Doctor and pharmacy shopping for controlled substances.

PubMed

Peirce, Gretchen L; Smith, Michael J; Abate, Marie A; Halverson, Joel

2012-06-01

Prescription drug abuse is a major health concern nationwide, with West Virginia having one of the highest prescription drug death rates in the United States. Studies are lacking that compare living subjects with persons who died from drug overdose for evidence of doctor and pharmacy shopping for controlled substances. The study objectives were to compare deceased and living subjects in West Virginia for evidence of prior doctor and pharmacy shopping for controlled substances and to identify factors associated with drug-related death. A secondary data study was conducted using controlled substance, Schedule II-IV, prescription data from the West Virginia Controlled Substance Monitoring Program and drug-related death data compiled by the Forensic Drug Database between July 2005 and December 2007. A case-control design compared deceased subjects 18 years and older whose death was drug related with living subjects for prior doctor and pharmacy shopping. Logistic regression identified factors related to the odds of drug-related death. A significantly greater proportion of deceased subjects were doctor shoppers (25.21% vs. 3.58%) and pharmacy shoppers (17.48% vs. 1.30%) than living subjects. Approximately 20.23% of doctor shoppers were also pharmacy shoppers, and 55.60% of pharmacy shoppers were doctor shoppers. Younger age, greater number of prescriptions dispensed, exposure to opioids and benzodiazepines, and doctor and pharmacy shopping were factors with greater odds of drug-related death. Doctor and pharmacy shopping involving controlled substances were identified, and shopping behavior was associated with drug-related death. Prescription monitoring programs may be useful in identifying potential shoppers at the point of care.

The ecology of prescription opioid abuse in the USA: geographic variation in patients’ use of multiple prescribers (“doctor shopping”)

PubMed Central

McDonald, Douglas C.; Carlson, Kenneth E.

2016-01-01

Purpose This study estimates the prevalence in US counties of opioid patients who use large numbers of prescribers, the amounts of opioids they obtain, and the extent to which their prevalence is predicted by ecological attributes of counties, including general medical exposure to opioids. Methods Finite mixture models were used to estimate the size of an outlier subpopulation of patients with suspiciously large numbers of prescribers (probable doctor shoppers), using a sample of 146 million opioid prescriptions dispensed during 2008. Ordinary least squares regression models of county-level shopper rates included independent variables measuring ecological attributes of counties, including rates of patients prescribed opioids, socioeconomic characteristics of the resident population, supply of physicians, and measures of healthcare service utilization. Results The prevalence of shoppers varied widely by county, with rates ranging between 0.6 and 2.5 per 1000 residents. Shopper prevalence was strongly correlated with opioid prescribing for the general population, accounting for 30% of observed county variation in shopper prevalence, after adjusting for physician supply, emergency department visits, in-patient hospital days, poverty rates, percent of county residents living in urban areas, and racial/ethnic composition of resident populations. Approximately 30% of shoppers obtained prescriptions in multiple states. Conclusions The correlation between prevalence of doctor shoppers and opioid patients in a county could indicate either that easy access to legitimate medical treatment raises the risk of abuse or that drug abusers take advantage of greater opportunities in places where access is easy. Approaches to preventing excessive use of different prescribers are discussed. PMID:25111716

Can front-of-pack labelling schemes guide healthier food choices? Australian shoppers' responses to seven labelling formats.

PubMed

Watson, Wendy L; Kelly, Bridget; Hector, Debra; Hughes, Clare; King, Lesley; Crawford, Jennifer; Sergeant, John; Chapman, Kathy

2014-01-01

There is evidence that easily accessible, comprehensible and consistent nutrient information on the front of packaged foods could assist shoppers to make healthier food choices. This study used an online questionnaire of 4357 grocery shoppers to examine Australian shoppers' ability to use a range of front-of-pack labels to identify healthier food products. Seven different front-of-pack labelling schemes comprising variants of the Traffic Light labelling scheme and the Percentage Daily Intake scheme, and a star rating scheme, were applied to nine pairs of commonly purchased food products. Participants could also access a nutrition information panel for each product. Participants were able to identify the healthier product in each comparison over 80% of the time using any of the five schemes that provided information on multiple nutrients. No individual scheme performed significantly better in terms of shoppers' ability to determine the healthier product, shopper reliance on the 'back-of-pack' nutrition information panel, and speed of use. The scheme that provided information about energy only and a scheme with limited numerical information of nutrient type or content performed poorly, as did the nutrition information panel alone (control). Further consumer testing is necessary to determine the optimal format and content of an interpretive front-of-pack nutrition labelling scheme. Copyright © 2013 Elsevier Ltd. All rights reserved.

Overcoming challenges to effectiveness of mobile markets in US food deserts.

PubMed

Zepeda, Lydia; Reznickova, Anna; Lohr, Luanne

2014-08-01

The purpose of this research is to investigate whether mobile food markets may be effective in facilitating healthy food choices in food deserts. We investigate who does and does not use mobile food markets and why, and whether mobile markets have the potential to alter attitudes and food choices, and if so, how? We use a focus group study at four sites in the US to ask groups of mobile market shoppers and non-shoppers about their shopping, cooking, and eating attitudes and behaviors. We find that mobile market shoppers eat significantly more servings of fruits and vegetables, however, both shoppers and non-shoppers perceive fruits and vegetables as luxury items, and both groups lack knowledge about what is a serving and what is the recommended number of servings per day. Both groups identified the following needs for mobile markets to be more successful: increased awareness and advertising; affordability; improved convenience by offering more stops and hours, as well as greater variety of items for one-stop shopping; emphasis on value and service; and building trust within communities. Copyright © 2014 Elsevier Ltd. All rights reserved.

Gender and internet consumers' decision-making.

PubMed

Yang, Chyan; Wu, Chia-Chun

2007-02-01

The purpose of this research is to provide managers of shopping websites information regarding consumer purchasing decisions based on the Consumer Styles Inventory (CSI). According to the CSI, one can capture what decision-making styles online shoppers use. Furthermore, this research also discusses the gender differences among online shoppers. Exploratory factor analysis (EFA) was used to understand the decision-making styles and discriminant analysis was used to distinguish the differences between female and male shoppers. The result shows that there are differences in purchasing decisions between online female and male Internet users.

Shoppers' perceived embeddedness and its impact on purchasing behavior at an organic farmers' market.

PubMed

Chen, Weiping; Scott, Steffanie

2014-12-01

This study explores the concept of perceived embeddedness (PE) and its impact on purchasing behavior at an organic farmers' market. Based on a review of the prior literature, the study refines the conceptualization and measurement of PE as a second-order factor construct reflected in its three dimensions: perceived social embeddedness, perceived spatial embeddedness, and perceived natural embeddedness. The study also suggests that organic farmers' market shoppers' PE is positively related to the two measures of purchasing behavior: expenditure per visit and repurchase intention. In a sample of 492 organic farmers' market shoppers in Beijing municipality, China, the study find support for the second-order factor structure of PE and the theorized relationship between the shoppers' PE and their purchasing behavior. The study also discusses theoretical and managerial implications of the findings. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decision-making patterns for dietary supplement purchases among women aged 25 to 45 years.

PubMed

Miller, Carla K; Russell, Teri; Kissling, Grace

2003-11-01

Women frequently consume dietary supplements but the criteria used to select supplements have received little investigation. This research identified the decision-making criteria used for dietary supplements among women aged 25 to 45 years who consumed a supplement at least four times per week. Participants (N=51) completed an in-store shopping interview that was audiotaped, transcribed, and analyzed qualitatively for the criteria used to make supplement selections. Qualitative analysis revealed 10 key criteria and the number of times each person used each criterion was quantified. Cluster analysis identified five homogeneous subgroups of participants based on the criteria used. These included brand shopper, bargain shopper, quality shopper, convenience shopper, and information gatherer. Supplement users vary in the criteria used to make point-of-purchase supplement selections. Dietetics professionals can classify supplement users according to the criteria used to tailor their nutrition counseling and better meet the educational needs of consumers.

E-Service Quality, E-Satisfaction and E-Loyalty of Online Shoppers in Business to Consumer Market; Evidence form Malaysia

NASA Astrophysics Data System (ADS)

Ting, Ong Soo; Ariff, Mohd Shoki Md; Zakuan, Norhayati; Sulaiman, Zuraidah; Zameri Mat Saman, Muhamad

2016-05-01

The growing usage of internet and online shopping in Malaysia presents a huge prospect in e-commerce market, specifically for B2C segment. As a result, electronic service quality (e-SQ), electronic satisfaction (e-Satisfaction) and electronic loyalty (e-Loyalty) become vital for online retailers to attract and retain online shoppers in this virtual environment. The association between e-SQ, e-Satisfaction and e-Loyalty should be continuously examined to cope with the advancement in information and communication technology, and the changing expectation of online shoppers. However, construct of e-SQ for online retailers in B2C market is still debatable. In this research, E-SERVQUAL was integrated with the other e-SQ scales to measure e-SQ of a prominent online retailer in Malaysia. Specifically, the e-SQ constructs are Efficiency, Privacy and Trust, Fulfilment, Responsiveness, Contact and Website Design. 390 sets of completed and usable questionnaires were gathered using online questionnaire and convenience sampling procedure. The result indicated that the five proposed dimensions of e-SQ constitute e-SQ of online retailer in B2C market. All the dimensions of e-SQ were found to have positive and significant effect on e-Satisfaction of online shoppers. Responsiveness of e-SQ had the strongest impact on e-satisfaction of online shoppers. The shoppers e-Satisfaction was positively and significantly affected their e-Loyalty towards continuous usage of online retailer's website. Managerial and theoretical implications are discussed based on the results of the study.

A 'mystery shopper' project to evaluate sexual health and contraceptive services for young people in Croydon.

PubMed

Sykes, Susie; O'Sullivan, Karin

2006-01-01

The purpose of the study was to evaluate the accessibility of, and advice provided by, sexual health and advice services for young people in Croydon, UK using a 'mystery shopper' approach. Nineteen young people aged 13-21 years were trained as mystery shoppers. The group developed a set of standards, based in part on existing guidelines of best practice, that should be met when working with young people. The group accessed local sexual health services in pairs posing as genuine patients. Using one of four scenarios, the mystery shoppers assessed the service they received against the predefined standards. The main access difficulties occurred in the reception area. Confidentiality was a major concern and was frequently not explained. The advice and information received was generally clearly given and with an appropriate level of detail. Additional training and support needs to be offered to receptionists. Confidentiality policies and statements need to be more effectively communicated.

Perceived Informativeness of and Irritation with Local Advertising.

ERIC Educational Resources Information Center

Pasadeos, Yorgo

1990-01-01

Surveys mall shoppers to determine the relative informativeness of retail advertising. Finds that newspaper advertisements are considered the most informative with radio commercials next and television commercials least. Finds that newspaper ads are more irritating than radio or television advertising. Finds older and wealthier shoppers more…

Statement of the National Association of Advertising Publishers.

ERIC Educational Resources Information Center

Howe, Jonathan T.; Pearson, James W.

This is one of several papers presented at a Federal Trade Commission Symposium on Media Concentration. It expresses views of the National Association of Advertising Publishers regarding problems that publishers of advertising shoppers and free newspapers encounter from chain-owned newspapers. Shoppers and free newspapers are described and…

Helping Behavior: Effects of Sex and Sex-Typing.

ERIC Educational Resources Information Center

Basow, Susan A.; Crawley, Donna M.

1982-01-01

Male and female experimenters requested adult shoppers (N=178) to fill out a questionnaire. Refusal data showed shoppers helping other-sex more than same-sex experimenters. Other results showed a significant three-way interaction among helper and helpee sex and sex-typing and situation sex-typing and that helper sex-typing did not have significant…

Secrets of Taming the Wild Food Bill. A Guide to Supermarket Super Shopping.

ERIC Educational Resources Information Center

Urshan, J.

This guide to supermarket shopping begins with a study of the American food shopper. The major types of shoppers and their needs are identified. Chapter 2 discusses planning at home. Topics include preparation of a comprehensive list, using coupons, impulse buying, and comparison shopping. Chapter 3 focuses on the actual shopping experience. Unit…

Pawtucket Heart Health Program Point-of-Purchase Nutrition Education Program in Supermarkets.

ERIC Educational Resources Information Center

Hunt, Mary K.; And Others

1990-01-01

Evaluates a point-of-purchase nutrition education program in Pawtucket (Rhode Island). Uses consumer interviews to evaluate the effect of awareness of shelf labels on purchase behavior. Reports increases in shoppers' ability to identify correct shelf labels and in the number of shoppers who were encouraged to buy the identified foods. (FMW)

Price comparisons on the internet based on computational intelligence.

PubMed

Kim, Jun Woo; Ha, Sung Ho

2014-01-01

Information-intensive Web services such as price comparison sites have recently been gaining popularity. However, most users including novice shoppers have difficulty in browsing such sites because of the massive amount of information gathered and the uncertainty surrounding Web environments. Even conventional price comparison sites face various problems, which suggests the necessity of a new approach to address these problems. Therefore, for this study, an intelligent product search system was developed that enables price comparisons for online shoppers in a more effective manner. In particular, the developed system adopts linguistic price ratings based on fuzzy logic to accommodate user-defined price ranges, and personalizes product recommendations based on linguistic product clusters, which help online shoppers find desired items in a convenient manner.

Price Comparisons on the Internet Based on Computational Intelligence

PubMed Central

Kim, Jun Woo; Ha, Sung Ho

2014-01-01

Information-intensive Web services such as price comparison sites have recently been gaining popularity. However, most users including novice shoppers have difficulty in browsing such sites because of the massive amount of information gathered and the uncertainty surrounding Web environments. Even conventional price comparison sites face various problems, which suggests the necessity of a new approach to address these problems. Therefore, for this study, an intelligent product search system was developed that enables price comparisons for online shoppers in a more effective manner. In particular, the developed system adopts linguistic price ratings based on fuzzy logic to accommodate user-defined price ranges, and personalizes product recommendations based on linguistic product clusters, which help online shoppers find desired items in a convenient manner. PMID:25268901

Patient counseling practices in U.S. pharmacies: effects of having pharmacists hand the medication to the patient and state regulations on pharmacist counseling.

PubMed

Kimberlin, Carole L; Jamison, Allison Newland; Linden, Stephan; Winterstein, Almut G

2011-01-01

To determine the amount and type of oral counseling given to shoppers posing as new patients with new prescriptions and to determine how state regulations, pharmacy and pharmacist characteristics, and environmental factors affect oral counseling practices. Cross-sectional, observational, correlational study. 41 states and the District of Columbia between January 28 and March 31, 2008. 365 community pharmacy staff members had interactions with shopper-patients. Shoppers presented new prescriptions in community pharmacies and recorded observations related to oral communication with pharmacy staff. Oral provision of medication information and risk information to shoppers by pharmacy staff, as well as questions asked of shoppers by pharmacy staff. Some form of oral communication related to a medication was reported in 68% of encounters. At least one informational item for either medication was provided for approximately 42% of encounters. At least one risk information item was provided in 22% of encounters. Logistic regression findings indicated that the strongest predictor of oral counseling, either providing information or asking questions, was the pharmacist being the pharmacy staff member who handed the medication to the patient, controlling for all other variables in the models. In addition, having strict state regulations specifying that pharmacists must counsel all patients receiving new prescriptions predicted whether patients received counseling. A more private area for prescription pick up also was a significant predictor. The importance of the direct encounter between the pharmacist and patient and strict state regulations mandating that pharmacists counsel patients with new prescriptions were highlighted by these findings.

Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets.

PubMed

Payne, Collin R; Niculescu, Mihai; Just, David R; Kelly, Michael P

2015-01-01

We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets.

Shopper marketing nutrition interventions: Social norms on grocery carts increase produce spending without increasing shopper budgets☆

PubMed Central

Payne, Collin R.; Niculescu, Mihai; Just, David R.; Kelly, Michael P.

2015-01-01

Objectives We assessed the efficacy of an easy-to-implement shopper marketing nutrition intervention in a pilot and two additional studies to increase produce demand without decreasing store profitability or increasing shopper budgets. Methods We created grocery cart placards that detailed the number of produce items purchased (i.e., descriptive norm) at particular stores (i.e., provincial norm). The effect of these placards on produce spending was assessed across 971,706 individual person grocery store transactions aggregated by day. The pilot study designated a baseline period (in both control and intervention store) followed by installation of grocery cart placards (in the intervention store) for two weeks. The pilot study was conducted in Texas in 2012. In two additional stores, we designated baseline periods followed by 28 days of the same grocery cart placard intervention as in the pilot. Additional interventions were conducted in New Mexico in 2013. Results The pilot study resulted in a significant difference between average produce spending per day per person across treatment periods (i.e., intervention versus same time period in control) (16%) and the difference between average produce spending per day per person across stores in the control periods (4%); Furthermore, the same intervention in two additional stores resulted in significant produce spending increases of 12.4% and 7.5% per day per person respectively. In all stores, total spending did not change. Conclusions Descriptive and provincial social norm messages (i.e., on grocery cart placards) may be an overlooked tool to increase produce demand without decreasing store profitability and increasing shopper budgets. PMID:26844084

A Model to Predict Shopper Reaction to Commissary Stockouts

DTIC Science & Technology

1989-12-01

consumer behavior brought about by inflation. Because food items doubled in price during the 1970s, these authors focus their study on the purchase...situation, and shopper characteristics - were used to predict consumer behavior . The investigative questions which addressed demographics used ten...demographic variables in an attempt to predict consumer behavior . The variables were sex, age, education, household description, number of children

Effects of shopping addiction on consumer decision-making: Web-based studies in real time.

PubMed

Lo, Hui-Yi; Harvey, Nigel

2012-12-01

Background and aims Most research into compulsive buying has focused on its causes: questionnaires have been used to study its association with various factors assumed to be important in its etiology. Few studies have dealt with the effects of being a compulsive buyer on shopping decisions. Also, processes underlying compulsive buying are dynamic but questionnaires give access only to a retrospective view of them from the standpoint of the participant. The aim of the current study was to investigate the decision processes underlying compulsive buying. Methods Two simulated shopping experiments, each with over 100 participants, were used to compare the decision processes of compulsive shoppers with those of non-compulsive shoppers. This approach allowed us to measure many features of consumer decision-making that are relevant to compulsive shopping. Results Compulsive shoppers differed from general shoppers in six ways: choice characteristics, searching behavior, overspending, budget-consciousness, effects of credit card availability, and emotional responses to overspending. Conclusions Results are consistent with the view that compulsive buying, like other behavioral addictions, develops because the cognitive system under-predicts the extent of post-addiction craving produced by emotional and visceral processes.

Increasing Trends in Schedule II Opioid Use and Doctor Shopping during 1999–2007 in California

PubMed Central

Han, Huijun; Kass, Philip H.; Wilsey, Barth L.; Li, Chin-Shang

2013-01-01

Purpose To examine the age and gender-specific trends of schedule II opioid use among California residents, with special reference to multiple provider users (“doctor shoppers”). Methods Utilizing data from the California Prescription Drug Monitoring Program, we examined age and gender-specific trends of Schedule II opioid use during calendar years 1999–2007. Specifically, we analyzed: 1) the prevalence of Schedule II opioid users among California’s population, and 2) the proportion of these opioid users who were doctor shoppers (defined as an individual who used more than five different prescribers for all schedule II opioids he/she obtained in a calendar year). Results Among all age and gender groups, the prevalence of Schedule II opioid users in California increased by 150%–280% and the prevalence of doctor shoppers among users increased by 111%–213% over nine years. The prevalence of opioid users was lowest among 18–44 year-old males (1.25%) and highest among 65 years and older females (5.31%) by 2007. The prevalence of doctor shoppers was approximately 1.4% among those up to age 64 and 0.5% among those 65 years and older. The gender difference in doctor shoppers among all age groups was negligible. On average, the cumulative morphine-equivalent amount of Schedule II opioid per individual obtained per year was three- to six-fold higher for doctor shoppers than for the general population across different age and gender groups. Conclusions Age and gender differences in opioid use were relatively small, while the trends for use of opioids and multiple providers grew at a disquieting rate. PMID:23956137

The Influence of Social Presence on e-Loyalty in Women Online Shoppers: An Application of the Social Identity Approach to Website Design

ERIC Educational Resources Information Center

Coverdale, Tonjia Simmone

2010-01-01

The objective of this study is to propose and test the Social Identity Approach to Website Design research model, which extends the traditionally examined interaction between website design and e-Commerce Success by considering the role of Social Identity in the development of e-Loyalty in women online shoppers. The Social Identity Approach is a…

FDA Consumer Nutrition Knowledge Survey. Report II, 1975. A Nationwide Study of Food Shopper's Knowledge, Beliefs, Attitudes and Reported Behavior Regarding Food and Nutrition. Factors Related to Nutrition Labeling.

ERIC Educational Resources Information Center

Abelson, Herbert; And Others

During 1973, a nationwide study for the Food and Drug Administration (FDA) was conducted which provided information on nutrition knowledge, beliefs about nutrition, and first reactions to nutrition labeling among food shoppers. This initial research provided a baseline measurement of nutrition knowledge and attitudes among consumers, and in 1975…

Consumer use of health-related endorsements on food labels in the United Kingdom and Australia.

PubMed

Rayner, M; Boaz, A; Higginson, C

2001-01-01

The objective of this research was to examine how consumers use health-related food endorsements on food labels. Three endorsement programs were examined: those of the two major retailers in the United Kingdom, Tesco and Sainsbury's, and the "Pick the Tick" program of the National Heart Foundation of Australia. The main methodology used was protocol analysis. This involves the subject "thinking aloud" while performing a task--in this case, (a) shopping normally and (b) shopping "healthily" for foods on a predetermined list--to generate a protocol. Each subject was also interviewed to investigate reported use of endorsements. Subjects were a quota sample (N = 44) of shoppers representative of the U.K. and Australian populations. Information about the subjects, the protocols, and interview data were analyzed quantitatively; the protocols were also analyzed qualitatively. Sainsbury's and Australian shoppers never used the endorsements when shopping but Tesco shoppers did, albeit rarely. Tesco shoppers used the endorsement in complex ways and not just as a trigger to food selection. They sometimes used the endorsement to reject endorsed foods. Subjects claimed to use the endorsements even though the protocol analysis revealed no actual use. There are features of the Tesco endorsement program that make it more helpful to consumers than the other programs.

A Mixed-Method Assessment of a New Supermarket in a Food Desert: Contributions to Everyday Life and Health.

PubMed

Chrisinger, Benjamin

2016-06-01

Initiatives to build supermarkets in low-income areas with relatively poor access to large food retailers ("food deserts") have been implemented at all levels of government, although evaluative studies have not found these projects to improve diet or weight status for shoppers. Though known to be influential, existing evaluations have neglected in-store social dynamics and shopper behaviors. Surveys and walking interviews were used with shoppers (n = 32) at a supermarket developed through the Pennsylvania Fresh Food Financing Initiative in Philadelphia, PA. Key informant interviews with stakeholders in the supermarket's development and operations provided additional context to these shopper experiences. Data were collected in July and September 2014 and qualitatively analyzed in NVivo 10.0. Participants described how the retailer helped them adapt or cope with difficult shopping routines and how it presented a reliable high-quality option (in terms of cleanliness, orderliness, and social atmosphere) in contrast to other neighborhood retailers. Health concerns were also identified, especially among those managing chronic disease for themselves or a family member. These issues underscored multiple points of challenge required to adjust shopping and eating behavior. In-store supports that reflect these challenges are warranted to more fully address food deserts and reduce health disparities.

Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study.

PubMed

Saxena, Pikee; Mishra, Archana; Nigam, Aruna

2016-01-01

Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter.

Observations of parent-child co-shoppers in supermarkets: children's involvement in food selections, parental yielding, and refusal strategies.

PubMed

O'Dougherty, Maureen; Story, Mary; Stang, Jamie

2006-01-01

The study aimed to collect descriptive information on the decision-making processes of adult shoppers around food purchases when young children are present. Anthropological field observations were conducted on adult-child grocery shoppers. Eleven supermarkets in the Minneapolis-St. Paul metropolitan region. A convenience sample (n = 142) of adult-child shoppers at 8 budget and 3 deluxe supermarkets located in diverse urban and suburban areas. Observations registered adult-child interactions over food selections, including parental yielding or refusal strategies and child engagement in shopping. Means and frequencies were calculated for food items considered. In 67 (50.4%) of the total 133 observations, a child initiated a request. Half (55.2%) of the requests were for sweets or snacks. Nearly half (47.8%) of adults yielded to the child's request. Brands and marketing techniques appeared to be a factor in 28.6% of selections. The most frequent adult refusals either provided an explanation or ignored the request. Adults yield to children's requests for sweets and snacks nearly as often as they refuse them. However, effective refusal strategies are used by many adults. Opportunities exist in the grocery store for adults to reinforce young children's interest in food and nutrition.

Spatial displacement among pedestrians: a cross-cultural replication.

PubMed

Rawdon, V A; Willis, F N

1993-10-01

An observational study of pedestrians in a shopping mall in a mid-western U.S. city was replicated in shopping malls in London. The avoidance movements of 2692 shoppers were recorded as they approached other shoppers. The relationships between these movements and the shoppers' gender, age, race, group size, and other characteristics were examined. Results of both studies indicated that men were likely to be displaced by women, smaller groups by larger ones, and nonhandicapped persons by handicapped ones. The results differed, however, with respect to race, with black persons tending to displace white individuals in the Midwest regardless of group size, while lone white pedestrians tended to displace lone black pedestrians in London. In London larger groups tended to displace smaller ones regardless of race. Hypotheses regarding spatial displacement were discussed. The need for more cross-situational and cross-cultural research in social psychology was clear.

Association of supermarket characteristics with the body mass index of their shoppers.

PubMed

Lear, Scott A; Gasevic, Danijela; Schuurman, Nadine

2013-08-13

Research on the built food environment and weight status has mostly focused on the presence/absence of food outlets while ignoring their internal features or where residents actually shop. We explored associations of distance travelled to supermarkets and supermarket characteristics with shoppers' body mass index (BMI). Shoppers (n=555) of five supermarkets situated in different income areas in the city were surveyed for food shopping habits, demographics, home postal code, height and weight. Associations of minimum distance to a supermarket (along road network, objectively measured using ArcGIS), its size, food variety and food basket price with shoppers' BMI were investigated. The 'food basket' was defined as the mixture of several food items commonly consumed by residents and available in all supermarkets. Supermarkets ranged in total floor space (7500-135,000 square feet) and had similar varieties of fruits, vegetables and cereals. The majority of participants shopped at the surveyed supermarket more than once per week (mean range 1.2 ± 0.8 to 2.3 ± 2.1 times per week across the five supermarkets, p < 0.001), and identified it as their primary store for food (52% overall). Mean participant BMI of the five supermarkets ranged from 23.7 ± 4.3 kg/m² to 27.1 ± 4.3 kg/m² (p < 0.001). Median minimum distance from the shoppers' residence to the supermarket they shopped at ranged from 0.96 (0.57, 2.31) km to 4.30 (2.83, 5.75) km (p < 0.001). A negative association was found between food basket price and BMI. There were no associations between BMI and minimum distance to the supermarket, or other supermarket characteristics. After adjusting for age, sex, dissemination area median individual income and car ownership, BMI of individuals who shopped at Store 1 and Store 2, the supermarkets with lowest price of the 'food basket', was 3.66 kg/m² and 3.73 kg/m² higher compared to their counterparts who shopped at the supermarket where the 'food basket' price was highest (p < 0.001). The food basket price in supermarkets was inversely associated with BMI of their shoppers. Our results suggest that careful manipulation of food prices may be used as an intervention for decreasing BMI.

Determinants of food label use among supermarket shoppers: a Singaporean perspective.

