Community Nursing, Preventive Medicine and Public Health and History of Science, Universitat d'Alacant, 03690 San Vicente del Raspeig, 03001 Alicante, Spain
Dr. Eva María Trescastro-López
Community Nursing, Preventive Medicine and Public Health and History of Science, Universitat d'Alacant, 03690 San Vicente del Raspeig, 03001 Alicante, Spain
The rise in obesity prevalence has increased research interest in the obesogenic environment and its influence on excess weight. The aim of the present study was to review and map data collection instruments for obesogenic environments in adults in order to provide an overview of the existing evidence and enable comparisons. Through the scoping review method, different databases and webpages were searched between January 1997 and May 2018. Instruments were included if they targeted adults. The documents were categorised as food environment or built environment. In terms of results, 92 instruments were found: 46 instruments measuring the food environment, 42 measuring the built environment, and 4 that characterised both environments. Numerous diverse instruments have been developed to characterise the obesogenic environment, and some of them have been developed based on existing ones; however, most of them have not been validated and there is very little similarity between them, hindering comparison of the results obtained. In addition, most of them were developed and used in the United States and were written in English. In conclusion, there is a need for a robust instrument, improving or combining existing ones, for use within and across countries, and more sophisticated study designs where the environment is contemplated in an interdisciplinary approach.
Individuals’ perceptions of their food environments are a mediator between exposure to the environment and people’s interaction with it. The Nutrition Environment Measures Surveys (NEMS) are valid and reliable measures to assess food environments. In Spain, there is no adapted instrument to measure the perceived obesogenic environment. This article aims to adapt and evaluate the Perceived Nutrition Environment Measures Survey for a Spanish context (NEMS-P-MED). The Spanish version has 32 questions to measure the perception about availability, accessibility and marketing of 3 types of environment: home, shops and restaurants. We assess feasibility, construct validity and internal consistency reliability through a sample of 95 individuals. The internal consistency was acceptable for most items (Cronbach’s alpha coefficients range from 0.6 to 0.9), similar to that of the original scale. The NEMS-P-MED has been shown to be valid and, on certain items reliable, and was useful to assess the population’s perceptions of the food environment in the home, restaurants and food stores in a Spanish context. Adapting standardized measurement tools to specific contexts to assess the perceived and observed characteristics of food environments may facilitate the development of effective policy interventions to reduce excess weight.
The Nutrition Environment Measures Surveys are valid and reliable measures of community and consumer food environments. This article describes the adaptation and evaluation of the Nutrition Environment Measures Survey in Stores (NEMS-S) for Mediterranean urban contexts (NEMS-S-MED). Trained raters used the adapted NEMS-S-MED tool to observe and rate food outlets in 21 census tracts and 43 food stores across the city of Madrid, Spain. We evaluated inter-rater and intra-rater reliabilities, construct validity, and the tool’s ability to discriminate between store types and between stores by area-level Socio-Economic Status (SES). Overall, the mean NEMS-S-MED score was 20.7 (SD = 9.8), which ranged from 7 to 43. Most food items displayed substantial or almost perfect inter-rater and intra-rater agreements; the percentage agreement across availability items was almost perfect and kappa statistics were also very high (median κ = 1.00 for inter-rater; κ = 0.92 for intra-rater). Furthermore, the NEMS-S-MED tool was able to discriminate between store types and census tracts of different SES. The adapted NEMS-S-MED instrument is a reliable and valid audit tool to assess the consumer food environment in Mediterranean urban contexts. Well-constructed measurement tools, such as the NEMS-S-MED, may facilitate the development of effective policy interventions to increase healthy food access and affordability.
Social determinants of health are a major contributing factor to health inequalities and have important effects on the health of the population. The aim of the study was to estimate the prevalence of overweight/obesity in native and immigrant children aged 2–14 years residing in Spain, and to explore its relationship with socioeconomic factors, habits, and living and health conditions. This study used data from the 2017 Spanish National Health Survey, which collects health information on the population residing in Spain. Multivariate logistic regression models were fitted to estimate the risk of overweight/obesity controlling for the variables of interest. The final sample consisted of 2351 households. Children of immigrant origin had a significantly higher overall prevalence of overweight and/or obesity than natives, both in boys (40.5% vs. 29.5%) and girls (44.8% vs. 30.3%), and a higher adjusted risk of overweight/obesity (OR = 1.67). In addition, it has been observed that children of immigrant origin were at higher risk of consuming sugary soft drinks, exercising less, and using screens more. In conclusion, the increased risk of having different habits that may contribute to developing excess weight and of having overweight/obesity in children with a migrant background should guide public health policies and interventions, emphasizing those groups at higher risk and incorporating considerations of socioeconomic inequalities.
Resumen El objetivo del estudio fue determinar los efectos sobre los hábitos alimentarios de escolares en una intervención educativa alternativa al modelo convencional de promoción de alimentación a un centro con comedor y proyecto de huerto ecológico. Estudio observacional descriptivo de corte transversal y comparativo de 111 niños y niñas entre 9 y 12 años, en el periodo 2013-15. Se comparó un colegio con intervención alternativa con otro que únicamente incluía contenidos propios del currículo de Educación Infantil y Primaria, mediante evaluación de adherencia a la dieta mediterránea del alumnado con cuestionario validado Kidmed. El centro de intervención presentó mayor adherencia a la dieta mediterránea que el centro control. En el centro de intervención el porcentaje de alumnado con dieta óptima (64,52%) fue mayor que los que necesitaban mejorar su dieta (33,87%), mientras que en el centro fue inferior (42,86% y 51,02% respectivamente). Los escolares del centro de intervención presentaron mayor porcentaje de respuestas afirmativas en ítems Kidmed. El programa de promoción de alimentación saludable alternativo del centro de intervención podría ser efectivo para la adquisición de una dieta de mayor adherencia a la dieta mediterránea.
Introduction: The Mediterranean diet (MD) has been shown to be a good tool for the prevention of obesity and other chronic noncommunicable diseases (NCDs) and to have a low environmental impact. The aim of the present study was to evaluate the relationship between declared morbidity, lifestyles and other sociodemographic factors with high adherence to the MD (AMD) in an adult population in southeastern Spain. Material and Methods: We conducted a cross-sectional study of a sample (n = 2728) representative of a non-institutionalized population ≥16 years. The data corresponded to the 2010-11 Nutrition Survey of the Valencian Community. The AMD was assessed using the Mediterranean Diet Adherence Screener questionnaire. The association of variables and high AMD was assessed by univariate and multivariate logistic regression determining crude and adjusted odds ratios. Results: Multivariate analysis showed that age 45 years or older, living with a partner, eating between meals, and not smoking were associated with high AMD. The age groups 45–64 years and 65 years or older showed the strongest association with high AMD in both sexes. Conclusion: The investigation showed a generational loss of AMD. People older than 45 years and living in company are more likely to adhere to DM, the risk group being young people living alone and smokers.