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Assessment of Food Offerings and Marketing Strategies in the Food-Service Venues at California Children’s Hospitals

  • Lenard I. Lesser
    Correspondence
    Address correspondence to Lenard I. Lesser, MD, MSHS, Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, 911 Broxton Ave, 3rd Floor, Los Angeles, CA 90049.
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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  • Dana E. Hunnes
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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  • Phedellee Reyes
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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  • Lenore Arab
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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  • Gery W. Ryan
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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  • Robert H. Brook
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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  • Deborah A. Cohen
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program and Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Dr. Lesser); Department of Nutrition, UCLA Medical Center and School of Public Health, University of California, Los Angeles, Calif. (Mrs. Hunnes); the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Calif. (Ms. Reyes and Dr. Arab); RAND Corporation, Santa Monica, Calif. (Drs Ryan, Brook, and Cohen)
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Published:December 05, 2011DOI:https://doi.org/10.1016/j.acap.2011.09.004

      Abstract

      Objective

      Marketing strategies and food offerings in hospital cafeterias can impact dietary choices. Using a survey adapted to assess food environments, the purpose of this study was to assess the food environment available to patients, staff, and visitors at the food-service venues in all 14 California children’s hospitals.

      Methods

      We modified a widely-used tool to create the Nutritional Environment Measures Survey for Cafeterias (NEMS-C) by partnering with a hospital wellness committee. The NEMS-C summarizes the number of healthy items offered, whether calorie labeling is present, if there is signage promoting healthy or unhealthy foods, pricing structure, and the presence of unhealthy combination meals. The range of possible scores is zero (unhealthy) to 37 (healthy). We directly observed the food-service venues at all 14 tertiary care children's hospitals in California and scored them.

      Results

      Inter-rater reliability showed 89% agreement on the assessed items. For the 14 hospitals, the mean score was 19.1 (SD = 4.2; range, 13–30). Analysis revealed that nearly all hospitals offered diet drinks, low-fat milk, and fruit. Fewer than one-third had nutrition information at the point of purchase and 30% had signs promoting healthy eating. Most venues displayed high calorie impulse items such as cookies and ice cream at the registers. Seven percent (7%) of the 384 entrees served were classified as healthy according to NEMS criteria.

      Conclusions

      Most children’s hospitals’ food venues received a mid-range score, demonstrating there is considerable room for improvement. Many inexpensive options are underused, such as providing nutritional information, incorporating signage that promotes healthy choices, and not presenting unhealthy impulse items at the register.

      Keywords

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