PubMed

Vijaykumar, Santosh; Lwin, May O; Chao, Jiang; Au, Cyndy

2013-01-01

Examining factors influencing food label use among Singapore's supermarket shoppers using the Theory of Planned Behavior. A point-of-purchase survey among general shoppers in 2 supermarkets. Singapore, a country whose population is exposed to a wide range of food labeling formats because of the import-dependent nature of the food industry. A total of 200 shoppers (Chinese [75.5%], Malays [8.5%], and Indians [7.0%]) participated in the survey. Independent variables composed of attitudes and subjective norms (both 5-point Likert); perceived behavioral control and diet-health concern (both 5-point semantic differential); and knowledge (18-item index). Dependent variables were intention to use food labels (5-point differential scale) and actual use of food labels (19-item index). Data were analyzed using descriptive statistics, mean analysis, and multivariate linear regression. Low levels of knowledge and health literacy were found. Attitudes, subjective norms, and behavioral control differed significantly by age and ethnicity. Subjective norms and diet-health concern were significant predictors of intention to use food labels. Lack of knowledge but positive attitudes toward food labels make Singapore's consumers vulnerable to misusing or being misled by food label information. Demographic differences demonstrate the need to develop targeted educational interventions and enhance awareness of and ability to use food labels. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Evaluation of Pharmacists' Services for Dispensing Emergency Contraceptive Pills in Delhi, India: A Mystery Shopper Study

PubMed Central

Saxena, Pikee; Mishra, Archana; Nigam, Aruna

2016-01-01

Background: Although emergency contraceptive pills are available over the counter, the quality of consultation, including key areas of contraceptive counseling and prevention of sexually transmitted infections (STI), has not been well documented. Objective: To evaluate actual pharmacist services while dispensing emergency contraception through a mystery shopper technique. Material and Methods: This cross-sectional study was conducted in 81 pharmacies situated in Delhi by 4 trained mystery shoppers posed as customers over a period of 6 months. Results: None of the pharmacists asked about the time lapsed since last unprotected sexual intercourse or last menstrual period before deciding the eligibility of the customer. The majority were unclear about side effects associated with emergency contraception (78.57%) or with anticipated changes in menstrual flow (78.57%); 85.71% did not know whether subsequent unprotected intercourse would be protected. Only 15.71% counseled shoppers regarding risk of STI on asking leading questions and 88.5% did not provide any contraceptive advice. Conclusion: There is a huge gap in the technical knowledge and mindset of the pharmacists when it comes to checking for the eligibility of the client and providing advice regarding use of regular contraception and barrier for protection from STI, which needs to be addressed in order to realize the full benefit of making emergency contraceptive pills available over the counter. PMID:27385872

The Development and Structure of Consumer Credit in Japan

DTIC Science & Technology

1989-06-01

specializing in granting credit to their shoppers, mainly as a means of promoting sales.15 However, the biggest of these stores, the Marui chain of department...stores, has made credit into a profit-making activity of its own. In a 1980s shift in strategy, Marui was successful in reorienting its clientele from...a lower income, working class shopper to a younger, credit-using customer. In early 1988, Marui had issued 9.6 million credit cards. 16 Its annual

Consumers' health perceptions of three types of milk: a survey in Australia.

PubMed

Bus, A E M; Worsley, A

2003-04-01

A survey was conducted among 345 randomly selected shoppers in Melbourne, Australia, to identify their perceptions of the healthiness of whole milk, reduced fat milk and soy milk and to investigate demographic influences on health perceptions and types of milk consumption. The survey revealed major differences in shoppers' perceptions of the three types of milk along the themes of bone health, weight control, disease prevention, and, allergy and disease causation. Generally whole milk was perceived more negatively than soy or reduced fat milk. There were few demographic differences in the shoppers' perceptions of the three products. Reported consumption of reduced fat milk was more frequent among women and elderly people, and whole milk consumption was positively related to parenthood. The findings suggest that previous marketing and education campaigns have been effective but the widespread uncertainty and erroneous beliefs about milk products suggest that many consumers have not assimilated new findings about milk products. This represents a challenge for industry and public health practitioners.

Shopper cards data and storage practices for the investigation of an outbreak of Shiga-toxin producing Escherichia coli O157 infections.

PubMed

Barret, A-S; Charron, M; Mariani-Kurkdjian, P; Gouali, M; Loukiadis, E; Poignet-Leroux, B; Godron, A; Gault, G; Faure, M; Mailles, A

2013-09-01

An outbreak of shiga-toxin producing Escherichia coli infections occurred in southwest France in June 2012. The outbreak was investigated to identify the source of infection, and guide control measures. Confirmed outbreak cases were patients who developed bloody diarrhoea or haemolytic uremic syndrome (HUS) between 28 May and 6 July 2012, with E. coli O157 isolates showing indistinguishable patterns on pulse field gel electrophoresis (PFGE). A standardized questionnaire was administered to patients to document food consumption and other risk exposures. Their purchase was checked through their supermarket shopper card data. Six patients (four with HUS and two with bloody diarrhea) were confirmed outbreak cases. Fresh ground beef burgers from one supermarket were the only common food exposure, identified by interviews and shopper card data. The PFGE profile of shiga toxin-producing E. coli O157 isolated from the suspected beef burgers was identical to those from the human cases. The suspected beef burgers were no longer on sale at the time of investigation but three patients confirmed as outbreak cases had deep-frozen some at home. Shopper card data was particularly useful to obtain precise and reliable information on the traceability of consumed food. Despite the expired use-by date, a recall was issued for the beef burgers. This contributed to preventing other cases among consumers who had deep-frozen the beef burgers. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Features in Grocery Stores that Motivate Shoppers to Buy Healthier Foods, ConsumerStyles 2014.

PubMed

Moore, Latetia V; Pinard, Courtney A; Yaroch, Amy L

2016-08-01

We examined nine features in grocery stores shoppers reported motivated them to purchase more healthful foods in the past month. Features were compiled from common supermarket practices for each of the 4 Ps of marketing: pricing, placement, promotion, and product. We examined percentages of the features overall and by shopping frequency using Chi square tests from a 2014 cross sectional web-based health attitudes and behaviors survey, ConsumerStyles. The survey was fielded from June to July in 2014. Participants were part of a market research consumer panel that were randomly recruited by probability-based sampling using address-based sampling methods to achieve a sample representative of the U.S. Data from 4242 adults ages 18 and older were analyzed. About 44 % of respondents indicated at least one feature motivated them to purchase more healthful foods. Top choices included in-store coupons or specials (20.1 %), availability of convenient, ready-to-eat more healthful foods (18.8 %), product labels or advertising on packages (15.2 %), and labels or signs on shelves that highlighted more healthful options (14.6 %). Frequent shoppers reported being motivated to purchase more healthful foods by in-store tastings/recipe demonstrations and coupons/specials more often than infrequent shoppers. Enhancing the visibility and appeal of more healthful food items in grocery stores may help improve dietary choices in some populations but additional research is needed to identify the most effective strategies for interventions.

Features in grocery stores that motivate shoppers to buy healthier foods, ConsumerStyles 2014

PubMed Central

Moore, Latetia V; Pinard, Courtney A.; Yaroch, Amy L.

2016-01-01

Objective We examined nine features in grocery stores shoppers reported motivated them to purchase more healthful foods in the past month. Design Features were compiled from common supermarket practices for each of the 4 Ps of marketing: pricing, placement, promotion, and product. We examined percentages of the features overall and by shopping frequency using chi-square tests from a 2014 cross sectional web-based health attitudes and behaviors survey, ConsumerStyles. The survey was fielded from June to July in 2014. Setting Participants were part of a market research consumer panel that were randomly recruited by probability-based sampling using address-based sampling methods to achieve a sample representative of the U.S. population. Subjects Data from 4,242 adults ages 18 and older were analyzed. Results About 44% of respondents indicated at least one feature motivated them to purchase more healthful foods. Top choices included in-store coupons or specials (20.1%), availability of convenient, ready-to-eat more healthful foods (18.8%), product labels or advertising on packages (15.2%), and labels or signs on shelves that highlighted more healthful options (14.6%). Frequent shoppers reported being motivated to purchase more healthful foods by in-store tastings/recipe demonstrations and coupons/specials more often than infrequent shoppers. Conclusions Enhancing the visibility and appeal of more healthful food items in grocery stores may help improve dietary choices in some populations but additional research is needed to identify the most effective strategies for interventions. PMID:26831484

Australian pharmacies prevent potential adverse reactions in patients taking warfarin requesting over-the-counter analgesia.

PubMed

MacFarlane, Brett V; Bergin, Jenny K; Reeves, Peter; Matthews, Andrew

2015-06-01

The objective of this article was to assess if Australian pharmacy staff prevent potential adverse reactions in warfarin patients requesting over-the-counter (OTC) analgesia. Mystery shoppers entered 170 pharmacies across Australia to request OTC analgesia for a hypothetical patient with a wrist injury who currently takes warfarin following a heart valve replacement. The request was made to the first pharmacist or non-pharmacist staff member to approach the mystery shopper. The interaction was audio-taped and assessed by a pharmacist. The OTC analgesic recommended was assessed for the potential to cause an adverse bleeding event. The quality of advice given with the OTC analgesic was assessed against determined criteria. Results were compared with scenarios of similar request type where the hypothetical patient was not taking warfarin. Mystery shoppers enquiring about taking OTC analgesics concomitantly with warfarin had access to the pharmacist in 97.0% of cases. All 170 pharmacies recommended OTC analgesics that were less likely to cause adverse events when taken with warfarin. The advice given and the communication between pharmacy staff and mystery shoppers were of high quality. Australian pharmacies support the quality use of medicines by patients taking warfarin by providing expeditious access to the pharmacist, appropriate recommendations of OTC analgesics, high standards of quality of advice and they communicate in a way to ensure ease of understanding by the consumer. The protocols used by pharmacy staff help prevent potentially serious adverse drug events. © 2014 Royal Pharmaceutical Society.

Accessibility and Barriers to Oncology Appointments at 40 National Cancer Institute-Designated Comprehensive Cancer Centers: Results of a Mystery Shopper Project.

PubMed

Hamlyn, Geoffrey S; Hutchins, Kathryn E; Johnston, Abby L; Thomas, Rishonda T; Tian, James; Kamal, Arif H

2016-10-01

Patients turn to National Cancer Institute (NCI) -designated comprehensive cancer centers because of perceived better quality and more timely access to care. However, recent studies have found that patients at various institutions may struggle to gain access to an appointment or obtain consistent information from attendants. Our study employs a mystery shopper format to identify and quantify barriers faced by patients seeking to make a first consultation appointment across a homogenous sample of 40 NCI-designated comprehensive cancer centers. Five mystery shoppers used a standardized call script to inquire about first available appointment times and service offerings. When inquiring about a date for a first available appointment, 29% of callers were unable to secure an estimated date without registering into the center's database, 51% were able to secure an estimated date, and 20% were provided with an actual date. Of estimated or actual dates for a first available appointment, 74% were greater than 1 week away. There was no statistically significant variation between appointment availability across insurance type or US region. Our study highlights the difficulty of accessing information about appointment availability. Although not statistically significant, inquiries regarding first available appointments for Medicaid patients resulted in longer estimated or actual wait times than those for patients with private insurance, and Medicaid shoppers noted qualitative differences. Although our study was limited by small sample size and imperfect analytic methods, our results suggest the need for more efficient and accessible care for patients at our nation's top cancer centers.

Increasing access to farmers markets for beneficiaries of nutrition assistance: evaluation of the farmers market access project.

PubMed

Cole, Kate; McNees, Molly; Kinney, Karen; Fisher, Kari; Krieger, James W

2013-10-03

Increased acceptance of nutrition benefits at farmers markets could improve access to nutritious foods for low-income shoppers. The objective of this study was to evaluate a pilot project to increase participation by farmers markets and their vendors in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The intervention targeted 9 markets in lower-income regions of King County, Washington. Markets and vendors were offered subsidized electronic benefits transfer (EBT) terminals for processing SNAP, and vendors could apply to accept WIC cash value vouchers. WIC staff received information on using SNAP and vouchers at farmers markets. We used mixed methods post-implementation to measure participation, describe factors in acceptance of benefits, and assess information needs for WIC staff to conduct effective outreach. Of approximately 88 WIC-eligible vendors, 38 agreed to accept vouchers. Ten of 125 vendors installed an EBT terminal, and 6 markets installed a central market terminal. The number of market stalls accepting SNAP increased from 80 to 143, an increase of 79%. Participating vendors wanted to provide access to SNAP and WIC shoppers, although redemption rates were low. Some WIC staff members were unfamiliar with markets, which hindered outreach. Vendors and markets value low-income shoppers and, when offered support, will take on some inconvenience to serve them. To improve participation and sustainability, we recommend ongoing subsidies and streamlined procedures better suited to meet markets' capabilities. Low EBT redemption rates at farmers markets suggest a need for more outreach to low-income shoppers and relationship building with WIC staff.

Nutrition education at the point of purchase: the foods for health project evaluated.

PubMed

Ernst, N D; Wu, M; Frommer, P; Katz, E; Matthews, O; Moskowitz, J; Pinsky, J L; Pohl, S; Schreiber, G B; Sondik, E

1986-01-01

Foods for Health, a nutrition education and research program sponsored by the National Heart, Lung, and Blood Institute and Giant Food, Inc., was designed to demonstrate the feasibility of cardiovascular nutrition education at the point of purchase, specifically, in the supermarket. To evaluate the program's effectiveness, measures of consumer awareness, knowledge, and food purchases were determined before, during, and after the campaign. The program was conducted in the Washington, D.C., area, with Baltimore, Maryland, area stores serving as controls. At the conclusion of the campaign, Washington shoppers showed a significant increase in knowledge scores, while these scores decreased in the Baltimore area. The gain in correct knowledge scores for Washington shoppers compared with Baltimore shoppers was 9% for food fat and cholesterol content and 11% for the relationship between dietary fat and blood cholesterols levels. The food sales data indicate no apparent differences attributable to the intervention. Issues that might account for the lack of a significant change in food purchases, such as cost and the markets' individual sales promotion campaigns, are discussed, and recommendations for the design of future projects are made.

Increasing Access to Farmers Markets for Beneficiaries of Nutrition Assistance: Evaluation of the Farmers Market Access Project

PubMed Central

Cole, Kate; Kinney, Karen; Fisher, Kari; Krieger, James W.

2013-01-01

Introduction Increased acceptance of nutrition benefits at farmers markets could improve access to nutritious foods for low-income shoppers. The objective of this study was to evaluate a pilot project to increase participation by farmers markets and their vendors in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods The intervention targeted 9 markets in lower-income regions of King County, Washington. Markets and vendors were offered subsidized electronic benefits transfer (EBT) terminals for processing SNAP, and vendors could apply to accept WIC cash value vouchers. WIC staff received information on using SNAP and vouchers at farmers markets. We used mixed methods post-implementation to measure participation, describe factors in acceptance of benefits, and assess information needs for WIC staff to conduct effective outreach. Results Of approximately 88 WIC-eligible vendors, 38 agreed to accept vouchers. Ten of 125 vendors installed an EBT terminal, and 6 markets installed a central market terminal. The number of market stalls accepting SNAP increased from 80 to 143, an increase of 79%. Participating vendors wanted to provide access to SNAP and WIC shoppers, although redemption rates were low. Some WIC staff members were unfamiliar with markets, which hindered outreach. Conclusion Vendors and markets value low-income shoppers and, when offered support, will take on some inconvenience to serve them. To improve participation and sustainability, we recommend ongoing subsidies and streamlined procedures better suited to meet markets’ capabilities. Low EBT redemption rates at farmers markets suggest a need for more outreach to low-income shoppers and relationship building with WIC staff. PMID:24135392

Where do U.S. households purchase healthy foods? An analysis of food-at-home purchases across different types of retailers in a nationally representative dataset.

PubMed

Chrisinger, Benjamin W; Kallan, Michael J; Whiteman, Eliza D; Hillier, Amy

2018-07-01

Food shopping decisions are pathways between food environment, diet and health outcomes, including chronic diseases such as diabetes and obesity. The choices of where to shop and what to buy are interrelated, though a better understanding of this dynamic is needed. The U.S. Department of Agriculture's nationally representative Food Acquisitions and Purchase Survey food-at-home dataset was joined with other databases of retailer characteristics and Healthy Eating Index-2010 (HEI) of purchases. We used linear regression models with general estimating equations to assess relationships between trip, store, and shopper characteristics with trip HEI scores. We examined HEI component scores for conventional supermarkets and discount/limited assortment retailers with descriptive statistics. Overall, 4962 shoppers made 11,472 shopping trips over one-week periods, 2012-2013. Trips to conventional supermarkets were the most common (53.6%), followed by supercenters (18.6%). Compared to conventional supermarkets, purchases at natural/gourmet stores had significantly higher HEI scores (β = 6.48, 95% CI = [4.45, 8.51], while those from "other" retailers (including corner and convenience stores) were significantly lower (-3.89, [-5.87, -1.92]). Older participants (versus younger) and women (versus men) made significantly healthier purchases (1.19, [0.29, 2.10]). Shoppers with less than some college education made significantly less-healthy purchases, versus shoppers with more education, as did households participating in SNAP, versus those with incomes above 185% of the Federal Poverty Level. Individual, trip, and store characteristics influenced the healthfulness of foods purchased. Interventions to encourage healthy purchasing should reflect these dynamics in terms of how, where, and for whom they are implemented. Copyright © 2018 Elsevier Inc. All rights reserved.

Lifestyle segmentation of US food shoppers to examine organic and local food consumption.

PubMed

Nie, Cong; Zepeda, Lydia

2011-08-01

The food related lifestyle (FRL) model, widely used on European data, is applied to US data using a modified survey instrument to examine organic and local food consumption. Since empirical studies indicate these shoppers are motivated by environmental and health concerns and limited by access, the conceptual framework employs an environmental behavior model, Attitude Behavior Context (ABC), which is consistent with means-end chain theory, the Health Belief (HB) model, and the FRL model. ABC theory incorporates contextual factors that may limit consumers' ability to act on their intentions. US food shopper data was collected in 2003 (n=956) utilizing an instrument with variables adapted from the FRL, ABC, and HB models. Cluster analysis segmented food shoppers into four FRL groups: rational, adventurous, careless, and a fourth segment that had some characteristics of both conservative and uninvolved consumers. The segments exhibited significant differences in organic and local food consumption. These were correlated with consumers' environmental concerns, knowledge and practices, health concerns and practices, as well as some demographic characteristics (race, gender, age, education), income, and variables that measured access to these foods. Implications for marketing and public policy strategies to promote organic and local foods include: emphasizing taste, nutrition, value, children, and enjoyment of cooking for rational consumers; and emphasizing health, fitness, and freshness, and providing ethnic foods for adventurous consumers. While both careless and conservative/uninvolved consumers valued convenience, the former tended to be in the highest income group, while the latter were in the lowest, were more likely to be either in the youngest or oldest age groups, and were very concerned about food safety and health. Copyright © 2011 Elsevier Ltd. All rights reserved.

Grocery store podcast about omega-3 fatty acids influences shopping behaviors: a pilot study.

PubMed

Bangia, Deepika; Palmer-Keenan, Debra M

2014-01-01

To determine whether listening to a podcast about omega-3 fatty acids (n-3s) while grocery shopping increased shoppers' awareness about and purchases of seafood and other foods rich in n-3s. Repeated-measures design with a convenience sample (n = 56) of grocery shoppers who listened to the podcast while shopping. Pre- and postintervention semistructured interviews were conducted. The Theory of Reasoned Action was the study's framework. Shoppers were primarily females (mean age, 41 ± 15.3 years). Their perceived ability to buy [t(55) = 6.27, P < .0001] and perceived importance regarding buying [t(55) = 3.38, P < .01] n-3-rich foods improved significantly. At least 1 n-3 rich food (mean, 1.5 ± 0.8) was purchased by 30%, and 79% planned future purchases. Podcasts may effectively communicate nutrition information. More research with a larger sample size is needed to evaluate the effects of the podcast on long-term changes in shopping behavior. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Nutrition education in supermarkets: an unsuccessful attempt to influence knowledge and product sales.

PubMed

Jeffery, R W; Pirie, P L; Rosenthal, B S; Gerber, W M; Murray, D M

1982-06-01

Although much evidence links dietary patterns with coronary heart disease, effective and economical methods for inducing dietary change in nonclinical populations are needed to influence public health. This study was designed as a preliminary investigation of the feasibility of conducting effective nutrition education campaigns in supermarket settings. Eight supermarkets from a supermarket chain in the Twin Cities area participated. Four were assigned to an experimental condition in which educational materials consisting of posters, recipes, and brochures were placed in the dairy section during a 6-month period. Four other stores were assigned to a control condition and received no educational materials. Shoppers in experimental and control stores completed a nutrition survey pre- and post-intervention. In addition, sales data for 25 dairy products were collected during a 10-month period. A significant increase in knowledge on the nutrition survey between pre- and posttests occurred among shoppers in all stores. There was no significant knowledge or product sales effect due to the education campaign. Study results suggest that, overall, shopper knowledge of food selections for cardiovascular disease risk reduction is high and improving. Unfortunately, knowledge is often not reflected in food purchase patterns.

The Veggie Project: a case study of a multi-component farmers' market intervention.

PubMed

Freedman, Darcy A; Bell, Bethany A; Collins, Leslie V

2011-08-01

This case study provides an in-depth examination of process and feasibility factors associated with the development of a multi-component environmental intervention designed to increase access to fresh fruits and vegetables in four low-income, minority, urban communities with few healthy food retail outlets. The intervention, the Veggie Project, included three components: (a) onsite farmers' markets, (b) a Super Shopper voucher program, and (c) a Youth Leader Board. We analyzed receipts from sales transactions at the farmers' markets, close-ended surveys with participants, in-depth interviews with project stakeholders, and journal entries completed by youth participants. Thirty-four farmers' markets occurred, resulting in 1,101 sales transactions. Financial vouchers were used to purchased 63% of the produce. All of the youth Super Shoppers came to the market at least once and made significantly more purchase transactions than adults. The farmers' markets were never accessed by 38% of the adult Super Shoppers. The Veggie Project increased access to healthy foods, particularly among youth. More research is warranted to examine the relationship between market use and dietary behaviors as well as other factors (i.e., besides physical and economic) influencing food access among adults.

Let's talk about health: shoppers' discourse regarding health while food shopping.

PubMed

O'Brien, Michelle C; McConnon, Aine; Hollywood, Lynsey E; Cuskelly, Geraldine J; Barnett, Julie; Raats, Monique; Dean, Moira

2015-04-01

The present study aimed to examine the role of health in consumers' food purchasing decisions through investigating the nature of people's discourse regarding health while conducting their food shopping. The study employed the think-aloud technique as part of an accompanied shop. All mentions of health and terms relating to health were identified from the data set. Inductive thematic analysis was conducted to examine how health was talked about in relation to people's food choice decisions. Supermarkets in Dublin, Republic of Ireland and Belfast, Northern Ireland. Participants (n 50) were aged over 18 years and represented the main household shopper. Responsibility for others and the perceived need to illicit strict control to avoid 'unhealthy' food selections played a dominant role in how health was talked about during the accompanied shop. Consequently healthy shopping was viewed as difficult and effort was required to make the healthy choice, with shoppers relating to product-based inferences to support their decisions. This qualitative exploration has provided evidence of a number of factors influencing the consideration of health during consumers' food shopping. These results highlight opportunities for stakeholders such as public health bodies and the food industry to explore further ways to help enable consumers make healthy food choices.

Male access to emergency contraception in pharmacies: a mystery shopper survey.

PubMed

Bell, David L; Camacho, Elvis J; Velasquez, Andrew B

2014-10-01

Pharmacy access to emergency contraception (EC) could involve men in pregnancy prevention. The objectives were to assess the availability and cost of EC. Male mystery shoppers visited 158 pharmacies in three neighborhoods in New York City. They asked for EC and its cost and noted weekend hours. Twenty-two (73.3%) of 30 pharmacies created barriers to get EC. The cost of EC was higher in the higher-socioeconomic status (SES) neighborhood (p<.001), and the higher-SES neighborhood pharmacies had a greater number of weekend hours (p<.001). Overall, males had a 20% probability of not being able to access EC. The national dialogue should include males. Copyright © 2014 Elsevier Inc. All rights reserved.

Examining food purchasing patterns from sales data at a full-service grocery store intervention in a former food desert.

PubMed

Fuller, Daniel; Engler-Stringer, Rachel; Muhajarine, Nazeem

2015-01-01

The Good Food Junction Grocery Store was opened in a former food desert in the inner city of Saskatoon, Canada. The purpose of this research was to examine, using grocery store sales data, healthy and less healthful food purchasing over a one-year period beginning eight months after opening by shoppers' neighborhood of residence. A multilevel cross sectional design was used. The sample consisted of members of the Good Food Junction with a valid address in Saskatoon, Saskatchewan. All purchases made by members who reported their postal code of residence from May 15, 2013 to April 30, 2014 were analyzed. The outcome variable was the total amount spent on foods in 11 food groups. Linear random intercept models with three levels were fit to the data. Shoppers who were residents of former food desert neighborhoods spent $0.7 (95% CI: 0.2 to 1.2) more on vegetables, and $1.2 (95% CI: - 1.8 to - 0.6) less on meat, and $1.1 (95% CI: - 2.0 to - 0.3) less on prepared foods than shoppers who did not reside in those neighborhoods. When given geographical access to healthy food, people living in disadvantaged former food desert neighborhoods will take advantage of that access.

The functional food trend: what's next and what Americans think about eggs.

PubMed

Gilbert, L C

2000-10-01

The Health Focus National Study of Public Attitudes and Actions Toward Healthy Foods is conducted every two years to identify current issues in consumer health and nutrition behavior and attitudes, to assess the trends in consumer priorities and to develop an understanding of where consumers are headed in their behavior towards their health and diet. This paper focuses on consumer interests in functional nutrition for disease prevention and health enhancement. It examines the role consumers see for eggs in healthy diets. The data for this study were collected from written questionnaires completed by 2,074 qualified respondents in August, September and October of 1998. The research was conducted in two stages: 1. A telephone pre-recruit from a national probability sample of households qualified respondents as Primary Grocery Shoppers (those who make most of the food buying decisions for their household or who equally share that responsibility). 2. A 12-page, self-administered questionnaire was mailed to qualified respondents. Respondents to this survey represent shoppers in the U.S. in all respects except race. Women account for 81% of the survey respondents, since they do most of the household shopping. Most shoppers believe foods can offer benefits that reach beyond basic nutrition to functional nutrition for disease prevention and health enhancement. As consumers better understand the functional benefits of eggs, from Prevention to Performance, Wellness, Nurturing and Cosmetics, eggs will continue to play an important role in healthy eating for many consumers. Eggs are considered a healthy food by most consumers as long as they are eaten in moderation. Increased egg consumption is being driven by consumer interest in health benefits that reach beyond dietary avoidance strategies to positive nutrition strategies. Today's self-reliant approach to health creates significant opportunities for health and nutrition marketers to use knowledge-based marketing programs to shape present and future health decisions and product choices among shoppers.

Food bundling as a health nudge: Investigating consumer fruit and vegetable selection using behavioral economics.

PubMed

Carroll, Kathryn A; Samek, Anya; Zepeda, Lydia

2018-02-01

Displaying bundles of healthy foods at the grocery store is a health nudge that simplifies shopping and may have the potential for increasing fruit and vegetable (F&V) purchasing. To evaluate the impact of food bundling, we conduct an artefactual field experiment with community participants in a laboratory set up as a grocery store. Dual-self theory suggests that food choices may differ depending on whether shoppers are under cognitive load - in our experiment, we exogenously vary whether bundles are displayed (with and without a price discount) and whether shoppers are under cognitive load. Our findings align with prior studies that suggest unhealthy options are more likely to be selected when cognitive resources are constrained. When bundles are displayed, we observe increased F&V purchasing. We also observe a significant interaction between cognitive load and price discounting. We find discounted bundles are more effective in the absence of cognitive load, but non-discounted bundles are more effective when shoppers are under cognitive load. Although more research is warranted, our findings suggest that when shopping under cognitive load, it is possible that discounts impose additional cognitive strain on the shopping experience. For retailers and policymakers, our results point to the potential power of bundling as a strategy for increasing healthy food purchasing. Copyright © 2017 Elsevier Ltd. All rights reserved.

Contamination by Meat Juice When Shopping for Packages of Raw Poultry.

