Browsing by Author "Kraak, Vivica"

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    Advice for Food Systems Governance Actors to Decide Whether and How to Engage With the Agri-Food and Beverage Industry to Address Malnutrition Within the Context of Healthy and Sustainable Food Systems
    Kraak, Vivica (2021-07-06)
    The effectiveness of public-private partnerships (PPPs) to address malnutrition will depend on the issue, engagement purpose, policy context and actors' interactions. This commentary offers advice for governments, United Nations (UN) and civil society organizations to decide whether and how to engage with industry actors to improve diets for populations. First, food systems governance actors must acknowledge and reconcile competing visions, harmonize numerous corporate-engagement principles, and support a shared narrative to motivate collective actions toward healthy sustainable diets. Second, food systems governance actors have tools to guide engagement through many alliances, networks, coalitions and multi-stakeholder platforms with different levels of risk and trust. Third, food systems governance actors must prioritize accountability by setting corporate-performance threshold scores to justify private-sector engagement; evaluating engagement processes, outcomes and consequences; using incentives, financial penalties and social media advocacy to accelerate time-bound changes; and revoking UN consultative status for corporate actors who undermine healthy people and planet.
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    Applying a Multi-Dimensional Digital Food and Nutrition Literacy Model to Inform Research and Policies to Enable Adults in the U.S. Supplemental Nutrition Assistance Program to Make Healthy Purchases in the Online Food Retail Ecosystem
    Consavage Stanley, Katherine; Harrigan, Paige B.; Serrano, Elena L.; Kraak, Vivica (MDPI, 2021-08-06)
    The United States (U.S.) Department of Agriculture (USDA)-administered Supplemental Nutrition Assistance Program (SNAP) made substantial changes in response to the coronavirus disease 2019 (COVID-19) pandemic. These changes highlight the need to identify the digital literacy skills and capacities of SNAP adults to purchase healthy groceries online. We conducted a scoping review of four electronic databases, Google and Google Scholar to identify studies that measured food and nutrition literacy outcomes for U.S. adults. We applied a multi-dimensional digital food and nutrition literacy (MDFNL) model to assess six literacy levels and components. Of 18 studies published from 2006–2021, all measured functional and interactive literacy but no study measured communicative, critical, translational, or digital literacy. Six studies examined SNAP or SNAP-Education outcomes. Adults with higher food or nutrition literacy scores had better cognitive, behavioral, food security and health outcomes. We suggest how these findings may inform research, policies, and actions to strengthen the multi-dimensional literacy skills of SNAP participants and SNAP-eligible adults to support healthy purchases in the online food retail ecosystem.
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    An Assessment of Government Capacity Building to Restrict the Marketing of Unhealthy Food and Non-Alcoholic Beverage Products to Children in the Region of the Americas
    Rincón-Gallardo Patiño, Sofía; da Silva Gomes, Fabio; Constantinou, Steven; Lemaire, Robin Hargroder; Hedrick, Valisa E.; Serrano, Elena L.; Kraak, Vivica (MDPI, 2021-08-06)
    The Pan American Health Organization (PAHO) Strategic Plan 2020–2025 committed to reduce children’s consumption of energy-dense nutrient-poor food and beverage products high in fat, sugar and salt (HFSS) and promote healthy eating patterns to reduce malnutrition in all forms. This paper describes the capacity-building needs in PAHO’s Member States to restrict the marketing of HFSS food and beverages to children. We asked Ministries of Health officials or national institutes/departmental representatives (n = 35) to complete a 28-item web-based survey (January to July 2020). Capacity-building needs were assessed using an adapted version of the World Health Organization’s government capacity-building framework with three modules: public health infrastructure, policies and information systems. Notable achievements for the PAHO’s Plan of Action were identified. State representatives reported strong infrastructure and information systems; however, policy improvements are needed to increase comprehensive national responses. These include using a constitutional health and human rights approach within the policies, policies that document conflict of interest from non-state actors, and strengthening regulatory oversight for digital media platforms. These findings provide baseline data and we suggest priorities for further action to strengthen national governments’ capacity-building and to accelerate the development, implementation, and monitoring systems to restrict the marketing of HFSS food and non-alcoholic beverages to children in the region of the Americas.
