors. Useful in demonstrating how environmental factors can interact to influence outcomes.

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  • Welker, Emily, Megan Lott, and Mary Story. 2016. The school food environment and obesity prevention: Progress over the last decade. Current Obesity Reports 5.2: 145–155.

    DOI: 10.1007/s13679-016-0204-0Save Citation »Export Citation » Share Citation »

    Reviews in detail numerous population-level school programs that aimed to improve the quality of foods and beverages available to students. Provides sample solutions to current challenges. Highlights six notably important references related to school food and nutrition. Useful for readers interested in the history and current state of American school food programs.

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  • Zenk, Shannon M., Irina Horoi, Ashley McDonald, Colleen Corte, Barth Riley, and Angela M. Odoms-Young. 2014. Ecological momentary assessment of environmental and personal factors and snack food intake in African American women. Appetite 83:333–341.

    DOI: 10.1016/j.appet.2014.09.008Save Citation »Export Citation » Share Citation »

    Investigated factors associated with unhealthy snack intake at particular points in time. At any given time, perceived easy access to a food retailer was associated with increased snacking (twice as likely when near restaurant, convenience store, bakery, or candy store, and 83 percent more likely when near a grocery store). Demonstrates temporal interaction between individuals and environments.

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Debates Surrounding the Physical Environment

The resources in Reviews on the Physical Environment and Physical Environment Features demonstrate a breadth of research methods and findings. The complexity of the topic and mixed results fuel debates around the true nature of the relationship between physical environmental factors and diet. First, there is a debate as to whether poor diets are caused by a lack of access to healthy food (often termed “food deserts”) or by an overabundance of easily accessible unhealthy food (also known as a “food swamp” or “food prairie”). Hackett, et al. 2008 explores whether it is poor access to healthy food or easy access to unhealthy food that is associated with poor diet—but finds that it appears to be the latter. Other researchers (Ver Ploeg, et al. 2015; Wright, et al. 2016; and Kato and McKinney 2015) suggest that explaining poor diet by lack of geographic access to healthy food is too simplistic and inadequately considers social, economic, and individual factors that also impact food purchasing and intake. Ver Ploeg, et al. 2015 contributes to this debate by focusing on the contribution of both area-level and individual-level factors, while Wright, et al. 2016 raises concerns with the research methods used to generate the concept of “food deserts.” Kato and McKinney 2015 provides an example of a food access intervention and the social, economic, and personal factors that impact its effectiveness. Lucan, et al. 2014 expands the discussion on environmental features by investigating the degree to which objective and non-objective (perceived food environment) factors contribute to eating fruits and vegetables. These findings suggest that objectively measuring the environment may be insufficient for a complete understanding of the relationships between determinants and diet. Going further, Cummins 2006 provides a discussion as to whether physical food environment features are a product of the community in which individuals, food stores, and restaurants are located or whether they are influenced by broader societal influences beyond the community. Estima, et al. 2014 uses a cross-cultural design to investigate what Cummins 2006 suggests by researching differential impacts of local and national food systems on eating behavior between Brazil and the United States.

  • Cummins, Steven. 2006. Food environments and obesity–neighborhood or nation? International Journal of Epidemiology 35.1: 100–104.

    DOI: 10.1093/ije/dyi276Save Citation »Export Citation » Share Citation »

    Discusses whether the association between the physical environment and diet is generated from neighborhood characteristics or broader societal (social, cultural, economic, political) factors that impact how the physical environment is structured in different neighborhoods across nations. Addresses questions important to policy interventions and policy-relevant research.

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  • Estima, Camilla C. P., Meg Bruening, and Peter J. Hannan, et al. 2014. A cross-cultural comparison of eating behaviors and home food environmental factors in adolescents from São Paulo (Brazil) and Saint Paul-Minneapolis (US). Journal of Nutrition Education & Behavior 46.5: 370–375.

    DOI: 10.1016/j.jneb.2014.01.007Save Citation »Export Citation » Share Citation »

    Compares adolescent food behaviors and home environments between United States and Brazil, which makes it possible to compare local and global influences on eating behaviors. Finds significant differences in the frequency of eating family meals and fast food between the two countries. Useful reflection on the progression of the Western diet in Brazil.

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  • Hackett, Allan, L. Boddy, J. Bootby, T. J. B. Drummer, B. Johnson, and G. Stratton. 2008. Mapping dietary habits may provide clues about the factors that determine food choice. Journal of Human Nutrition and Dietetics 21:428–437.

    DOI: 10.1111/j.1365-277X.2008.00894.xSave Citation »Export Citation » Share Citation »

    Cross-sectional study assessing geographical access and diet in children. Critical of the theory of “food deserts” as a predictor of poor diets. Suggests that the term “food prairie” is more appropriate, indicating easy access to food stores selling junk food is associated with poorer diets irrespective of neighborhood socioeconomic status. Provides introductory discussion on interrelationship between physical and social environments.

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  • Kato, Yuki, and Laura McKinney. 2015. Bringing food desert residents to an alternative food market: A semi-experimental study of impediments to food access. Agriculture and Human Values 32.2: 215–227.

    DOI: 10.1007/s10460-014-9541-3Save Citation »Export Citation » Share Citation »

    Example of intervention to improve food access for individuals living in a “food desert.” Investigates the economic, temporal, and social factors that impacts the public engagement in and experience of a food access intervention. May be useful for researchers or practitioners in designing and evaluating multilevel interventions and their impact on users.

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  • Lucan, Sean C., Amy Hillier, Clyde B. Schechter, and Karen Glanz. 2014. Objective and self-reported factors associated with food-environment perceptions and fruit-and-vegetable consumption: A multilevel analysis. Preventing Chronic Disease 11:1–11.

    DOI: 10.5888/pcd11.130324Save Citation »Export Citation » Share Citation »

    Using vegetable and fruit intake as the outcome, this article provides an example of how factors at multiple levels can impact food choice, including objective and perceived factors. Useful in providing a basic understanding of the relative contribution of determinants and why geographic only investigations may not provide the whole picture of how physical environments impact diet.

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  • Ver Ploeg, Michele, Paula Dutko, and Vince Breneman. 2015. Measuring food access and food deserts for policy purposes. Applied Economic Perspectives and Policy 37.2: 205–225.

    DOI: 10.1093/aepp/ppu035Save Citation »Export Citation » Share Citation »

    Focusing on food access as a determinant of eating behavior, this article explores the importance of both area-level factors and individual-level factors. Introduces readers to critical factors to consider when developing policy to improve food store access to populations. Maintains that access to (and barriers to) healthy food is the determining factor of diet.

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  • Wright, James, Amy Donley, Marie Gualtieri, and Sara Strickhouser. 2016. Food deserts: What is the problem? What is the solution? Society 53.2: 171–181.

    DOI: 10.1007/s12115-016-9993-8Save Citation »Export Citation » Share Citation »

    Critique of the “food desert” concept. Outlines methodological issues and general concerns with the current evidence linking food access and eating. Highlights social and individual factors (i.e., class/race) that intersect with physical environments and impact food choice. Useful for practitioners or policymakers to understand why research may not demonstrate expected findings and provides important considerations for interventions.

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The Economic Environment

Economic determinants of (un)healthy eating explore how food prices, income, socioeconomic status, and economic systems influence food consumption and eating behavior. At a societal level, market-based economies assume that the market appropriately produces healthy foods and that consumers will be responsible enough to purchase healthy foods. Such a system can generate or maintain health inequities by unfairly distributing healthy products within populations. Taxation and subsidies are economic policy levers that can be used at a macro-societal level to influence food choices by making healthy food more affordable or unhealthy foods more expensive. This section explores economically relevant factors associated with (un)healthy eating and the mechanisms by which said factors do so. First, seven systematic reviews are listed covering topics of food prices, taxes, subsidies, employment, income, and food security (See Reviews on the Economic Environment). A collection of research available under Food Costs provides specific details on food prices and financial access to food and explores how relevant contextual and personal factors influence the impact of said factors on food intake. Household and societal economic and other factors that influence food security in low and high income countries are discussed in brief (See Food Security). Finally, several resources are provided in the section Income, Education, Employment, and Other Socioeconomic Factors that collectively explore how various economic determinants can influence food choice and intake at an individual and societal level.