PubMed

Chen, Fur-Chi; Godwin, Sandria; Chambers, Delores; Chambers, Edgar; Cates, Sheryl; Stone, Richard; Donelan, Amy

2018-05-01

Raw poultry products often are contaminated with Salmonella and Campylobacter, and these bacteria can be transmitted through meat juice on the packages. An observational study was conducted to assess consumer exposure to meat juice during shopping and to quantify the transmission of meat juice from poultry packages to hands and other surfaces. Ninety-six participants completed the shopping study; 402 swabs were collected and analyzed for the presence of meat juice by an immunoassay. Overall, meat juice was detected on 61% of poultry package surfaces, 34% of shoppers' hands, 41% of grocery bags, 60% of kitchen surfaces, and 51% of food item surfaces. When meat juice was detected on the purchased poultry packages, the chance of the meat juice being on the shopper's hands, grocery bags, food items, and kitchen surfaces was significantly higher ( P < 0.005) compared with packages on which meat juice was not present. Shoppers who had poultry wrapped separately during checkout had a significantly lower ( P < 0.05) chance of meat juice on the food items. However, using plastic bags and wrapping poultry separately did not significantly reduce the likelihood of meat juice on kitchen surfaces at home due to consumers' practices of repackaging before storage. Results suggested that the transfer of meat juice through direct contact with the poultry packages is a major concern during shopping and should be prevented.

Examining food purchasing patterns from sales data at a full-service grocery store intervention in a former food desert

PubMed Central

Fuller, Daniel; Engler-Stringer, Rachel; Muhajarine, Nazeem

2015-01-01

Background The Good Food Junction Grocery Store was opened in a former food desert in the inner city of Saskatoon, Canada. Objective The purpose of this research was to examine, using grocery store sales data, healthy and less healthful food purchasing over a one-year period beginning eight months after opening by shoppers' neighborhood of residence. Design A multilevel cross sectional design was used. The sample consisted of members of the Good Food Junction with a valid address in Saskatoon, Saskatchewan. All purchases made by members who reported their postal code of residence from May 15, 2013 to April 30, 2014 were analyzed. The outcome variable was the total amount spent on foods in 11 food groups. Linear random intercept models with three levels were fit to the data. Results Shoppers who were residents of former food desert neighborhoods spent $0.7 (95% CI: 0.2 to 1.2) more on vegetables, and $1.2 (95% CI: − 1.8 to − 0.6) less on meat, and $1.1 (95% CI: − 2.0 to − 0.3) less on prepared foods than shoppers who did not reside in those neighborhoods. Conclusions When given geographical access to healthy food, people living in disadvantaged former food desert neighborhoods will take advantage of that access. PMID:26844066

The Child-Centered Shopper

ERIC Educational Resources Information Center

Miner, Clint

1974-01-01

Selecting the right equipment and toys means paying attention to what's important. The vice president of Childcraft discusses how to ensure that the needs of children and program become the focus of purchasing. (Author)

Buying Food on Sale: A Mixed Methods Study With Shoppers at an Urban Supermarket, Philadelphia, Pennsylvania, 2010–2012

PubMed Central

Kumanyika, Shiriki K.; Stites, Shana D.; Singletary, S. Brook; Cooblall, Clarissa; DiSantis, Katherine Isselmann

2014-01-01

Introduction The obesity epidemic has drawn attention to food marketing practices that may increase the likelihood of caloric overconsumption and weight gain. We explored the associations of discounted prices on supermarket purchases of selected high-calorie foods (HCF) and more healthful, low-calorie foods (LCF) by a demographic group at high risk of obesity. Methods Our mixed methods design used electronic supermarket purchase data from 82 low-income (primarily African American female) shoppers for households with children and qualitative data from focus groups with demographically similar shoppers. Results In analyses of 6,493 food purchase transactions over 65 weeks, the odds of buying foods on sale versus at full price were higher for grain-based snacks, sweet snacks, and sugar-sweetened beverages (odds ratios: 6.6, 5.9, and 2.6, respectively; all P < .001) but not for savory snacks. The odds of buying foods on sale versus full price were not higher for any of any of the LCF (P ≥ .07). Without controlling for quantities purchased, we found that spending increased as percentage saved from the full price increased for all HCF and for fruits and vegetables (P ≤ .002). Focus group participants emphasized the lure of sale items and took advantage of sales to stock up. Conclusion Strategies that shift supermarket sales promotions from price reductions for HCF to price reductions for LCF might help prevent obesity by decreasing purchases of HCF. PMID:25188276

Buying food on sale: a mixed methods study with shoppers at an urban supermarket, Philadelphia, Pennsylvania, 2010-2012.

PubMed

Phipps, Etienne J; Kumanyika, Shiriki K; Stites, Shana D; Singletary, S Brook; Cooblall, Clarissa; DiSantis, Katherine Isselmann

2014-09-04

The obesity epidemic has drawn attention to food marketing practices that may increase the likelihood of caloric overconsumption and weight gain. We explored the associations of discounted prices on supermarket purchases of selected high-calorie foods (HCF) and more healthful, low-calorie foods (LCF) by a demographic group at high risk of obesity. Our mixed methods design used electronic supermarket purchase data from 82 low-income (primarily African American female) shoppers for households with children and qualitative data from focus groups with demographically similar shoppers. In analyses of 6,493 food purchase transactions over 65 weeks, the odds of buying foods on sale versus at full price were higher for grain-based snacks, sweet snacks, and sugar-sweetened beverages (odds ratios: 6.6, 5.9, and 2.6, respectively; all P < .001) but not for savory snacks. The odds of buying foods on sale versus full price were not higher for any of any of the LCF (P ≥ .07). Without controlling for quantities purchased, we found that spending increased as percentage saved from the full price increased for all HCF and for fruits and vegetables (P ≤ .002). Focus group participants emphasized the lure of sale items and took advantage of sales to stock up. Strategies that shift supermarket sales promotions from price reductions for HCF to price reductions for LCF might help prevent obesity by decreasing purchases of HCF.

Nutrition labels: a survey of use, understanding and preferences among ethnically diverse shoppers in New Zealand.

PubMed

Gorton, Delvina; Ni Mhurchu, Cliona; Chen, Mei-Hua; Dixon, Robyn

2009-09-01

Effective nutrition labels are part of a supportive environment that encourages healthier food choices. The present study examined the use, understanding and preferences regarding nutrition labels among ethnically diverse shoppers in New Zealand. A survey was carried out at twenty-five supermarkets in Auckland, New Zealand, between February and April 2007. Recruitment was stratified by ethnicity. Questions assessed nutrition label use, understanding of the mandatory Nutrition Information Panel (NIP), and preference for and understanding of four nutrition label formats: multiple traffic light (MTL), simple traffic light (STL), NIP and percentage of daily intake (%DI). In total 1525 shoppers completed the survey: 401 Maori, 347 Pacific, 372 Asian and 395 New Zealand European and Other ethnicities (ten did not state ethnicity). Reported use of nutrition labels (always, regularly, sometimes) ranged from 66% to 87% by ethnicity. There was little difference in ability to obtain information from the NIP according to ethnicity or income. However, there were marked ethnic differences in ability to use the NIP to determine if a food was healthy, with lesser differences by income. Of the four label formats tested, STL and MTL labels were best understood across all ethnic and income groups, and MTL labels were most frequently preferred. There are clear ethnic and income disparities in ability to use the current mandatory food labels in New Zealand (NIP) to determine if foods are healthy. Conversely, MTL and STL label formats demonstrated high levels of understanding and acceptance across ethnic and income groups.

Although Relatively Few, "Doctor Shoppers" Skew Opioid Prescribing

MedlinePlus

... Medicines Prescription Medicines Steroids (Anabolic) Synthetic Cannabinoids (K2/Spice) Synthetic Cathinones (Bath Salts) Tobacco/Nicotine and E- ... Fentanyl GHB Hallucinogens Heroin Illegal Drugs Inhalants K2/Spice Kratom LSD (Acid) Marijuana MDMA (Ecstasy) Methamphetamine Opioids ...

Doctor-Shopping Behavior among Patients with Eye Floaters

PubMed Central

Tseng, Gow-Lieng; Chen, Cheng-Yu

2015-01-01

Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers) who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters. PMID:26184266

Doctor-Shopping Behavior among Patients with Eye Floaters.

PubMed

Tseng, Gow-Lieng; Chen, Cheng-Yu

2015-07-13

Patients suffering from eye floaters often resort to consulting more than one ophthalmologist. The purpose of this study, using the Health Belief Model (HBM), was to identify the factors that influence doctor-shopping behavior among patients with eye floaters. In this cross-sectional survey, 175 outpatients who presented floaters symptoms were enrolled. Data from 143 patients (77 first time visitors and 66 doctor-shoppers) who completed the questionnaire were analyzed. Descriptive and logistic regression analyses were performed. We found that women and non-myopia patients were significantly related with frequent attendance and doctor switching. Though the HBM has performed well in a number of health behaviors studies, but most of the conceptual constructors of HBM did not show significant differences between the first time visitors and true doctor-shoppers in this study. Motivation was the only significant category affecting doctor-shopping behavior of patients with eye floaters.

Paying for Express Checkout: Competition and Price Discrimination in Multi-Server Queuing Systems

PubMed Central

Deck, Cary; Kimbrough, Erik O.; Mongrain, Steeve

2014-01-01

We model competition between two firms selling identical goods to customers who arrive in the market stochastically. Shoppers choose where to purchase based upon both price and the time cost associated with waiting for service. One seller provides two separate queues, each with its own server, while the other seller has a single queue and server. We explore the market impact of the multi-server seller engaging in waiting cost-based-price discrimination by charging a premium for express checkout. Specifically, we analyze this situation computationally and through the use of controlled laboratory experiments. We find that this form of price discrimination is harmful to sellers and beneficial to consumers. When the two-queue seller offers express checkout for impatient customers, the single queue seller focuses on the patient shoppers thereby driving down prices and profits while increasing consumer surplus. PMID:24667809

Women who doctor shop for prescription drugs.

PubMed

Worley, Julie; Thomas, Sandra P

2014-04-01

Doctor shopping is a term used to describe a form of diversion of prescription drugs when patients visit numerous prescribers to obtain controlled drugs for illicit use. Gender differences exist in regard to prescription drug abuse and methods of diversion. The purpose of this phenomenological study guided by the existential philosophy of Merleau-Ponty was to understand the lived experience of female doctor shoppers. Interviews were conducted with 14 women, which were recorded, transcribed, and analyzed. Included in the findings are figural aspects of the participants' experience of doctor shopping related to the existential grounds of world, time, body, and others. Four themes emerged from the data: (a) feeding the addiction, (b) networking with addicts, (c) playing the system, and (d) baiting the doctors. The findings suggest several measures that nurses can take to reduce the incidence of doctor shopping and to provide better care for female doctor shoppers.

Paying for express checkout: competition and price discrimination in multi-server queuing systems.

PubMed

Deck, Cary; Kimbrough, Erik O; Mongrain, Steeve

2014-01-01

We model competition between two firms selling identical goods to customers who arrive in the market stochastically. Shoppers choose where to purchase based upon both price and the time cost associated with waiting for service. One seller provides two separate queues, each with its own server, while the other seller has a single queue and server. We explore the market impact of the multi-server seller engaging in waiting cost-based-price discrimination by charging a premium for express checkout. Specifically, we analyze this situation computationally and through the use of controlled laboratory experiments. We find that this form of price discrimination is harmful to sellers and beneficial to consumers. When the two-queue seller offers express checkout for impatient customers, the single queue seller focuses on the patient shoppers thereby driving down prices and profits while increasing consumer surplus.

Shopping in the healthcare information systems market--a search for well-camouflaged land mines.

PubMed

Grams, R R

1998-10-01

The selection of a healthcare information system is analogous to a big game hunt. The buyers perceive themselves as the hunters while the truth is just the opposite. To strip away the carefully crafted facade of corporate marketing is an art form and requires due diligence on the part of the shopper. Suggestions are offered to the consumer on how to pierce the shell of corporate silence and find the facts that will make a significant difference in product selection. The objectives on the seller's side are to make as much profit as possible and give as little as required to make the sale. The buyer is looking for the best product, the best company, and the most painless installation. The ground between these two vastly different goals is the battlefield of healthcare computer procurement. May the best shopper win! Caveat emptor.

Shopping for clothes: Body satisfaction, appearance investment, and functions of clothing among female shoppers.

PubMed

Tiggemann, Marika; Lacey, Catherine

2009-09-01

The present study aimed to investigate the link between clothing and body experience in women of different ages. Participants were 162 female clothes shoppers between the ages of 18 and 55 who completed questionnaire measures of body image, functions of clothing, self-esteem, and enjoyment of clothes shopping. It was found that clothing was worn primarily for assurance and fashion by women of all ages. On the other hand, BMI and body dissatisfaction were related to the use of clothing for camouflage purposes and to a more negative clothes shopping experience. Both components of appearance investment were related to choice of clothes for fashion and assurance. However, the self-evaluative salience component was negatively related, while the motivational salience was positively related, to enjoyment of clothes shopping. It was concluded that although clothing is an under-researched aspect of body image, it represents an important part of women's appearance management, whatever their age.

The stigma of obesity in customer service: a mechanism for remediation and bottom-line consequences of interpersonal discrimination.

PubMed

King, Eden B; Shapiro, Jenessa R; Hebl, Michelle R; Singletary, Sarah L; Turner, Stacey

2006-05-01

Using a customer service paradigm, the authors extended the justification-suppression model (JSM) of prejudice (C. S. Crandall & A. Eshleman, 2003) to include contemporary, covert forms of discrimination and to identify a discrimination remediation mechanism. Overall, the results of 3 studies revealed that actual and confederate obese shoppers in high-prejudice justification conditions faced more interpersonal discrimination than average-weight shoppers. Furthermore, Studies 1 and 2 demonstrate that adopting strategies that remove perceivers' justifications for discriminating against obese individuals (i.e., the controllability of weight) decreases the incidence of interpersonal discrimination. Additionally, Study 3 demonstrates negative bottom-line consequences of interpersonal discrimination for organizations (e.g., customer loyalty, purchasing behavior). Together, these studies confirm that the JSM applies to covert forms of discrimination, show the importance of examining subtle discrimination, and offer a mechanism for theory-driven strategies for the reduction of covert forms of discrimination.

How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study

PubMed Central

Molloy, Phillip; Chambers, Ruth; Cork, Tania

2016-01-01

Objective To determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol. Methods Stages 1 and 2 of the study deployed eight and four medical students, respectively, to undertake a mystery shopper style investigation. Stage 1: eight medical students attempted to buy ≥96 tablets/capsules aspirin or paracetamol in one transaction in 62 shops. Stage 2: four medical students attempted to purchase 32 paracetamol 500 mg along with a ‘flu remedy preparation also containing paracetamol, in 54 shops. Results Stage 1 data revealed that 58% and 57% retailers sold more than the MHRA guidelines recommended for paracetamol and aspirin, respectively. We observed that 23% and 28% retailers were willing to sell ≥96 tablets of paracetamol or aspirin with no questions asked. Stage 2 results showed that 57% retailers sold 32×500 mg paracetamol in conjunction with a paracetamol-containing ‘flu preparation; while 98% shops sold 16×paracetamol 500 mg along with a paracetamol-containing ‘flu remedy, with no questions asked of the shopper or advice given. Discussion MHRA national guidelines for OTC medicines sales appear to be poorly adhered to in non-pharmacy shops. Sales of aspirin and paracetamol OTC must be better regulated in the UK to ultimately reduce morbidity and mortality rates of deliberate and accidental overdoses. PMID:26781508

An analysis of the effects of a campaign supporting use of a health symbol on food sales and shopping behaviour of consumers.

PubMed

Mørk, Trine; Grunert, Klaus G; Fenger, Morten; Juhl, Hans Jørn; Tsalis, George

2017-03-09

Since 2009, the green Keyhole symbol has been a joint Nordic initiative for signalling healthfulness of specific food products. In 2014, the Danish Ministry of Food, Agriculture and Fisheries carried out a campaign aimed mainly at men over 35 with a low level of education, encouraging them to use the Keyhole in their shopping process. The objective of the study is to evaluate the campaign by measuring its effect on consumer behaviour in the store. The impact of the Keyhole campaign was measured in selected retail stores. Sales data were analysed to ascertain whether sales of Keyhole labelled products changed during and after the campaign. Observations and interviews were conducted in the same stores. The campaign had a positive effect on sales of Keyhole-labelled products in two out of three retail chains investigated. In these two retail chains, sales of Keyhole labelled products rose by about 20%. In the third chain, there was a slight decrease of sales of Keyhole labelled products. The effect differed considerably between product categories. Analysis of the interview data indicated that by the end of the campaign, shoppers with a short education had a higher likelihood of mentioning health as a purchase motive, and there was a higher general tendency to look for nutrition information. Results suggest that the campaign did have effects on shopper behaviour and that it is possible to address shoppers with a short education by a tailored campaign. However, long-term effect of the campaign was not ascertained.

A Point-of-Purchase Intervention Using Grocery Store Tour Podcasts About Omega-3s Increases Long-Term Purchases of Omega-3-Rich Food Items.

PubMed

Bangia, Deepika; Shaffner, Donald W; Palmer-Keenan, Debra M

2017-06-01

To assess the impacts associated with a grocery store tour point-of-purchase intervention using podcasts about omega-3 fatty acid (n-3)-rich food items. A repeated-measures secondary data analysis of food purchase records obtained from a convenience sample of shoppers' loyalty cards. Shoppers (n = 251) who had listened to podcasts regarding n-3-rich foods while shopping. The number of omega-3-rich food purchases made according to food or food category by participants determined via spreadsheets obtained from grocery store chain. Descriptive statistics were performed on demographic characteristics. Wilcoxon signed-rank tests were used to assess whether food purchases increased from 6 months before to 6 months after intervention. Correlations assessed the relationship between intentions to purchase n-3-rich foods expressed on the intervention day with actual long-term n-3-rich food purchases. Nonparametric Kruskal-Wallis ANOVAs and Wilcoxon signed-rank tests were used to analyze differences between changes made and demographic variables (ie, participants' gender, race, and education levels). Most shoppers (59%) increased n-3-rich food purchases, with significant mean purchase changes (t[172] = -6.9; P < .001; pre = 0.2 ± 0.7; post = 3.6 ± 5.1). Podcasts are promising nutrition education tools. Longer studies could assess whether lasting change results from podcast use. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Momentum--"Evaluating Your Marketing Program: Measuring and Tracking Techniques."

ERIC Educational Resources Information Center

Meservey, Lynne D.

1990-01-01

Suggests 10 tracking techniques for evaluating marketing performance. Techniques involve utilization rate, inquiry and source of inquiry tracking, appointment and interview tracking, enrollment conversion, cost per inquiry and per enrollment, retention rate, survey results, and "mystery shopper." (RJC)

Effects of interpretive nutrition labels on consumer food purchases: the Starlight randomized controlled trial.

PubMed

Ni Mhurchu, Cliona; Volkova, Ekaterina; Jiang, Yannan; Eyles, Helen; Michie, Jo; Neal, Bruce; Blakely, Tony; Swinburn, Boyd; Rayner, Mike

2017-03-01

Background: Nutrition labeling is a prominent policy to promote healthy eating. Objective: We aimed to evaluate the effects of 2 interpretive nutrition labels compared with a noninterpretive label on consumer food purchases. Design: In this parallel-group randomized controlled trial, we enrolled household shoppers across New Zealand who owned smartphones and were aged ≥18 y. Eligible participants were randomly assigned (1:1:1) to receive either traffic light labels (TLLs), Health Star Rating labels (HSRs), or a control [nutrition information panel (NIP)]. Smartphone technology allowed participants to scan barcodes of packaged foods and to receive allocated labels on their smartphone screens. The primary outcome was the mean healthiness of all packaged food purchases over the 4-wk intervention period, which was measured by using the Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion (NPSC). Results: Between October 2014 and November 2015, 1357 eligible shoppers were randomly assigned to TLL ( n = 459), HSR ( n = 443), or NIP ( n = 455) labels. Overall difference in the mean transformed NPSC score for the TLL group compared with the NIP group was -0.20 (95% CI: -0.94, 0.54; P = 0.60). The corresponding difference for HSR compared with NIP was -0.60 (95% CI: -1.35, 0.15; P = 0.12). In an exploratory per-protocol analysis of participants who used the labeling intervention more often than average ( n = 423, 31%), those who were assigned to TLL and HSR had significantly better NPSC scores [TLL compared with NIP: -1.33 (95% CI: -2.63, -0.04; P = 0.04); HSR compared with NIP: -1.70 (95% CI: -2.97, -0.43; P = 0.01)]. Shoppers who were randomly assigned to HSR and TLL also found the labels significantly more useful and easy to understand than the NIP (all P values <0.001). Conclusions: At the relatively low level of use observed in this trial, interpretive nutrition labels had no significant effect on food purchases. However, shoppers who used interpretive labels found them to be significantly more useful and easy to understand, and compared with frequent NIP users, frequent TLL and HSR users had significantly healthier food purchases. This trial was registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366446&isReview=true) as ACTRN12614000644662. © 2017 American Society for Nutrition.

75 FR 38725 - Service Performance Measurement

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-06

... of Customer Sastisfaction A. General Considerations B. Rule 3055.91--Consumer Access to Postal Services C. Rule 3055.92--Customer Experience Measurement Surveys D. Rule 3055.93--Mystery Shopper Program... Commission is adopting a final rule on service perfomance measurement and customer satisfaction. The final...

Not sold here: limited access to legally available syringes at pharmacies in Tijuana, Mexico

PubMed Central

2011-01-01

Background Sterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies. Methods Trained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency. Results Only 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription. Conclusions IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission. PMID:21609471

Shopper marketing: a new challenge for Spanish community pharmacies.

PubMed

Gavilan, Diana; Avello, Maria; Abril, Carmen

2014-01-01

Changes that have occurred over the past few decades in retailing and in the health care sector--namely, a drastic reduction in drug profit-margins, and a more critical use of health services by patients--have created a scenario characterized by rising competitiveness. This new context is necessitating community pharmacies (hereafter, pharmacies) to improve their business model through new strategies. Shopper marketing has proven invaluable in other retail settings and therefore, could be a critical element for new practices in pharmacies. First, to analyze how shopping experiences in pharmacies based on new practices in shopper marketing affect shopping behavior. Second, to study the mediating effect of customer satisfaction on the relationship between shopping experiences and shopping behavior. A self-reported questionnaire was developed to measure four concepts: hedonic experience (enjoyable), functional experience (goal-oriented), customer satisfaction and shopping behavior. Data were collected from 28 different pharmacies dispersed throughout Spain. Structural equation modeling (SEM) was used to test the relationships in the theoretical model. First, the measurement model was estimated to assess model fit, reliability, convergent and discriminant validity. Then, the parameters of the structural model were estimated and the mediation effects were subsequently tested. Functional experience and hedonic experience each significantly and positively correlate with consumer satisfaction and with customer shopping behavior (purchases and loyalty). Moreover, the effects of each type of experience on shopping behavior are partially mediated by customer satisfaction. The results suggest that even in Spanish pharmacies, which have traditionally been considered as strictly functional retailers, ensuring customer satisfaction and enhancing shopping behavior now demand more than just functional experiences. Moreover, a customer's experience at a pharmacy can itself trigger a shopping cycle; therefore, pharmacists should consider prioritizing investments in hedonic experiences. Copyright © 2014 Elsevier Inc. All rights reserved.

How well are national guidelines relating to the general sales of aspirin and paracetamol, adhered to by retail stores: a mystery shopper study.

PubMed

Molloy, Phillip; Chambers, Ruth; Cork, Tania

2016-01-18

To determine whether non-pharmaceutical retail outlets are aboding to the current Medicines and Healthcare products Regulatory Agency (MHRA) national guidelines for over-the-counter (OTC) sales of aspirin and paracetamol. Stages 1 and 2 of the study deployed eight and four medical students, respectively, to undertake a mystery shopper style investigation. Stage 1: eight medical students attempted to buy ≥ 96 tablets/capsules aspirin or paracetamol in one transaction in 62 shops. Stage 2: four medical students attempted to purchase 32 paracetamol 500 mg along with a 'flu remedy preparation also containing paracetamol, in 54 shops. Stage 1 data revealed that 58% and 57% retailers sold more than the MHRA guidelines recommended for paracetamol and aspirin, respectively. We observed that 23% and 28% retailers were willing to sell ≥ 96 tablets of paracetamol or aspirin with no questions asked. Stage 2 results showed that 57% retailers sold 32 × 500 mg paracetamol in conjunction with a paracetamol-containing 'flu preparation; while 98% shops sold 16 × paracetamol 500 mg along with a paracetamol-containing 'flu remedy, with no questions asked of the shopper or advice given. MHRA national guidelines for OTC medicines sales appear to be poorly adhered to in non-pharmacy shops. Sales of aspirin and paracetamol OTC must be better regulated in the UK to ultimately reduce morbidity and mortality rates of deliberate and accidental overdoses. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The use of mystery shopping for quality assurance evaluations of HIV/STI testing sites offering services to young gay and bisexual men.

PubMed

Bauermeister, José A; Pingel, Emily S; Jadwin-Cakmak, Laura; Meanley, Steven; Alapati, Deepak; Moore, Michael; Lowther, Matthew; Wade, Ryan; Harper, Gary W

2015-10-01

Young men who have sex with men (YMSM) are at increased risk for HIV and STI infection. While encouraging HIV and STI testing among YMSM remains a public health priority, we know little about the cultural competency of providers offering HIV/STI tests to YMSM in public clinics. As part of a larger intervention study, we employed a mystery shopper methodology to evaluate the LGBT cultural competency and quality of services offered in HIV and STI testing sites in Southeast Michigan (n = 43).We trained and deployed mystery shoppers (n = 5) to evaluate the HIV and STI testing sites by undergoing routine HIV/STI testing. Two shoppers visited each site, recording their experiences using a checklist that assessed 13 domains, including the clinic's structural characteristics and interactions with testing providers. We used the site scores to examine the checklist's psychometric properties and tested whether site evaluations differed between sites only offering HIV testing (n = 14) versus those offering comprehensive HIV/STI testing (n = 29). On average, site scores were positive across domains. In bivariate comparisons by type of testing site, HIV testing sites were more likely than comprehensive HIV/STI testing clinics to ascertain experiences of intimate partner violence, offer action steps to achieve safer sex goals, and provide safer sex education. The developed checklist may be used as a quality assurance indicator to measure HIV/STI testing sites' performance when working with YMSM. Our findings also underscore the need to bolster providers' provision of safer sex education and behavioral counseling within comprehensive HIV/STI testing sites.

Small Convenience Stores and the Local Food Environment: An Analysis of Resident Shopping Behavior Using Multilevel Modeling.

PubMed

Ruff, Ryan Richard; Akhund, Ali; Adjoian, Tamar

2016-01-01

Local food environments can influence the diet and health of individuals through food availability, proximity to retail stores, pricing, and promotion. This study focused on how small convenience stores, known in New York City as bodegas, influence resident shopping behavior and the food environment. Using a cross-sectional design, 171 bodegas and 2118 shoppers were sampled. Small convenience stores in New York City. Any bodega shopper aged 18+ who purchased food or beverage from a participating store. Data collection consisted of a store assessment, a health and behavior survey given to exiting customers, and a bag check that recorded product information for all customer purchases. Descriptive statistics were generated for bodega store characteristics, shopper demographics, and purchase behavior. Multilevel models were used to assess the influence of product availability, placement, and advertising on consumer purchases of sugar-sweetened beverages (SSBs), water, and fruits and vegetables. Seventy-one percent of participants reported shopping at bodegas five or more times per week, and 35% reported purchasing all or most of their monthly food allotment at bodegas. Model results indicated that lower amounts of available fresh produce were significantly and independently associated with a higher likelihood of SSB purchases. A second, stratified multilevel model showed that the likelihood of purchasing an SSB increased with decreasing varieties of produce when produce was located at the front of the store. No significant effects were found for water placement and beverage advertising. Small convenience stores in New York City are an easily accessible source of foods and beverages. Bodegas may be suitable for interventions designed to improve food choice and diet.

Not sold here: limited access to legally available syringes at pharmacies in Tijuana, Mexico.