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    The Availability of Competitive Foods and Beverages to Middle School Students in Appalachian Virginia Before Implementation of the 2014 Smart Snacks in School Standards
    Mann, Georgianna Rhodes; Kraak, Vivica; Serrano, Elena L. (Centers for Disease Control and Prevention, 2015-09)
    The study objective was to examine the nutritional quality of competitive foods and beverages (foods and beverages from vending machines and à la carte foods) available to rural middle school students, before implementation of the US Department of Agriculture’s Smart Snacks in School standards in July 2014. In spring 2014, we audited vending machines and à la carte cafeteria foods and beverages in 8 rural Appalachian middle schools in Virginia. Few schools had vending machines. Few à la carte and vending machine foods met Smart Snacks in School standards (36.5%); however, most beverages did (78.2%). The major challenges to meeting standards were fat and sodium content of foods. Most competitive foods (62.2%) did not meet new standards, and rural schools with limited resources will likely require assistance to fully comply.
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    Awareness and outcomes of the fruits and veggies (FNV) campaign to promote fruit and vegetable consumption among targeted audiences in California and Virginia: a cross-sectional study
    Englund, Tessa R.; Hedrick, Valisa E.; Patiño, Sofía R.; Kennedy, Lauren E.; Hosig, Kathryn W.; Serrano, Elena L.; Kraak, Vivica (2021-06-09)
    Background In 2015, the Partnership for a Healthier America launched the branded Fruits & Veggies (FNV) Campaign to apply a unique industry-inspired marketing approach to promote fruit and vegetable sales and intake to moms and teens in two US pilot markets: Fresno, California and Hampton Roads, Virginia. The aims of this cross-sectional study were to: 1) assess brand awareness and fruit- and vegetable-related outcomes among FNV Campaign target audiences in the California and Virginia market locations; and 2) examine whether reported awareness of the FNV Campaign was associated with differences in fruit- and vegetable-related cognitive and behavioral outcomes. Methods Data for this cross-sectional study were collected using an online survey administered to a non-probability convenience sample (n = 1604; February–July 2017) of youth aged 14–20 years (n = 744) and moms aged 21–36 years (n = 860) in the two pilot markets. Descriptive statistics were computed and outcomes compared between unaware and aware respondents, controlling for sociodemographic covariates. Multivariate analysis of covariance (MANCOVA) was conducted to assess whether fruit- and vegetable-related attitude, belief, and encouragement outcomes differed by FNV Campaign awareness; logistic regression was used to examine associations between FNV brand awareness and dichotomous variables (fruit- and vegetable-related behavioral intentions, trying new fruits and vegetables); and ANCOVA was used to assess associations with daily fruit and vegetable intake frequency. Results Approximately 20% (n = 315/1604) of respondents reported awareness of the FNV Campaign. Youth that reported awareness of the FNV Campaign (n = 167, 22.4%) had higher intentions to buy (p = 0.003) and eat (p = 0.009) fruits and vegetables than unaware respondents. Mothers that reported awareness of the FNV Campaign (n = 148, 17.2%) reported greater encouragement for friends and family to eat fruits and vegetables (p = 0.013) and were approximately 1.5 times more likely to report trying a new fruit or vegetable (p = 0.04) than mothers unaware of the Campaign. Daily fruit and vegetable intake frequency did not differ by Campaign awareness. Conclusions FNV Campaign awareness was associated with limited but positive short- and intermediate-term cognitive and behavioral outcomes among target audience respondents. These findings can inform future research to enhance understanding and improve the FNV Campaign as it is expanded to new markets nationwide.
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    Branded Marketing and Media Campaigns to Support a Healthy Diet in the United States, 1999-2016: Insights to Inform the Partnership for a Healthier America’s Fruits & Veggies (FNV) Campaign
    Kraak, Vivica; Englund, Tessa R.; Zhou, Mi; Duffey, Kiyah J. (2017-03)
    Introduction Obesity and diet-related non-communicable diseases (NCD) are serious public health challenges that have created an enormous financial burden on the United States (U.S) health care system. The United States spends an estimated $190 billion annually on obesity-related costs, representing about 20 percent of all medical spending. Childhood obesity is responsible for more than $14 billion dollars in direct medical costs...