Reviews on the Economic Environment

Several reviews and meta-analyses explore economic factors as determinants of food choice. Rao, et al. 2013 simply compared the price of following a healthy diet to the price of an unhealthy one to understand how food costs can act as barriers to healthy eating or facilitators of less healthy eating. Lee, et al. 2011 conducted a similar review but links food prices to diet quality and health outcomes. Andreyeva, et al. 2010 explores how changes in price result in changes in food purchasing. Looking at several food groups, Andreyeva, et al. 2010 finds a variety of effects of price changes on demand for foods. Emphasizing that food prices are not local influencers that may impact various populations differently, Green, et al. 2013 evaluates how global price changes impact food consumption on a household and country level. Thow, et al. 2014 provides an overview of the use of different methods of subsidy and taxation. These policy approaches can be used to promote healthy food choices and dissuade unhealthy ones. Conklin, et al. 2013 looks at a specific population, older adults, and examines whether dietary quality and spending on food changed after retirement. Finally, Bashir and Schilizzi 2013 provides a broad overview of the economic and other factors that contribute to food security in rural African and Asian countries. This resource helps explain how determinants of food intake can be grounded in broader societal factors.

  • Andreyeva, Tatiana, Michael W. Long, and Kelly D. Brownell. 2010. The impact of food prices on consumption: A systematic review of research on the price elasticity of demand for food. American Journal of Public Health 100:216–222.

    DOI: 10.2105/AJPH.2008.151415Save Citation »Export Citation » Share Citation »

    Systematically reviews 160 studies that evaluated how price changes for several types of food and beverages impact demand for the same. Largest impacts were for takeaway foods and soda. A resource for policymakers or those within retail food environments to gain a basic understand how pricing interventions could impact food intake.

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  • Bashir, Muhammad K., and Steven Schilizzi. 2013. Determinants of rural household food security: A comparative analysis of African and Asian studies. Journal of the Science of Food and Agriculture 93.6: 1251–1258.

    DOI: 10.1002/jsfa.6038Save Citation »Export Citation » Share Citation »

    Provides a model for how systemic factors (i.e., markets, income distribution, and food safety) and their determinants (i.e., technology adoption, farm size, family structure, and gender) contribute to food security in low-income countries. Offers a brief but comprehensive account of determinants within the home and society but lacks explanation of the relative importance of the same.

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  • Conklin, Annalign, Eva R. Maguire, and Pablo Monsivais. 2013. Economic determinants of diet in older adults: Systematic review. Journal of Epidemiology & Community Health 67.9: 721–727.

    DOI: 10.1136/jech-2013-202513Save Citation »Export Citation » Share Citation »

    Review of longitudinal studies, many of which focused on work-to-retirement transition and impact on diet and food spending. Sees mixed impact on amount spent on food and the type of foods purchased. Gender and household composition appear to influence the impact after retiring. Provides unique insight on how income may impact diet at one particular life stage.

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  • Green, Rosemary, Laura Cornelsen, Alan D. Dangour, et al. 2013. The effect of rising food prices on food consumption: Systematic review with meta regression. British Medical Journal 346:1–9.

    DOI: 10.1136/bmj.f3703Save Citation »Export Citation » Share Citation »

    Takes a global perspective to investigate how changes in food prices impact consumption of several foods by countries and households at varying income levels. Highlights potential for inequities between groups within and between countries as a result of price increases. Provides an international perspective on economic determinants of population diets.

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  • Lee, Jia Hwa, Robin A. Ralston, and Helen Truby. 2011. Influence of food cost on diet quality and risk factors for chronic disease: A systematic review. Nutrition & Dietetics 68.4: 248–261.

    DOI: 10.1111/j.1747-0080.2011.01554.xSave Citation »Export Citation » Share Citation »

    Assesses the evidence on food pricing, nutritional quality of foods and disease risk factors. Findings suggest how economic factors impact health outcomes (and thus health-care spending) through poor diet quality. May be useful for policymakers in considering food pricing as an intervention to reduce health-care costs.

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  • Rao, Mayuree, Ashkan Afshin, Gitanjali Singh, and Dariush Mozaffarian. 2013. Do healthier food and diet patterns cost more? A systematic review and meta-analysis. BioMed Central Open 3:1–6.

    DOI: 10.1136/bmjopen-2013-004277Save Citation »Export Citation » Share Citation »

    Explores cost differences between healthy and unhealthy foods and dietary patterns. Found that it was more expensive to eat healthier food, which creates barriers for low income individuals, and queries why healthy food costs more. Good introduction into the difference in food costs as an explanation of poor diets in certain populations.

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  • Thow, Anne Marie, Stephen Jan, and Shauna Downs. 2014. A systematic review of the effectiveness of food taxes and subsidies to improve diets: Understanding the recent evidence. Nutrition Reviews 72.9: 551–565.

    DOI: 10.1111/nure.12123Save Citation »Export Citation » Share Citation »

    Critically assesses the strength of the evidence of economic interventions to impact food intake, specifically subsidizing healthy food and taxing sugar-sweetened beverages, fat, sugar, salt, and products classified as unhealthy. Provides synopsis of effects from each type of intervention that can be used to guide effective economic population interventions.

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Food Costs

The cost of food is one economic factor associated with food choice. An environment in which healthy foods, such as fruits and vegetables, are generally more expensive than unhealthy foods, such as sugar-sweetened beverages or salty and fatty snacks, will likely promote the intake of the latter. (See Reviews on the Economic Environment). Economic factors do not appear to act alone but have shown to also impact diet through interaction with other environmental features (geography) and individual factors (gender, weight status). Pollard, et al. 2014 describes a difference in food prices according to geographic area. This research intersects a physical dimension into the economic determinant, since food price could impact food choice as a function of location. Powell, et al. 2010 is a more local assessment of physical and economic environmental factors that evaluates how physical access and economic affordability of fast food impacts consumption in youth. Gordon-Larsen, et al. 2011 also researched fast food consumption but investigated differences in individual reactions to fast food prices according to race, gender, and income levels. Epstein, et al. 2007 also assesses how individual factors impact food choice by testing whether women of different weight reacted differently to increased and reduced prices on high- and low-calorie foods. In addition to actual affordability, perception of affordability of foods and beverages may be an important determinant of food choice; Bihan, et al. 2010 investigates how the perception of vegetables and fruit prices can impact their consumption. These research studies contribute to a discussion that: (a) economic factors are an important determinant of food choice, (b) economic factors interact with other environmental features, and (c) personal characteristics may influence how an individual reacts to economic factors. Two final resources included in this section reflect on other ways economic access to food can impact food intake. First, Dingman, et al. 2014 investigates the impact of having a prepaid account dedicated to meals at college on food intake. This study demonstrates that food affordability may relate not only to the price of the item but also the perceived relative cost of an item as a function of the dollars an individual intends to spend on food. Finally, Andreyeva, et al. 2011 provides an analysis of how taxation can be used to reduce the intake of sugar-sweetened beverages and create revenue at the same time.

  • Andreyeva, Tatiana, Frank J. Chaloupka, and Kelly D. Brownell. 2011. Estimating the potential of taxes on sugar-sweetened beverages to reduce consumption and generate revenue. Preventive Medicine 52:413–416.

    DOI: 10.1016/j.ypmed.2011.03.013Save Citation »Export Citation » Share Citation »

    Models impact of price changes of sugary drinks on demand and energy intake. Outlines the economic benefits for society from a penny-per-ounce tax on sugary drinks. Useful for practitioners or policymakers to help understand how food tax reform could benefit the economic well-being of a region or country.

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  • Bihan, Helen, Katia Castetbon, Caroline Mejean, et al. 2010. Sociodemographic factors and attitudes toward food affordability and health are associated with fruit and vegetable consumption in a low-income French population. Journal of Nutrition 140.4: 823–830.

    DOI: 10.3945/jn.109.118273Save Citation »Export Citation » Share Citation »

    Explores associations between economic and demographic factors, including perceived affordability, on the consumption of fruits and vegetables. Adults were more than twice as likely to consume fruits and vegetables infrequently if they did not believe that they were affordable. Introduces several factors that may influence healthy eating.

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  • Dingman, Deirdre A., Mark R. Schulz, David L. Wyrick, Daniel L. Bibeau, and Sat N. Gupta. 2014. Factors related to the number of fast food meals obtained by college meal plan students. Journal of American College Health 62.8: 562–569.

    DOI: 10.1080/07448481.2014.945456Save Citation »Export Citation » Share Citation »

    Assesses impact of ready access to fast food through pre-paid student meal plans on fast food intake. Study is insufficient to determine cause and effect but finds that individuals who choose pre-paid meal plans with fast food access consume more fast food on and off campus. Useful introduction to the link between financial access to food types and food choice.