PubMed

Pollini, Robin A; Rosen, Perth C; Gallardo, Manuel; Robles, Brenda; Brouwer, Kimberly C; Macalino, Grace E; Lozada, Remedios

2011-05-24

Sterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies. Trained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency. Only 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription. IDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission.

The Use of Mystery Shopping for Quality Assurance Evaluations of HIV/STI Testing Sites Offering Services to Young Gay and Bisexual Men

PubMed Central

Bauermeister, José A.; Pingel, Emily S.; Jadwin-Cakmak, Laura; Meanley, Steven; Alapati, Deepak; Moore, Michael; Lowther, Matthew; Wade, Ryan; Harper, Gary W.

2015-01-01

Young men who have sex with men (YMSM) are at increased risk for HIV and STI infection. While encouraging HIV and STI testing among YMSM remains a public health priority, we know little about the cultural competency of providers offering HIV/STI tests to YMSM in public clinics. As part of a larger intervention study, we employed a mystery shopper methodology to evaluate the LGBT cultural competency and quality of services offered in HIV and STI testing sites in Southeast Michigan (n = 43).We trained and deployed mystery shoppers (n = 5) to evaluate the HIV and STI testing sites by undergoing routine HIV/STI testing. Two shoppers visited each site, recording their experiences using a checklist that assessed 13 domains, including the clinic’s structural characteristics and interactions with testing providers. We used the site scores to examine the checklist’s psychometric properties and tested whether site evaluations differed between sites only offering HIV testing (n = 14) versus those offering comprehensive HIV/STI testing (n = 29). On average, site scores were positive across domains. In bivariate comparisons by type of testing site, HIV testing sites were more likely than comprehensive HIV/STI testing clinics to ascertain experiences of intimate partner violence, offer action steps to achieve safer sex goals, and provide safer sex education. The developed checklist may be used as a quality assurance indicator to measure HIV/STI testing sites’ performance when working with YMSM. Our findings also underscore the need to bolster providers’ provision of safer sex education and behavioral counseling within comprehensive HIV/STI testing sites. PMID:26303197

Impact of Florida's prescription drug monitoring program and pill mill law on high-risk patients: A comparative interrupted time series analysis.

PubMed

Chang, Hsien-Yen; Murimi, Irene; Faul, Mark; Rutkow, Lainie; Alexander, G Caleb

2018-04-01

We quantified the effects of Florida's prescription drug monitoring program and pill mill law on high-risk patients. We used QuintilesIMS LRx Lifelink data to identify patients receiving prescription opioids in Florida (intervention state, N: 1.13 million) and Georgia (control state, N: 0.54 million). The preintervention, intervention, and postintervention periods were July 2010 to June 2011, July 2011 to September 2011, and October 2011 to September 2012. We identified 3 types of high-risk patients: (1) concomitant users: patients with concomitant use of benzodiazepines and opioids; (2) chronic users: long-term, high-dose, opioid users; and (3) opioid shoppers: patients receiving opioids from multiple sources. We compared changes in opioid prescriptions between Florida and Georgia before and after policy implementation among high-risk/low-risk patients. Our monthly measures included (1) average morphine milligram equivalent per transaction, (2) total opioid volume across all prescriptions, (3) average days supplied per transaction, and (4) total number of opioid prescriptions dispensed. Among opioid-receiving individuals in Florida, 6.62% were concomitant users, 1.96% were chronic users, and 0.46% were opioid shoppers. Following policy implementation, Florida's high-risk patients experienced relative reductions in morphine milligram equivalent (opioid shoppers: -1.08 mg/month, 95% confidence interval [CI] -1.62 to -0.54), total opioid volume (chronic users: -4.58 kg/month, CI -5.41 to -3.76), and number of dispensed opioid prescriptions (concomitant users: -640 prescriptions/month, CI -950 to -340). Low-risk patients generally did not experience statistically significantly relative reductions. Compared with Georgia, Florida's prescription drug monitoring program and pill mill law were associated with large relative reductions in prescription opioid utilization among high-risk patients. Copyright © 2018 John Wiley & Sons, Ltd.

Restore Online Shoppers' Confidence Act

THOMAS, 111th Congress

Rep. Space, Zachary T. [D-OH-18

2010-07-01

House - 07/01/2010 Referred to the House Committee on Energy and Commerce. (All Actions) Notes: For further action, see S.3386, which became Public Law 111-345 on 12/29/2010. Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

What information do consumers consider, and how do they look for it, when shopping for groceries online?☆

PubMed Central

Benn, Yael; Webb, Thomas L.; Chang, Betty P.I.; Reidy, John

2015-01-01

Previous research investigating what information shoppers seek when purchasing groceries has used either lab-experiments or observed shoppers in supermarkets. The present research investigates this question in a relatively naturalistic online-grocery environment. Forty participants completed their weekly shopping online while their eye-movements were recorded. Ten of the participants were subsequently interviewed to gain insight into their information seeking behaviour. We found that, when looking for products, 95% of participants navigated through the ‘virtual departments’, 80% used the ‘search’ facility, and 68% browsed the special offer pages. Once on the product pages, participants tended to look at the pictures of products, rather than examine detailed product information. To explain these findings, we suggest that online grocery sites simulate familiar supermarket environments, which may explain why consumers prefer to browse categories of products rather than use search terms. We also suggest that additional strategies are needed if consumers are to be encouraged to view detailed product information. PMID:25660339

Nationwide outbreak of multidrug-resistant Salmonella Heidelberg infections associated with ground turkey: United States, 2011.

PubMed

Routh, J A; Pringle, J; Mohr, M; Bidol, S; Arends, K; Adams-Cameron, M; Hancock, W T; Kissler, B; Rickert, R; Folster, J; Tolar, B; Bosch, S; Barton Behravesh, C; Williams, I T; Gieraltowski, L

2015-11-01

On 23 May 2011, CDC identified a multistate cluster of Salmonella Heidelberg infections and two multidrug-resistant (MDR) isolates from ground turkey retail samples with indistinguishable pulsed-field gel electrophoresis patterns. We defined cases as isolation of outbreak strains in persons with illness onset between 27 February 2011 and 10 November 2011. Investigators collected hypothesis-generating questionnaires and shopper-card information. Food samples from homes and retail outlets were collected and cultured. We identified 136 cases of S. Heidelberg infection in 34 states. Shopper-card information, leftover ground turkey from a patient's home containing the outbreak strain and identical antimicrobial resistance profiles of clinical and retail samples pointed to plant A as the source. On 3 August, plant A recalled 36 million pounds of ground turkey. This outbreak increased consumer interest in MDR Salmonella infections acquired through United States-produced poultry and played a vital role in strengthening food safety policies related to Salmonella and raw ground poultry.

Constructivisms and Relativisms: A Shopper`s Guide

NASA Astrophysics Data System (ADS)

Bickhard, Mark H.

Diverse forms of constructivism can be found in the literature today. They exhibit a commonality regarding certain classical positions that they oppose - a unity in their negative identities - but a sometimes wild multiplicity and incompatibility regarding the positive proposals that they put forward. In particular, some constructivisms propose an epistemological idealism, with a concomitant relativism, while others are explicitly opposed to such positions, and move in multifarious different directions. This is a potentially confusing situation, and has resulted in some critics branding all constructivisms with the charge of relativism, and throwing out the baby with the bath water. In addition, since the epistemological foundations of even non-relativist constructivisms are not as familiar as the classical positions, there is a risk of mis-interpretation of constructivisms and their consequences, even by some who endorse them, not to mention those who criticize. Because I urge that some version of constructivism is an epistemological necessity, this situation strikes me as seriously unfortunate for philosophy, and potentially dangerous for the practice of education.

Geographical information software and shopper card data, aided in the discovery of a Salmonella Enteritidis outbreak associated with Turkish pine nuts.

PubMed

Bedard, B; Kennedy, B S; Weimer, A C

2014-12-01

In 2011, from August to November, the Monroe County Department of Public Health (MCDPH) investigated 47 salmonellosis cases. Geographical information software (GIS) was used to map the address locations of these cases. The resulting GIS analysis and culture information indicated that there were two distinct clusters of Salmonella that were geographically different. Pulsed-field gel electrophoresis (PFGE) testing was run at the New York State Department of Health Wadsworth Laboratory and identified S. Enteritidis (23 cases) and S. Typhimurium (10 cases). The epidemiological investigation identified Turkish pine nuts as the link between ill S. Enteritidis cases. Pine nut samples sent for laboratory testing were a PFGE match to human isolates with S. Enteritidis. A national recall of Turkish pine nuts ensued. A multistate outbreak was identified as a result of the initial investigation of MCDPH, in which 43 people were infected with the outbreak strain from five states. GIS software and shopper card data provided important tools in the epidemiological investigation.

For Third Enrollment Period, Marketplaces Expand Decision Support Tools To Assist Consumers.

PubMed

Wong, Charlene A; Polsky, Daniel E; Jones, Arthur T; Weiner, Janet; Town, Robert J; Baker, Tom

2016-04-01

The design of the Affordable Care Act's online health insurance Marketplaces can improve how consumers make complex health plan choices. We examined the choice environment on the state-based Marketplaces and HealthCare.gov in the third open enrollment period. Compared to previous enrollment periods, we found greater adoption of some decision support tools, such as total cost estimators and integrated provider lookups. Total cost estimators differed in how they generated estimates: In some Marketplaces, consumers categorized their own utilization, while in others, consumers answered detailed questions and were assigned a utilization profile. The tools available before creating an account (in the window-shopping period) and afterward (in the real-shopping period) differed in several Marketplaces. For example, five Marketplaces provided total cost estimators to window shoppers, but only two provided them to real shoppers. Further research is needed on the impact of different choice environments and on which tools are most effective in helping consumers pick optimal plans. Project HOPE—The People-to-People Health Foundation, Inc.

A framework for understanding grocery purchasing in a low-income urban environment.

PubMed

Zachary, Drew A; Palmer, Anne M; Beckham, Sarah W; Surkan, Pamela J

2013-05-01

Research demonstrates that food desert environments limit low-income shoppers' ability to purchase healthy foods, thereby increasing their likelihood of diet-related illnesses. We sought to understand how individuals in an urban American food desert make grocery-purchasing decisions, and specifically why unhealthy purchases arise. Analysis is based on ethnographic data from participant observation, 37 in-depth interviews, and three focus groups with low-income, primarily African American shoppers with children. We found participants had detailed knowledge of and preference for healthy foods, but the obligation to consistently provide food for their families required them to apply specific decision criteria which, combined with structural qualities of the supermarket environment, increased unhealthy purchases and decreased healthy purchases. Applying situated cognition theory, we constructed an emic model explaining this widely shared grocery-purchasing decision process and its implications. This context-specific understanding of behavior suggests that multifaceted, system-level approaches to intervention are needed to increase healthy purchasing in food deserts.

Exploratory and problem-solving consumer behavior across the life span.

PubMed

Lesser, J A; Kunkel, S R

1991-09-01

Different cognitive functioning, social, and personality changes appear to occur systematically during the adult life span. This article synthesizes research on life span changes in order to develop age-specific models of shopping behavior. The models are tested within a naturalistic field study of shoppers.

76 FR 23816 - Agency Information Collection Request; 60-Day Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the... (Mystery 4,185 2 8,370 5/60 698 Shopper) PCP Office Staff (Direct 465 1 465 5/60 39 Questioning) Total 737...

Enjoy Life in the Fast Lane.

ERIC Educational Resources Information Center

Urshan, J.

This guide to supermarket shopping provides information in an outline format. It first covers preliminary activities such as determining family needs, shopping on a budget, and planning at home. A number of suggestions are then made for the actual shopping. Topics include shopper aids (unit pricing, nutritional labeling, freshness coding), store…

Using the Paper around Us to Supplement a Life Skills Curriculum.

ERIC Educational Resources Information Center

Hayes, Miriam F.

1987-01-01

Such everyday paper materials as cash register receipts, labels, travel pamphlets, and train schedules provide a wealth of excellent materials for teaching life skills and functional reading to multihandicapped hearing-impaired students. Possible activities include comparing grocery receipts and conjecturing about the shoppers and reading medicine…

Assessment of Suicide Ideation and Parasuicide: Hopelessness and Social Desirability.

ERIC Educational Resources Information Center

Linehan, Marsha M.; Nielsen, Stevan L.

1981-01-01

Shoppers completed the Beck Hopelessness Scale, the Edwards Social Desirability Inventory, and a survey of past suicidal behavior. Results indicated hopelessness and social desirability were reliably related to reports of past suicidal behavior, to frequency of current suicidal ideation, and to subjects' predictions of future suicide potential.…

Monkey Business

ERIC Educational Resources Information Center

Blackwood, Christine Horvatis

2012-01-01

A ballerina, a gladiator, a camper, a baseball player, a surfer, and a shopper; these are just a few of the amazing monkeys that the author's seventh graders created from papier-mache. This project provided an opportunity for students to express themselves through the creation of sculptural characters based on their own interests, hobbies, and…

Secret Shopping as User Experience Assessment Tool

ERIC Educational Resources Information Center

Boyce, Crystal M.

2015-01-01

Secret shopping is a form of unobtrusive evaluation that can be accomplished with minimal effort, but still produce rich results. With as few as 11 shoppers, the author was able to identify trends in user satisfaction with services provided across two entry-level desks at Illinois Wesleyan University's The Ames Library. The focus of this secret…

The Use of Nutritive Composition Data at the Point of Purchase.

ERIC Educational Resources Information Center

Muller, Thomas E.

1984-01-01

Determined whether shoppers would use nutrition information when making in-store choices among brands of five packaged products. Also determined whether information used would be affected by the number of nutrients appearing on signs displayed in the store, and/or by the perceived importance of the set of nutrients presented. (JN)

Secret Shoppers: The Stealth Applicant Search for Higher Education

ERIC Educational Resources Information Center

Dupaul, Stephanie; Harris, Michael S.

2012-01-01

Stealth applicants who do not flow through the traditional admission funnel now represent nearly one-third of the national applicant pool. This study employs a consumer behavior framework to examine the behaviors of stealth applicants at a private university. The findings provide a rich illustration of how stealth applicants search for college.…

Effects of a national information campaign on compliance with age restrictions for alcohol sales.

PubMed

Gosselt, Jordy F; Van Hoof, Joris J; Baas, Niels; De Jong, Menno D T

2011-07-01

To investigate the effect of a national information campaign, introduced by the Dutch Food Retail Organization, named "Under 20? Show Your ID!," on compliance with age restrictions on alcohol sales. The compliance level after the campaign was compared with a baseline compliance, that we calculated based on 458 preintervention compliance measurements. Data were collected using the method of mystery shopping. Three teams, each consisting of two 15-year-old mystery shoppers, conducted 105 alcohol purchase attempts in supermarkets in three regions in the Netherlands. A compliance rate of 24.8% was found, which is a significant improvement compared with Dutch basement compliance rate from the past (14.9%), but is nominally still very low. This mass media intervention campaign failed to increase compliance to an acceptable level. Also the specific goal of the campaign (ask everybody under <20 years old for identification [ID]) failed because fewer than half of the 15-year-old mystery shoppers in the study were asked to show their ID when purchasing alcoholic beverages. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Altering shoppers' supermarket purchases to fit nutritional guidelines: An interactive information system

PubMed Central

Winett, Richard A.; Geller, E. Scott; Mundy, Laurie L.; Moore, John F.; Wagner, Jana L.; Hite, Lee A.; Leahy, Michael; Neubauer, Tamara E.; Walberg, Janet L.; Walker, W. Bruce; Lombard, David

1991-01-01

This study reports the results of one effort to help supermarket shoppers alter food purchases to make purchases (and meals) that are lower in fat and higher in fiber. A prototype interactive information system using instructional video programs, feedback on purchases with specific goals for change, weekly programs, and the ability to track user interactions and intended purchases was evaluated. The major dependent measure was users' actual food purchases as derived from participants' highly detailed supermarket receipts. After a 5- to 7-week baseline phase, participants were randomly assigned to an experimental or control condition for the 7- to 8-week intervention phase. A follow-up phase began 5 to 8 weeks after participants completed the intervention and discontinued use of the system. The results indicated that experimental participants, when compared to control participants, decreased high fat purchases and increased high fiber purchases during intervention, with evidence for some maintenance of effect in follow-up. Plans for increasing the use and impact of the system are discussed. ImagesFigure 1 PMID:1647387

What information do consumers consider, and how do they look for it, when shopping for groceries online?

PubMed

Benn, Yael; Webb, Thomas L; Chang, Betty P I; Reidy, John

2015-06-01

Previous research investigating what information shoppers seek when purchasing groceries has used either lab-experiments or observed shoppers in supermarkets. The present research investigates this question in a relatively naturalistic online-grocery environment. Forty participants completed their weekly shopping online while their eye-movements were recorded. Ten of the participants were subsequently interviewed to gain insight into their information seeking behaviour. We found that, when looking for products, 95% of participants navigated through the 'virtual departments', 80% used the 'search' facility, and 68% browsed the special offer pages. Once on the product pages, participants tended to look at the pictures of products, rather than examine detailed product information. To explain these findings, we suggest that online grocery sites simulate familiar supermarket environments, which may explain why consumers prefer to browse categories of products rather than use search terms. We also suggest that additional strategies are needed if consumers are to be encouraged to view detailed product information. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Consumer Poultry Handling Behavior in the Grocery Store and In-Home Storage.

PubMed

Donelan, Amy K; Chambers, Delores H; Chambers, Edgar; Godwin, Sandria L; Cates, Sheryl C

2016-04-01

Considerable work on consumers' food safety habits has highlighted issues associated with home food preparation. However, consumer handling of foods, such as poultry, during shopping and storage has not been noted. The objective of this study was to determine consumer behaviors during purchasing and initial storage of raw poultry to determine potential cross-contamination issues. A shop-along observational study was conducted to determine actual shopping, transportation, and storage behavior of consumers who purchase raw poultry products. Neither hand sanitizer nor wipes were observed in 71% of grocery store meat sections of stores visited. Plastic bags could be found in the meat section 85% of the time, but only 25% of shoppers used the bag for their raw poultry purchases. During checkout, the poultry was bagged separately from other products 71% of the time. A majority of shoppers stored raw poultry in the original package without an additional container or overwrap. Overall, there needs to be an increase in food safety education on the handling of poultry during purchasing, transportation, and storage.

Reducing lighting energy use in retail display windows

NASA Astrophysics Data System (ADS)

Freyssinier, Jean Paul; Frering, Daniel; Taylor, Jennifer; Narendran, Nadarajah; Rizzo, Patricia

2006-08-01

A field study was conducted at three clothing stores to validate previous laboratory findings indicating that colored LEDs used as background display lighting could: 1) lower the power demand of accent lighting by up to 50 percent; and 2) provide greater attention capture and visual appeal than current lighting practice. Blue LEDs provided a colored background for window mannequins by illuminating white backdrops. Eliminating fluorescent general lighting and reducing the number and wattage of halogen accent lamps in the display windows reduced the lighting power demand by up to 50 percent. During an eight-week period, more than 700 shoppers rated the attractiveness, eye-catching ability, comfort, and visibility of four different lighting conditions. The results of this field study showed that by introducing color contrast between the displayed objects and the background, the power demand of the accent lighting could be reduced by up to 50 percent without sacrificing visual appeal, visibility, ability to capture the attention of shoppers, and the ability to see the colors of the objects on display. Furthermore, the sales of the products on display were not affected by the 50 percent reduction in lighting.

Doctor shopping by overweight and obese patients is associated with increased healthcare utilization

PubMed Central

Gudzune, Kimberly A.; Bleich, Sara N.; Richards, Thomas M.; Weiner, Jonathan P.; Hodges, Krista; Clark, Jeanne M.

2012-01-01

Negative interactions with healthcare providers may lead patients to switch physicians or “doctor shop.” We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight non-shoppers. We combined claims data from a health plan in one state with information from beneficiaries’ health risk assessments. The primary outcome was “doctor shopping,” which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations. Of the 20,726 beneficiaries, the mean BMI was 26.3 kg/m2 (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04–1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26–1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37–2.45; IRR 1.83, 95%CI 1.34–2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10–2.03; Obese IRR 1.54, 95%CI 1.12–2.11). Frequently changing PCPs may impair continuity and result in increased healthcare utilization. PMID:23671015

Do We Provide Meaningful Guidance for Healthful Eating? An Investigation into Consumers' Interpretation of Frequency Consumption Terms

ERIC Educational Resources Information Center

King, Lesley; Watson, Wendy L.; Chapman, Kathy; Kelly, Bridget; Louie, Jimmy C. Y.; Hughes, Clare; Crawford, Jennifer; Gill, Timothy P.

2012-01-01

Objective: To investigate consumers' understanding of terms commonly used to provide guidance about frequency and quantity of food consumption. Methods: A survey of 405 shoppers explored how frequently consumers thought food labeled with the terms "eat often," "eat moderately," "eat occasionally," "a sometimes food," and "an extra food" should be…

Adolescents' Clothing Purchase Motivations, Information Sources, and Store Selection Criteria: A Comparison of Male/Female and Impulse/Nonimpulse Shoppers.

ERIC Educational Resources Information Center

Chen-Yu, Jessie H.; Seock, Yoo-Kyoung

2002-01-01

Male (n=69) and female (n=68) adolescents spent similar amounts on clothing with similar conformity, sexual attractiveness, and recognition motivations. Females shopped significantly more often and were more influenced by friends and magazines. There were significant differences between impulse buyers and others in shopping frequency, expenditure,…

Food Category Purchases Vary by Household Education and Race/Ethnicity: Results from Grocery Receipts

USDA-ARS?s Scientific Manuscript database

In order to characterize food group purchases from grocery receipts. Food shoppers (aged >/=19 years with at least one child aged

A shopper's eye view of food safety at retail stores: lessons from photographs taken while grocery shopping

USDA-ARS?s Scientific Manuscript database

Retail grocery stores are the source of over 50% of food sales in the U.S., representing the most important sector for consumer food choices. Food safety-related infrastructure, procedures, and practices at retail grocery stores play an important role in protecting public health. Beyond actual risk ...

Price and Value: Considerations for College Shoppers

ERIC Educational Resources Information Center

Broh, C. Anthony; Ansel, Dana

2010-01-01

Parents and students recognize the value of a college degree. Increasingly, they are borrowing large sums of money to invest in the future. Their choices about how to save for college, where to attend college, how much and from where to borrow for college, and how to repay their loans, have grown more complex. Yet families work with incomplete…

Shopping Behaviors of Low-income Families during a 1-Month Period of Time

ERIC Educational Resources Information Center

Darko, Janice; Eggett, Dennis L.; Richards, Rickelle

2013-01-01

Objective: To explore food shopping behaviors among low-income families over the course of the month. Design: Two researchers conducted 13 90-minute focus groups. Setting: Two community organizations serving low-income populations and a university campus. Participants: Low-income adults (n = 72) who were the primary household food shoppers and who…

Food Purchase Decision-Making Typologies of Women with Non-Insulin-Dependent Diabetes Mellitus.

ERIC Educational Resources Information Center

Miller, Carla; Warland, Rex; Achterberg, Cheryl

1997-01-01

Food selection is a key factor in the nutritional management of diabetes. Criteria that influence point-of-purchase decision making in women with non-insulin-dependent diabetes mellitus were identified. Four types of shoppers were distinguished from interviews; cluster analysis was used to confirm the analysis. Usefulness in patient education is…

Effects of Information Technology on Reducing Perishable Waste in Supermarkets

ERIC Educational Resources Information Center

Kipkulei, Kenneth

2013-01-01

Leaders within retail supermarkets struggle to manage perishable waste that has been at least partly attributed to shoppers' desire to buy fresh food; however, supermarket managers do not always exhaust the stock of fresh food as scheduled. Based on disruptive innovation theory, the purpose of this case study was to explore employee use of an…

How Does Target Know so Much about Its Customers? Utilizing Customer Analytics to Make Marketing Decisions

ERIC Educational Resources Information Center

Corrigan, Hope B.; Craciun, Georgiana; Powell, Allison M.

2014-01-01

Every time shoppers make a purchase at a store or browse a Web site, customer behavior is tracked, analyzed, and perhaps shared with other businesses. Target Corporation is a leader in analyzing vast amounts of data to identify buying patterns, improve customer satisfaction, predict future trends, select promotional strategies, and increase…

Touch in Computer-Mediated Environments: An Analysis of Online Shoppers' Touch-Interface User Experiences

ERIC Educational Resources Information Center

Chung, Sorim

2016-01-01

Over the past few years, one of the most fundamental changes in current computer-mediated environments has been input devices, moving from mouse devices to touch interfaces. However, most studies of online retailing have not considered device environments as retail cues that could influence users' shopping behavior. In this research, I examine the…

Predicting Commissary Store Success

DTIC Science & Technology

2014-12-01

that make any retail store successful: the number of shoppers, the price differential between a store and its competition, and the number of...the planning of future stores to maximize the return on taxpayers’ investment. 3 II. BACKGROUND A. COMMISSARY HISTORY Commissary stores began...Defense Commissary Agency (DeCA) in 1990. DeCA currently oversees all commissary stores ( History , n.d.). B. COMMISSARY REGULATIONS Top-level

Object and image retrieval over the Internet

NASA Astrophysics Data System (ADS)

Gilles, Sebastien; Winter, A.; Feldmar, J.; Poirier, N.; Bousquet, R.; Bussy, B.; Lamure, H.; Demarty, C.-H.; Nastar, Chahab

2000-12-01

In this article, we describe some of the work that was carried out at LookThatUp for designing an infrastructure enabling image-based search over the Internet. The service was designed to be remotely accessible and easily integrated to partner sites. One application of the technology, called Image-Shopper, is described and demonstrated. The technological basis of the system is then reviewed.

In Pursuit of the Secret Shopper: Effective New Strategies for Finding and Engaging Prospective Students. Noel-Levitz White Paper

ERIC Educational Resources Information Center

Noel-Levitz, Inc, 2010

2010-01-01

Today, prospective students in ever greater numbers are secretly exploring colleges online on their own terms, using official and unofficial sources, without completing a college's response form. Many are withholding college entrance exam scores from colleges they might be interested in and remaining unknown to their institutions of choice until…

Youth Health Coordinating Council Ward 8 Secret Health Clinic Shopper Report

ERIC Educational Resources Information Center

Behrens, Donna

2010-01-01

There are over 70,000 residents in Ward 8, the poorest area of Washington, DC and along with Ward 7, it's most geographically remote. Approximately 36% of the Ward 8 population consists of children and youth, 18 years or younger. Children in the District of Columbia are at greater risk for poorer health and life outcomes than children in other…

Effects of time of day on shopping behavior.

PubMed

Chebat, J C

1999-04-01

Shoppers interviewed in a shopping mall at different times of the day show different activities within the mall and attitudes toward the products. Prices also vary with the time of the day. These results can be explained in terms of shopping values and the related demographic characteristics of the population visiting the shopping center at different times of the day.

Shop Local—and Fresh—at the Summer Farmers' Market | Poster

Cancer.gov

The summer farmers’ market at NCI at Frederick is under way right on schedule, undeterred by a cool and rainy May. Shoppers can find fresh produce, starter plants, local meats and cheeses, coffee, crafts, and more in the front parking lot of Building 549 every Tuesday from 11 a.m. to 1 p.m. The market will run through Oct. 25.

The Future of Russia and the Russian Navy. Report of Discussions in Moscow November 2-6, 2003

DTIC Science & Technology

2004-01-01

grave existence of their workers. It is also reported that for oil especially, the companies are simply 4. IKEA has found that the average Russian...shopper spends as much as the average Swedish shopper— IKEA is only in Moscow now, but is planning to expand around the country. 5. Erin A. Arvedlund

Women Entrepreneurs: Their Success and Problems. Hearing before the Committee on Small Business, United States Senate, Ninety-Eighth Congress, Second Session (Eugene, Oregon).

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Small Business.

This is a congressional hearing to acquire testimony and information about women in business or about unusual problems that have been found. Testimony includes statements from individuals representing Big Bear Shopper, Inc.; United States Business and Professional Women (BPW/USA); Rural Small Business Programs, Lane Community College;…

Community pharmacists providing emergency contraception give little advice about future contraceptive use: a mystery shopper study.