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    Challenges and Opportunities for Member States to Implement Resolution WHA63.14 to Restrict the Marketing of Unhealthy Food and Non-alcoholic Beverage Products to Children to Decrease Global Obesity and Non-Communicable Disease Risks by 2025
    Rincon Gallardo Patino, Sofia (Virginia Tech, 2020-11-05)
    The widespread marketing of food and beverage products high in fat, sugar and salt (HFSS) es is a significant driver of obesity and diet-related non-communicable diseases (NCDs). This PhD dissertation examined the factors related to Member States' capacity and actions to fully implement the 2010 World Health Assembly's Resolution WHA63.14 to restrict the marketing of HFSS food and non-alcoholic beverage products to children up to 18 years by 2025. The first study describes the capacity-building needs of Ministries of Health (MoH) to implement the Resolution WHA63.14. The research used a 28-item web-based survey administered to representatives of MoH from the Pan American Health Organization (PAHO) region (n= 35). A government capacity-building and integrated marketing communications (IMC) frameworks guided this research. The second study examined the government policies to restrict the marketing of HFSS food and beverage products in a purposive sample of countries in the PAHO region (n=14). The WHO policy and IMC frameworks were used to develop a responsible policy index (RESPI). A web-based platform was developed that uses data visualization tools to depict the results. The third study explored the dimensions of power in the Mexican social networks of stakeholders that influenced the policy-making process that enabled the government to enact front-of-pack (FOP) warning labels on HFSS food and beverage products marketed to children and adults in 2020. The study followed a case study approach, using semi-structured interviews with stakeholders, and guided by the Gaventa's power cube framework. Social Network Analyses were conducted using the UCINET software (version 6) that measured centrality, factions and quadratic assignment procedures (QAP). These PhD studies applied several theoretically grounded conceptual frameworks related to nutrition governance that allowed me to draw conclusions from empirical and published evidence to develop and implement comprehensive policies to restrict the marketing of HFSS food and beverage products to children. Results may inform government agencies, civil society organizations, academic researchers, private foundations and industry actors about the areas needed for policy improvement and promising or best practices that should be adopted to implement Resolution WHA63.14 to reduce children's future risks of obesity and diet-related NCDs by 2025.
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    Clinical Management of Low Vitamin D: A Scoping Review of Physician's Practices
    Rockwell, Michelle S.; Kraak, Vivica; Hulver, Matthew W.; Epling, John W. (MDPI, 2018-04-16)
    The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies do not recommend population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. To assess patterns of physicians’ management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and the gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Thirteen studies published between 2006 and 2015 across seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining a light on physicians’ practices in the face of uncertainty. Future research is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.
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    A collective call to strengthen monitoring and evaluation efforts to support healthy and sustainable food systems: 'The Accountability Pact'
    Garton, Kelly; Kraak, Vivica; Fanzo, Jessica; Sacks, Gary; Vandevijvere, Stefanie; Haddad, Lawrence; Brinsden, Hannah; Laar, Amos; Karupaiah, Tilakavati; Omidvar, Nasrin; Masters, William; Kauer, Inge; Swinburn, Boyd (Cambridge University Press, 2022-05-16)
    There is widespread agreement among experts that a fundamental reorientation of global, regional, national and local food systems is needed to achieve the UN Sustainable Development Goals Agenda and address the linked challenges of undernutrition, obesity and climate change described as the Global Syndemic. Recognising the urgency of this imperative, a wide range of global stakeholders - governments, civil society, academia, agri-food industry, business leaders and donors - convened at the September 2021 UN Food Systems Summit to coordinate numerous statements, commitments and declarations for action to transform food systems. As the dust settles, how will they be pieced together, how will governments and food corporations be held to account and by whom? New data, analytical methods and global coalitions have created an opportunity and a need for those working in food systems monitoring to scale up and connect their efforts in order to inform and strengthen accountability actions for food systems. To this end, we present - and encourage stakeholders to join or support - an Accountability Pact to catalyse an evidence-informed transformation of current food systems to promote human and ecological health and wellbeing, social equity and economic prosperity.
