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المؤلفون: Adrian J. Cameron, Maira Bes-Rastrollo, Christine M. White, Claudia Nieto, Lana Vanderlee, Gary Sacks, David Hammond, Clara Gómez-Donoso
المصدر: International Journal of Behavioral Nutrition and Physical Activity, Vol 18, Iss 1, Pp 1-12 (2021)
The International Journal of Behavioral Nutrition and Physical Activityمصطلحات موضوعية: Adult, Male, RC620-627, 030309 nutrition & dietetics, Cross-sectional study, Food policy, Psychological intervention, Medicine (miscellaneous), Behavioural sciences, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Food Supply, Nutrition Policy, 03 medical and health sciences, 0302 clinical medicine, Environmental health, medicine, Humans, 030212 general & internal medicine, Product (category theory), Supermarkets, Nutritional diseases. Deficiency diseases, 2. Zero hunger, 0303 health sciences, Nutrition and Dietetics, Research, Retail, Commerce, Supermarket, Middle Aged, medicine.disease, Obesity, Purchasing, language.human_language, Diet, Food environment, Cross-Sectional Studies, Food, Attitudes, language, Female, Business, Public aspects of medicine, RA1-1270
الوصف: Background Food retail environments have an influential role in shaping purchasing behavior and could contribute to improving dietary patterns at a population level. However, little is known about the level of public support for different types of initiatives to encourage healthy food choices in supermarkets, and whether this varies across countries or context. The current study aimed to explore the level of support for three potential supermarket initiatives focused on product placement across five countries, and factors that may influence this support. Methods A total of 22,264 adults from Australia, Canada, Mexico, the United Kingdom and the United States (US) provided information on support for three supermarket initiatives related to product placement (targeting product positioning: ‘checkouts with only healthy products’, ‘fewer end-of-aisle displays containing unhealthy foods or soft drinks’ or availability: ‘more shelf space for fresh and healthier foods’) as part of the online 2018 International Food Policy Study. The proportion of respondents that supported each initiative was assessed across countries, and multivariable logistic regression analyses were conducted to evaluate the influence of sociodemographic factors on support. Results The initiative that received the highest support was ‘more shelf space for fresh and healthier foods’: 72.0% [95% CI 71.3–72.7], whereas ‘checkouts with only healthy products’ received the lowest support: 48.6% [95% CI 47.8–49.4]. The level of support differed between countries (p Conclusions Most people in the assessed five countries showed a generally high level of support for three placement initiatives in supermarkets to encourage healthy food choices. Support varied by type of initiative (i.e., product positioning or availability) and was influenced by several factors related to country context and sociodemographic characteristics. This evidence could prompt and guide retailers and policy makers to take stronger action to promote healthy food choices in stores.
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المؤلفون: Rebecca M. Leech, Sarah A. McNaughton, Qi-qiang He, Ming-wei Liu
المصدر: International Journal of Behavioral Nutrition and Physical Activity, Vol 18, Iss 1, Pp 1-11 (2021)
The International Journal of Behavioral Nutrition and Physical Activity
Curr Dev Nutrمصطلحات موضوعية: Adult, Male, China, Adolescent, Trajectory, Medicine (miscellaneous), Physical Therapy, Sports Therapy and Rehabilitation, Clinical nutrition, Nutrition Policy, Diabetes mellitus, Environmental health, Humans, Medicine, Nutrition survey, Mortality, lcsh:RC620-627, Aged, Nutrition and Dietetics, business.industry, Mortality rate, Dietary Patterns, Research, lcsh:Public aspects of medicine, Hazard ratio, Nutrition Guidelines, Cohort, Correction, Chinese adults, lcsh:RA1-1270, Middle Aged, Nutrition Surveys, medicine.disease, Healthy diet, Diet, lcsh:Nutritional diseases. Deficiency diseases, Diet quality, Marital status, Female, Diet, Healthy, business, Demography, Food Science
الوصف: Background China has witnessed a significant nutritional transition. However, there is a gap in the literature investigating the association between change of diet and mortality among Chinese. Thus, we aimed to explore the longitudinal trajectories of diet quality over 10 years (from 1997 to 2006) and the subsequent risk of death till 2015 among Chinese adults. Methods Data from the China Health and Nutrition Survey were analyzed in 6398 adults. Dietary intake was assessed using three consecutive 24-h recalls. Diet quality was assessed by the Chinese Healthy Eating Index (CHEI), which includes 17 components and is based on the Dietary Guidelines for Chinese. Latent Class Growth Analysis was conducted to derive trajectories of diet quality over 10 years. Cox proportional hazard regression was used to calculate hazard ratios for total mortality. Results Four distinct CHEI trajectories were identified: 1) worsening; 2) low-moderate-low; 3) improving; 4) high-moderate-high. Group 3 had the lowest mortality rate (5.6%) in the subsequent 9 years, while the groups with worsening or low diet quality had a higher mortality rate (Group 1: 7.5%; Group 2: 10.8%). In the fully adjusted model, compared to group 2, mortality rates were lower for group 3 (RR = 0.73; 95% CI: 0.55, 0.97) and group 4 (RR = 0.76; 95% CI: 0.59, 0.98). No associations with mortality were found for the group 1, when compared to group 2. Conclusions Long-term improved diet quality and adherence to the Dietary Guidelines for Chinese may decrease the risk of death in Chinese adults.