PubMed

Glasier, Anna; Manners, Rachel; Loudon, Joanna C; Muir, Aileen

2010-12-01

UK women increasingly prefer to attend a pharmacy for emergency contraception (EC) rather than a doctor. Most women who use EC do not conceive and remain at risk of pregnancy unless they start regular contraception. We undertook a study to evaluate the quality of service provision in community pharmacies in Lothian, Scotland, and to determine what advice is given about contraception after EC use. Mystery shopper study. EC was unobtainable from 5/40 pharmacies (12.5%), refused because of "contraindications" in 7 (17.5%) and offered in 28 (70%). Most pharmacists appeared nonjudgemental, over 75% asked appropriate questions about eligibility, and over 90% gave appropriate advice about use. EC was universally refused beyond 72 h after sex but universally provided when the date of the last menstrual period was uncertain. Ongoing contraception after EC use was discussed in only 32.5% of all pharmacies and only 43% of those issuing EC. The quality of consultations for EC in pharmacies is generally good but only a minority discuss ongoing contraception after EC use. The implications for contraceptive use and unintended pregnancy rates are worrying. Copyright © 2010 Elsevier Inc. All rights reserved.

Autonomy and control: the co-construction of adolescent food choice.

PubMed

Bassett, Raewyn; Chapman, Gwen E; Beagan, Brenda L

2008-01-01

We explored how adolescents and parents negotiate adolescents' increasing food choice autonomy in European Canadian, Punjabi Canadian and African Canadian families. Data were collected through semi-structured interviews with 47 adolescents and their parents, participant observation at a family meal and a grocery shopping trip with the family shopper(s). Thematic and constant comparative analyses were used. Adolescents exercised considerable autonomy over much of their food choice and their parents monitored and controlled the environment within which adolescents were given independence and responsibility. Parents used strategies of coaxing, coaching and coercing, while teens responded by complaining, ignoring and refusing their parents' advice. At the same time, teens took responsibility and reflected on their behaviours while keeping in mind their parents' advice, even if in some cases they were as yet unable to act upon it. Food choice autonomy is not simply a negative act of teenage defiance. Instead, it is actively co-constructed by both teens and their parents as each resists and responds to the others. Studies of adolescent autonomy related to food choices, and interventions based on nutritional autonomy as a risk factor for poor nutrition would do well to take account of the co-constructive parent-adolescent process of teen autonomy.

Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.

PubMed

Haeder, Simon F; Weimer, David L; Mukamel, Dana B

2016-07-01

The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a "secret shopper" survey of 743 primary care providers from five of California's nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information. Project HOPE—The People-to-People Health Foundation, Inc.

Compulsive buying. Demography, phenomenology, and comorbidity in 46 subjects.

PubMed

Schlosser, S; Black, D W; Repertinger, S; Freet, D

1994-05-01

Compulsive buying has been generally ignored in the psychiatric literature, although it is apparently frequent, underrecognized, and can lead to severe financial and legal consequences for its sufferers. The current investigation was designed to assess the overall life-style and problems of subjects identified as compulsive shoppers. Forty-six compulsive buyers were assessed for comorbid psychiatric disorders with the Diagnostic Interview Schedule, the Structured Interview for DSM-III-R Personality Disorders, and a semistructured interview to assess buying behavior. The typical shopper was a 31-year-old female who had developed compulsive buying at age 18 years. Subjects spent their money on clothing, shoes, and records/compact discs. The average debt load accrued was $5,422 out of an average yearly income of $23,443. More than two-thirds met lifetime criteria for a major (Axis I) mental disorder, most commonly anxiety, substance abuse, and mood disorders. Nearly 60% were found to meet criteria for a DSM-III-R personality disorder, most commonly the obsessive-compulsive, borderline, and avoidant types. The authors conclude that compulsive buying is a definable clinical syndrome which can cause its sufferers significant distress and is associated with significant psychiatric comorbidity.

A study investigating the association between compulsive buying with measures of anxiety and obsessive-compulsive behavior among internet shoppers.

PubMed

Weinstein, A; Mezig, Hila; Mizrachi, S; Lejoyeux, M

2015-02-01

Compulsive buying is a chronic, repetitive behavior that becomes a primary response to negative events and feelings. Compulsive buyers are obsessed by buying and their behavior occurs in response to negative emotions and results in a decrease in the intensity of negative emotions. Euphoria or relief from negative emotions is the most common consequence of compulsive buying. A large number of studies have investigated the association between compulsive buying and anxiety, and some studies have used the Spielberger trait-state anxiety inventory. Compulsive buying, state and trait anxiety and general obsessive-compulsive measures were assessed among 120 habitual internet shoppers (2+ times a week, 70 men and 50 women). Results showed that Edwards Compulsive Buying scale measures were associated with Spielberger trait and not state anxiety measures. Spielberger Trait anxiety measures were also correlated with measures of Yale-Brown Obsessive-Compulsive scale (Y-Bocs). Finally, there were no sex differences in this sample. The results of this study support existing evidence for an association between compulsive buying and anxiety and they will be discussed in view of current research on comorbidity of behavioural addiction. Copyright © 2014 Elsevier Inc. All rights reserved.

Decision-making in the dairy aisle: maximizing taste, health, cost and family considerations.

PubMed

Hammond, Gail K; Chapman, Gwen E

2008-01-01

To gain insight into the decision-making processes used by women when selecting dairy and dairy alternative foods, including examination of the role of bone health concerns. Semi-structured, point-of-purchase interviews were conducted with a convenience sample of 30 female grocery shoppers. Constant comparative data analysis was used to generate themes on shoppers' decision-making processes. Women considered multiple issues in their dairy and dairy alternative food choice strategies: taste was most often associated with the fat and sugar content of foods; health concerns were centred on achieving an acceptable body weight and preventing osteoporosis and cardiovascular disease, and women chose foods to satisfy other family members' needs and preferences and to obtain "good food value." Women prioritized their food choices by weighing the value of each issue, which led to a strategic process for "maximizing the value" of their food choices. The availability of a wide range of dairy and dairy alternative foods meant that in most instances, it was unnecessary for women to "trade off" one area of concern for another. Dietitians and nutrition educators can help women make dietary changes by helping them identify foods that they perceive as meeting a variety of needs.

User-Interface Design Characteristics of Fortune 500 B2C E-Commerce Sites and Industry Differences

ERIC Educational Resources Information Center

Zhao, Jensen J.; Truell, Allen D.; Alexander, Melody W.

2006-01-01

This study examined the user-interface design characteristics of 107 Fortune 500 B2C e-commerce Web sites and industry differences. Data were collected from corporate homepages, B2C product/service pages, B2C interactive shopping pages, as well as customer satisfaction of 321 online shoppers. The findings indicate that (a) to attract online…

Magic at the Marketplace: Choice Blindness for the Taste of Jam and the Smell of Tea

ERIC Educational Resources Information Center

Hall, Lars; Johansson, Petter; Tarning, Betty; Sikstrom, Sverker; Deutgen, Therese

2010-01-01

We set up a tasting venue at a local supermarket and invited passerby shoppers to sample two different varieties of jam and tea, and to decide which alternative in each pair they preferred the most. Immediately after the participants had made their choice, we asked them to again sample the chosen alternative, and to verbally explain why they chose…

Financial Irresponsibility: Background Information for Security Personnel

DTIC Science & Technology

1991-09-01

shoppers he has treated have also suffered from some eating disorder , usually bulimia .6 3 A study of Gamblers Anonymous members found that 52% also...ramifications--compulsive gambling, compulsive shopping, drug or alcohol abuse. Compulsive behavior is a form of emotional disorder in which one loses...financial problems, however, as this emotional disorder affects the wealthy as well as those with limited means. Like alcoholism, compulsive shopping

A decision-making process model of young online shoppers.

PubMed

Lin, Chin-Feng; Wang, Hui-Fang

2008-12-01

Based on the concepts of brand equity, means-end chain, and Web site trust, this study proposes a novel model called the consumption decision-making process of adolescents (CDMPA) to understand adolescents' Internet consumption habits and behavioral intention toward particular sporting goods. The findings of the CDMPA model can help marketers understand adolescents' consumption preferences and habits for developing effective Internet marketing strategies.

Do 'food deserts' influence fruit and vegetable consumption?--A cross-sectional study.

PubMed

Pearson, Tim; Russell, Jean; Campbell, Michael J; Barker, Margo E

2005-10-01

Lack of access to affordable healthy foods has been suggested to be a contributory factor to poor diet. This study investigated associations between diet and access to supermarkets, transport, fruit and vegetable price and deprivation, in a region divergent in geography and socio-economic indices. A postal survey of 1000 addresses (response rate 42%) gathered information on family demographics, supermarket and shop use, car ownership, mobility and previous day's fruit and vegetable intake. Postcode information was used to derive road travel distance to nearest supermarket and deprivation index. Fruit and vegetable prices were assessed using a shopping basket survey. Generalised linear regression models were used to ascertain predictors of fruit and vegetable intake. Male grocery shoppers ate less fruit than female grocery shoppers. Consumption of vegetables increased slightly with age. Deprivation, supermarket fruit and vegetable price, distance to nearest supermarket and potential difficulties with grocery shopping were not significantly associated with either fruit or vegetable consumption. These data suggest that the three key elements of a food desert, fruit and vegetable price, socio-economic deprivation and a lack of locally available supermarkets, were not factors influencing fruit or vegetable intake. We suggest that food policies aimed at improving diet should be orientated towards changing socio-cultural attitudes towards food.

Purchasing habits of senior farmers' market shoppers: utilizing the theory of planned behavior.

PubMed

Middleton, Crystal; Smith, Sylvia

2011-01-01

The purpose of this study was to understand fresh fruit and vegetable purchasing habits among senior farmers' market shoppers using the theory of planned behavior. A survey instrument was developed to collect information on seniors' fruit and vegetable purchasing habits. A convenience sample of seniors shopping at farmers' markets was employed. A total of 184 surveys were collected. Respondents were divided into two groups based on response to a question of whether they received Senior Farmers' Market Nutritional Program (SFMNP) checks: 35 were on the SFMNP and 149 were not. Results indicated attitudes, subjective norms (SN), and perceived behavioral control (PBC) were all significantly correlated with intentions at the p < 0.01 level. Attitude had the strongest association with intentions (0.730), followed by PBC (0.666) and SN (0.587). Regression analysis was significant and explained 66% of the variance (F = 86.151, p < 0.001, adjusted R square = 0.656). Results indicated attitude to be the strongest predictor of seniors' intentions to purchase more fresh fruits and vegetables at farmers' markets. Senior programs may find this information useful when promoting fresh fruits and vegetables for senior citizens. These findings may also benefit farmers' markets while promoting fresh fruits and vegetables.

The Effect of Mystery Shopper Reports on Age Verification for Tobacco Purchases

PubMed Central

KREVOR, BRAD S.; PONICKI, WILLIAM R.; GRUBE, JOEL W.; DeJONG, WILLIAM

2011-01-01

Mystery shops (MS) involving attempted tobacco purchases by young buyers have been employed to monitor retail stores’ performance in refusing underage sales. Anecdotal evidence suggests that MS visits with immediate feedback to store personnel can improve age verification. This study investigated the impact of monthly and twice-monthly MS reports on age verification. Forty-five Walgreens stores were each visited 20 times by mystery shoppers. The stores were randomly assigned to one of three conditions. Control group stores received no feedback, whereas two treatment groups received feedback communications every visit (twice monthly) or every second visit (monthly) after baseline. Logit regression models tested whether each treatment group improved verification rates relative to the control group. Post-baseline verification rates were higher in both treatment groups than in the control group, but only the stores receiving monthly communications had a significantly greater improvement than control group stores. Verification rates increased significantly during the study period for all three groups, with delayed improvement among control group stores. Communication between managers regarding the MS program may account for the delayed age-verification improvements observed in the control group stores. Encouraging inter-store communication might extend the benefits of MS programs beyond those stores that receive this intervention. PMID:21541874

Could EBT Machines Increase Fruit and Vegetable Purchases at New York City Green Carts?

PubMed

Breck, Andrew; Kiszko, Kamila; Martinez, Olivia; Abrams, Courtney; Elbel, Brian

2017-09-21

Residents of some low-income neighborhoods have limited access to fresh fruits and vegetables. In 2008, New York City issued new mobile fruit and vegetable cart licenses for neighborhoods with inadequate availability of fresh produce. Some of these carts were equipped with electronic benefit transfer (EBT) machines, allowing them to accept Supplemental Nutrition Assistance Program (SNAP) benefits. This article examines the association between type and quantities of fruits and vegetables purchased from mobile fruit and vegetable vendors and consumer characteristics, including payment method. Customers at 4 produce carts in the Bronx, New York, were surveyed during 3 periods in 2013 and 2014. Survey data, including purchased fruit and vegetable quantities, were analyzed using multivariable negative binomial regressions, with payment method (cash only vs EBT or EBT and cash) as the primary independent variable. Covariates included availability of EBT, vendor, and customer sociodemographic characteristics. A total of 779 adults participated in this study. Shoppers who used SNAP benefits purchased an average of 5.4 more cup equivalents of fruits and vegetables than did shoppers who paid with cash. Approximately 80% of this difference was due to higher quantities of purchased fruits. Expanding access to EBT machines at mobile produce carts may increase purchases of fruits and vegetables from these vendors.

Could EBT Machines Increase Fruit and Vegetable Purchases at New York City Green Carts?

PubMed Central

Breck, Andrew; Kiszko, Kamila; Martinez, Olivia; Abrams, Courtney

2017-01-01

Introduction Residents of some low-income neighborhoods have limited access to fresh fruits and vegetables. In 2008, New York City issued new mobile fruit and vegetable cart licenses for neighborhoods with inadequate availability of fresh produce. Some of these carts were equipped with electronic benefit transfer (EBT) machines, allowing them to accept Supplemental Nutrition Assistance Program (SNAP) benefits. This article examines the association between type and quantities of fruits and vegetables purchased from mobile fruit and vegetable vendors and consumer characteristics, including payment method. Methods Customers at 4 produce carts in the Bronx, New York, were surveyed during 3 periods in 2013 and 2014. Survey data, including purchased fruit and vegetable quantities, were analyzed using multivariable negative binomial regressions, with payment method (cash only vs EBT or EBT and cash) as the primary independent variable. Covariates included availability of EBT, vendor, and customer sociodemographic characteristics. Results A total of 779 adults participated in this study. Shoppers who used SNAP benefits purchased an average of 5.4 more cup equivalents of fruits and vegetables than did shoppers who paid with cash. Approximately 80% of this difference was due to higher quantities of purchased fruits. Conclusion Expanding access to EBT machines at mobile produce carts may increase purchases of fruits and vegetables from these vendors. PMID:28934080

Preventing illegal tobacco and alcohol sales to minors through electronic age-verification devices: a field effectiveness study.

PubMed

Krevor, Brad; Capitman, John A; Oblak, Leslie; Cannon, Joanna B; Ruwe, Mathilda

2003-01-01

Efforts to prohibit the sales of tobacco and alcohol products to minors are widespread. Electronic Age Verification (EAV) devices are one possible means to improve compliance with sales to minors laws. The purpose of this study was to evaluate the implementation and effectiveness of EAV devices in terms of the frequency and accuracy of age verification, as well as to examine the impact of EAV's on the retailer environment. Two study locations were selected: Tallahassee, Florida and Iowa City, Iowa. Retail stores were invited to participate in the study, producing a self-selected experimental group. Stores that did not elect to test the EAV's comprised the comparison group. The data sources included: 1) mystery shopper inspections: two pre- and five post-EAV installation mystery shopper inspections of tobacco and alcohol retailers; 2) retail clerk and manager interviews; and 3) customer interviews. The study found that installing EAV devices with minimal training and encouragement did not increase age verification and underage sales refusal. Surveyed clerks reported positive experiences using the electronic ID readers and customers reported almost no discomfort about being asked to swipe their IDs. Observations from this study support the need for a more comprehensive system for responsible retailing.

Waste reduction through consumer education. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harrison, E.Z.

The Waste Reduction through Consumer Education research project was conducted to determine how environmental educational strategies influence purchasing behavior in the supermarket. The objectives were to develop, demonstrate, and evaluate consumer education strategies for waste reduction. The amount of waste generated by packaging size and form, with an adjustment for local recyclability of waste, was determined for 14 product categories identified as having more waste generating and less waste generating product choices (a total of 484 products). Using supermarket scan data and shopper identification numbers, the research tracked the purchases of shoppers in groups receiving different education treatments for 9more » months. Statistical tests applied to the purchase data assessed patterns of change between the groups by treatment period. Analysis of the data revealed few meaningful statistical differences between study groups or changes in behavior over time. Findings suggest that broad brush consumer education about waste reduction is not effective in changing purchasing behaviors in the short term. However, it may help create a general awareness of the issues surrounding excess packaging and consumer responsibility. The study concludes that the answer to waste reduction in the future may be a combination of voluntary initiatives by manufacturers and retailers, governmental intervention, and better-informed consumers.« less

Clostridium difficile in retail baskets, trolleys, conveyor belts, and plastic bags in Saudi Arabia.

PubMed

Alqumber, Mohammed A

2014-10-01

To determine Clostridium difficile (C. difficile) prevalence on retail surfaces and shoppers plastic bags. From 20 June to 10 August 2011, in a cross-sectional epidemiological study, 17 supermarkets from 2 cities, Albaha and Altaif, Saudi Arabia were sampled. A total of 800 samples, which comprised 200 samples per surveyed surface, were studied. These included baskets, trolleys, conveyer belts, and outgoing shoppers' plastic bags. Clostridium difficile strains were isolated. The isolates were characterized using ribotyping and  polymerase chain reaction for the detection of toxin A (tcdA), toxin B (tcdB), binary toxin (cdtB), and toxin C (tcdC) genes. Susceptibility to antibiotics was determined on a Muller-Hinton agar with 5% sheep blood agar using E-tests. Overall, the C. difficile prevalence on sampled surfaces was 0.75%. The highest prevalence was found on retail baskets and trolleys, followed by plastic bags. A total of 5 different ribotypes were identified. Alterations in tcdC were detected in ribotype 027 and BT1. All the identified isolates were susceptible to vancomycin, but resistant to levofloxacin. In this study, C. difficile was present at a rate of 0.75% on supermarket surfaces. Spore disinfection of implicated surfaces may be necessary to control any community-acquired infections caused by this pathogen. 

Underage alcohol sales--it only takes a minute: a new approach to underage alcohol availability.

PubMed

van Hoof, Joris J; Gosselt, Jordy F

2013-05-01

Because minors generally report higher accessibility than one would expect on the basis of the "compliance rates" established by researchers (the percentage of stores that comply with age limits for sales of age-restricted products such as alcoholic beverages), we propose a new method to better depict the availability of age-restricted products for minors as an alternative to the compliance approach, which in our view is too narrow. Underage mystery shoppers were assigned to buy alcohol in a store of their preference, using any (legally allowed) purchase method. The time required to buy alcohol was the main outcome variable. As a benchmark, the time required to buy soft drinks was recorded. All underage mystery shoppers succeeded in buying alcohol, which means 100% availability. On average, buying alcohol took less than 10 minutes (including travel and shopping time), which was 2 minutes more than when purchasing soft drinks. Compliance at an outlet level can misrepresent the actual availability to minors. Both the proposed approach to availability and a new approach to age validation indicate that the general assumption that the traditional methods of age validation can effectively prevent the commercial availability of age-restricted products to minors should be seriously questioned.

Consumer knowledge and attitudes to salt intake and labelled salt information.

PubMed

Grimes, Carley A; Riddell, Lynn J; Nowson, Caryl A

2009-10-01

The objective of this study was to investigate consumers' knowledge of health risks of high salt intake and frequency of use and understanding of labelled salt information. We conducted a cross-sectional survey in shopping centres within Metropolitan Melbourne. A sample of 493 subjects was recruited. The questionnaire assessed salt related shopping behaviours, attitudes to salt intake and health and their ability to interpret labelled sodium information. Four hundred and seventy four valid surveys were collected (65% female, 64% being the main shopper). Most participants knew of the relationship between salt intake and high blood pressure (88%). Sixty five percent of participants were unable to correctly identify the relationship between salt and sodium. Sixty nine percent reported reading the salt content of food products when shopping. Salt label usage was significantly related to shoppers concern about the amount of salt in their diet and the belief that their health could improve by lowering salt intake. Approximately half of the sample was unable to accurately use labelled sodium information to pick low salt options. Raising consumer awareness of the health risks associated with high salt consumption may increase salt label usage and purchases of low salt foods. However, for food labels to be effective in helping consumers select low salt foods a more 'user friendly' labelling format is needed.

The effect of mystery shopper reports on age verification for tobacco purchases.

PubMed

Krevor, Brad S; Ponicki, William R; Grube, Joel W; DeJong, William

2011-09-01

Mystery shops involving attempted tobacco purchases by young buyers have been implemented in order to monitor retail stores' performance in refusing underage sales. Anecdotal evidence suggests that mystery shop visits with immediate feedback to store personnel can improve age verification. This study investigated the effect of monthly and twice-monthly mystery shop reports on age verification. Mystery shoppers visited 45 Walgreens stores 20 times. The stores were randomly assigned to 1 of 3 conditions. Control group stores received no feedback, whereas 2 treatment groups received feedback communications on every visit (twice monthly) or on every second visit (monthly) after baseline. Logit regression models tested whether each treatment group improved verification rates relative to the control group. Postbaseline verification rates were higher in both treatment groups than in the control group, but only the stores receiving monthly communications had a significantly greater improvement compared with the control group stores. Verification rates increased significantly during the study period for all 3 groups, with delayed improvement among control group stores. Communication between managers regarding the mystery shop program may account for the delayed age-verification improvements observed in the control group stores. Encouraging interstore communication might extend the benefits of mystery shop programs beyond those stores that receive this intervention. Copyright © Taylor & Francis Group, LLC

Careers that Combine Culinary and Food Science

NASA Astrophysics Data System (ADS)

Tittl, Michelle

Imagine yourself perusing the aisles of your local grocery store. You head down the frozen food section and, being a cost-conscious shopper with little to no time to cook, you choose a seemingly delectable heat-and-serve meal of grilled chicken medallions and sautéed spinach doused in a mushroom sauce. Taking a closer look at the bag, you ask yourself, is this a delicious food concoction of culinary art or of food technology?

Passion and dependency in online shopping activities.

PubMed

Wang, Chih-Chien; Yang, Hui-Wen

2007-04-01

This study examines the influence of harmonious passion (HP) and obsessive passion (OP) to online shopping dependency. The results show that both HP and OP might lead to online shopping dependency and online shoppers with OP are more dependent on online shopping activities. In addition, this study also found out that HP and OP could be denoted as a sequence of different intensities of passion, where HP might be a necessity of OP.

Shop floor compliance with age restrictions for tobacco sales: remote versus in-store age verification.

PubMed

van Hoof, Joris J; Gosselt, Jordy F; de Jong, Menno D T

2010-02-01

To compare traditional in-store age verification with a newly developed remote age verification system, 100 cigarette purchase attempts were made by 15-year-old "mystery shoppers." The remote system led to a strong increase in compliance (96% vs. 12%), reflecting more identification requests and more sale refusals when adolescents showed their identification cards. Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

Association of supermarket characteristics with the body mass index of their shoppers

PubMed Central

2013-01-01

Background Research on the built food environment and weight status has mostly focused on the presence/absence of food outlets while ignoring their internal features or where residents actually shop. We explored associations of distance travelled to supermarkets and supermarket characteristics with shoppers’ body mass index (BMI). Methods Shoppers (n=555) of five supermarkets situated in different income areas in the city were surveyed for food shopping habits, demographics, home postal code, height and weight. Associations of minimum distance to a supermarket (along road network, objectively measured using ArcGIS), its size, food variety and food basket price with shoppers’ BMI were investigated. The ‘food basket’ was defined as the mixture of several food items commonly consumed by residents and available in all supermarkets. Results Supermarkets ranged in total floor space (7500–135 000 square feet) and had similar varieties of fruits, vegetables and cereals. The majority of participants shopped at the surveyed supermarket more than once per week (mean range 1.2 ± 0.8 to 2.3 ± 2.1 times per week across the five supermarkets, p < 0.001), and identified it as their primary store for food (52% overall). Mean participant BMI of the five supermarkets ranged from 23.7 ± 4.3 kg/m2 to 27.1 ± 4.3 kg/m2 (p < 0.001). Median minimum distance from the shoppers’ residence to the supermarket they shopped at ranged from 0.96 (0.57, 2.31) km to 4.30 (2.83, 5.75) km (p < 0.001). A negative association was found between food basket price and BMI. There were no associations between BMI and minimum distance to the supermarket, or other supermarket characteristics. After adjusting for age, sex, dissemination area median individual income and car ownership, BMI of individuals who shopped at Store 1 and Store 2, the supermarkets with lowest price of the ‘food basket’, was 3.66 kg/m2 and 3.73 kg/m2 higher compared to their counterparts who shopped at the supermarket where the ‘food basket’ price was highest (p < 0.001). Conclusions The food basket price in supermarkets was inversely associated with BMI of their shoppers. Our results suggest that careful manipulation of food prices may be used as an intervention for decreasing BMI. PMID:23941309

Shopping list development and use of advertisements' pre-store food-buying practices within different socio-economic status areas in South Africa.

PubMed

Duffett, Rodney Graeme; Foster, Crystal

2017-01-01

The purpose of this paper is to determine whether there is a difference in the development of shopping lists and use of advertisements as pre-store food-buying practices in terms of planned shopping by South African consumers who dwell in different socio-economic status (SES) areas. The paper also considers the influence of shopper and socio-demographic characteristics on pre-store food-buying practices in a developing country. A self-administered questionnaire was used to survey 1 200 consumers in retail stores in low, middle and high SES areas in South Africa. A generalised linear model was employed for the statistical analysis of pre-store food-buying practices within the SES area groups in a developing country. South African consumers that reside in high SES area displayed the largest of shopping list development, while consumers who dwell in low SES areas showed the highest incidence of advertisement usage. Several shopper and socio-demographic characteristics were also found to have an influence on pre-store food-buying practices in different SES areas in South Africa. A qualitative approach would offer a deeper understanding of consumers' pre-store food shopping predispositions as opposed to the quantitative approach, which was adopted for this study. A longitudinal design would also provide a more extensive representation of pre-store food shopping practices over a longer time frame than cross-sectional research. The survey was conducted on Saturdays, whereas consumers who shop during the week may have different shopping and socio-demographic characteristics. Astute food brands, marketers and grocery stores could use the findings of this study to assist with their marketing efforts that they direct at consumers in different SES areas in South Africa and other developing countries. The findings of this study may assist consumers in developing countries, especially those who reside in low SES areas, with food-buying strategies to reduce food costs, make wiser purchase decisions and reduce shopping. No study (to the best of the researchers' knowledge) has considered shopping list development and use of advertisements' pre-store food-buying practices in different SES areas in a developing country. Furthermore, there is a dearth of research analysing shopper and socio-demographic characteristics in relation to pre-store food-buying practices among different SES areas in developing and developed countries.