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    Comment on Lau et al. Trends in Beef Intake in the United States: Analysis of the National Health and Nutrition Examination Survey, 2001–2018. Nutrients 2023, 15, 2475
    Consavage Stanley, Katherine; Kraak, Vivica (MDPI, 2023-09-11)
    We were interested to read the results of Lau et al., 2023 [...]
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    A Content Analysis of Persuasive Appeals Used in Media Campaigns to Encourage and Discourage Sugary Beverages and Water in the United States
    Kraak, Vivica; Holz, Adrienne; Woods, Chelsea Lane; Whitlow, Ann R.; Leary, Nicole (MDPI, 2023-07-13)
    The frequent consumption of sugary beverages is associated with many health risks. This study examined how persuasive appeals and graphics were used in different media campaigns to encourage and discourage sugary beverages and water in the United States (U.S.) The investigators developed a codebook, protocol and systematic process to conduct a qualitative content analysis for 280 media campaigns organized into a typology with six categories. SPSS version 28.0 was used to analyze rational and emotional appeals (i.e., positive, negative, coactive) for campaign slogans, taglines and graphic images (i.e., symbols, colors, audiences) for 60 unique campaigns across the typology. Results showed that positive emotional appeals were used more to promote sugary beverages in corporate advertising and marketing (64.7%) and social responsibility campaigns (68.8%), and less to encourage water in social marketing campaigns (30%). In contrast, public awareness campaigns used negative emotional appeals (48.1%), and advocacy campaigns combined rational (30%) and emotional positive (50%) and negative appeals (30%). Public policy campaigns used rational (82.6%) and positive emotional appeals (73.9%) to motivate support or opposition for sugary beverage tax legislation. Chi-square analyses assessed the relationships between the U.S. media campaign typology categories and graphic elements that revealed three variables with significant associations between the campaign typology and race/ethnicity (χ2(103) = 32.445, p = 0.039), content (χ2(103) = 70.760, p < 0.001) and product image (χ2(103) = 11.930, p = 0.036). Future research should examine how positive persuasive appeals in text and graphics can promote water to reduce sugary beverage health risks.
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    Development and feasibility testing of a theory-based intervention to reduce sugar-sweetened beverage consumption among Central Appalachian adolescents
    Lane, Hannah Grace (Virginia Tech, 2016-08-23)
    Children and adolescents consume sugar-sweetened beverages (SSBs) excessively, which is associated with childhood obesity, dental caries, and increased risk for cardiovascular disease and type 2 diabetes. Interventions spanning the socio-ecological model (i.e., intrapersonal, interpersonal, environmental, policy) have been shown to reduce SSB consumption under controlled conditions. However, not much is known about their potential to work under "real-world" conditions. This information can ensure that effective programs reach populations that could most benefit, such as children and adolescents in Central Appalachia, who consume three to four times more SSBs than their American peers. Central Appalachia is a rural, geographically isolated region where attempts to reduce SSBs are challenged by limited resources, skepticism toward health programs/providers, and pervasive cultural norms around SSBs. This dissertation describes three studies (2014-2016) that address these challenges by testing multi-level interventions that prioritize cultural acceptability and feasibility. The first study was a systematic review of child and adolescent SSB studies using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, maintenance) framework to evaluate whether studies reported elements necessary for replicability, such as resources needed for delivery or factors that might prevent participation. The review revealed that available evidence does not provide this information, and recommended that future studies prioritize evaluating and reporting these elements. The second and third studies describe methods to test implementation of Kids SIPsmartER, a theory-based program targeting various socio-ecological levels, in an Appalachian Virginia county. The second study engaged a group on local middle school youth (n=9) in adapting the program, which targeted universal theoretical constructs, to ensure that it was culturally acceptable and demonstrated potential to generate community-wide changes. The third study used a randomized controlled design to determine whether Kids SIPsmartER was feasible as a school-based program. This study tested the program's potential reduce SSBs, as well as whether it was accepted, in demand, and able to be practically implemented within schools, the most common gathering place for rural adolescents. Taken together, these studies provide the foundation for larger, more controlled studies that prioritize both efficacy and replicability, in order to reduce the disproportionate burden of SSBs and associated diseases across Central Appalachia.