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المؤلفون: Cassandra Lane, Simón Barquera, Ana Munguía, Luke Wolfenden, Hannah M. Brown, Sze Lin Yoong, Sam McCrabb, Sarah Gerritsen, Courtney Barnes, Lesly Samara Véjar
المصدر: International Journal of Behavioral Nutrition and Physical Activity, Vol 18, Iss 1, Pp 1-21 (2021)
The International Journal of Behavioral Nutrition and Physical Activityمصطلحات موضوعية: Adult, Male, Adolescent, Nutrition policy, Psychological intervention, Medicine (miscellaneous), Behavioural sciences, Physical Therapy, Sports Therapy and Rehabilitation, Review, 030204 cardiovascular system & hematology, 03 medical and health sciences, Recommended dietary allowances, 0302 clinical medicine, Behavior Therapy, Intervention (counseling), Vegetables, eHealth, Humans, 030212 general & internal medicine, Marketing, Child, Workplace, Health Education, lcsh:RC620-627, Public health, Schools, Nutrition and Dietetics, lcsh:Public aspects of medicine, Infant, lcsh:RA1-1270, Feeding Behavior, Grey literature, Telemedicine, Diet, lcsh:Nutritional diseases. Deficiency diseases, Health promotion, Systematic review, Child, Preschool, Fruit, Food systems, Female, Business, Diet, Healthy
الوصف: Background The overarching objective was to examine the effectiveness of intervention strategies to promote fruit and vegetable consumption. To do this, systematic review evidence regarding the effects of intervention strategies was synthesized; organized, where appropriate, by the setting in which the strategies were implemented. Additionally, we sought to describe gaps in the review of evidence; that is, where evidence regarding the effectiveness of recommended policy actions had not been systematically synthesised. Methods We undertook a systematic search of electronic databases and the grey literature to identify systematic reviews describing the effects of any intervention strategy targeting fruit and/or vegetable intake in children or adults of any age. Results The effects of 32 intervention strategies were synthesised from the 19 included reviews. The strategies were mapped across all three broad domains of the NOURISHING framework (i.e. food environment, food system and behaviour change communication), but covered just 14 of the framework’s 65 sub-policy areas. There was evidence supporting the effectiveness of 19 of the 32 intervention strategies. The findings of the umbrella review suggest that intervention strategies implemented within schools, childcare services, homes, workplaces and primary care can be effective, as can eHealth strategies, mass media campaigns, household food production strategies and fiscal interventions. Conclusions A range of effective strategy options are available for policy makers and practitioners interested in improving fruit and/or vegetable intake. However, the effects of many strategies – particularly those targeting agricultural production practices, the supply chain and the broader food system – have not been reported in systematic reviews. Primary studies assessing the effects of these strategies, and the inclusion of such studies in systematic reviews, are needed to better inform national and international efforts to improve public health nutrition. Trial registration The review protocol was deposited in a publicly available Open Science framework prior to execution of the search strategy. https://osf.io/unj7x/.