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  • Epstein, Leonard H., Kelly K. Dearing, Rocco A. Paluch, James N. Roemmich, and David Cho. 2007. Price and maternal obesity influence purchasing of low- and high-energy-dense foods. American Journal of Clinical Nutrition 86:914–922.

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    Lab experiment modeling the effects of individual reactions to manually manipulated food prices. Compares own-price elasticities and cross-price elasticities, or the impact of a price change on purchase of a particular food or an alternative, respectively. Found that weight status impacts sensitivity to price changes. Reflects on potential effectiveness of economic public policy for obesity prevention.

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  • Gordon-Larsen, Penny, David K. Guilkey, and Barry M. Popkin. 2011. An economic analysis of community-level fast food prices and individual-level fast food intake: A longitudinal study. Healthy & Place 17.6: 1235–1241.

    DOI: 10.1016/j.healthplace.2011.07.011Save Citation »Export Citation » Share Citation »

    Investigates whether fast food prices impact food intake using a large national longitudinal cohort of American adolescents. A 20 percent price increase for burgers or soda was associated with a reduction in visits to fast food restaurants per week of up to 25 percent, with varying effects based on income, gender, and race.

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  • Pollard, Christina M., Tim Landrigan, Pernilla Ellies, Deborah A. Kerr, Matthew Lester, and Stan Goodchild. 2014. Geographic factors as determinants of food security: A Western Australian food pricing and quality study. Asia Pacific Journal of Clinical Nutrition 23.4: 703–713.

    DOI: 10.6133/apjcn.2014.23.4.12Save Citation »Export Citation » Share Citation »

    Survey of prices and quality of several food categories (including “non-core foods” and “junk food”) in Australia. Provides a geographical comparison demonstrating association between food price, quality, and access. No analysis on how price impacts food intake by geography but provides policy recommendations.

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  • Powell, Lisa M., Frank K. J. Chaloupka, and Euna Han. 2010. Economic contextual factors, food consumption, and obesity among U.S. adolescents. Journal of Nutrition 140.6: 1175–1180.

    DOI: 10.3945/jn.109.111526Save Citation »Export Citation » Share Citation »

    Reviews studies completed by the authors for the Bridging the Gap: Research Informing Policies and Practices for Healthy Youth research program. Examines the impact of physical (food access) and economic (food price) factors on weight status through food consumption. Suggests relevant policy interventions. Useful for graduate students to increase their understanding of the topic and conceptualize a research program.

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Food Security

According to the Food and Agriculture Organization of the United Nations, food security is when “all people, at all times, have physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” (World Food Summit, 1996, para 11) It can be measured at the household or community level and is considered a determinant of (un)healthy eating. Understanding determinants of food security can clarify linkages between economic and other community or societal environmental factors and poor diet. Gorton, et al. 2010 provides a review of economic, physical, social, and political factors that impact food security in high-income countries. Since these factors are likely to be much different in lower income countries, two studies are included to provide insight into breadth of determinants of food security in low-income countries (with a focus on economic factors). Mohammadzadeh, et al. 2010 describes associations between household food security and food consumption in Iran. Their findings reveal that food security is related to economic factors (employment and education) and that the diets of students of food insecure households differ from those of food secure households. Harris-Fry, et al. 2015 investigates associations between specific household and societal factors and food security for women in rural Bangladesh, including economic and other determinants (such as literacy and freedom). Although contextual factors often differ by countries, these studies show that there are systemic factors that can affect population groups and impact food security—and thus food intake.

  • Gorton, Delvina, Chris R. Bullen, and Cliona Ni Mhurchu. 2010. Environmental influences on food security in high income countries. Nutrition Reviews 68.1: 1–29.

    DOI: 10.1111/j.1753-4887.2009.00258.xSave Citation »Export Citation » Share Citation »

    Comprehensive review of environmental factors that are associated with food insecurity in high-income countries. Describes several economic, physical, social, and political factors that can be targeted through population and policy interventions to improve food security.

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  • Harris-Fry, Helen, Azad Kishwar, and Abdul Kuddus, et al. 2015. Socio-economic determinants of household food security and women’s dietary diversity in rural Bangladesh: A cross-sectional study. Journal of Health, Population and Nutrition 33:1–12.

    DOI: 10.1186/s41043-015-0022-0Save Citation »Export Citation » Share Citation »

    Informed by a detailed conceptual model of components contributing to food insecurity, this paper examined three aspects of food security (availability, access, utilization) and factors at the household (land ownership, wealth) and societal (women’s freedom to go to shops, literacy, access to media) levels.

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  • Mohammadzadeh, Assieh, Ahmadreza Dorosty, and Mohammadreza Eshraghian. 2010. Household food security status and associated factors among high-school students in Esfahan, Iran. Public Health Nutrition 13.10: 1609–1613.

    DOI: 10.1017/S1368980010000467Save Citation »Export Citation » Share Citation »

    This cross-sectional study identifies economic factors associated with food security, including income, education, and employment. By including dietary assessment, the paper links levels of household food insecurity with dietary quality. May be useful for informing research or interventions that improve economic conditions to improve diet.

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Income, Education, Employment, and Other Socioeconomic Factors

As food is a commodity, it is easy to understand that income and food cost are determinants of food intake. However, since income can be tied to several other socioeconomic factors such as education and employment, the relationship between income and diet becomes more complex. The resources included here are research studies that have evaluated several different socioeconomic components as determinants of food intake. The research presented provides a plethora of explanations of how income, education, and employment are related to diet. First, van’t Riet, et al. 2003 explored associations between income levels and the purchase of foods away from home by adults in Kenya, finding significant differences in foods purchased between high- and low- income neighborhoods. Moreira and Padrao 2004 looked at associations between level of education and level of income with consumption of specific foods and beverages in adults in Portugal, finding that education level was a particularly important determinant of food choice. Similarly, a Canadian study, Ricciuto, et al. 2006, also found differences between the impact of income and education on foods purchased at the household level. The relationship between socioeconomic factors and diet became more complex when Vilela, et al. 2015 shows that unhealthy food consumption by toddler children was associated with two generations of income and education levels. Furthermore, Evans, et al. 2002 investigates how a global phenomenon, the nutrition transition from traditional foods, in Tonga is associated with changes in dietary patterns that differ by socioeconomic status. By investigating how personal, social, and historical factors (which underpin or are underpinned by education level), impact food choice, Lawrence, et al. 2009 may help to provide some clarity on the complexity of socioeconomic factors and diet. Pelto and Backstrand 2003 describes systemic economic determinants of food intake by explaining that income and education are power-laden factors that interact with our beliefs about food to impact eating behaviors and patterns. Finally, Dilip, et al. 2013 provides a unique investigation into how a population intervention to increase employment in rural India impacted income inequities and food purchasing.

  • Dilip, T. R., Rakhi Dandona, and Lalit Dandona. 2013. National employment guarantee scheme and inequities in household spending on food and non-food determinants of health in rural India. International Journal for Equity in Health 12:84–95.

    DOI: 10.1186/1475-9276-12-84Save Citation »Export Citation » Share Citation »

    Describes how an employment scheme impacts on inequities and household expenditures on food in a low-income country. Also reports on nonfood spending, medical care, and other outcomes. An excellent example of a population intervention that can improve nutrition without it being the focus. Useful for advanced readers interested in population policy and programs to improve health.

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  • Evans, Mike, R. C. Sinclair, C. Fusimalohi, and V. Liava’a. 2002. Diet, health and the nutrition transition: Some impacts of economic and socio-economic factors on food consumption patterns in the Kingdom of Tonga. Pacific Health Dialogue 9.2: 309–315.

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    Considers the access to imported food and perceptions of access by socioeconomic status (SES): greater availability and consumption of imported food in higher SES areas. Nutrition knowledge, and food preference were not influential on food intake. Provides a unique economic perspective on the impact of the nutrition transition in a low-income country.

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  • Lawrence, Wendy, Chas Skinner, and Cheryl Haslam, et al. 2009. Why women of lower educational attainment struggle to make healthier food choices: The importance of psychological and social factors. Psychology and Health 24.9: 1003–1020.

    DOI: 10.1080/08870440802460426Save Citation »Export Citation » Share Citation »

    Qualitatively explores how personal, social, economic, and historical factors differ by a woman’s education level, which influences her food choices. May help to explain the findings by Moreira and Padrao 2004 as to why education was more important than income. Useful in considering how different populations may react differently to interventions.