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    Development of a Responsible Policy Index to Improve Statutory and Self-Regulatory Policies that Protect Children’s Diet and Health in the America’s Region
    Rincón-Gallardo Patiño, Sofía; Rajamohan, Srijith; Meaney, Kathleen; Coupey, Eloise; Serrano, Elena L.; Hedrick, Valisa E.; da Silva Gomes, Fabio; Polys, Nicholas F.; Kraak, Vivica (MDPI, 2020-01-13)
    In 2010, 193 Member States of the World Health Organization (WHO) endorsed World Health Assembly Resolution WHA63.14 to restrict the marketing of food and beverage products high in fat, sugar and salt (HFSS) to children to prevent obesity and non-communicable diseases (NCDs). No study has examined HFSS marketing policies across the WHO regional office countries in the Americas. Between 2018 and 2019, a transdisciplinary team examined policies to restrict HFSS food and beverage product marketing to children to develop a responsible policy index (RESPI) that provides a quality score based on policy characteristics and marketing techniques. After designing the RESPI, we conducted a comprehensive literature review through October 2019 to examine policies in 14 countries in the WHO Americans Region. We categorized policies (n = 38) as either self-regulatory or statutory and calculated the RESPI scores, ranked from 0 (lowest) to 10 (highest). Results showed Brazil, Canada, Chile, and Uruguay had the highest RESPI scores associated with statutory policies that restricted point of sale, cartoon, licensed media characters and celebrities; and HFSS products in schools and child care settings, and broadcast and print media. Policymakers can use the RESPI tool to evaluate marketing policies within and across geopolitical boundaries to protect children’s diet and health.
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    Digital marketing to young people: Consequences for the health and diets of future generations
    Kraak, Vivica; Zhou, Mi; Rincón-Gallardo Patiño, Sofía (United Nations Standing Committee on Nutrition (UNSCN), FAO, 2020-07-30)
    Digital marketing is widely used to promote highly processed food and beverage products with excessive energy and high in fat, sugars and salt (HFSS) to young people, negatively impacting their diet and health. In this paper, we describe the global trends in digital marketing used to promote unhealthy HFSS products to children, adolescents and young adults aged 7 to 24 years. We review the digital privacy policies of 18 major transnational firms — six technology and 12 international food and beverage companies — to promote food and beverage products, brands and healthy and sustainable lifestyles to young people. Our analysis shows that four of the six technology firms have privacy-protection policies for children under 13 years, but that no firm has a digital marketing policy to restrict the targeting of HFSS food and beverage products to young people. Only one of the 12 food and beverage companies studied has publicly pledged not to use digital marketing to promote HFSS food and beverage products to adolescents (aged 13–18). Governments must develop comprehensive privacy-protection laws that restrict firms from using digital marketing to promote HFSS products to young people and only allow products that meet healthy nutrient-profile criteria. Global and national actors should encourage these 18 firms to adopt best practices to use digital marketing to support healthy and sustainable diets, lifestyles and food systems for future generations.