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المؤلفون: M Pia Chaparro, May C. Wang, Catherine M. Crespi, Shannon E. Whaley, Christopher E. Anderson
المصدر: BMC Public Health, Vol 20, Iss 1, Pp 1-11 (2020)
BMC Public Healthمصطلحات موضوعية: Male, Pediatric Obesity, medicine.medical_specialty, Nutrition policy, Health benefits, Childhood obesity, Body Mass Index, Food Supply, 03 medical and health sciences, symbols.namesake, Effect modification, 0302 clinical medicine, Residence Characteristics, Environmental health, medicine, Humans, 030212 general & internal medicine, Poisson regression, Obesity, Nutrition assistance program, 030505 public health, business.industry, Public health, lcsh:Public aspects of medicine, digestive, oral, and skin physiology, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, medicine.disease, Los Angeles, Food environment, Child, Preschool, symbols, Female, Residence, Food Assistance, Biostatistics, 0305 other medical science, business, human activities, Research Article
الوصف: Background Food packages provided by the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) were revised in 2009 to better align them with the Dietary Guidelines for Americans. This study was conducted to evaluate whether the effect of the food package change on childhood obesity varied by the food environment in the neighborhoods where WIC-participating children live. Methods Administrative data from participating children in Los Angeles County, California (2003–2016) were merged with geocoded food vendor information by neighborhood of residence. Obesity risk at age 4 was compared between children receiving old (2003–2009) and new (2010–2016) WIC food packages using sex-stratified Poisson regression models, with interaction terms between WIC package and neighborhood density (number per square mile) of healthy and unhealthy food outlets. Results The new food package was associated with a significant decrease in obesity risk. Among boys, the new food package was associated with 8 to 18% lower obesity risk at all healthy and unhealthy food outlet densities, and the association was not modified by neighborhood food outlet density. Among girls, the association of the new food package with obesity risk was protective in neighborhoods with high healthy and low unhealthy food outlet densities, and adverse in neighborhoods with high unhealthy and low healthy food outlet densities. The effect of the new food package among girls was modified by unhealthy food outlet density, with significantly smaller (p-value = 0.004) decreases in obesity risk observed in neighborhoods with higher unhealthy food outlet density. Conclusions The impact of the food package change was modified by the neighborhood food environment among girls only. Future policy changes should incorporate consideration of ways to mitigate potentially inequitable geographic distribution of the health benefits of policy changes.
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المؤلفون: David Crawford, Kylie Ball, Sarah A. McNaughton, Catherine M. Milte
المصدر: BMC Geriatrics, Vol 19, Iss 1, Pp 1-14 (2019)
BMC Geriatricsمصطلحات موضوعية: Male, Aging, Victoria, medicine.medical_treatment, Nutritional Status, lcsh:Geriatrics, Nutrition Policy, Food group, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Cognition, Surveys and Questionnaires, Medicine, Humans, 030212 general & internal medicine, Social determinants of health, Healthy Lifestyle, Longitudinal Studies, Prospective Studies, Dietary change, Exercise, Aged, 2. Zero hunger, Aged, 80 and over, Rehabilitation, business.industry, Dietary guideline, Middle Aged, Diet, lcsh:RC952-954.6, Cross-Sectional Studies, Dietary guidelines, Telephone interview, Diet quality, Female, Cognitive function, Geriatrics and Gerontology, Diet, Healthy, business, 030217 neurology & neurosurgery, Demography, Research Article
الوصف: Background To date much research into nutrition and cognitive function has been at the nutrient or food level, with inconsistent results. There is increasing interest in the dietary pattern approach to assess whole diet quality and its association with cognitive function. This study investigated if diet quality is associated with cognitive function in men and women aged 55 years and over. Methods Adults aged 55–65 years in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 617) completed a postal survey including a 111-item food frequency questionnaire in 2010 and 2014. Diet quality was assessed via the revised dietary guideline index (DGI-2013) and also by its individual components which assessed key food groups and dietary behaviours from the Australian Dietary Guidelines. The Telephone Interview of Cognitive Status (TICS-m) measured cognitive function in 2014. Associations between past (2010) and recent (2014) diet quality and its components, and cognitive function were assessed by linear regression adjusted for covariates. Results After adjustment for age, sex, education, urban/rural status and physical activity there were no associations between diet quality in 2010 and cognitive function in 2014. However participants who reported higher dietary variety (B = 0.28, 95% CI 0.03, 0.52) and women who reported “sometimes” adding salt to food after cooking (B = 0.98, 95% CI 0.25, 1.71) in 2010 displayed better cognitive function in 2014. In 2014, usual consumption of higher fibre bread choices in the total sample (B = 1.32, 95% CI 0.42, 2.23), and higher diet quality (B = 0.03, 95% CI 0.00, 0.07) and greater fluid consumption (B = 0.14, 95% CI 0.01, 0.27) in men were all associated with better cognitive function. In addition, men who reported “usually” adding salt to their food during cooking displayed poorer cognitive function (B = -1.37, 95% CI -2.39, − 0.35). There were no other associations between dietary intake and cognitive function observed in the adjusted models. Conclusion An association between dietary variety and some limited dietary behaviours and cognitive function was observed, with variation by gender. Future research should consider trajectories of dietary change over longer time periods as determinants of health and function in older age.