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  • Moreira, Pedro A., and Patricia D. Padrao. 2004. Educational and economic determinants of food intake in Portuguese adults: A cross-sectional survey. BioMed Central Public Health 4:58–69.

    DOI: 10.1186/1471-2458-4-58Save Citation »Export Citation » Share Citation »

    Explored how food intake may differ according to level of income and education. Findings may suggest that because dietary intake differed by education levels but not by income, education may be a critical factor to improve population diets.

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  • Pelto, Gretel H., and Jeffery R. Backstrand. 2003. Interrelationships between power-related and belief-related factors determine nutrition in populations. Journal of Nutrition 133.1: 297S–300S.

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    Using an example of income and education levels, this article provides a clear explanation of how different environmental and individual factors interact to impact diet. Cautions that most research fails to consider the interaction between “power” (i.e., social structures), “beliefs” (i.e., psychosocial factors), and behaviors. Useful for understanding systemic influences on diet.

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  • Ricciuto, L. V. Tarasuk, and A. Yatchew. 2006. Socio-demographic influences on food purchasing among Canadian households. European Journal of Clinical Nutrition 60:778–790.

    DOI: 10.1038/sj.ejcn.1602382Save Citation »Export Citation » Share Citation »

    Large population survey examining links between income, education, and household composition and grocery purchases. Useful in explaining how diets differ by populations; for example, having a university degree was associated with 1.4 percent increase in fruits and vegetables and 1.4 percent decrease in other foods (desserts, fat, sugar, beverages) purchased compared to having less than a high school education.

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  • van’t Riet, Helen, Adel P. den Hartog, Danny A. P. Hooftman, Dick W. J. Foeken, Alice M. Mwangi, and Wija A. can Staveren. 2003. Determinants of non-home-prepared food consumption in two low-income areas in Nairobi. Nutrition in Africa 19.11–12: 1006–1012.

    DOI: 10.1016/S0899-9007(03)00183-7Save Citation »Export Citation » Share Citation »

    Shows how determinants of non-home food intake differs by socioeconomic level and gender. Findings demonstrate that one’s income level not only limits what food one can purchase but also the number and type of opportunities to purchase food. Helpful in understanding how income groups may be inequitably affected by broader societal factors which impact one’s ability to consume a healthy diet.

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  • Vilela, S. A., A. Oliveira, E. Pinto, P. Moreira, H. Barros, and C. Lopes. 2015. The influence of socioeconomic factors and family context on energy-dense food consumption among 2-year-old children. European Journal of Clinical Nutrition 69.1: 47–54.

    DOI: 10.1038/ejcn.2014.140Save Citation »Export Citation » Share Citation »

    Birth cohort in Portugal assessing parental socioeconomic factors as determinants of unhealthy foods and beverages intake in toddler children. This study highlights that there may be a generational effect since the education level of the child’s maternal grandmother was associated with intake of high calorie foods.

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The Social Environment

The social environment, while less immediately tangible than other environmental influences on eating behaviors, nonetheless comprises multiple features that act as strong determinants of (un)healthy eating. This section includes a collection of Reviews on the Social Environment as well as featured resources on micro and macro social influences on eating. Four reviews discuss social norms of eating (Robinson, et al. 2013) and social influences at home and school (Campbell and Crawford 2001; Fletcher, et al. 2011; and Bruce, et al. 2015). At the micro level, the influence of families and peers are strong determinants of (un)healthy eating, particularly for children and youth (see Family and Friends). At the macro level, social environment factors include gender, ethnicity, and social status which influence eating behavior through cultural acceptability of food and social norms for eating (see Cultural and Societal Norms).

Reviews on the Social Environment

Social environmental factors may be less visible that other environmental factors, such as physical food availability, or the food prices. However, systematic reviews on social influences on diet suggest that family, peers, even unknown strangers, and societal social norms have an impact on what and how we eat. Robinson, et al. 2013 reviews evidence from lab and natural experiments on how modeling and social norms impact food intake. He suggests that nutrition interventions could be strengthened by considering the social influences on eating. Campbell and Crawford 2001 reviews the literature on how family environments impact children’s eating behaviors and provides suggestions for how families can support obesity prevention efforts. Fletcher, et al. 2011 uses social network analysis to understand eating behaviors, such as dieting, in youth. This method allows researchers to explore social influences by examining linkages between individuals and their association with behaviors. Finally, Bruce, et al. 2015 describes personal and social factors that have been associated with food intake in young children, including parents, friends, and food marketing.

  • Bruce, Amanda S., Seung-Lark Lim, and Timothy R. Smith, et al. 2015. Apples or candy? Internal and external influences on children’s food choices. Appetite 93:31–34.

    DOI: 10.1016/j.appet.2015.04.061Save Citation »Export Citation » Share Citation »

    Brief narrative review of social influences on food intake at an eating occasion. Good introductory paper for undergraduate students of the multitude of factors, including both personal and social, that collectively impact children’s diet.

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  • Campbell, Karen, and David Crawford. 2001. Family food environments as determinants of preschool-aged children’s eating behaviors: Implications for obesity prevention policy. A review. Australian Journal of Nutrition & Dietetics 58.1: 19–25.

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    Describes features of home food and meal environments that have been found to be associated with children’s eating behaviors. Focuses on social interactions (parenting style, role modelling), social norms (exposure to food, TV viewing, meal environment). Provides brief overview as an introduction to how the family impacts children’s diets.

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  • Fletcher, Adam, Chris Bonell, and Annik Sorhaindo. 2011. You are what your friends eat: Systematic review of social network analyses of young people’s eating behaviors and body weight. Journal of Epidemiology and Community Health 65.6: 548–555.

    DOI: 10.1136/jech.2010.113936Save Citation »Export Citation » Share Citation »

    Systematic review of ten studies on school social influences on the weight status and eating behaviors of young people. Only one study examines social influences on calorie intake. Introductory overview into topic and methods to assess social influences on diet.

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  • Robinson, Eric, Jackie Blissett, and Suzanne Higgs. 2013. Social influences on eating: Implications for nutritional interventions. Nutrition Research Reviews 26:166–176.

    DOI: 10.1017/S0954422413000127Save Citation »Export Citation » Share Citation »

    Narrative review on different types of food- and eating-related norms and their impact on food intake. Explores impact of norms on people eating individually and together in lab and natural experiments. Provides clear introduction of social psychology of eating.

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Family and Friends

The most studied social influences on diet have been family and friends. McIntosh, et al. 2011 looks at multiple family characteristics and their associations with children eating out of the home. McIntosh, et al. 2011 finds that time-relevant factors (work schedule, time spent in cars) were associated with visits to fast food restaurants. McGowan, et al. 2012 explores associations between several maternal, paternal, child, and home factors and intake of fruits, vegetables, sugary and salty snacks, and sugary drinks in children aged two to five years. In this study, maternal intake and feeding style was an important determinant of food intake. Similarly, Dos Santos Barroso, et al. 2012 investigates how family factors were linked with food intake by infants and toddlers (six to twenty months old), finding that parental food intake influences child’s food intake. Kroller and Warschburger 2009 and Fisk, et al. 2011 provide insight into the variance by which maternal factors influence children’s diets. Kroller and Warschburger 2009 investigates mothers’ feeding practices on children’s food intake. Fisk, et al. 2011 looks at correlations between mother’s and children’s dietary patterns, in addition to several other maternal factors. Both found that approximately one-third of the children’s diet (unhealthy eating in Kroller and Warschburger 2009, and whole diet in Fisk, et al. 2011) was influenced by maternal factors. Kalavana, et al. 2010 investigates several personal and social factors of family and friends, highlighting which factors most impacted adolescents’ dietary intake. Outside of the home Vartanian, et al. 2008 executed two studies to understand how social situations impact food intake in a laboratory setting and how aware participants are of the social influences on their food intake. In these studies, the social influencers were not individuals that were known to the participant, meaning that food intake is can be influenced by our friends and family as well as by strangers in social situations. Finally, Elliott 2014 conducts a qualitative study on how teenagers identify with different types of foods demonstrating that foods have symbolic meaning irrespective of food industry brand marketing.

  • Dos Santos Barroso, Gariela, Rosely Sichieri, and Rosana Salles-Costa. 2012. Relationship of socio-economic factors and parental eating habits with children’s food intake in a population-based study in a metropolitan area of Brazil. Public Health Nutrition 17.1: 156–161.