The Good Food Junction: a Community-Based Food Store Intervention to Address Nutritional Health Inequities

PubMed Central

Muhajarine, Nazeem; Ridalls, Tracy; Abonyi, Sylvia; Vatanparast, Hassan; Whiting, Susan; Walker, Ryan

2016-01-01

Background This is a 2-year study to assess the early impacts of a new grocery store intervention in a former food desert. Objective The purpose of the study is to understand the early health effects of the introduction of a large-scale food and nutrition-focused community-based population health intervention, the Good Food Junction (GFJ) Cooperative Store, in a geographically bounded group of socially disadvantaged neighborhoods (the “core neighborhoods”) in a midsized Canadian city. The GFJ grocery store was tasked with improving the access of residents to healthy, affordable food. The 5 research questions are: (1) What is the awareness and perception of the GFJ store among residents of the core neighborhoods? (2) Are there differences in awareness and perception among those who do and do not shop at the GFJ? (3) Will healthy food purchasing at the GFJ by residents of the core neighborhoods change over time, and what purchases are these individuals making at this store? (4) What early impact(s) will the GFJ have on key health-related outcomes (such as household food security status, vegetable and fruit intake, key aspects of self-reported mental health, self-reported health)? and (5) Are the effects of the intervention seen for specific vulnerable population groups, such as Aboriginal people, seniors (65 years old or older) and new immigrants (settled in Saskatoon for less than 5 years)? Methods The research project examined initial impacts of the GFJ on the health of the residents in surrounding neighborhoods through a door-to-door cross-sectional survey of food access and household demographics; an examination of GFJ sales data by location of shoppers' residences; and a 1-year, 3-time-point longitudinal study of self-reported health of GFJ shoppers. Results Analyses are on-going, but preliminary results show that shoppers are using the store for its intended purpose, which is to improve access to healthy food in a former food desert. Conclusions To our knowledge this is the first large-scale study of a full-service grocery store intervention in a former food desert in Canada that has used multiple data sources, as well as longitudinal analyses, to examine its effects. Its findings will contribute significantly to the knowledge base on food environment interventions. PMID:27079140

Sequential Pattern Detection and Time Series Models for Predicting IED Attacks

DTIC Science & Technology

2009-03-01

customer purchases spaghetti sauce at the grocery store, do they also purchase some kind of meat and pasta noodles ? Knowing what items a shopper tends...such as the mileage, the number of passengers that can fit in the car, and the year the car was manufactured . The number of hidden nodes are...technology weapons that are inexpensive to manufacture and do not require extensive training to deploy. An improvised explosive device (IED) 28 is a

Socioeconomic Status, Energy Cost, and Nutrient Content of Supermarket Food Purchases

PubMed Central

Appelhans, Bradley M.; Milliron, Brandy-Joe; Woolf, Kathleen; Johnson, Tricia J.; Pagoto, Sherry L.; Schneider, Kristin L.; Whited, Matthew C.; Ventrelle, Jennifer C.

2013-01-01

Background The relative affordability of energy-dense versus nutrient-rich foods may promote socioeconomic disparities in dietary quality and obesity. Although supermarkets are the largest food source in the American diet, the associations between SES and the cost and nutrient content of freely chosen food purchases have not been described. Purpose To investigate relationships of SES with the energy cost ($/1000 kcal) and nutrient content of freely chosen supermarket purchases. Methods Supermarket shoppers (n=69) were recruited at a Phoenix AZ supermarket in 2009. The energy cost and nutrient content of participants’ purchases were calculated from photographs of food packaging and nutrition labels using dietary analysis software. Data were analyzed in 2010–2011. Results Two SES indicators, education and household income as a percentage of the federal poverty guideline (FPG), were associated with the energy cost of purchased foods. Adjusting for covariates, the amount spent on 1000 kcal of food was $0.26 greater for every multiple of the FPG, and those with a baccalaureate or postbaccalaureate degree spent an additional $1.05 for every 1000 kcal of food compared to those with no college education. Lower energy cost was associated with higher total fat and less protein, dietary fiber, and vegetables per 1000 kcal purchased. Conclusions Low-SES supermarket shoppers purchase calories in inexpensive forms that are higher in fat and less nutrient-rich. PMID:22424253

Socioeconomic status, energy cost, and nutrient content of supermarket food purchases.

PubMed

Appelhans, Bradley M; Milliron, Brandy-Joe; Woolf, Kathleen; Johnson, Tricia J; Pagoto, Sherry L; Schneider, Kristin L; Whited, Matthew C; Ventrelle, Jennifer C

2012-04-01

The relative affordability of energy-dense versus nutrient-rich foods may promote socioeconomic disparities in dietary quality and obesity. Although supermarkets are the largest food source in the American diet, the associations between SES and the cost and nutrient content of freely chosen food purchases have not been described. To investigate relationships of SES with the energy cost ($/1000 kcal) and nutrient content of freely chosen supermarket purchases. Supermarket shoppers (n=69) were recruited at a Phoenix AZ supermarket in 2009. The energy cost and nutrient content of participants' purchases were calculated from photographs of food packaging and nutrition labels using dietary analysis software. Data were analyzed in 2010-2011. Two SES indicators, education and household income as a percentage of the federal poverty guideline (FPG), were associated with the energy cost of purchased foods. Adjusting for covariates, the amount spent on 1000 kcal of food was $0.26 greater for every multiple of the FPG, and those with a baccalaureate or postbaccalaureate degree spent an additional $1.05 for every 1000 kcal of food compared to those with no college education. Lower energy cost was associated with higher total fat and less protein, dietary fiber, and vegetables per 1000 kcal purchased. Low-SES supermarket shoppers purchase calories in inexpensive forms that are higher in fat and less nutrient-rich. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

A simple health sign increases stair use in a shopping mall and two train stations in Flanders, Belgium.

PubMed

Boen, Filip; Maurissen, Katrien; Opdenacker, Joke

2010-06-01

The aim of this study was to test the impact of a simple health-promotion sign on stair use in three community settings in Flanders, Belgium. A health sign was placed at the junction between the stairs and an escalator in a shopping mall and two train stations. Observations took place on four days: baseline, first intervention, post-intervention and second intervention. In the second station, a second post-intervention phase was added. In total, 1437 choices of shoppers were registered in the mall, while 2869 and 2025 choices of commuters were recorded in the two stations, respectively. Despite the different baselines of stair use, the introduction of the health sign in the first intervention phase resulted in a significant increase in all three settings: 10.0% increase in the mall, 8.6% in the first station and 18.0% in the second station. In the second station, the increase during the second intervention exceeded that of the first intervention. Moreover, in this station stair use in the second post-intervention phase was significantly higher than at baseline. An inexpensive health-promoting sign has a substantial effect on the proportion of stair users among shoppers and commuters. Preliminary evidence was found that repeated exposure to a health sign might have a longer term effect on stair use.

Opioid shopping behavior: how often, how soon, which drugs, and what payment method.

PubMed

Cepeda, M Soledad; Fife, Daniel; Chow, Wing; Mastrogiovanni, Gregory; Henderson, Scott C

2013-01-01

Doctor shopping (obtaining opioid prescriptions from multiple prescribers) is one example of opioid abuse and diversion. The authors assessed how soon shopping behavior was observed after opioid exposure, number of events per shopper, preferred opioids, and method of payment. This was a cohort study. Individuals with ≤1 dispensing for any opioid in 2008 were followed for 18 months. Shopping behavior was defined as ≤2 prescriptions by different prescribers with ≤1 day of overlap and filled at ≤3 pharmacies. Of 25,161,024 subjects, 0.30% exhibited shopping behavior. Opioid-experienced subjects were 13.7 times more likely to exhibit shopping behavior and had more shopping episodes than opioid-naive subjects. Time to first shopping event was 246.90 ± 163.61 days. Number of episodes was 2.74 ± 4.66. Most subjects with shopping behavior (55.27%) had 1 shopping episode, whereas 9.52% had ≤6 episodes; 88.99% had ≤4 prescribers. Subjects with shopping behavior filled schedule II opioids more often than subjects without shopping behavior (19.51% vs 10.89%) and more often paid in cash (44.85% vs 18.54%). Three of 1000 people exposed to opioids exhibit shopping behavior, on average, 8 months after exposure. Opioid shoppers seek strong opioids, avoid combination products, often pay cash, and obtain prescriptions from few prescribers. © 2012 The Author(s).

[Usage of food and beverage labels by supermarket shoppers in Brasilia, Brazil].

PubMed

Monteiro, Renata Alves; Coutinho, Janine Giuberti; Recine, Elisabetta

2005-09-01

To investigate whether adults who shop in supermarkets in one part of Brasilia, the capital city of Brazil, use the information contained in food and beverage labels, as well as to characterize this usage. This study was done in five supermarkets in the Plano Piloto (Pilot Plan) central core area of Brasilia. The research was carried out in two stages: (1) a quantitative stage, based on a cross-sectional study, during which 250 individuals were randomly selected and surveyed in the supermarkets; and (2) a qualitative stage, in which 25 individuals who had participated in the first stage underwent more extensive individual interviews. Of the 250 persons surveyed, 187 of them (74.8%) reported that they usually read food and beverage labels. However, only 25.7% of the consumers who consulted the labels did so for all foods and beverages. Of the persons who read the labels, the majority (59.9%) only read the labels for specific foods, including milk, dairy products, canned foods, sausages, and diet products. The information that shoppers most often wanted to know from the labels was the number of calories and the fat and sodium content. Our study shows the need to utilize our findings in improving the existing educational strategies for promoting healthy eating. We suggest that consumers, food producers, and food distributors all be involved in developing strategies for nutrition education.

Tensile Fabrics Enhance Architecture Around the World

NASA Technical Reports Server (NTRS)

2009-01-01

Using a remarkable fabric originally developed to protect Apollo astronauts, Birdair Inc. of Amherst, New York, has crafted highly durable, safe, environmentally friendly, and architecturally stunning tensile membrane roofs for over 900 landmark structures around the world. Travelers in airports, sports fans at stadiums, and shoppers in malls have all experienced the benefits of the Teflon-coated fiberglass fabric that has enabled Birdair to grow from a small company established in its founder?s kitchen in 1955 to a multimillion-dollar specialty contractor today.

Secondary analysis of a marketing research database reveals patterns in dairy product purchases over time.

PubMed

Van Wave, Timothy W; Decker, Michael

2003-04-01

Development of a method using marketing research data to assess food purchase behavior and consequent nutrient availability for purposes of nutrition surveillance, evaluation of intervention effects, and epidemiologic studies of diet-health relationships. Data collected on household food purchases accrued over a 13-week period were selected by using Universal Product Code numbers and household characteristics from a marketing research database. Universal Product Code numbers for 39,408 dairy product purchases were linked to a standard reference for food composition to estimate the nutrient content of foods purchased over time. Two thousand one hundred sixty-one households located in Victoria, Texas, and surrounding communities who were active members of a frequent shopper program. Demographic characteristics of sample households and the nutrient content of their dairy product purchases were analyzed using frequency distribution, cross tabulation, analysis of variance, and t test procedures. A method for using marketing research data was successfully used to estimate household purchases of specific foods and their nutrient content from a marketing database containing hundreds of thousands of records. Distribution of dairy product purchases and their concomitant nutrients between Hispanic and non-Hispanic households were significant (P<.01, P<.001, respectively) and sustained over time. Purchase records from large, nationally representative panels of shoppers, such as those maintained by major market research companies, might be used to accomplish detailed longitudinal epidemiologic studies or surveillance of national food- and nutrient-purchasing patterns within and between countries and segments of their respective populations.

Positive Attitude toward Healthy Eating Predicts Higher Diet Quality at All Cost Levels of Supermarkets☆

PubMed Central

Aggarwal, Anju; Monsivais, Pablo; Cook, Andrea J.; Drewnowski, Adam

2014-01-01

Shopping at low-cost supermarkets has been associated with higher obesity rates. This study examined whether attitudes toward healthy eating are independently associated with diet quality among shoppers at low-cost, medium-cost, and high-cost supermarkets. Data on socioeconomic status (SES), attitudes toward healthy eating, and supermarket choice were collected using a telephone survey of a representative sample of adult residents of King County, WA. Dietary intake data were based on a food frequency questionnaire. Thirteen supermarket chains were stratified into three categories: low, medium, and high cost, based on a market basket of 100 commonly eaten foods. Diet-quality measures were energy density, mean adequacy ratio, and total servings of fruits and vegetables. The analytical sample consisted of 963 adults. Multivariable regressions with robust standard error examined relations between diet quality, supermarket type, attitudes, and SES. Shopping at higher-cost supermarkets was associated with higher-quality diets. These associations persisted after adjusting for SES, but were eliminated after taking attitudinal measures into account. Supermarket shoppers with positive attitudes toward healthy eating had equally higher-quality diets, even if they shopped at low-, medium-, or high-cost supermarkets, independent of SES and other covariates. These findings imply that shopping at low-cost supermarkets does not prevent consumers from having high-quality diets, as long as they attach importance to good nutrition. Promoting nutrition-education strategies among supermarkets, particularly those catering to low-income groups, can help to improve diet quality. PMID:23916974

Supermarket discounts of low-energy density foods: effects on purchasing, food intake, and body weight.

PubMed

Geliebter, Allan; Ang, Ian Yi Han; Bernales-Korins, Maria; Hernandez, Dominica; Ochner, Christopher N; Ungredda, Tatiana; Miller, Rachel; Kolbe, Laura

2013-12-01

To assess the effects of a 50% discount on low-energy density (ED) fruits and vegetables (F&V), bottled water, and diet sodas on shoppers' purchasing, food intake, and body weight. A randomized, controlled trial was conducted at two Manhattan supermarkets, in which a 4-week baseline period (no discounts) preceded an 8-week intervention period (50% discount), and a 4-week follow-up period (no discounts). Twenty-four hour dietary recall, as well as body weight and body composition measures were obtained every 4 weeks. Participants (n = 47, 33f; 14m) were overweight and obese (BMI ≥ 25) shoppers. Purchasing of F&V during intervention was greater in the discount group than in the control group (P < 0.0001). Purchasing of these items by the discount group relative to the control group during follow-up was reduced from intervention (P = 0.002), but still remained higher than during baseline (P = 0.01), indicating a partially sustained effect. Intake of F&V increased from baseline to intervention in the discount group relative to the control group (P = 0.037) and was sustained during follow-up. Body weight change did not differ significantly between groups, although post hoc analysis indicated a change within the discount group (-1.1 kg, P = 0.006) but not within the control group. Discounts of low-ED F&V led to increased purchasing and intake of those foods. Copyright © 2013 The Obesity Society.

Accessing primary care: a simulated patient study.

PubMed

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-03-01

Simulated patient, or so-called 'mystery-shopper', studies are a controversial, but potentially useful, approach to take when conducting health services research. To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients' reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders' possible confusion in answering this question. Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients' satisfaction with their practice is not related to practice call handling, but is related to appointment availability.

Use of simulated patients to assess the clinical and communication skills of community pharmacists.

PubMed

Weiss, Marjorie C; Booth, Anneka; Jones, Bethan; Ramjeet, Sarah; Wong, Eva

2010-06-01

To investigate the quality and appropriateness of Emergency Hormonal Contraception (EHC) supply from community pharmacies. Community pharmacies in the southwest of England during 2007. Two simulated patient ('mystery shopper') scenarios to each participating pharmacy, one where the supply of EHC would be appropriate (scenario 1) and one where there was a drug interaction between EHC and St John's Wort, and the supply inappropriate (scenario 2). Pharmacy consultations were rated using criteria developed from two focus groups: one with pharmacist academics and one with female university students. Feedback to pharmacists to inform their continuing professional development was provided. Scores on rating scales encompassing the clinical and communication skills of the participating community pharmacists completed immediately after each mystery shopper visit. 40 pharmacist visits were completed: 21 for scenario 1 and 19 for scenario 2. Eighteen pharmacists were visited twice. Five pharmacists visited for scenario 2 supplied EHC against professional guidance, although other reference sources conflicted with this advice. Pharmacies which were part of the local PGD scheme scored higher overall in scenario 1 (P = 0.005) than those not part of the scheme. Overall the communication skills of pharmacists were rated highly although some pharmacists used jargon when explaining the interaction for scenario 2. Formatively assessing communication skills in an integrative manner alongside clinical skills has been identified as an important part of the medical consultation skills training and can be incorporated into the routine assessment and feedback of pharmacy over-the-counter medicines advice.

Improving outpatient access and patient experiences in academic ambulatory care.

PubMed

O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

2012-02-01

Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

Impacts of a farmers' market incentive programme on fruit and vegetable access, purchase and consumption.

PubMed

Olsho, Lauren Ew; Payne, Gayle Holmes; Walker, Deborah Klein; Baronberg, Sabrina; Jernigan, Jan; Abrami, Alyson

2015-10-01

The present study examines the impact of Health Bucks, a farmers' market incentive programme, on awareness of and access to farmers' markets, and fruit and vegetable purchase and consumption in low-income New York City neighbourhoods. The evaluation used two primary data collection methods: (i) an on-site point-of-purchase survey of farmers' market shoppers; and (ii) a random-digit-dial telephone survey of residents in neighbourhoods where the programme operates. Additionally, we conducted a quasi-experimental analysis examining differential time trends in consumption before and after programme introduction using secondary Community Health Survey (CHS) data. New York City farmers' markets and communities. Farmers' market shoppers (n 2287) completing point-of-purchase surveys in a representative sample of New York City farmers' markets in 2010; residents (n 1025) completing random-digit-dial telephone survey interviews in 2010; and respondents (n 35 606) completing CHS interviews in 2002, 2004, 2008 and 2009. Greater Health Bucks exposure was associated with: (i) greater awareness of farmers' markets; (ii) increased frequency and amount of farmers' market purchases; and (iii) greater likelihood of a self-reported year-over-year increase in fruit and vegetable consumption. However, our CHS analysis did not detect impacts on consumption. While our study provides promising evidence that use of farmers' market incentives is associated with increased awareness and use of farmers' markets, additional research is needed to better understand impacts on fruit and vegetable consumption.

Perceptions of New Zealand nutrition labels by Māori, Pacific and low-income shoppers.

PubMed

Signal, Louise; Lanumata, Tolotea; Robinson, Jo-Ani; Tavila, Aliitasi; Wilton, Jenny; Ni Mhurchu, Cliona

2008-07-01

In New Zealand the burden of nutrition-related disease is greatest among Māori, Pacific and low-income peoples. Nutrition labels have the potential to promote healthy food choices and eating behaviours. To date, there has been a noticeable lack of research among indigenous peoples, ethnic minorities and low-income populations regarding their perceptions, use and understanding of nutrition labels. Our aim was to evaluate perceptions of New Zealand nutrition labels by Māori, Pacific and low-income peoples and to explore improvements or alternatives to current labelling systems. Māori, Samoan and Tongan researchers recruited participants who were regular food shoppers. Six focus groups were conducted which involved 158 people in total: one Māori group, one Samoan, one Tongan, and three low-income groups. Māori, Pacific and low-income New Zealanders rarely use nutrition labels to assist them with their food purchases for a number of reasons, including lack of time to read labels, lack of understanding, shopping habits and relative absence of simple nutrition labels on the low-cost foods they purchase. Current New Zealand nutrition labels are not meeting the needs of those who need them most. Possible improvements include targeted social marketing and education campaigns, increasing the number of low-cost foods with voluntary nutrition labels, a reduction in the price of 'healthy' food, and consideration of an alternative mandatory nutrition labelling system that uses simple imagery like traffic lights.

Consumer purchase behaviour of foods with added phytosterols in six European countries: Data from a post-launch monitoring survey.

PubMed

Ras, Rouyanne T; Trautwein, Elke A

2017-12-01

A variety of foods with added phytosterols (plant sterols and stanols, PS) known to lower elevated blood cholesterol is available on the European market. This paper reports findings from a 2015 post-launch monitoring survey on consumer purchase behaviour of foods with added PS in UK, Germany, France, Netherlands, Belgium and Greece. Data from 80,825 households were included. Households were divided into categories depending on number of purchases, household size, age of primary shopper and presence of children <5 years. Penetration rates of households purchasing foods with added PS ranged between 3 and 34%. Of households purchasing PS, 34-61% purchased infrequently (≤2 times/year), 29-36% occasionally (

TRADOC Union List of Periodicals.

DTIC Science & Technology

1988-08-01

Comp11t er Products TSO Nov 1987+ Compul er Rev iew TRQ 1980. Computer Security Journal TRADOC UNION LIST OF SERIALS P\\GE 103 TSO 1987+ Computer Shopper...c:urrcnrt monith onl.N TSP 1988+ TS( cu-rrenft year only TTF Ap1)r 21 , ŝ 86 + TT1T[’ rr-erit ,ear only De fvii <t - v ’P,’ort T s : 12+ Dfe r :iS 5...Executive Orders TTG 1948-1962. Executive Proclamations TTG 1955-1960. Executive Productivity TSR 0277-5298 current year only Executive Risk Assessment TRC V

Social image of students who shop and don't shop online.

PubMed

Lammers, H Bruce; Curren, Mary T; Cours, Deborah; Lammers, Marilyn L

2003-06-01

A descriptive survey of a stratified random sample of 326 undergraduates from a large, diverse university in Los Angeles was conducted to assess whether resistance to online shopping might be, in part, related to negative social perceptions of those who shop online. Indirect questioning showed that students perceived online student shoppers as more lazy and less likely to fear for the safety and security of others but also as more trustworthy, attractive, successful, and smart. Differences in social perceptions were not related to these students' own online spending.

Urban food environments and residents' shopping behaviors.

PubMed

Cannuscio, Carolyn C; Tappe, Karyn; Hillier, Amy; Buttenheim, Alison; Karpyn, Allison; Glanz, Karen

2013-11-01

Food environments may promote or undermine healthy behaviors, but questions remain regarding how individuals interact with their local food environments. This study incorporated an urban food environment audit as well as an examination of residents' food shopping behaviors within that context. In 2010, the research team audited the variety and healthfulness of foods available in 373 Philadelphia stores, using the validated Nutrition Environment Measures Survey in Stores (NEMS-S); higher scores indicate more diverse and healthful food inventories. The team also surveyed urban residents (n=514) regarding their food shopping. Descriptive and multivariate analyses (conducted in 2012) assessed variation in retail food environments and in shoppers' store choices. Corner and convenience stores were common (78.6% of food retail outlets) and had the lowest mean NEMS-S scores of any store type. Most participants (94.5%) did their primary food shopping at higher-scoring chain supermarkets, and the majority of participants did not shop at the supermarket closest to home. Supermarket offerings varied, with significantly fewer healthful foods at supermarkets closest to the homes of disadvantaged residents. In multivariate analyses, participants were significantly more likely to shop at supermarkets closest to home if those supermarkets had higher NEMS-S scores. These data suggest that, when possible, shoppers chose supermarkets that offered more variety and more healthful foods. Findings from this study also reinforce concern regarding unhealthy immediate food environments for disadvantaged residents, who disproportionately relied on nearby stores with more limited food items. Interventions to improve nutrition and health should address not only food store proximity but also diversity of healthful foods available. © 2013 American Journal of Preventive Medicine.

Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana.

PubMed

Clum, G; Gustat, J; O'Malley, K; Begalieva, M; Luckett, B; Rice, J; Johnson, C

2016-01-01

The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana. A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper. All participants were in the New Orleans metro area and were surveyed in 2011. Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older. Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping. Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men. FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.

Positive attitude toward healthy eating predicts higher diet quality at all cost levels of supermarkets.

PubMed

Aggarwal, Anju; Monsivais, Pablo; Cook, Andrea J; Drewnowski, Adam

2014-02-01

Shopping at low-cost supermarkets has been associated with higher obesity rates. This study examined whether attitudes toward healthy eating are independently associated with diet quality among shoppers at low-cost, medium-cost, and high-cost supermarkets. Data on socioeconomic status (SES), attitudes toward healthy eating, and supermarket choice were collected using a telephone survey of a representative sample of adult residents of King County, WA. Dietary intake data were based on a food frequency questionnaire. Thirteen supermarket chains were stratified into three categories: low, medium, and high cost, based on a market basket of 100 commonly eaten foods. Diet-quality measures were energy density, mean adequacy ratio, and total servings of fruits and vegetables. The analytical sample consisted of 963 adults. Multivariable regressions with robust standard error examined relations between diet quality, supermarket type, attitudes, and SES. Shopping at higher-cost supermarkets was associated with higher-quality diets. These associations persisted after adjusting for SES, but were eliminated after taking attitudinal measures into account. Supermarket shoppers with positive attitudes toward healthy eating had equally higher-quality diets, even if they shopped at low-, medium-, or high-cost supermarkets, independent of SES and other covariates. These findings imply that shopping at low-cost supermarkets does not prevent consumers from having high-quality diets, as long as they attach importance to good nutrition. Promoting nutrition-education strategies among supermarkets, particularly those catering to low-income groups, can help to improve diet quality. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Primary care appointment availability and nonphysician providers one year after Medicaid expansion.

PubMed

Tipirneni, Renuka; Rhodes, Karin V; Hayward, Rodney A; Lichtenstein, Richard L; Choi, HwaJung; Reamer, Elyse N; Davis, Matthew M

2016-06-01

With insurance enrollment greater than expected under the Affordable Care Act, uncertainty about the availability and timeliness of healthcare services for newly insured individuals has increased. We examined primary care appointment availability and wait times for new Medicaid and privately insured patients before and after Medicaid expansion in Michigan. Simulated patient ("secret shopper") study. Extended follow-up of a previously reported simulated patient ("secret shopper") study assessing accessibility of routine new patient appointments in a stratified proportionate random sample of Michigan primary care practices before versus 4, 8, and 12 months after Medicaid expansion. During the study period, approximately 600,000 adults enrolled in Michigan's Medicaid expansion program, representing 57% of the previously uninsured nonelderly adult population. One year after expansion, we found that appointment availability remained increased by 6 percentage points for new Medicaid patients (95% CI, 1.6-11.1) and decreased by 2 percentage points for new privately insured patients (95% CI, -0.5 to -3.8). Over the same period, the proportion of appointments scheduled with nonphysician providers (nurse practitioners or physician assistants) increased from 8% to 21% of Medicaid appointments (95% CI, 5.6-20.2) and from 11% to 19% of private-insurance appointments (95% CI, 1.3-14.1). Median wait times remained stable for new Medicaid patients and increased slightly for new privately insured patients, both remaining within 2 weeks. During the first year following Medicaid expansion in Michigan, appointment availability for new Medicaid patients increased, a greater proportion of appointments could be obtained with nonphysician providers, and wait times remained within 2 weeks.

Impact of a targeted direct marketing price promotion intervention (Buywell) on food-purchasing behaviour by low income consumers: a randomised controlled trial.

PubMed

Stead, M; MacKintosh, A M; Findlay, A; Sparks, L; Anderson, A S; Barton, K; Eadie, D

2017-08-01

Price promotions are a promising intervention for encouraging healthier food purchasing. We aimed to assess the impact of a targeted direct marketing price promotion combined with healthy eating advice and recipe suggestions on the purchase of selected healthier foods by low income consumers. We conducted a randomised controlled trial (n = 53 367) of a direct marketing price promotion (Buywell) combined with healthy eating advice and recipe suggestions for low income consumers identified as 'less healthy' shoppers. Impact was assessed using electronic point of sale data for UK low income shoppers before, during and after the promotion. The proportion of customers buying promoted products in the intervention month increased by between 1.4% and 2.8% for four of the five products. There was significantly higher uptake in the promotion month (P < 0.001) for the intervention group than would have been expected on the basis of average uptake in the other months. When product switching was examined for semi-skimmed/skimmed milk, a modest increase (1%) was found in the intervention month of customers switching from full-fat to low-fat milk. This represented 8% of customers who previously bought only full-fat milk. The effects were generally not sustained after the promotion period. Short-term direct marketing price promotions combined with healthy eating advice and recipe suggestions targeted at low income consumers are feasible and can have a modest impact on short-term food-purchasing behaviour, although further approaches are needed to help sustain these changes. © 2017 The British Dietetic Association Ltd.

Residential Energy Consumption Survey (RECS): National interim energy consumption survey, 1978-1979, household monthly energy consumption and expenditures. Shopper's guide

NASA Astrophysics Data System (ADS)

Windell, P.

1981-08-01

The data from the National Interim Energy Consumption Survey (NIECS) is available to the public on machine readable magnetic tapes. Brief overviews of the Residential Energy Consumption Survey as a whole and of the NIECS in particular is a brief description of each of the files included in this tape, and a list of the variables in the data set are included. A copy of the fuel supplier record form used to collect consumption and expenditure data for each of the sample households is also included.