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المؤلفون: Alejandra Contreras-Manzano, Alejandra Jáuregui, Simón Barquera, Claudia Nieto, Jorge Vargas-Meza
المصدر: BMC Public Health, Vol 19, Iss 1, Pp 1-12 (2019)
BMC Public Healthمصطلحات موضوعية: Adult, Male, Attractiveness, Health Knowledge, Attitudes, Practice, Adolescent, Nutritional quality, Choice Behavior, Odds, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Guideline daily allowance, Food Labeling, Food choice, Economic Status, Humans, Medicine, Front of pack, 030212 general & internal medicine, Product (category theory), Mexico, 030505 public health, business.industry, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, Consumer Behavior, Middle Aged, Chilean nutrition policy, Multiple traffic light, Front-of-pack label, Female, Biostatistics, Cognitive workload, 0305 other medical science, business, Nutritive Value, Research Article, Demography
الوصف: Background Front-of-package labelling is a cost-effective strategy to help consumers make healthier choices and informed food purchases. The effect of labels is mediated by consumer understanding and acceptability of the label. We compared the acceptability and understanding of labels used in Latin-America among low- and middle-income Mexican adults. Methods Participants (n = 2105) were randomly assigned to one of three labels: Mexican Guideline Daily Allowances (GDA), Ecuador’s Multiple Traffic Lights (MTL), or Chile’s Warning Labels (WL) in red. Label acceptability was evaluated through items regarding likeability, attractiveness and perceived cognitive workload. Objective understanding was evaluated by asking participants to select the product with the lowest nutritional quality among three products. We measured the time participants took to choose the product. Differences in label acceptability, understanding and time required to choose a product across labels were tested. Results Compared to the GDA, a higher proportion of participants liked the MTL and WL, considered them attractive, and with a lower perceived cognitive workload (p p Conclusions GDA had the lowest acceptability and understanding among the labels tested. The MTL and the WL were more accepted and understood, and allowed low- and middle-income consumers to make nutrition-quality related decisions more quickly. WL or MTL may foster healthier food choices in the most vulnerable groups in Mexico compared to the current labelling format.
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المصدر: Nutrition Journal, Vol 18, Iss 1, Pp 1-13 (2019)
Nutrition Journalمصطلحات موضوعية: Adult, Male, 0301 basic medicine, Czech, Low income, Adolescent, Affordable diet, Relative standard deviation, Medicine (miscellaneous), 030209 endocrinology & metabolism, lcsh:TX341-641, Health Promotion, Clinical nutrition, Food-based dietary guidelines (FBDGs), World health, Nutrition Policy, Food group, 03 medical and health sciences, 0302 clinical medicine, Environmental health, Linear programming, Humans, Medicine, Minimum wage, Child, Poverty, lcsh:RC620-627, Czech Republic, Low socio-economic status, 2. Zero hunger, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Research, 1. No poverty, Middle Aged, Cultural acceptability, Culturally Competent Care, language.human_language, Diet, lcsh:Nutritional diseases. Deficiency diseases, Nutritionally adequate diet, language, Female, Cost constraint, business, Nutritive Value, lcsh:Nutrition. Foods and food supply
الوصف: Background Czech nutrition recommendations prioritize health aspects without considering affordability. Low socio-economic groups have the highest risk of nutrition-related noncommunicable diseases and cost has been identified as an obstacle to achieve a healthy diet, making the implementation of affordability into dietary guidelines necessary. The aim of this study was to develop a food basket (FB) for a low income Czech family of four that is nutritionally adequate, health-promoting and culturally acceptable at an affordable price. Methods Linear programming optimisation was used to ascertain that the FB covered the recommended nutrient intakes from the Czech Nutrition Society and from the World Health Organization (WHO). Cost of the FB was calculated on the basis of more than 3900 prices of 330 foods. Within a given cost constraint, all FBs were optimized for the highest possible similarity to the reported food group intake according to the most recent Czech National Food Consumption survey, which was used as a proxy for cultural acceptability. Results The optimised FB affordable at a daily food budget for a Czech family on minimum wage (CZK 177, ~ € 6.8) contained 76 foods and had an average relative deviation of 10% per food category from reported intake. The main deviations were: 72% less sweets and confectionery; 66% less salt; 52% less meat; 50% less milk products; 8% less potatoes; and 484% more milk; 69% more oils and fats; 20% more cereals; and 6% more vegetables. Conclusions The optimised FB can help to guide the development of food-based dietary guidelines for low income households in Czech Republic.