    DOI: 10.1017/S1368980012004624Save Citation »Export Citation » Share Citation »

    Links food intake of six- to twenty-month-olds with parental intake and economic factors. Found determinants of children’s intake differed by food group (i.e., grains associated with parental intake and income, sugar with food insecurity and child’s age). Provides example of statistical methods (hierarchical regression modeling) to examine determinants of diet.

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  • Elliott, Charlene. 2014. Food as people: Teenagers’ perspectives on food personalities and implications for healthy eating. Social Science & Medicine 121:85–90.

    DOI: 10.1016/j.socscimed.2014.09.044Save Citation »Export Citation » Share Citation »

    Qualitative investigation into symbolic nature of food. Adolescents assigned consistent personalities to foods, stating broccoli was geeky, eggs were emotional, junk food was a superficial partier, and organic food was a youthful hippy, for example. Provides unique investigation into broad social norms related to food branding resulting from food marketing (or lack thereof).

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  • Fisk, Catherine M., Sarah R. Crozier, and Hazel M. Inskip, et al. 2011. Influences on the quality of young children’s diets: The importance of maternal food choices. British Journal of Nutrition 105:287–296.

    DOI: 10.1017/S0007114510003302Save Citation »Export Citation » Share Citation »

    Using a birth cohort, researchers investigated how family and maternal factors were associated with children’s diet at three years. Found a significant impact of mother’s diet on child’s diet at year three (30 percent variance in diet). Useful example life-course approach to researching eating.

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  • Kalavana, Theano V., Stan Maes, and Veronique De Gucht. 2010. Interpersonal and self-regulation determinants of healthy and unhealthy eating behavior in adolescents. Journal of Health Psychology 15.1: 44–52.

    DOI: 10.1177/1359105309345168Save Citation »Export Citation » Share Citation »

    Using factor analysis, Kalavana explores intra and interpersonal influences on eating patterns in youth. Found that significant results with both family and friend influences. This is a technical paper, but its easy-to-understand findings are appropriate for undergraduate or graduate students.

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  • Kroller, Katja, and Petra Warschburger. 2009. Maternal feeding strategies and child’s food intake: Considering weight and demographic influences using structural equation modeling. International Journal of Behavioral Nutrition and Physical Activity 6.78: 1–11.

    DOI: 10.1186/1479-5868-6-78Save Citation »Export Citation » Share Citation »

    Technical study of the link between maternal factors and children’s dietary patterns. Model demonstrates that feeding style, age (child), weight (mother), and socioeconomic status explained over one-third of the variance of child’s intake of candy, salty snacks, fast food, and soda. Useful in understanding social and economic influences on healthy and unhealthy eating in children.

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  • McGowan, L., H. Croker, J. Wardle, and L. J. Cooke. 2012. Environmental determinants of core and non-core food and drink intake in preschool-aged children in the United Kingdom. European Journal of Clinical Nutrition 66:322–328.

    DOI: 10.1038/ejcn.2011.224Save Citation »Export Citation » Share Citation »

    Survey of caregivers of two- to five-year-old children assessing the relationship between family and home features on food consumption. Child snack intake was significantly associated with social and physical environmental factors, including maternal intake, parental monitoring, and snack availability in the home. Useful comprehensive assessment on social factors impacting children’s food choices.

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  • McIntosh, Alex, Karen S. Kubena, Glen Tolle, et al. 2011. Determinants of children’s use of and time spent in fast-food and full-service restaurants. Journal of Nutrition Education and Behavior 43.3: 142–149.

    DOI: 10.1016/j.jneb.2010.04.002Save Citation »Export Citation » Share Citation »

    Cross-sectional analysis of family characteristics, such as parenting style or work type that are associated with children eating out of the home. Useful in understanding how non-food related factors, such as work schedule, can impact unhealthy food intake.

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  • Vartanian, Lenny, Peter C. Herman, and Brian Wansink. 2008. Are we aware of the external factors that influence our food intake? Health Psychology 27.5: 533–538.

    DOI: 10.1037/0278-6133.27.5.533Save Citation »Export Citation » Share Citation »

    Includes two experimental studies on social influences on food intake at an eating occasion. Found that many participants were unaware that their food intake is influenced by social situations. Reflects on the implications of this lack of awareness and difficulty for the public to maintain a healthy diet within current “toxic” food environments that encourage overeating.

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Cultural and Societal Norms

There are social factors beyond interpersonal interactions that are important population determinants of diets. These factors include (but are not limited to) culture, immigration, gender, and societal norms and beliefs. Zaman, et al. 2013 reports on the nutrition transition in Bangladesh and how it has altered the culture of food in youth. This paper explains how food is used as a symbol of identity. Franzen and Smith 2010 investigates the acculturation of Thai immigrants to the United States and its impact on food purchasing, showing different dietary patterns based on place of birth and length of time in the United States. Castellanos, et al. 2013 investigates similar determinants of Hispanic immigrants, finding that several cultural norms (i.e., gender roles) impacted food choices of immigrants in the United States. Brimblecombe, et al. 2014 explores how culture-related physical, economic, social, and historical factors within a rural Aboriginal community in Australia impact food choice. Shannon, et al. 2008 show how social norms and cultural taboos impact eating behaviors in pregnant women in Bangladesh. Several types of foods were believed to help with the physiology of pregnancy (i.e., sour foods help nausea and vomiting) while other foods were avoided for fear of negative impacts on the baby or pregnancy (i.e., eggs will cause a difficult labor). These articles provide only examples of how culturally related factors can impact food choice; the impacts are likely to vary by culture or ethnicity. Similar to the differential impacts of environmental factors on diet by income level (see Income, Education, Employment, and Other Socioeconomic Factors), social factors may also inequitably differ by cultural or ethnic population groups and can be considered a possible systemic factor impacting diets of populations. Holmes, et al. 2009 provides one example of differential effects by exploring the impacts of economic factors, such as food price, on women versus men. Women’s social norms and beliefs and their potential ability to influence food choices are examined by Wang, et al. 2009. Finally, Diaz Mendez 2006 provides a theoretical sociological discussion on broad social factors that may impact food intake, such as politics, technology, and food systems.

  • Brimblecombe, Julie, Elaine Maypilama, Susan Colles, et al. 2014. Factors influencing food choice in an Australian Aboriginal community. Qualitative Health Research 24.3: 387–400.

    DOI: 10.1177/1049732314521901Save Citation »Export Citation » Share Citation »

    Qualitative study that investigated multiple levels of factors (historical, economic, social, physical) impacting food choice in a rural Aboriginal community. Useful in highlighting that culture and food choice are intersections of several environmental factors.

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  • Castellanos, Diana C., Laura Downey, Susan Graham-Kresge, Kathleen Yadick, Jamie Zoellner, and Carol L. Connell. 2013. Examining the diet of post-migrant Hispanic males using precede-proceed model: Predisposing, reinforcing, and enabling dietary factors. Journal of Nutrition Education and Behavior 45.2: 109–118.

    DOI: 10.1016/j.jneb.2012.05.013Save Citation »Export Citation » Share Citation »

    Examines how cultural differences and immigration impact dietary habits in males in the United States. Uses findings of perceived barriers to generate suggestions for culturally relevant interventions that would improve dietary habits for this population.

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  • Diaz Mendez, Cecilia. 2006. The sociology of food in Spain: European influences in social analyses on eating habits. Comparative Sociology 5.4: 353–380.

    DOI: 10.1163/156913306779147335Save Citation »Export Citation » Share Citation »

    Discussion on why eating patterns and diets may differ between individuals and populations using sociological theories, including those by Giddens, Bourdieu, and Foucault. Does not include empirical evidence on intake but provides a unique perspective on potential social determinants of diet. May be a useful theoretical argument for undergraduate sociological or graduate nutrition students.

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  • Franzen, Lisa, and Chery Smith. 2010. Food system access, shopping behaviors, and influences on purchasing groceries in adult Hmong living in Minnesota. American Journal of Health Promotion 24.6: 396–409.

    DOI: 10.4278/ajhp.080710-QUAL-121Save Citation »Export Citation » Share Citation »

    Comprehensive study on food behaviors in immigrants from Thailand and Laos in the United States, including food shopping, storage, preparation, and consumption. Important factors in acculturation and implications on nutritional intake and health are discussed. Useful introduction to how culture and immigration can impact food habits.