Consumer Perceived Risk, Attitude and Online Shopping Behaviour; Empirical Evidence from Malaysia

NASA Astrophysics Data System (ADS)

Ariff, Mohd Shoki Md; Sylvester, Michele; Zakuan, Norhayati; Ismail, Khalid; Mat Ali, Kamarudin

2014-06-01

The development of e-commerce has increased the popularity of online shopping worldwide. In Malaysia, it was reported that online shopping market size was RM1.8 billion in 2013 and it is estimated to reach RM5 billion by 2015. However, online shopping was rated 11th out of 15 purposes of using internet in 2012. Consumers' perceived risks of online shopping becomes a hot topic to research as it will directly influence users' attitude towards online purchasing, and their attitude will have significant impact to the online purchasing behaviour. The conceptualization of consumers' perceived risk, attitude and online shopping behaviour of this study provides empirical evidence in the study of consumer online behaviour. Four types of risks - product risk, financial, convenience and non-delivery risks - were examined in term of their effect on consumers' online attitude. A web-based survey was employed, and a total of 300 online shoppers of a Malaysia largest online marketplace participated in this study. The findings indicated that product risk, financial and non-delivery risks are hazardous and negatively affect the attitude of online shoppers. Convenience risk was found to have positive effect on consumers' attitude, denoting that online buyers of this site trusted the online seller and they encountered less troublesome with the site. It also implies that consumers did not really concern on non-convenience aspect of online shopping, such as handling of returned products and examine the quality of products featured in the online seller website. The online buyers' attitude was significantly and positively affects their online purchasing behaviour. The findings provide useful model for measuring and managing consumers' perceived risk in internet-based transaction to increase their involvement in online shopping and to reduce their cognitive dissonance in the e-commerce setting.

Corner store purchases made by adults, adolescents and children: items, nutritional characteristics and amount spent.

PubMed

Lent, Michelle R; Vander Veur, Stephanie; Mallya, Giridhar; McCoy, Tara A; Sanders, Timothy A; Colby, Lisa; Rauchut Tewksbury, Colleen; Lawman, Hannah G; Sandoval, Brianna; Sherman, Sandy; Wylie-Rosett, Judith; Foster, Gary D

2015-06-01

Corner stores, also known as bodegas, are prevalent in low-income urban areas and primarily stock high-energy foods and beverages. Little is known about individual-level purchases in these locations. The purpose of the present study was to assess corner store purchases (items, nutritional characteristics and amount spent) made by children, adolescents and adults in a low-income urban environment. Evaluation staff used 9238 intercept surveys to directly examine food and beverage purchases. Intercepts were collected at 192 corner stores in Philadelphia, PA, USA. Participants were adult, adolescent and child corner store shoppers. Among the 9238 intercept surveys, there were 20 244 items. On average, at each corner store visit, consumers purchased 2.2 (sd 2.1) items (1.3 (sd 2.0) foods and 0.9 (sd 0.9) beverages) that cost $US 2.74 (sd $US 3.52) and contained 2786.5 (sd 4454.2) kJ (666.0 (sd 1064.6) kcal). Whether the data were examined as a percentage of total items purchased or as a percentage of intercepts, the most common corner store purchases were beverages, chips, prepared food items, pastries and candy. Beverage purchases occurred during 65.9% of intercepts and accounted for 39.2% of all items. Regular soda was the most popular beverage purchase. Corner store purchases averaged 66.2 g of sugar, 921.1 mg of sodium and 2.5 g of fibre per intercept. Compared with children and adolescents, adults spent the most money and purchased the most energy. Urban corner store shoppers spent almost $US 3.00 for over 2700 kJ (650 kcal) per store visit. Obesity prevention efforts may benefit from including interventions aimed at changing corner store food environments in low-income, urban areas.

Incidence of high dosage buprenorphine and methadone shopping behavior in a retrospective cohort of opioid-maintained patients in France.

PubMed

Delorme, Jessica; Chenaf, Chouki; Kabore, Jean-Luc; Pereira, Bruno; Mulliez, Aurélien; Tremey, Aurore; Brousse, Georges; Zenut, Marie; Laporte, Catherine; Authier, Nicolas

2016-05-01

Opioid Substitution Treatment (OST) misuse and diversion have significantly increased worldwide. Obtaining OST prescriptions from multiple prescribers, known as doctor shopping, is a way in which opioids may be diverted. The aim of this study was to assess the incidence of OST (high dosage buprenorphine (HDB) and methadone (MTD)) shopping behavior and identify associated risk factors, and its impact on mortality. A retrospective cohort of patients treated by OST between April 1, 2004 and December 31, 2012 from a sample of the French Health Insurance database was established. Doctor shopping was defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies. A total of 2043 patients were enrolled, 1450HDB and 593 MTD. The one-year incidence of shopping behavior was 8.4% (95% CI: 7.0-10.1) in HDB group and 0% in MTD group, compared to 0.2% (95% CI: 0.1-0.2) for diuretics. On multivariate analysis, factors associated with HDB shopping behavior were: male gender HR: 1.74 (95% CI: 1.20-2.54); low-income status HR: 2.95 (95% CI: 2.07-4.44); mental health disorders HR: 1.43 (95% CI: 1.06-1.94); concurrent hypnotics use HR: 1.90 (95% CI: 1.39-2.61); concurrent use of weak opioids HR: 1.48 (95% CI: 1.09-1.99) and morphine HR: 1.69 (95% CI: 1.02-2.80). HDB shoppers had a higher, yet non-significant risk of death (HR: 1.56 (95% CI: 0.64-3.81)) than non HDB shoppers. Shopping behavior was only found in high dosage buprenorphine patients and concerned almost one out ten patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Doctor shopping by overweight and obese patients is associated with increased healthcare utilization.

PubMed

Gudzune, Kimberly A; Bleich, Sara N; Richards, Thomas M; Weiner, Jonathan P; Hodges, Krista; Clark, Jeanne M

2013-07-01

Negative interactions with healthcare providers may lead patients to switch physicians or "doctor shop." We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight nonshoppers. We combined claims data from a health plan in one state with information from beneficiaries' health risk assessments. The primary outcome was "doctor shopping," which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations. Of the 20,726 beneficiaries, the mean BMI was 26.3 kg m(-2) (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04-1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26-1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37-2.45; IRR 1.83, 95%CI 1.34-2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10-2.03; Obese IRR 1.54, 95%CI 1.12-2.11). Frequently changing PCPs may impair continuity and result in increased healthcare utilization. Copyright © 2012 The Obesity Society.

Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet and BMI.

PubMed

Dubowitz, Tamara; Zenk, Shannon N; Ghosh-Dastidar, Bonnie; Cohen, Deborah A; Beckman, Robin; Hunter, Gerald; Steiner, Elizabeth D; Collins, Rebecca L

2015-08-01

To provide a richer understanding of food access and purchasing practices among US urban food desert residents and their association with diet and BMI. Data on food purchasing practices, dietary intake, height and weight from the primary food shopper in randomly selected households (n 1372) were collected. Audits of all neighbourhood food stores (n 24) and the most-frequented stores outside the neighbourhood (n 16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and BMI were conducted. Two low-income, predominantly African-American neighbourhoods with limited access to healthy food in Pittsburgh, PA, USA. Household food shoppers. Only one neighbourhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighbourhood. Although the nearest full-service supermarket was an average of 2·6 km from their home, respondents shopped an average of 6·0 km from home. The average trip was by car, took approximately 2 h for the round trip, and occurred two to four times per month. Respondents spent approximately $US 37 per person per week on food. Those who made longer trips had access to cars, shopped less often and spent less money per person. Those who travelled further when they shopped had higher BMI, but most residents already shopped where healthy foods were available, and physical distance from full-service supermarkets was unrelated to weight or dietary quality. Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought, and thus policy and interventions that focus merely on improving access may not be effective.

Family food purchases of high- and low-calorie foods in full-service supermarkets and other food retailers by Black women in an urban US setting.

PubMed

Chrisinger, Benjamin W; DiSantis, Katherine Isselmann; Hillier, Amy E; Kumanyika, Shiriki K

2018-06-01

Public health interventions to increase supermarket access assume that shopping in supermarkets is associated with healthier food purchases compared to other store types. To test this assumption, we compared purchasing patterns by store-type for certain higher-calorie, less healthy foods (HCF) and lower-calorie, healthier foods (LCF) in a sample of 35 black women household shoppers in Philadelphia, PA. Data analyzed were from 450 food shopping receipts collected by these shoppers over four-week periods in 2012. We compared the likelihood of purchasing the HCF (sugar-sweetened beverages, sweet/salty snacks, and grain-based snacks) and LCF (low-fat dairy, fruits, and vegetables) at full-service supermarkets and six other types of food retailers, using generalized estimating equations. Thirty-seven percent of participants had household incomes at or below the poverty line, and 54% had a BMI >30. Participants shopped primarily at full-service supermarkets (55%) or discount/limited assortment supermarkets (22%), making an average of 11 shopping trips over a 4-week period and spending mean (SD) of $350 ($222). Of full-service supermarket receipts, 64% included at least one HCF item and 58% at least one LCF. Most trips including HCF (58%) and LCF (60%) expenditures were to full-service or discount/limited assortment supermarkets rather than smaller stores. Spending a greater percent of total dollars in full-service supermarkets was associated with spending more on HCF (p = 0.03) but not LCF items (p = 0.26). These findings in black women suggest a need for more attention to supermarket interventions that change retailing practices and/or consumer shopping behaviors related to foods in the HCF categories examined.

A moveable feast: Exploring barriers and enablers to food citizenship.

PubMed

O'Kane, Gabrielle

2016-10-01

Despite the ability of the globalised food system to deliver varied and plentiful food supplies to most in the developed world it also disconnects consumers from where, how and by whom food is grown, which discourages food citizenship. This paper uses an ecological framework to examine the individual, social, physical and macro-level environments that can positively or negatively influence peoples' engagement with food citizenship. This research used narrative inquiry methodology and purposive sampling to gather stories through focus group conversations. Fifty-two people voluntarily attended focus groups comprised of food procurers from one of five sources: community gardens, Community Supported Agriculture (CSA), farmers' markets, fresh food markets or supermarkets. A narrative was constructed for each of these groups of food procurers; their commonalities and particularities were illuminated through a final interpretive narrative. The findings showed that the community gardeners exhibited a range of personal characteristics that prioritised engagement with local food systems. The physical setting of the community garden enabled the gardeners to make connections to the earth and the people within their social networks. The CSA and farmers' market groups were cognisant of the implications of their food choices and usually proved to be food citizens, as they selected seasonal, local and ethically produced food from their farmer(s). The fresh food market shoppers were ambivalent towards organic and seasonal food and the market setting did not connect them directly to the provenance of their food. The supermarket shoppers' disconnection from those who grew their food and where it was grown disempowered them from making sustainable food choices. Adjustments to the macro-level food environment are needed to enable people to have a greater commitment to food citizenship. Copyright © 2016 Elsevier Ltd. All rights reserved.

Food prices and food shopping decisions of black women.

PubMed

DiSantis, Katherine I; Grier, Sonya A; Oakes, J Michael; Kumanyika, Shiriki K

2014-06-01

Identifying food pricing strategies to encourage purchases of lower-calorie food products may be particularly important for black Americans. Black children and adults have higher than average obesity prevalence and disproportionate exposure to food marketing environments in which high calorie foods are readily available and heavily promoted. The main objective of this study was to characterize effects of price on food purchases of black female household shoppers in conjunction with other key decision attributes (calorie content/healthfulness, package size, and convenience). Factorial discrete choice experiments were conducted with 65 low- and middle-/higher-income black women. The within-subject study design assessed responses to hypothetical scenarios for purchasing frozen vegetables, bread, chips, soda, fruit drinks, chicken, and cheese. Linear models were used to estimate the effects of price, calorie level (or healthfulness for bread), package size, and convenience on the propensity to purchase items. Moderating effects of demographic and personal characteristics were assessed. Compared with a price that was 35% lower, the regular price was associated with a lesser propensity to purchase foods in all categories (β = -0.33 to -0.82 points on a 1 to 5 scale). Other attributes, primarily calorie content/healthfulness, were more influential than price for four of seven foods. The moderating variable most often associated with propensity to pay the regular versus lower price was the reported use of nutrition labels. Price reductions alone may increase purchases of certain lower-calorie or more healthful foods by black female shoppers. In other cases, effects may depend on combining price changes with nutrition education or improvements in other valued attributes. Copyright © 2014 Elsevier Ltd. All rights reserved.

The contribution of three components of nutrition knowledge to socio-economic differences in food purchasing choices.

PubMed

McKinnon, Loretta; Giskes, Katrina; Turrell, Gavin

2014-08-01

To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) dietary guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices. The cross-sectional study considered household food purchasing, nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size. Brisbane, Australia in 2000. Main household food shoppers (n 1003, response rate 66·4 %), located in fifty small areas (Census Collectors Districts). Shoppers in households of low SEP made food purchasing choices that were less consistent with dietary guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing. Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with dietary guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.

Shopping behavior for ADHD drugs: results of a cohort study in a pharmacy database.

PubMed

Cepeda, M Soledad; Fife, Daniel; Berwaerts, Joris; Yuan, Yingli; Mastrogiovanni, Greg

2014-09-01

Attention-deficit hyperactivity disorder (ADHD) medications are subject to abuse, misuse, and diversion. Obtaining ADHD prescriptions from multiple prescribers or filled across multiple pharmacies, known as 'doctor shopping', may reflect such unsanctioned use. We sought to create a definition of shopping behavior that differentiated ADHD medications from medications with low risk of diversion, i.e. asthma medications, and describe the incidence, frequency, and demography of shopping behavior. This was a retrospective cohort study in a pharmacy database-LRx-covering 65 % of US retail pharmacies. Subjects had ADHD or asthma medication dispensed between February 2011 and January 2012. We followed subjects for 18 months to assess the number with overlapping dispensings from different prescribers, and the number of prescribers and pharmacies involved in those dispensings. We included 4,402,464 subjects who were dispensed ADHD medications, and 6,128,025 subjects who were dispensed asthma medications. Overlapping prescriptions from two or more prescribers dispensed by three or more pharmacies was four times more frequent in the ADHD cohort than in the asthma cohort. Using this definition, ADHD medication shopping behavior was more common among experienced users than naïve users, and was most common in subjects aged 10-39 years. Among subjects who shopped, 57.4 % shopped only once (accounting for 22.4 % of episodes), and 9.2 % shopped six or more times (accounting for 42.0 % of episodes). Shoppers more often received stimulant ADHD drugs than non-stimulants. Overlapping prescriptions by different prescribers and filled at three or more pharmacies defines ADHD medication shopping. Shopping behavior is most common in adolescents and younger adults. A small proportion of shoppers is responsible for a large number of shopping episodes.

Understanding the Role of Accredited Drug Dispensing Outlets in Tanzania's Health System.

PubMed

Embrey, Martha; Vialle-Valentin, Catherine; Dillip, Angel; Kihiyo, Bernard; Mbwasi, Romuald; Semali, Innocent A; Chalker, John C; Liana, Jafary; Lieber, Rachel; Johnson, Keith; Rutta, Edmund; Kimatta, Suleiman; Shekalaghe, Elizabeth; Valimba, Richard; Ross-Degnan, Dennis

2016-01-01

People in many low-income countries access medicines from retail drug shops. In Tanzania, a public-private partnership launched in 2003 used an accreditation approach to improve access to quality medicines and pharmaceutical services in underserved areas. The government scaled up the accredited drug dispensing outlet (ADDO) program nationally, with over 9,000 shops now accredited. This study assessed the relationships between community members and their sources of health care and medicines, particularly antimicrobials, with a specific focus on the role ADDOs play in the health care system. Using mixed methods, we collected data in four regions. We surveyed 1,185 households and audited 96 ADDOs and 84 public/nongovernmental health facilities using a list of 17 tracer drugs. To determine practices in health facilities, we interviewed 1,365 exiting patients. To assess dispensing practices, mystery shoppers visited 306 ADDOs presenting one of three scenarios (102 each) about a child's respiratory symptoms. Of 614 household members with a recent acute illness, 73% sought outside care-30% at a public facility and 31% at an ADDO. However, people bought medicines more often at ADDOs no matter who recommended the treatment; of the 581 medicines that people had received, 49% came from an ADDO. Although health facilities and ADDOs had similar availability of antimicrobials, ADDOs had more pediatric formulations available (p<0.001). The common perception was that drugs from ADDOs are more expensive, but the difference in the median cost to treat pneumonia was relatively minimal (US$0.26 in a public facility and US$0.30 in an ADDO). Over 20% of households said they had someone with a chronic condition, with 93% taking medication, but ADDOs are allowed to sell very few chronic care-related medicines. ADDO dispensers are trained to refer complicated cases to a health facility, and notably, 99% of mystery shoppers presenting a pneumonia scenario received an antimicrobial (54%), a referral (90%), or both (45%), which are recommended practices for managing pediatric pneumonia. However, one-third of the dispensers needlessly sold antibiotics for cold symptoms, and 85% sold an antibiotic on request. In addition, the pneumonia scenario elicited more advice on handling the illness than the cold symptoms scenario (61% vs. 15%; p<0.0001), but overall, only 44% of the dispensers asked any of the shoppers about danger signs potentially associated with pneumonia in a child. ADDOs are the principal source of medicines in Tanzania and an important part of a multi-faceted health care system. Poor prescribing in health facilities, poor dispensing at ADDOs, and inappropriate patient demand continue to contribute to inappropriate medicines use. Therefore, while accreditation has attempted to address the quality of pharmaceutical services in private sector drug outlets, efforts to improve access to and use of medicines in Tanzania need to target ADDOs, public/nongovernmental health facilities, and the public to be effective.

Avian Influenza Risk Perception and Preventive Behavior among Traditional Market Workers and Shoppers in Taiwan: Practical Implications for Prevention

PubMed Central

Liu, Ming-Der

2011-01-01

Background Avian influenza (AI) can be highly pathogenic and fatal. Preventive behavior such as handwashing and wearing face masks has been recommended. However, little is known about what psychosocial factors might influence people's decision to adopt such preventive behavior. This study aims to explore risk perception and other factors associated with handwashing and wearing face masks to prevent AI. Methodology/Principal Findings An interviewer-administered survey was conducted among 352 traditional market workers and shoppers in Taiwan between December 2009 and January 2010. Factors associated with the recommended AI preventive behavior (i.e., when in a traditional market, wearing a face mask and also washing hands after any contact with poultry) included: having correct knowledge about the fatality rate of AI (adjusted odds ratio [AOR] = 4.18), knowing of severe cases of AI (AOR = 2.13), being informed of local AI outbreaks (AOR = 2.24), living in northeastern Taiwan (AOR = 6.01), having a senior high-school education (AOR = 3.33), and having a university or higher education (AOR = 6.86). Gender interactive effect was also found among participants with a senior high-school education, with males being less likely to engage in the recommended AI preventive behavior than their female counterparts (AOR = 0.34). Conclusions/Significance Specific information concerning AI risk perception was associated with the recommended AI preventive behavior. In particular, having correct knowledge about the fatality rate of AI and being informed of severe cases and local outbreaks of AI were linked to increased AI preventive behavior. These findings underscore the importance of transparency in dealing with epidemic information. These results also have practical implications for prevention and policy-making to more effectively promote the recommended AI preventive behavior in the public. PMID:21912667

Healthy food access for urban food desert residents: examination of the food environment, food purchasing practices, diet, and body mass index

PubMed Central

Dubowitz, Tamara; Zenk, Shannon N.; Ghosh-Dastidar, Bonnie; Cohen, Deborah; Beckman, Robin; Hunter, Gerald; Steiner, Elizabeth D.; Collins, Rebecca L.

2015-01-01

Objective Provide a richer understanding of food access and purchasing practices among U.S. urban food desert residents and their association with diet and body mass. Design Data on food purchasing practices, dietary intake, height, and weight from the primary food shopper in randomly selected households (n=1372) was collected. Audits of all neighborhood food stores (n=24) and the most-frequented stores outside the neighborhood (n=16) were conducted. Aspects of food access and purchasing practices and relationships among them were examined and tests of their associations with dietary quality and body mass index (BMI) were conducted. Setting Two low-income predominantly African-American neighborhoods with limited access to healthy food in Pittsburgh, Pennsylvania. Subjects Household food shoppers. Results Only one neighborhood outlet sold fresh produce; nearly all respondents did major food shopping outside the neighborhood. Although the nearest full-service supermarket was an average of 2.6 km from their home, respondents shopped an average of 6.0 km from home. The average trip was by car, took approximately two hours roundtrip, and occurred two to four times per month. Respondents spent approximately $37 per person per week on food. Those who made longer trips had access to cars, shopped less often, and spent less money per person. Those who traveled further when they shopped had higher BMIs, but most residents already shopped where healthy foods were available, and physical distance from full service groceries was unrelated to weight or dietary quality. Conclusions Improved access to healthy foods is the target of current policies meant to improve health. However, distance to the closest supermarket might not be as important as previously thought and thus policy and interventions that focus merely on improving access may not be effective. PMID:25475559

Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care.

PubMed

Stevens, Sarah L; McManus, Richard J; Stevens, Richard John

2018-04-12

Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. Primary care. Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Proportion of patients having BP measured according to guidelines. 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Awareness, understanding and use of sodium information labelled on pre-packaged food in Beijing:a cross-sectional study.

PubMed

He, Yao; Huang, Liping; Yan, Sijin; Li, Yuan; Lu, Lixin; Wang, Hongbo; Niu, Wenyi; Zhang, Puhong

2018-04-17

Nutrition labelling has been mandatory for pre-packaged foods since 2013 in China, and sodium is one of the nutrients required for display on the nutritional information panel (NIP). This study aimed to estimate the awareness, understanding of, and use of sodium labelling information among the population in China. A cross-sectional survey was carried out in urban Beijing in 2016 on pre-packaged foods. The researchers randomly selected 380 residents from four convenient but disconnected communities and 370 shoppers from four supermarkets owned by different companies and conducted face-to-face interviews. Questions on nutritional knowledge, health attitude, understanding and use of nutritional labels as well as other related factors were assessed. All of the 380 community residents and 308 of the 370 supermarket shoppers successfully completed the survey. Of those 688 respondents, 91.3% understood that excessive salt intake was harmful, 19.5% were aware that sodium content is listed on the NIP, 5.5% understood the meaning of NRV% (Percentage of Nutrient Reference Values), 47.7% did not know the relationship between sodium and salt, and 12.6% reported they frequently read the label when shopping. Factors for why people were more likely to choose a product because of its low level of salt shown on the label include income level and their level of awareness of the link between salt and diet. Although the participants had a good understanding of the harmful effects of salt, the awareness, understanding and use of sodium labels was very low in Beijing, and even worse nationwide. Efforts should be taken to educate the public to understand and use the NIP better and design clearer ways of displaying such information, such as front-of pack (FoP) labelling or health-related smartphone applications to improve health and help people make better food choices.

Retailing in Tennessee 1980

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1980-01-01

Data on retail sales compiled from sales tax records are summarized. Contained in this report are retail sales estimates for the 95 counties in the State of Tennessee and 303 cities, towns, or parts of towns which are shown in various degrees of detail depending on disclosure restrictions. Number of firms is determined by the total number of reports submitted. Sales and percent distribution of sales are shown for the State of Tennessee and counties by Standard Metropolitan Statistical Area (SMSA) designation and by various county groupings based on the size of largest city. A list of counties by SMSAmore » designation and by size class of largest city is given in the Appendix. The number of firms and estimated retail sales are also shown for 10 business groups defined by the US Department of Commerce along with the total retail sales for each of the 95 counties in Tennessee and for 137 of the larger cities, towns, or parts of towns in the state. Sales for 37 smaller incorporated places or parts of towns are given. Any attempt to report retail activity in the same detail that is possible for large cities is hampered by disclosure restrictions for towns in this group. Through the use of fewer categories, the amount of information that can be revealed is maximized while maintaining confidentiality for individual businesses. A classification widely adopted by economists and planners is the use of the broad retail categories of shoppers' goods, convenience goods, and all other stores. Shoppers' goods stores include department and variety stores, apparel and accessory shops, and furniture and home furnishings outlets. Convenience goods stores are food stores, gasoline service stations, drug stores, and eating and drinking places. The remaining category of all other stores includes building materials, hardware, automotive, and miscellaneous retail stores. Total sales are given for 129 very small incorporated towns.« less

New directions in the use of virtual reality for food shopping: marketing and education perspectives.

PubMed

Ruppert, Barb

2011-03-01

Virtual reality is used in marketing research to shape food selection and purchase decisions. Could it be used to counteract the marketing of less-nutritious foods and teach healthier food selection? This article presents interviews with Raymond Burke, Ph.D., of Indiana University Bloomington, and Rachel Jones, M.P.H., of the University of Utah College of Health. Topics covered include new marketing research technologies, including virtual reality simulations; retailing and shopper behavior; and the use of virtual grocery stores to help students explore quality of diet and food/nutrient relationships. The interviewees discuss how the technologies they have developed fit into research and behavior change related to obesity and diabetes. © 2011 Diabetes Technology Society.

New Directions in the Use of Virtual Reality for Food Shopping: Marketing and Education Perspectives

PubMed Central

Ruppert, Barb

2011-01-01

Virtual reality is used in marketing research to shape food selection and purchase decisions. Could it be used to counteract the marketing of less-nutritious foods and teach healthier food selection? This article presents interviews with Raymond Burke, Ph.D., of Indiana University Bloomington, and Rachel Jones, M.P.H., of the University of Utah College of Health. Topics covered include new marketing research technologies, including virtual reality simulations; retailing and shopper behavior; and the use of virtual grocery stores to help students explore quality of diet and food/nutrient relationships. The interviewees discuss how the technologies they have developed fit into research and behavior change related to obesity and diabetes. PMID:21527099

A study of patients with spinal disease using Maudsley Personality Inventory.

PubMed

Kasai, Yuichi; Takegami, Kenji; Uchida, Atsumasa

2004-02-01

We administered the Maudsley Personality Inventory (MPI) preoperatively to 303 patients with spinal diseases about to undergo surgery. Patients younger than 20 years, patients previously treated in the Department of Psychiatry, and patients with poor postoperative results were excluded. Patients with N-scores (neuroticism scale) of 39 points or greater or L-scores (lie scale) of 26 points or greater were regarded as "abnormal." Based on clinical definitions we identified 24 "problem patients" during the course and categorized them as "Unsatisfied," "Indecisive," "Doctor shoppers," or "Distrustful." Preoperative MPI categorized 26 patients as abnormal; 22 patients categorized as abnormal became problem patients ( p<0.001). MPI sensitivity and specificity was 84.6% and 99.3%, respectively. Preoperative MPI to patients with spinal disease was found to be useful in detecting problem patients.

Crazy for bargains: inventing the irrational female shopper in modernizing English Canada.

PubMed

Belisle, Donica

2011-01-01

Between the 1890s and 1930s, anglophone politicians, journalists, novelists, and other commentators living in western, central, and eastern Canada drew upon established connections among greed, luxury, hysteria, and femininity to describe women who went shopping as irrational. Their motivations for doing so included their desires to assuage feelings of guilt about increased abundance; articulate anger caused by spousal conflicts over money; assert the legitimacy of male authority; and assign blame for the decline of small communities’ sustainability, the degradation of labour standards, and the erosion of independent shopkeeping. By calling upon stock stereotypes of femininity, and by repositioning them to fit the current capitalist moment, English-Canadian commentators constructed disempowering representations of women to alleviate their anxieties about what they perceived as the ills of modernization.

The TSX Gives a Short Course in Health Economics: It's the Prices, Stupid!

PubMed Central

Evans, Robert G.

2010-01-01

The fall in Shoppers Drug Mart shares last April 8 gave a crystal-clear demonstration of the link between health expenditures and health incomes. Reacting (finally) to the excessive retail prices of generic drugs, the Ontario government effectively halved the rate of reimbursement of ingredient costs and banned the “professional allowances” (kickbacks) paid to pharmacies by generic manufacturers. Taxpayers and private payers will save hundreds of millions of dollars, and pharmacy revenues will fall by an equivalent amount. Patients will still get their drugs, with no loss of quantity, quality or even convenience; no one's health is threatened. But investor profits will fall. There are similar savings opportunities throughout the health system. Health costs are primarily a political, not an economic, problem. PMID:22043220

Consumers' Response to an On-Shelf Nutrition Labelling System in Supermarkets: Evidence to Inform Policy and Practice.