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المصدر: BMC Public Health, Vol 19, Iss 1, Pp 1-12 (2019)
BMC Public Healthمصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Malawi, 030309 nutrition & dietetics, Psychological intervention, Breastfeeding, Mothers, Child Nutrition Disorders, Nutrition Policy, 03 medical and health sciences, 0302 clinical medicine, Thinness, Child undernutrition, Environmental health, Epidemiology, Maternal determinants, medicine, Humans, 030212 general & internal medicine, Infant Nutritional Physiological Phenomena, Wasting, Meals, Growth Disorders, 0303 health sciences, business.industry, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Infant, Newborn, Infant, IYCF, lcsh:RA1-1270, Feeding Behavior, medicine.disease, Health Surveys, Malnutrition, Breast Feeding, Child, Preschool, Female, Underweight, medicine.symptom, Biostatistics, business, Research Article
الوصف: Background Optimal breastfeeding and complementary feeding practices are critical to prevent child undernutrition. Despite the occurrence of child undernutrition and widespread suboptimal feeding practices in Malawi, the association of breastfeeding and complementary feeding practices and undernutrition among Malawian children remains unclear. The purpose of the study was to determine the current breastfeeding and complementary feeding practices, to identify maternal determinants of each practice, and to analyze the associations between breastfeeding and complementary feeding practices with stunting, underweight, and wasting. Methods The most recent Malawi Demographic Health Survey (2015–2016) was used and data for 2294 children aged 0–23 months were included. A conceptual framework of five maternal domains: sociodemographic, health status, health behaviors, women’s empowerment, and media exposure was used. Each domain contained exposure variables and the WHO Infant and Young Child Feeding indicators were used as outcome variables. All analyses were adjusted for clustering, and variables that reached a p-value of Results Among children, 30.8% were stunted, 9.9% were underweight, and 3.7% were wasted. Many (78%) were breastfed within the first hour of birth, 89% were breastfed until their first birthday, yet 40% were not exclusively breastfed to 6 months. Only 32% met minimum dietary diversity, 23% met minimum meal frequency, 12% met minimum acceptable diet and 12% consumed iron-rich foods. Children whose mothers lived in urban areas were less likely to be breastfed within 1 hour of birth but more likely to meet minimum dietary diversity. Children whose mothers listened to radio were more likely to meet minimum meal frequency. Children (13–23 months) who met minimum meal frequency and minimum acceptable diet were less likely to be underweight. Conclusions Optimal breastfeeding and complementary feeding practices in Malawi remain suboptimal and child undernutrition remains problematic. Maternal characteristics from the five domains were significantly associated with optimal breastfeeding and complementary feeding indicators. Knowledge of these maternal determinants can assist in improving nutrition policies and interventions that aim to impact breastfeeding and complementary feeding practices and child growth in Malawi.