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  • Holmes, Rebecca, Nicola Jones, and Hannah Marsden. Gender vulnerabilities, food price shocks and social protection responses. Overseas Development Institute Background Paper, August 2009.

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    Detailed account of gender dimensions of food purchasing and consumption regarding food price changes. Assesses social norms and cultural aspects that contribute to a gender gap in the vulnerability of females during a food crisis. Useful in providing policy recommendations and highlighting that certain interventions may inequitably affect certain populations.

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  • Shannon, Kate, Zeba Mahmud, Azim Asfia, and Mohammed Ali. 2008. The social and environmental factors underlying maternal malnutrition in rural Bangladesh: Implications for reproductive health and nutrition programs. Health Care for Women International 29:826–840.

    DOI: 10.1080/07399330802269493Save Citation »Export Citation » Share Citation »

    Detailed account of cultural factors impacting pregnant women’s food choices that impact the nutritional status of the mother and child. Identifies types of foods that may be consumed during pregnancy. Reviews broader social factors, such as minimal household power and status, which impact women’s food behaviors. Introduces a collection of cultural factors important in women’s diet in lower-income countries.

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  • Wang, W. C., A. Worsley, and E. G. Cunningham. 2009. Social ideological influences on food consumption, physical activity and BMI. Appetite 53:288–296.

    DOI: 10.1016/j.appet.2009.07.004Save Citation »Export Citation » Share Citation »

    Uses structural equation modeling to explore women’s beliefs and attitudes on foods consumed at a meal. May be useful in understanding how social opinions on body image or growing environmental concerns may impact food choices in positive or negative ways.

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  • Zaman, Shahaduz, Nasima Selim, and Taufique Joarder. 2013. McDonaldization without a McDonald’s: Globalization and food culture as social determinants of health in urban Bangladesh. Food, Culture & Society 16.4: 551–568.

    DOI: 10.2752/175174413X13758634982010Save Citation »Export Citation » Share Citation »

    Qualitative investigation into the degree of nutrition transition of Bangladesh as a result of global influences on the food culture of affluent youth. Findings suggest that there are differences in how one reacts to nutrition transition: adopting, resisting, or combining attributes of Western dietary features. Useful in understanding how global culture can act within local environments.

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The Communication Environment

The communication environment captures the messages people receive about food and eating and how those messages are interpreted to influence food choice and eating behavior. While health practitioners may conceive the communication environment as a constituent of nutrition education, in modern society messages about food and eating are most often received through media including marketing. Marketing of foods and beverages is an important contributor of social perceptions of food (Raine 2005, cited under General Overviews and Theoretical Frameworks). This section includes six systematic reviews that explore the impact of communication factors, including food and beverage marketing to children, menu labeling, front-of-pack labeling, and nutrition education (see Reviews on the Communication Environment). Food Marketing and Labeling provides more detailed information on select aspects of food marketing and labeling and their impact on diet. Specifically, this section includes resources that explore product packaging and its impact on children and parents (Elliott 2012, Elliott and Brierley 2012, cited under Food Marketing and Labeling), parents’ influence on food choice in a food advertisement situation (Ferguson, et al. 2012, cited under Food Marketing and Labeling), and the types and effectiveness of front-of-pack food labeling as a means to encourage healthier food purchasing (Wartella, et al. 2012, cited under Food Marketing and Labeling). Finally, four resources are provided in Nutrition Education, which explores the potential and limitations of food and nutrition knowledge and education and social marketing campaigns in producing healthy food behaviors.

Reviews on the Communication Environment

Food marketing is one example of a communication environmental factor that influences food consumption and impacts diets. Cairns, et al. 2013 is an excellent review of the strength of evidence on how marketing impacts children’s eating behaviors and patterns. Based on the findings that food and beverage marketing is present across the world and has moderate to strong effects of children’s food knowledge, preferences, purchases, and consumption, Cairns, et al. 2013 calls for global policy interventions. Looking specifically at single eating occasions, Boyland, et al. 2016 completed a systematic review of how advertising on television and the Internet impacts immediate food consumption in adults and children. Similarly, Kraak and Story 2015 systematically reviews the impact of a marketing technique that may be particularly powerful for children. Studies on food branding with cartoon media characters found that marketing foods using cartoon characters increased children’s intake of unhealthy foods, as well as vegetables and fruits, with a stronger impact on the former when the character was more commonly well known. A second communication environmental factor that impacts how the public understands food and eating is food package and menu labeling. Long, et al. 2015 provides a systematic review on providing calorie information on restaurant menus. This is only one example of a labeling strategy in a specific setting. There are other types of nutrition communication, such as front-of-package food labels and shelf labels. Hersey, et al. 2013 systematically reviews the studies on these two types of communication. Nutrition education is a third form of nutrition communication that impacts food knowledge and intake. Yip, et al. 2015 provides a systematic review of peer-to-peer nutrition education, which could be highly impactful based on the strong influence of friends on diet (see Family and Friends).

  • Boyland, Emma, Sarah Nolan, Bridget Kelly, et al. 2016. Advertising as a cue to consume: A systematic review and meta-analysis of the effects of acute exposure to unhealthy food and nonalcoholic beverage advertising on intake in children and adults. American Journal of Clinical Nutrition 103.2: 519–533.

    DOI: 10.3945/ajcn.115.120022Save Citation »Export Citation » Share Citation »

    Reviews evidence on the impact of a short exposure to a food advertisement on the television or Internet on food intake by children and adults on a single eating occasion. Found moderate effects on children’s intake. Useful in understanding the magnitude of impact of food marketing on children’s diets and the need for careful consideration as to how to reduce this impact.

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  • Cairns, Georgina, Martin Caraher, Gerard Hastings, and Kathryn Angus. 2013. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite 62:209–215.

    DOI: 10.1016/j.appet.2012.04.017Save Citation »Export Citation » Share Citation »

    Systematic review grading the strength of evidence of marketing on children’s eating behaviors and patterns. Highlights how marketing impacts certain food behaviors (requests, purchasing, consumption) according to age. Useful for policymakers in understanding how interventions may influence behavior change.

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  • Hersey, James C., Kelly C. Wohlgenant, Joanne E. Arsenault, Katherine M. Kosa, and Mary K. Muth. 2013. Effects of front-of-package and shelf nutrition labeling systems on consumers. Nutrition Reviews 71.1: 1–14.

    DOI: 10.1111/nure.12000Save Citation »Export Citation » Share Citation »

    Systematic review of multiple food product labeling systems in several countries. Reports on the impact of such labels on consumer knowledge, use, intentions, and behavior. Useful introduction to the state of the evidence and the types of existing systems.

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  • Kraak, V. I., and Mary Story. 2015. Influence of food companies’ brand mascots and entertainment companies’ cartoon media characters on children’s diet and health: A systematic review and research needs. Obesity Reviews 16:107–126.

    DOI: 10.1111/obr.12237Save Citation »Export Citation » Share Citation »

    Evaluates the impact of a type of food marketing to children (mascots and cartoons) on children’s diet, including intake of fruits and vegetables and unhealthy food. Explains current state of global policy, research findings, and what is needed in the future to improve understanding.

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  • Long, Michael E., Deirdre K. Tobias, Angie L. Cradock, Holly Batchelder, and Steven L. Gortmaker. 2015. Systematic review and meta-analysis of the impact of restaurant menu calorie labeling. American Journal of Public Health 105.5: e11–e24.

    DOI: 10.2105/AJPH.2015.302570Save Citation »Export Citation » Share Citation »

    Detailed review of the impact of calorie labeling on menus. Although findings suggest evidence is not strong, this article provides explanations as to why and how the findings are useful for researchers and policymakers.

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  • Yip, Calvin, Michelle Gates, Allison Gates, and Rhona M. Hanning. 2015. Peer-led nutrition education programs for school-aged youth: A systematic review of the literature. Health Education Research 31.1: 82–97.

    DOI: 10.1093/her/cyv063Save Citation »Export Citation » Share Citation »

    Evaluates the evidence on the effectiveness of peer nutrition education in schools in Canada and the United States on knowledge, diet, and weight status. Provides discussion on dose-response, feasibility, methodological concerns among other considerations. Valuable example of a type of nutrition education that has a promising impact on food choice.

