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      ‘Nutrition is out of our control’: soldiers’ perceptions of their local food environment

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          Abstract

          Objective:

          To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General’s worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace.

          Design:

          Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers’ nutrition behaviours.

          Setting:

          Three US Army installations located in the continental USA.

          Participants:

          Active duty soldiers ( n 366) participating in one of the fifty-eight focus groups.

          Results:

          Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices.

          Conclusions:

          Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers’ nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers’ daily food allowances on local produce and increased availability of grab-and-go options.

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          Most cited references21

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          The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food.

          In light of proposals to improve diets by shifting food prices, it is important to understand how price changes affect demand for various foods. We reviewed 160 studies on the price elasticity of demand for major food categories to assess mean elasticities by food category and variations in estimates by study design. Price elasticities for foods and nonalcoholic beverages ranged from 0.27 to 0.81 (absolute values), with food away from home, soft drinks, juice, and meats being most responsive to price changes (0.7-0.8). As an example, a 10% increase in soft drink prices should reduce consumption by 8% to 10%. Studies estimating price effects on substitutions from unhealthy to healthy food and price responsiveness among at-risk populations are particularly needed.
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            Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues.

            Current public health and medical evidence rely heavily on efficacy information to make decisions regarding intervention impact. This evidence base could be enhanced by research studies that evaluate and report multiple indicators of internal and external validity such as Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) as well as their combined impact. However, indices that summarize the combined impact of, and complex interactions among, intervention outcome dimensions are not currently available. We propose and discuss a series of composite metrics that combine two or more RE-AIM dimensions, and can be used to estimate overall intervention impact. Although speculative and, at this point, there have been limited empirical data on these metrics, they extend current methods and are offered to yield more integrated composite outcomes relevant to public health. Such approaches offer potential to help identify interventions most likely to meaningfully impact population health.
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              Is Open Access

              Effectiveness of interventions targeting physical activity, nutrition and healthy weight for university and college students: a systematic review and meta-analysis

              To examine the effectiveness of interventions aimed at improving physical activity, diet, and/or weight-related behaviors amongst university/college students. Five online databases were searched (January 1970 to April 2014). Experimental study designs were eligible for inclusion. Data extraction was performed by one reviewer using a standardized form developed by the researchers and checked by a second reviewer. Data were described in a narrative synthesis and meta-analyses were conducted when appropriate. Study quality was also established. Forty-one studies were included; of these, 34 reported significant improvements in one of the key outcomes. Of the studies examining physical activity 18/29 yielded significant results, with meta-analysis demonstrating significant increases in moderate physical activity in intervention groups compared to control. Of the studies examining nutrition, 12/24 reported significantly improved outcomes; only 4/12 assessing weight loss outcomes found significant weight reduction. This appears to be the first systematic review of physical activity, diet and weight loss interventions targeting university and college students. Tertiary institutions are appropriate settings for implementing and evaluating lifestyle interventions, however more research is needed to improve such strategies. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0203-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                Public Health Nutr
                Public Health Nutr
                PHN
                Public Health Nutrition
                Cambridge University Press (Cambridge, UK )
                1368-9800
                1475-2727
                October 2019
                21 June 2019
                : 22
                : 15
                : 2766-2776
                Affiliations
                [ 1 ] ICF, Rockville , MD, USA
                [ 2 ] Oak Ridge Institute for Science and Education (ORISE), Oak Ridge Associated Universities (ORAU), Former Participant in support of US Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, ORAU, Belcamp , MD, USA
                [ 3 ] US Army Public Health Center, Health Promotion and Wellness Directorate , 8977 Sibert Road, Aberdeen Proving Ground, MD 21010, USA
                [ 4 ] US Army Office of The Surgeon General, Health & Wellness, Falls Church , VA, USA
                Author notes
                [* ] Corresponding author: Email theresa.j.santo.civ@ 123456mail.mil
                Article
                00138 S1368980019001381
                10.1017/S1368980019001381
                6751505
                31221240
                37656296-2aae-4c28-913f-986ae8538d12
                © The Authors 2019

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 October 2018
                : 08 March 2019
                : 21 March 2019
                Page count
                Figures: 3, Tables: 3, References: 45, Pages: 11
                Categories
                Research Paper
                Behavioural Nutrition

                Public health
                food preferences,environment and public health,qualitative research,military facilities,environment design

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