The Influence of Food Environments on Chronic Disease: Evidence for Policy Change

Abstract

The environment in which we make food choices has a powerful influence on eating behavior, which in turn impacts health. This dissertation builds quantitative evidence for policies that can make it easier for consumers to make healthier choices across a variety of settings, including restaurants, schools, workplaces, and supermarkets. In Chapter 1, we examined the influence of sodium warning labels on consumers’ hypothetical choices, meal perceptions, and knowledge using four sequential randomized controlled online experiments. Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control by 3–5%. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text were more effective than those without text. In Chapter 2, we assessed the national prevalence and nutritional quality of free food acquired by children at school and employees at work, stratified by participation in the Supplemental Nutrition Assistance Program (SNAP). Across all households, over one fifth of all food was acquired for free, and SNAP households had higher rates of free food acquisition compared to non-SNAP households. The nutritional quality of free food at school and work was relatively low across household SNAP status. For children participating in SNAP, free food acquired at school had higher nutritional quality. Improvements in dietary quality of free food acquired at school and work could contribute to the overall health of families, especially those participating in SNAP. In Chapter 3, we conducted a content analysis to assess the prevalence of front-of-package (FOP) claims and imagery on fruit drinks, 100% juices, and flavored waters purchased by households with 0-5-year-olds, and examined differential exposure based on purchased units between household demographic groups in a nationally representative sample. The majority of beverages contained FOP claims and imagery implying that the products were healthy and natural. Households across racial/ethnic groups, levels of income, and SNAP and WIC participation were widely exposed to these marketing tactics. Given the potential for these marketing elements to increase health perceptions and potentially mislead parents into purchasing sugary beverages for their young children, the FDA should consider updating regulations for FOP claims and imagery.