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Food Marketing and Labeling

There is significant research on food marketing and nutrition communication, such as labeling. Several systematic reviews (see Reviews on the Communication Environment) provide an excellent overview of the literature. Additional research is presented here to provide supplementary information about the communication environment that may not be captured within the systematic reviews. First, Elliott 2012 provides a detailed account of the marketing features on children’s food products and discusses how subtle marketing techniques may undermine parents’ desires or abilities to select healthy foods for their children. In an experiment conducted on whether parents can moderate the impact of food marketing to children, Ferguson, et al. 2012 found that parents do not seem able to override food marketing messages from food advertisements seen by their child and often fail to persuade their child to select the non-advertised product immediately after viewing. In addition to influencing food preferences or desires, Elliott and Brierley 2012 suggests that marketing features on a product’s packaging may interfere with a child’s ability to accurately choose healthy products. Elliott and Brierley 2012 finds that children frequently used product packaging features, such as color, front-of-pack health claims, spokes-characters, and text (and use nutrition facts and ingredient lists less frequently) to decide if a product was healthy. On the topic of food labeling, Wartella, et al. 2012 provides a complete review of information on product labeling, including consumer impacts and regulatory considerations. Front-of-pack labeling could be used as a communication strategy to share accurate messages about the healthfulness of food so that consumers do not have to rely on marketing on products to decide if a food or beverage is healthy.

  • Elliott, Charlene D. 2012. Packaging fun: Analyzing supermarket food messages targeted at children. Canadian Journal of Communication 37.2: 303–318.

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    Identified and analyzed product packaging on “children’s foods” in a Canadian supermarket. Several features (wording, images, colors) found on packaging may skew perceptions of children’s diets, suggesting that children are meant to eat fun, exciting food. Useful discussion on the implications of food marketing and its potential to misguide parents’ choices for their children’s diet.

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  • Elliott, Charlene, and Meaghan Brierley. 2012. Healthy choices?: Exploring how children evaluate the healthfulness of packaged foods. Canadian Journal of Public Health/Revue Canadienne de Santé Publique 103.6: 453–458.

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    Qualitative study with elementary school children investigating the features of product packages that children use to decide if a product is healthy. Highlights several food marketing and packaged features that impact food choice which do not necessarily align with heathy eating.

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  • Ferguson, Christopher J., Monica E. Munoz, and Maria R. Medrano. 2012. Advertising influences on young children’s food choices and parental influence. Journal of Pediatrics 160:452–454.

    DOI: 10.1016/j.jpeds.2011.08.023Save Citation »Export Citation » Share Citation »

    Experimental study showed that parents can only slightly moderate children’s food choices after viewing food advertising. Provides a start to evaluating relative impact and how much parents cannot assume full responsibility for children’s eating habits. Useful in understanding how social and communication factors interact to influence food choice.

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  • Wartella, Ellen A., Alice H. Lichtenstein, Ann Yaktine, and Romy Nathan, eds. 2012. Front-of-pack nutrition rating systems and symbols: Promoting healthier choices. Institute of Medicine of the National Academies. Washington, DC: National Academies.

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    Detailed report on food product labeling with a focus on front-of-pack ratings. Reviews regulatory environment, consumer use of labels, evidence on the impact of various labeling systems, and possible application and evaluation. Comprehensive and understandable account of relevant information for researchers or policymakers working on nutrition and food labeling in United States or similar countries.

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Nutrition Education

Nutrition knowledge is another determinant of food choice. Grosso, et al. 2013 assesses nutrition knowledge as one of several determinants of food intake for adolescents in Italy. Beydoun and Wang 2008 and Miura and Turrell 2014 both assess whether nutrition knowledge can mediate relationships between economic factors and diet. Beydoun and Wang 2008 focuses on dietary quality and fruits and vegetable intake as the outcome, while Miura and Turrell 2014 measures intake of food away from home. These studies provide an important perspective on population nutrition interventions by examining the idea that while improving nutrition knowledge is helpful it alone may be inadequate to produce significant long-term dietary change as other environmental factors persist that contradict nutrition education. Such findings reinforce that comprehensive multilevel interventions that address several population determinants are likely to be more effective than a single intervention. Finally, Gitelsohn, et al. 2013 provides an example of a nutrition education intervention that may take one step closer to aligning communication factors with other environmental factors, such as food availability, prices, and cultural factors since it is situated within a food store on an American Indian reserve.

  • Beydoun, Mary, and Youfa Wang. 2008. Do nutrition knowledge and beliefs modify the association of socio-economic factors and diet quality among US adults? Preventive Medicine 46:145–153.

    DOI: 10.1016/j.ypmed.2007.06.016Save Citation »Export Citation » Share Citation »

    Findings from a survey of over four thousand adults in the United States demonstrated that nutrition knowledge is an important factor determining whether individuals from different socioeconomic levels have optimal dietary quality and meet vegetables and fruit guidelines. Advanced research study suitable for graduate students.

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  • Gitelsohn, Joel, Elizabeth M. Kim, Siran He, and Maria Pardilla. 2013. A food store-based environmental intervention is associated with reduced BMI and improved psychosocial factors and food-related behaviors on the Navajo nation. Journal of Nutrition 143.9: 1494–1500.

    DOI: 10.3945/jn.112.165266Save Citation »Export Citation » Share Citation »

    Evaluation of healthy eating education and promotion intervention within a store on an American Indian reserve. The article’s findings are useful in understanding effectiveness of interventions in applied settings. This is an example of one type of communication or social marketing intervention to promote healthy eating.

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  • Grosso, Giuseppe, Antonio Mistretta, Giovanna Turconi, Hellas Cena, Carla Roggi, and Fabio Galvano. 2013. Nutrition knowledge and other determinants of food intake and lifestyle habits in children and youth adolescents living in a rural area of Sicily, South Italy. Public Health Nutrition 16.10: 1827–1836.

    DOI: 10.1017/S1368980012003965Save Citation »Export Citation » Share Citation »

    Cross-sectional evaluation of factors associated with diets of school-aged children. Findings demonstrate an independent relationship between nutrition knowledge and food group intake. Nutrition knowledge was also found to be associated with higher education and employment. A good basic study on economic and communication factors for undergraduate students.

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  • Miura, Kyoko, and Gavin Turrell. 2014. Contribution of psychosocial factors to the association between socioeconomic position and takeaway food consumption. PLoS ONE 9.9: 1–10.

    DOI: 10.1371/journal.pone.0108799Save Citation »Export Citation » Share Citation »

    Cross-sectional survey of 1,500 adults in Australia demonstrated that nutrition knowledge and beliefs can mediate the relationship between education level and away from home food consumption but does not completely explain the relationship. Suggests that changing attitudes and knowledge is not enough and that broader structural changes are needed.

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The Political Environment

The political environment encompasses the formal rules and policies that intersect with all other environmental types to influence food consumption and eating behavior. At a societal level, policies act as determinants of (un)healthy eating by setting priorities for broader food systems, such as influencing food production and distribution. Policies to protect consumers, such as food safety regulations or food labeling, would also be included. At local (municipal, school, etc.) levels, policies can influence the physical availability of food through zoning by-laws or school food policies (see Physical Environment). Food taxation and subsidy policies intersect with the economic environment through influencing the price of food (see The Economic Environment). Policies that influence the communication environment include those that govern nutrition education or food marketing (see Communication Environment). In this section, readers will gain a sense of how political factors can influence population diets and eating behaviors by acting at several levels in multiple settings. First, a collection of resources is provided that review what food policies are, how they work, and the impact of policy interventions (see General Overviews of the Political Environment). This article concludes by reviewing several research papers with examples of population-level policy-relevant interventions that have been or could be implemented to reduce consumption of unhealthy foods and beverages and increase consumption of healthy items (see Types of Policy Interventions).

General Overviews of the Political Environment

Several papers provide overviews of political food environments and policy levers to influence eating behavior at local levels (schools, workplaces, neighborhoods, municipalities) and broader jurisdictions (regions, nations, globally). Hawkes, et al. 2013 provides a basic framework of policy options to improve diets. Swinburn, et al. 2013 provides research and evaluation benchmarks and methods to monitor food environment features and policy actions to improve population nutrition. “Smart food policies,” as described by Hawkes, et al. 2015, are needed to effectively impact population diets. She describes the mechanisms in which “smart food policies” can be developed and implemented to improve diet and weight status. Booth, et al. 2001 reviews leverage points to optimize health promoting environments and policies for diet and physical activity. Focusing on highly processed foods and beverages, the Pan-American Health Organization 2015 provides a comprehensive report on population intake of these products and presents potential relevant policy interventions. Sacks, et al. 2008 explains how food policies can be implemented by multiple sectors and levels to effectively impact population diets. Finally, Hughes 2006 provides insight into the level of support and infrastructure needed in order to engage in public health nutrition work in Australia. These findings may be important for policymakers and researchers to understand the limit of the capacity of public health service and possible implications on population diets, with special attention to groups that may be vulnerable to systemic inequities.