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    An economic lens for sustainable dietary guidelines
    Kraak, Vivica; Consavage Stanley, Katherine (Elsevier, 2023-05)
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    Effect of a New Nationally-Mandated Healthy Competitive Foods Policy on Middle School Students' Dietary Intake
    Mann, Georgianna Rhodes (Virginia Tech, 2016-02-11)
    Nearly one-third of children in the United States (U.S.) are classified as overweight or obese. Weight status in childhood and adolescence has been tied to adult obesity, which also affects more than one-third of adults in the U.S. Availability of foods and beverages can affect dietary habits, particularly in schools. Students spend most of their waking hours and consume almost half of their daily energy intake in schools. In July of 2014, competitive foods and beverages were required to meet the U.S. Department of Agriculture's Smart Snacks in School nutrition standards. Competitive foods and beverages are items sold outside of the National School Lunch Program and School Breakfast Program. Competitive foods include items offered à la carte, in vending machines, in school stores, and as fundraisers. The goals of this study were to: 1) examine the nutritional quality of competitive foods and beverages in vending machines and as à la carte available to students and 2) assess snack food and beverage intake by students before and after the implementation of the new standards in a sample of middle schools in rural Appalachian Virginia. Eight middle schools with higher than 50% of student eligibility for free or reduced priced lunches were included in the sample. Audits of food and beverage products sold in vending machines and à la carte were completed in the spring of 2014 and 2015. Food frequency questionnaires were completed by students in participating schools. Results showed improvements in school food offerings, though no schools were completely compliant with the new standards. The components of students' diets did not change significantly during the study period, suggesting that improved compliance may not be enough to create a dietary shift. Foods were often replaced with reformulated versions of the same products sold before the implementation of the standards. Incentives for schools to sell more nutrient-dense options such as fruits and vegetables may be helpful to create changes in student's diets. Schools may also require additional training and assistance to fully implement nutrition standards and reach full compliance. Further research is needed to understand barriers to and possible solutions for offering healthier foods and beverages to students in middle schools.
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    The effect of mung bean on improving dietary diversity in women and children in Senegal
    Vashro, Taylor Nadine (Virginia Tech, 2017-06-20)
    Since 2015, a U.S. Agency for International Development and Virginia Tech Education and Research in Agriculture collaboration has introduced and tested mung bean as a potential crop to alleviate malnutrition and food insecurity in Senegal. This MS thesis describes a study conducted to assess the impact of mung bean on dietary diversity of Senegalese women and children in the Kaolack, Matam and Bakel localities of Senegal. A mixed-methods research approach included individual surveys to determine dietary diversity scores (DDS) and focus groups to assess the perceived impacts of mung bean. The dietary diversity survey was conducted with 194 participants including adult women, ages 15 to 70 years (n=109) and children, ages 0-10 years (n=85). Half (52%) of the population were mung bean consumers. The dietary diversity surveys revealed an average DDS of 5.73 on a scale of one to 10, with 5.83 and 5.62 for mung bean and non-mung bean consuming groups, respectively. There was a statistically significant difference in DDS between mung-bean consuming women and both mung bean and non-mung bean children, and between mung bean and non-mung bean consumers in Bakel; however, there was no significant difference between overall mung bean and non-mung bean groups DDS. Focus groups (n=11) with mung bean consuming women identified perceived agricultural, health, and financial benefits associated with mung bean consumption. These results can increase our understanding of how mung bean may influence policy-relevant issues for the Senegalese population, including agricultural, health and financial outcomes that are not reflected in dietary diversity surveys.
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    Effects of Menu Labeling Policies on Transnational Restaurant Chains to Promote a Healthy Diet: A Scoping Review to Inform Policy and Research
    Rincón-Gallardo Patiño, Sofía; Zhou, Mi; da Silva Gomes, Fabio; Lemaire, Robin Hargroder; Hedrick, Valisa E.; Serrano, Elena L.; Kraak, Vivica (MDPI, 2020-05-26)
    There is insufficient evidence that restaurant menu labeling policies are cost-effective strategies to reduce obesity and diet-related non-communicable diseases (NCDs). Evidence suggests that menu labeling has a modest effect on calories purchased and consumed. No review has been published on the effect of menu labeling policies on transnational restaurant chains globally. This study conducted a two-step scoping review to map and describe the effect of restaurant menu labeling policies on menu reformulation. First, we identified national, state, and municipal menu labeling policies in countries from global databases. Second, we searched four databases (i.e., PubMed, CINHAL/EBSCO, Web of Science, and Google Scholar) for peer-reviewed studies and gray-literature sources in English and Spanish (2000–2020). Step 1 identified three voluntary and eight mandatory menu labeling policies primarily for energy disclosures for 11 upper-middle and high-income countries, but none for low- or middle-income countries. Step 2 identified 15 of 577 studies that met the inclusion criteria. The analysis showed reductions in energy for newly introduced menu items only in the United States. We suggesr actions for governments, civil society organizations, and the restaurant businesses to develop, implement, and evaluate comprehensive menu labeling policies to determine whether these may reduce obesity and NCD risks worldwide.