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المؤلفون: David Hammond, Adrian J. Cameron, Christine M. White, Lana Vanderlee, Jasmin Bhawra, Janelle Kwon, Gary Sacks
المصدر: BMC Public Health, Vol 19, Iss 1, Pp 1-10 (2019)
BMC Public Healthمصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Canada, Public policy, Psychological intervention, Global health, 030209 endocrinology & metabolism, Public opinion, Nutrition Policy, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Medicine, Humans, 030212 general & internal medicine, Mexico, Public economics, business.industry, Public health, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Australia, Subsidy, lcsh:RA1-1270, language.human_language, United Kingdom, United States, 3. Good health, Incentive, Cross-Sectional Studies, Healthy diet, Food policy, language, Female, Diet, Healthy, business, Research Article
الوصف: Background Poor diet is a significant contributor to the burden of global disease. There are numerous policies available to address poor diets; however, these policies often require public support to encourage policy action. The current study aimed to understand the level of public support for a range of food policies and the factors associated with policy support. Methods An online survey measuring support for 13 food policies was completed by 19,857 adults in Australia, Canada, Mexico, the United Kingdom (UK) and the United States (US). The proportion of respondents that supported each policy was compared between countries, and the association between demographic characteristics and policy support was analysed using multivariate logistic regression. Results The level of support varied between policies, with the highest support for policies that provided incentives (e.g., price subsidies) or information (e.g., calorie labelling on menus), and the lowest support for those that imposed restrictions (e.g., restrictions on sponsorship of sport events). This pattern of support was similar in all countries, but the level differed, with Mexico generally recording the highest support across policies, and the US the lowest. Several demographic characteristics were associated with policy support; however, these relationships varied between countries. Conclusion The results suggest that support for food policies is influenced by several factors related to the policy design, country, and individual demographic characteristics. Policymakers and advocates should consider these factors when developing and promoting policy options. Electronic supplementary material The online version of this article (10.1186/s12889-019-7483-9) contains supplementary material, which is available to authorized users.
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المؤلفون: Nancy M. Wells, Kimberly A. Rollings
المصدر: BMC Public Health, Vol 18, Iss 1, Pp 1-16 (2018)
BMC Public Healthمصطلحات موضوعية: 0301 basic medicine, Male, Pediatric Obesity, Built environment, Nutrition Policy, 0302 clinical medicine, Poverty Areas, Vegetables, Photography, Medicine, 030212 general & internal medicine, Child, Children, Schools, biology, lcsh:Public aspects of medicine, Food Services, Assessment tool, Fruit and vegetable consumption, Scale (social sciences), Healthy eating, Female, Diet, Healthy, Research Article, Elementary school cafeteria, Predictive validity, medicine.medical_specialty, education, Cafeteria, Childhood obesity, 03 medical and health sciences, Humans, Students, 030109 nutrition & dietetics, business.industry, Public health, Dietary intake, Public Health, Environmental and Occupational Health, Reproducibility of Results, lcsh:RA1-1270, medicine.disease, biology.organism_classification, Lunch tray photography, United States, Reliability engineering, Diet, Lunch, Signage, Fruit, Environment Design, Biostatistics, business
الوصف: Background Strategies to reduce childhood obesity and improve nutrition include creating school food environments that promote healthy eating. Despite well-documented health benefits of fruit and vegetable (FV) consumption, many U.S. school-aged children, especially low-income youth, fail to meet national dietary guidelines for FV intake. The Cafeteria Assessment for Elementary Schools (CAFES) was developed to quantify physical attributes of elementary school cafeteria environments associated with students’ selection and consumption of FV. CAFES procedures require observation of the cafeteria environment where preparation, serving, and eating occur; staff interviews; photography; and scoring. Methods CAFES development included three phases. First, assessment items were identified via a literature review, expert panel review, and pilot testing. Second, reliability testing included calculating inter-item correlations, internal consistency (Kuder-Richardson-21 coefficients), and inter-rater reliability (percent agreement) based on data collected from 50 elementary schools in low-income communities and 3187 National School Lunch Program participants in four U.S. states. At least 43% of each participating school’s students qualified for free- or reduced-price meals. Third, FV servings and consumption data, obtained from lunch tray photography, and multi-level modeling were used to assess the predictive validity of CAFES. Results CAFES’ 198 items (grouped into 108 questions) capture four environmental scales: room (50 points), table/display (133 points), plate (4 points), and food (11 points). Internal consistency (KR-21) was 0.88 (overall), 0.80 (room), 0.72 (table), 0.83 (plate), and 0.58 (food). Room subscales include ambient environment, appearance, windows, layout/visibility, healthy signage, and kitchen/serving area. Table subscales include furniture, availability, display layout/presentation, serving method, and variety. Inter-rater reliability (percent agreement) of the final CAFES tool was 90%. Predictive validity analyses indicated that the total CAFES and four measurement scale scores were significantly associated with percentage consumed of FV served (p
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