  • Booth, Sarah L., James F. Sallis, and Cheryl Ritenbaugh, et al. 2001. Environmental and societal factors affect food choice and physical activity: Rationale, influences, and leverage points. Nutrition Reviews 59.3: S21–S39.

    DOI: 10.1111/j.1753-4887.2001.tb06983.xSave Citation »Export Citation » Share Citation »

    Provides framework of determinants of eating and activity with influences ranging from biological to societal influences. Explores potential points of intervention and considers level of difficulty and degree of impact for several interventions.

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  • Hawkes, C., J. Jewell, and K. Allen. 2013. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: The NOURISHING framework. Obesity Reviews 14.S2: 159–168.

    DOI: 10.1111/obr.12098Save Citation »Export Citation » Share Citation »

    Provides a framework for policy action in areas of food environments, food systems, and behavior change communication to support healthy diets and reduce disease in populations. Also provides rationale and examples of policy interventions. Useful for policymakers and researchers conducting policy-relevant work.

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  • Hawkes, Corinna, Trenton G. Smith, and Jo Jewell, et al. 2015. Smart food policies for obesity prevention. Lancet 385:2410–2421.

    DOI: 10.1016/S0140-6736(14)61745-1Save Citation »Export Citation » Share Citation »

    Describes in detail the mechanisms in which food policies can impact diet within the social, physical, and information environments. Provides several examples and suggestions for moving forward; useful for researchers and policymakers.

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  • Hughes, Roger. 2006. A socioecological analysis of the determinants of national public health nutrition work force capacity: Australia as a case study. Family & Community Health 29.1: 55–67.

    DOI: 10.1097/00003727-200601000-00007Save Citation »Export Citation » Share Citation »

    Discusses several attributes of public health nutrition in Australia that can impact the quality and reach of public health nutrition work through restricting resources and supports for policy and program action.

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  • Pan-American Health Organization. 2015. Ultra-processed food and drink products in Latin America: Trends, impact on obesity, policy implications. Washington, DC: PAHO.

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    Provides a cross-country comparison of environmental factors and processed food and beverage sales. Chapters 4 and 6 will be helpful in understanding broader national and global factors (urbanization, country income, market deregulation) on diet and the policies and actions that could improve population nutrition.

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  • Sacks, Gary, Boyd A. Swinburn, and Mark A. Lawrence. 2008. A systematic policy approach to changing the food system and physical activity environments to prevent obesity. Australia & New Zealand Health Policy 5:1–7.

    DOI: 10.1186/1743-8462-5-13Save Citation »Export Citation » Share Citation »

    Discusses potential actions to improve diet and physical activity through the multiple policy levels (from organizations to international governance) and multiple sectors (food production, distribution, marketing, etc.). Helpful in representing distributions of responsibility across areas of governance and industry sectors.

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  • Swinburn, B., G. Sacks, and S. Vandevijvere, et al. 2013. INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support): Overview and Key Principles. Obesity Reviews 14:1–12.

    DOI: 10.1111/obr.12087Save Citation »Export Citation » Share Citation »

    Describes the key pieces of monitoring population nutrition including private and public food-related policies and actions, their impact on food environments, and population nutrition and health outcomes. Provides guidance to other resources on specific food environment and policy topics. Invaluable source of internationally informed population nutrition research to inform policy and practice.

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Types of Policy Interventions

Policy interventions that can be undertaken to improve population diets are expansive. This section provides numerous examples of types of food-related policy interventions and the evidence behind them, but should not be considered a complete collection of possible actions. Mayne, et al. 2015 provides a systematic review of diet and physical activity-related policies that may be effective at reducing or preventing obesity. Traill, et al. 2014 reviews the significance of policies in impacting regional, national, and global sectors that impact food environmental features and thus food intake. Brennan, et al. 2014 summarizes the evidence on the relative effectiveness of policy and environmental interventions to improve childhood obesity through nutrition and physical activity. Campbell, et al. 2011 addresses a specific physical environmental factor, access to food, by exploring private-public partnerships to improve healthy food provision in the United States. A policy intervention to modify the nutrient content of products in the food supply is analyzed by Trieu, et al. 2015, specifying how sodium content in foods has changed across several countries. Jou and Techakehakij 2012 reviews the application of an economic food-related policy, taxing sugar-sweetened beverages, and explains why or why not such a policy would be effective in certain contexts. Finally, Potvin, et al. 2012 examines different types of policies related to food marketing to children in Canada and their impact on children’s exposure to marketing and the nutritional quality of foods and beverages advertised.

  • Brennan, Laura K., Ross C. Brownson, and C. Tracy Orleans. 2014. Childhood obesity policy research and practice: Evidence for policy and environmental strategies. American Journal of Preventive Medicine 46.1: e1–e16.

    DOI: 10.1016/j.amepre.2013.08.022Save Citation »Export Citation » Share Citation »

    Systematic review of twenty-four interventions to reduce childhood obesity. Analyzes impact by the RE-AIM framework and provides tiered ranking of evidence. Excellent article for novice researchers or policymakers in understanding types of interventions that have been researched and their relative effectiveness.

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  • Campbell, Keren R., Terri Lawson, and Kim Dohyeong. 2011. Eradication of food deserts through public policy: Case of Durham, North Carolina. Journal of Safety and Crisis Management 1.2: 23–30.

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    General overview of how private-public partnerships can be created and levered to generate programs and policy to increase access to healthy food provision in areas suffering from a food desert. May be useful for policymakers or for researchers interested in policy-relevant research. See also Debates Surrounding the Physical Environment.

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  • Jou, Judy, and Win Techakehakij. 2012. International application of sugar-sweetened beverage (SSB) taxation in obesity reduction: Factors that may influence policy effectiveness in country-specific contexts. Health Policy 107.1: 83–90.

    DOI: 10.1016/j.healthpol.2012.05.011Save Citation »Export Citation » Share Citation »

    Provides a summary of environmental and contextual factors that impact the usefulness of taxing sugar-sweetened beverages. Useful for policymakers to determine applicability of this economic policy intervention in their jurisdiction.

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  • Mayne, S. L., A. H. Auchincloss, and Y. L. Michael. 2015. Impact of policy and built environment changes on obesity-related outcomes: A systematic review of naturally occurring experiments. Obesity Reviews 16:363–375.

    DOI: 10.1111/obr.12269Save Citation »Export Citation » Share Citation »

    Reviews eighteen studies on nutrition and diet and identifies the differential impact of several food-related naturally occurring policy and environment interventions. Not only focuses on diet but also on physical activity within the context of obesity prevention. Useful for exploring types of policy interventions used thus far and their effectiveness in practice.

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  • Potvin, Kent M., L. Dubois, and A. Wanless. 2012. A nutritional comparison of foods and beverages marketed to children in two advertising policy environments. Obesity 20.9: 1829–1837.

    DOI: 10.1038/oby.2011.161Save Citation »Export Citation » Share Citation »

    Cross-provincial comparison in Canada of food marketing to children evaluating the impact of a having a provincial policy prohibiting all marketing to children (food and otherwise) versus no provincial policy. Useful research for understanding types of policy interventions and potential features that could weaken a food marketing policy.

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  • Traill, W. Bruce, Mario Mazzocchi, Bhavani Shankar, and David Hallam. 2014. Importance of government policies and other influences in transforming global diets. Nutrition Reviews 72.9: 591–604.

    DOI: 10.1111/nure.12134Save Citation »Export Citation » Share Citation »

    Takes an international perspective on how agriculture, trade, urbanization, and many other broad factors impact food consumption. An advanced article on the relationship of several global factors that is useful for readers interested in food systems.

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  • Trieu, Kathy, Bruce Neal, and Corinna Hawkes, et al. 2015. Salt reduction initiatives around the world—a systematic review of progress towards the global target. PLoS ONE 10.7: 1–22.

    DOI: 10.1371/journal.pone.0130247Save Citation »Export Citation » Share Citation »

    Systematic review on national-level interventions to reduce sodium content of food and population sodium intake. Approaches vary making it difficult to identify critical intervention features. Discusses cross-country differences and rationales and is a valuable example of a multicomponent population nutrition intervention.

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