PubMed

Hobin, Erin; Bollinger, Bryan; Sacco, Jocelyn; Liebman, Eli; Vanderlee, Lana; Zuo, Fei; Rosella, Laura; L'abbe, Mary; Manson, Heather; Hammond, David

2017-09-01

Policy Points: On-shelf nutrition labelling systems in supermarkets, such as the Guiding Stars system, are intended to provide consumers with simple, standardized nutrition information to support more informed and healthier food choices. Policies that support the provision of simplified nutrition labelling systems may encourage consumers to make positive shifts in food-purchasing behaviors. The shifts in consumer food-purchasing patterns observed in our study after the introduction of the Guiding Stars system in supermarkets translated into measurable nutritional benefits, including more items purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. This study is one of the first to report the positive impact of an on-shelf nutrition labelling system on supermarket sales and revenues-key information that was specifically requested by the US National Academies, as such labelling interventions may be more sustainable if they lead to higher revenues. Providing a nutrition rating system on the front of food packages or on retail shelf tags has been proposed as a policy strategy for supporting healthier food choices. Guiding Stars is an on-shelf nutrition labelling system that scores foods in a supermarket based on nutritional quality; scores are then translated into ratings of 0 to 3 stars. It is consistent with evidence-informed recommendations for well-designed labels, except for not labelling 0-star products. The largest supermarket retailer in Canada rolled out the Guiding Stars system in supermarkets across Ontario, Canada. The aim of our study was to examine the extent to which consumers respond to an on-shelf nutrition labelling system in supermarkets to inform current and future nutrition labelling policies and practices. Capitalizing on a natural experiment, we conducted a quasi-experimental study across 3 supermarket banners (or "chains") in Ontario, one of which implemented the Guiding Stars system in 2012. We used aggregated supermarket transaction data to test the effect of Guiding Stars on the nutritional quality of food purchases in intervention supermarkets relative to control supermarkets. We also conducted exit surveys among 783 randomly selected shoppers from intervention and control supermarkets to assess consumer awareness, understanding, trust, and self-reported use of the labelling system. Relative to control supermarkets, shoppers in intervention supermarkets made small but significant shifts toward purchasing foods with higher nutritional ratings; however, shifts varied in direction and magnitude across food categories. These shifts translated into foods being purchased with slightly less trans fat and sugar and more fiber and omega-3 fatty acids. We also found increases in the number of products per transaction, price per product purchased, and total revenues. Results of the exit surveys indicate a modest proportion of consumers were aware of, understood, and trusted Guiding Stars in intervention supermarkets, and a small proportion of consumers reported using this system when making purchasing decisions. However, 47% of shoppers exposed to Guiding Stars were confused when asked to interpret the meaning of a 0-star product that does not display a rating on the shelf tag. This study demonstrates support for policies promoting on-shelf nutrition labels designed according to evidence-informed principles, but policymakers should move forward with caution when investing in such systems until research has confirmed optimal label design, clarified the mechanisms through which dietary intake is improved, and assessed associations with nutrition-related health outcomes. © 2017 Milbank Memorial Fund.

Changes in Consumer Purchases in Stores Participating in an Obesity Prevention Initiative.

PubMed

Woodward-Lopez, Gail; Kao, Janice; Kuo, Elena S; Rauzon, Suzanne; Taylor, Anthony C; Goette, Christina; Collins, Carole; Gonzalez, Esmeralda P; Ronshausen, Danielle R; Boyle, Kathryn; Williamson, Dana; Cheadle, Allen

2018-05-01

From 2011 to 2014, small stores in three communities participated in a community-wide obesity prevention initiative. The study aimed to determine how participation in the initiative influenced store environments and consumer purchases. Pre- and post-intervention without control. Structured observations of the store environments and intercept surveys of adult shoppers at all stores, and of children at two stores, conducted at baseline and follow-up. Manager/owner interviews regarding perceived impacts of the intervention conducted at follow-up. Shoppers at nine small stores in three diverse, low-income communities in Northern California. The store interventions were determined locally with combinations of strategies such as product displays, healthier options, marketing and promotion, store layout, and facility improvements that were implemented to varying degrees at each site. Changes in store environments and purchases of select foods and beverages. Stores experienced consistent, but not always significant, declines in purchases of sweets and chips and increases in purchases of fruits and vegetables at select stores. Decreases in purchases of targeted sugar-sweetened beverages were offset by increases in purchases of other sugar-sweetened beverages. Changes in store environments and promotional activities varied widely from store to store and corresponded to variations in changes in purchasing. The owners/managers perceived benefits to their bottom line and community/customer relations, but challenges were identified that may account for the varied degree of implementation. Substantive improvements in fruit and vegetable availability and promotion were needed to achieve a measurable impact on purchases but reducing purchases of unhealthy foods, like sweets and chips, required a less consistent intensive effort. These findings suggest it may be challenging to achieve the consistent and targeted implementation of changes and ongoing promotional efforts at a large enough proportion of stores where residents shop that would be required to get measurable impacts at the community level. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Increasing compliance with alcohol service laws in a developing country: intervention trial in the Kingdom of Bhutan.

PubMed

Dorji, Gampo; DeJong, William; Bor, Jacob; Bachman DeSilva, Mary; Sabin, Lora; Feeley, Frank Rich; Udon, Pema; Wangchuk, Nima; Wangdi, Ugyen; Choden, Tshering; Gurung, Mongal Singh; Chogyel, Tandin; Wangchuk, Dorji; Kypri, Kypros

2016-03-01

Bhutan is a low-middle income country that, like many others, experiences significant alcohol-related harm and low compliance with laws restricting availability and promotion. This study assessed changes in compliance of alcohol outlets with sales restrictions following a multi-sector programme aimed at improving this. Pre-post design with covert observation of service practices. Thimphu, Bhutan, June-November 2013. Alcohol is not permitted for sale except from 1 to 10 p.m. Wednesday-Monday. Serving minors (< 18 years old) or intoxicated patrons is illegal. Seventy-one outlets selected randomly from all 209 on-premises outlets in downtown Thimphu. Multi-sector programme involving visits to outlets, education of owners and staff, a toolkit and implementation checks. Ten mystery-shopper visits were made to each outlet both before and after the intervention. We assessed compliance in five purchasing scenarios: (1) before 1 p.m., (2) after 10 p.m., (3) on Tuesdays and (4) shoppers who appeared to be underage or (5) intoxicated. Changes in compliance rates were assessed using multi-variable logistic regression models. Overall compliance increased from 20 to 34% [difference: 14%; 95% confidence interval (CI) = 7-22%]. Improvement was found in refusals of service before 1 p.m.: 10-34% (difference(adj) = 24%; 95% CI = 12-37%) and on Tuesdays: 43-58% (difference(adj) = 14%; 95% CI = 1-28%). Differences in refusal to serve alcohol: after 10 p.m. (difference(adj) = 15%; 95% CI = -8 to 37%); to underage patrons (difference(adj) = -5%; 95% CI = 14 to 4%); and to intoxicated patrons (difference(adj) = 7%; 95% CI = -7-20%) were not statistically significant. Younger servers, stand-alone bars and outlets permitting indoor smoking were each less likely to comply with the alcohol service laws. A multi-sector programme to improve compliance with legal restrictions on serving alcohol in Bhutan appeared to have a modest effect but even after the programme, in two-thirds of the occasions tested, the laws were broken. © 2015 Society for the Study of Addiction.

Ethanol-acetone pulping of wheat straw. Influence of the cooking and the beating of the pulps on the properties of the resulting paper sheets.

PubMed

Jiménez, L; Pérez, I; López, F; Ariza, J; Rodríguez, A

2002-06-01

The influence of independent variables in the pulping of wheat straw by use of an ethanol-acetone-water mixture [processing temperature and time, ethanol/(ethanol + acetone) value and (ethanol + acetone)/(ethanol + acetone + water) value] and of the number of PFI beating revolutions to which the pulp was subjected, on the properties of the resulting pulp (yield and Shopper-Riegler index) and of the paper sheets obtained from it (breaking length, stretch, burst index and tear index) was examined. By using a central composite factor design and the BMDP software suite, equations that relate each dependent variable to the different independent variables were obtained that reproduced the experimental results for the dependent variables with errors less than 30% at temperatures, times, ethanol/(ethanol + acetone) value, (ethanol + acetone)/(ethanol + acetone + water) value and numbers of PFI beating revolutions in the ranges 140-180 degrees C, 60-120 min, 25-75%, 35-75% and 0-1750, respectively. Using values of the independent variables over the variation ranges considered provided the following optimum values of the dependent variables: 78.17% (yield), 15.21 degrees SR (Shopper-Riegler index), 5265 m (breaking length), 1.94% (stretch), 2.53 kN/g (burst index) and 4.26 mN m2/g (tear index). Obtaining reasonably good paper sheets (with properties that differed by less than 15% from their optimum values except for the burst index, which was 28% lower) entailed using a temperature of 180 degrees C, an ethanol/(ethanol + acetone) value of 50%, an (ethanol + acetone)/(ethanol + acetone + water) value of 75%, a processing time of 60 min and a number of PFI beating revolutions of 1750. The yield was 32% lower under these conditions, however. A comparison of the results provided by ethanol, acetone and ethanol-acetone pulping revealed that the second and third process-which provided an increased yield were the best choices. On the other hand, if the pulp is to be refined, ethanol pulping is the process of choice.

Malaria treatment in the retail sector: Knowledge and practices of drug sellers in rural Tanzania

PubMed Central

Hetzel, Manuel W; Dillip, Angel; Lengeler, Christian; Obrist, Brigit; Msechu, June J; Makemba, Ahmed M; Mshana, Christopher; Schulze, Alexander; Mshinda, Hassan

2008-01-01

Background Throughout Africa, the private retail sector has been recognised as an important source of antimalarial treatment, complementing formal health services. However, the quality of advice and treatment at private outlets is a widespread concern, especially with the introduction of artemisinin-based combination therapies (ACTs). As a result, ACTs are often deployed exclusively through public health facilities, potentially leading to poorer access among parts of the population. This research aimed at assessing the performance of the retail sector in rural Tanzania. Such information is urgently required to improve and broaden delivery channels for life-saving drugs. Methods During a comprehensive shop census in the districts of Kilombero and Ulanga, Tanzania, we interviewed 489 shopkeepers about their knowledge of malaria and malaria treatment. A complementary mystery shoppers study was conducted in 118 retail outlets in order to assess the vendors' drug selling practices. Both studies included drug stores as well as general shops. Results Shopkeepers in drug stores were able to name more malaria symptoms and were more knowledgeable about malaria treatment than their peers in general shops. In drug stores, 52% mentioned the correct child-dosage of sulphadoxine-pyrimethamine (SP) compared to only 3% in general shops. In drug stores, mystery shoppers were more likely to receive an appropriate treatment (OR = 9.6), but at an approximately seven times higher price. Overall, adults were more often sold an antimalarial than children (OR = 11.3). On the other hand, general shopkeepers were often ready to refer especially children to a higher level if they felt unable to manage the case. Conclusion The quality of malaria case-management in the retail sector is not satisfactory. Drug stores should be supported and empowered to provide correct malaria-treatment with drugs they are allowed to dispense. At the same time, the role of general shops as first contact points for malaria patients needs to be re-considered. Interventions to improve availability of ACTs in the retail sector are urgently required within the given legal framework. PMID:18471299

Farmers’ market use is associated with fruit and vegetable consumption in diverse southern rural communities

PubMed Central

2014-01-01

Background While farmers’ markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers’ markets among rural residents. Thus, this study’s purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers’ market shopping in southern rural communities; and (3) associations between farmers’ market use with fruit and vegetable consumption and body mass index (BMI). Methods Cross-sectional surveys were conducted with a purposive sample of farmers’ market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers’ markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers’ market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers’ market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers’ market shopping. Linear regression analyses were used to examine associations between farmers’ market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender. Results Among farmers’ market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers’ market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers’ market shopping were market days and hours, “only come when I need something”, extreme weather, and market location. Among the KY farmers’ market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers’ markets. There were no associations between use of farmers’ markets and BMI. Conclusions Fruit and vegetable consumption was associated with farmers’ market shopping. Thus, farmers’ markets may be a viable method to increase population-level produce consumption. PMID:24405527

Protocol for a pilot randomised controlled trial of an intervention to increase the use of traffic light food labelling in UK shoppers (the FLICC trial).

PubMed

Scarborough, Peter; Hodgkins, Charo; Raats, Monique M; Harrington, Richard A; Cowburn, Gill; Dean, Moira; Doherty, Aiden; Foster, Charlie; Juszczak, Edmund; Matthews, Anne; Mizdrak, Anja; Mhurchu, Cliona Ni; Shepherd, Richard; Tiomotijevic, Lada; Winstone, Naomi; Rayner, Mike

2015-01-01

Traffic light labelling of foods-a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods-has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions. The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial. The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial. ISRCTN: ISRCTN19316955.

Farmers' market use is associated with fruit and vegetable consumption in diverse southern rural communities.

PubMed

Jilcott Pitts, Stephanie B; Gustafson, Alison; Wu, Qiang; Leah Mayo, Mariel; Ward, Rachel K; McGuirt, Jared T; Rafferty, Ann P; Lancaster, Mandee F; Evenson, Kelly R; Keyserling, Thomas C; Ammerman, Alice S

2014-01-09

While farmers' markets are a potential strategy to increase access to fruits and vegetables in rural areas, more information is needed regarding use of farmers' markets among rural residents. Thus, this study's purpose was to examine (1) socio-demographic characteristics of participants; (2) barriers and facilitators to farmers' market shopping in southern rural communities; and (3) associations between farmers' market use with fruit and vegetable consumption and body mass index (BMI). Cross-sectional surveys were conducted with a purposive sample of farmers' market customers and a representative sample of primary household food shoppers in eastern North Carolina (NC) and the Appalachian region of Kentucky (KY). Customers were interviewed using an intercept survey instrument at farmers' markets. Representative samples of primary food shoppers were identified via random digit dial (RDD) cellular phone and landline methods in counties that had at least one farmers' market. All questionnaires assessed socio-demographic characteristics, food shopping patterns, barriers to and facilitators of farmers' market shopping, fruit and vegetable consumption and self-reported height and weight. The main outcome measures were fruit and vegetable consumption and BMI. Descriptive statistics were used to examine socio-demographic characteristics, food shopping patterns, and barriers and facilitators to farmers' market shopping. Linear regression analyses were used to examine associations between farmers' market use with fruit and vegetable consumption and BMI, controlling for age, race, education, and gender. Among farmers' market customers, 44% and 55% (NC and KY customers, respectively) reported shopping at a farmers' market at least weekly, compared to 16% and 18% of NC and KY RDD respondents. Frequently reported barriers to farmers' market shopping were market days and hours, "only come when I need something", extreme weather, and market location. Among the KY farmers' market customers and NC and KY RDD respondents, fruit and vegetable consumption was positively associated with use of farmers' markets. There were no associations between use of farmers' markets and BMI. Fruit and vegetable consumption was associated with farmers' market shopping. Thus, farmers' markets may be a viable method to increase population-level produce consumption.

Human dynamics in repurchase behavior based on comments mining

NASA Astrophysics Data System (ADS)

Yang, Tian; Feng, Xin; Wu, Ye; Wang, Shengfeng; Xiao, Jinghua

2018-07-01

Hundreds of thousands of individual deals and comments are analyzed to ask: what kinds of patterns appear in their repurchase process? Our results suggest that, in the empirical description, the intervals between two consecutive purchases obey a power-law distribution. Notwithstanding a wide range of individual preferences, shoppers' repurchase behaviors show some similar patterns, called long-scale quiet and short-scale emergence, and the alternating appearance of them form an endless chain in repurchase. In agreement with the empirical results, these short-scale and long-scale patterns suggest an adaptive model with alterable exponents complying with a power-law distribution. And it also implies that each user behaves his own intrinsic pattern such as unique repurchase intensity and silence-emergence cycle, which contributes to customer life-time value from the new view of dynamics and repurchase cycles.

Benefits of mass customized products: moderating role of product involvement and fashion innovativeness.

PubMed

Park, Minjung; Yoo, Jungmin

2018-02-01

The objective of this study was to explore impacts and benefits of mass customized products on emotional product attachment, favorable attitudes toward a mass customization program, and the ongoing effect on loyalty intentions. This study further investigated how benefits, attachment, attitudes, and loyalty intentions differed as a function of involvement and fashion innovativeness. 290 female online shoppers in South Korea participated in an online survey. Results of this study revealed that perceived benefits positively influenced emotional product attachment and attitudes toward a mass customization program. In addition, attachment positively influenced attitudes, which in turn affected loyalty intentions. This study also found that benefits, attachment, attitudes, and loyalty intentions were all higher in highly involved consumers (high fashion innovators) than those in less involved consumers (low fashion innovators). This study concludes with theoretical and practical implications for mass customization programs.

Assessing soil and groundwater contamination in a metropolitan redevelopment project.

PubMed

Yun, Junki; Lee, Ju Young; Khim, Jeehyeong; Ji, Won Hyun

2013-08-01

The purpose of this study was to assess contaminated soil and groundwater for the urban redevelopment of a rapid transit railway and a new mega-shopping area. Contaminated soil and groundwater may interfere with the progress of this project, and residents and shoppers may be exposed to human health risks. The study area has been remediated after application of first remediation technologies. Of the entire area, several sites were still contaminated by waste materials and petroleum. For zinc (Zn) contamination, high Zn concentrations were detected because waste materials were disposed in the entire area. For petroleum contamination, high total petroleum hydrocarbon (TPH) and hydrocarbon degrading microbe concentrations were observed at the depth of 7 m because the underground petroleum storage tank had previously been located at this site. Correlation results suggest that TPH (soil) concentration is still related with TPH (groundwater) concentration. The relationship is taken into account in the Spearman coefficient (α).

Taiwanese consumer survey data for investigating the role of information on equivalence of organic standards in directing food choice.

PubMed

Yeh, Ching-Hua; Hartmann, Monika; Hirsch, Stefan

2018-06-01

The presentation of credence attributes such as the product's origin or the production method has a significant influence on consumers' food purchase decisions. The dataset includes survey responses from a discrete choice experiment with 1309 food shoppers in Taiwan using the example of sweet pepper. The survey was carried out in 2014 in the three largest Taiwanese cities. It evaluates the impact of providing information on the equality of organic standards on consumers' preferences at the example of sweet pepper. Equality of organic standards implies that regardless of products' country-of-origin (COO) organic certifications are based on the same production regulation and managerial processes. Respondents were randomly allocated to the information treatment and the control group. The dataset contains the product choices of participants in both groups, as well as their sociodemographic information.

Evolving food retail environments in Thailand and implications for the health and nutrition transition

PubMed Central

Banwell, Cathy; Dixon, Jane; Seubsman, Sam-ang; Pangsap, Suttinan; Kelly, Matthew; Sleigh, Adrian

2013-01-01

Objective An investigation into evolving food retail systems in Thailand Design Rapid assessment procedures based on qualitative research methods such as interviews, focus groups discussions and site visits Setting Seven freshmarkets located in the four main regions of Thailand Subjects Managers, food specialists, vendors and shoppers from seven freshmarkets who participated in interviews and focus group discussions. Results Freshmarkets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety. Conclusions Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As freshmarkets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women’s jobs and social capital with implications for the health and nutrition transition in Thailand. PMID:23021291

The predictability of consumer visitation patterns

NASA Astrophysics Data System (ADS)

Krumme, Coco; Llorente, Alejandro; Cebrian, Manuel; Pentland, Alex ("Sandy"); Moro, Esteban

2013-04-01

We consider hundreds of thousands of individual economic transactions to ask: how predictable are consumers in their merchant visitation patterns? Our results suggest that, in the long-run, much of our seemingly elective activity is actually highly predictable. Notwithstanding a wide range of individual preferences, shoppers share regularities in how they visit merchant locations over time. Yet while aggregate behavior is largely predictable, the interleaving of shopping events introduces important stochastic elements at short time scales. These short- and long-scale patterns suggest a theoretical upper bound on predictability, and describe the accuracy of a Markov model in predicting a person's next location. We incorporate population-level transition probabilities in the predictive models, and find that in many cases these improve accuracy. While our results point to the elusiveness of precise predictions about where a person will go next, they suggest the existence, at large time-scales, of regularities across the population.

Pharmacy access to ulipristal acetate in Hawaii: is a prescription enough?

PubMed

Bullock, Holly; Steele, Sarah; Kurata, Nicole; Tschann, Mary; Elia, Jennifer; Kaneshiro, Bliss; Salcedo, Jennifer

2016-05-01

To determine pharmacy availability of ulipristal acetate (UPA) and compare to availability of levonorgestrel-containing emergency contraceptive pills (LNG-ECPs). We conducted an observational population-based study utilizing a telephone-based secret shopper methodology. Researchers called all 198 unique retail pharmacies in Hawaii on December 2013-June 2014, representing themselves as patients and physicians. Only 2.6% of pharmacies had UPA immediately available, though 22.8% reported ability to order UPA. In contrast, 82.4% reported immediate availability of LNG-ECPs. No significant difference in availability was reported to patients and physicians. Availability of UPA is limited and significantly lower compared to LNG-ECPs. The study period did overlap with a change in distributor for UPA, likely capturing some disruption of the supply chain. Systems-based interventions are needed to address barriers to obtaining UPA. Copyright © 2015 Elsevier Inc. All rights reserved.

Breast cancer education program based in Asian grocery stores.

PubMed

Sadler, G R; Thomas, A G; Yen, J Y; Dhanjal, S K; Marie Ko, C; Tran, C H; Wang, K

2000-01-01

Culturally and linguistically compatible university students were trained as community health educators to provide breast cancer education and screening information to shoppers at Asian grocery stores. Information about early detection of breast cancer was shared with 8,877 women, who reported speaking 40 different languages. Baseline surveys were completed by 1,202 women; 779 took part in the follow-up survey. The survey questions assessed baseline knowledge, attitudes, and screening behaviors regarding breast cancer, tested the efficacy of the intervention, and sought barriers to accessing screening services. Screening adherence at baseline was low, but reported screening compliance had increased by follow-up. This study confirms the cost-effectiveness of student health educators and Asian grocery store sites as venues to reach the diverse age, ethnic, and socioeconomic segments of the Asian community, while demonstrating the community's receptiveness to the dissemination of health information and introducing bilingual students to health education and research careers.

Does price reveal poor-quality drugs? Evidence from 17 countries.

PubMed

Bate, Roger; Jin, Ginger Zhe; Mathur, Aparna

2011-12-01

Focusing on 8 drug types on the WHO-approved medicine list, we constructed an original dataset of 899 drug samples from 17 low- and median-income countries and tested them for visual appearance, disintegration, and analyzed their ingredients by chromatography and spectrometry. Fifteen percent of the samples fail at least one test and can be considered substandard. After controlling for local factors, we find that failing drugs are priced 13.6-18.7% lower than non-failing drugs but the signaling effect of price is far from complete, especially for non-innovator brands. The look of the pharmacy, as assessed by our covert shoppers, is weakly correlated with the results of quality tests. These findings suggest that consumers are likely to suspect low quality from market price, non-innovator brand and the look of the pharmacy, but none of these signals can perfectly identify substandard and counterfeit drugs. Copyright © 2011 Elsevier B.V. All rights reserved.

Transactional interactive multimedia banner

NASA Astrophysics Data System (ADS)

Shae, Zon-Yin; Wang, Xiping; von Kaenel, Juerg

2000-05-01

Advertising in TV broadcasting has shown that multimedia is a very effective means to present merchandise and attract shoppers. This has been applied to the Web by including animated multimedia banner ads on web pages. However, the issues of coupling interactive browsing, shopping, and secure transactions e.g. from inside a multimedia banner, have only recently started to being explored. Currently there is an explosively growing amount of back-end services available (e.g., business to business commerce (B2B), business to consumer (B2C) commerce, and infomercial services) in the Internet. These services are mostly accessible through static HTML web pages at a few specific web portals. In this paper, we will investigate the feasibility of using interactive multimedia banners as pervasive access point for the B2C, B2B, and infomercial services. We present a system architecture that involves a layer of middleware agents functioning as the bridge between the interactive multimedia banners and back-end services.

Evolving food retail environments in Thailand and implications for the health and nutrition transition.

PubMed

Banwell, Cathy; Dixon, Jane; Seubsman, Sam-Ang; Pangsap, S; Kelly, Matthew; Sleigh, Adrian

2013-04-01

To investigate evolving food retail systems in Thailand. Rapid assessment procedures based on qualitative research methods including interviews, focus groups discussions and site visits. Seven fresh markets located in the four main regions of Thailand. Managers, food specialists, vendors and shoppers from seven fresh markets who participated in interviews and focus group discussions. Fresh markets are under economic pressure and are declining in number. They are attempting to resist the competition from supermarkets by improving convenience, food diversity, quality and safety. Obesity has increased in Thailand at the same time as rapid growth of modern food retail formats has occurred. As fresh markets are overtaken by supermarkets there is a likely loss of fresh, healthy, affordable food for poorer Thais, and a diminution of regional culinary culture, women's jobs and social capital, with implications for the health and nutrition transition in Thailand.

PER PhDs & bachelor's degrees

NASA Astrophysics Data System (ADS)

White, Susan C.

2017-02-01

Recently, the editor remarked to me that physics departments that offered a PhD with a specialization in Physics Education Research (PER) seemed to graduate more bachelor's degree recipients than those physics PhD departments that did not have the specialization. I was not convinced. That led to quite a bit of discussion between us. He compiled a list of PhD departments that advertised a PhD specialization in PER in the 2004, 2005, 2009, and 2010 editions of GradSchoolShopper, a publication of the American Institute of Physics. Since not every department responded reliably every year, I combined the 2004 and 2005 data and the 2009 and 2010 data. I then compared the departments that advertised a PER specialization during both timeframes (2004 and/or 2005 and 2009 and/or 2010) with physics PhD-granting departments that did not indicate the specialization at all.

The effect of visualizing healthy eaters and mortality reminders on nutritious grocery purchases: an integrative terror management and prototype willingness analysis.

PubMed

McCabe, Simon; Arndt, Jamie; Goldenberg, Jamie L; Vess, Matthew; Vail, Kenneth E; Gibbons, Frederick X; Rogers, Ross

2015-03-01

To use insights from an integration of the terror management health model and the prototype willingness model to inform and improve nutrition-related behavior using an ecologically valid outcome. Prior to shopping, grocery shoppers were exposed to a reminder of mortality (or pain) and then visualized a healthy (vs. neutral) prototype. Receipts were collected postshopping and food items purchased were coded using a nutrition database. Compared with those in the control conditions, participants who received the mortality reminder and who were led to visualize a healthy eater prototype purchased more nutritious foods. The integration of the terror management health model and the prototype willingness model has the potential for both basic and applied advances and offers a generative ground for future research. PsycINFO Database Record (c) 2015 APA, all rights reserved.

The predictability of consumer visitation patterns

PubMed Central

Krumme, Coco; Llorente, Alejandro; Cebrian, Manuel; Pentland, Alex ("Sandy"); Moro, Esteban

2013-01-01

We consider hundreds of thousands of individual economic transactions to ask: how predictable are consumers in their merchant visitation patterns? Our results suggest that, in the long-run, much of our seemingly elective activity is actually highly predictable. Notwithstanding a wide range of individual preferences, shoppers share regularities in how they visit merchant locations over time. Yet while aggregate behavior is largely predictable, the interleaving of shopping events introduces important stochastic elements at short time scales. These short- and long-scale patterns suggest a theoretical upper bound on predictability, and describe the accuracy of a Markov model in predicting a person's next location. We incorporate population-level transition probabilities in the predictive models, and find that in many cases these improve accuracy. While our results point to the elusiveness of precise predictions about where a person will go next, they suggest the existence, at large time-scales, of regularities across the population. PMID:23598917

Pharmacists' knowledge and the difficulty of obtaining emergency contraception.

PubMed

Bennett, Wendy; Petraitis, Carol; D'Anella, Alicia; Marcella, Stephen

2003-10-01

This cross-sectional study was performed to examine knowledge and attitudes among pharmacists about emergency contraception (EC) and determine the factors associated with their provision of EC. A random systematic sampling method was used to obtain a sample (N = 320) of pharmacies in Pennsylvania. A "mystery shopper" telephone survey method was utilized. Only 35% of pharmacists stated that they would be able to fill a prescription for EC that day. Also, many community pharmacists do not have sufficient or accurate information about EC. In a logistic regression model, pharmacists' lack of information relates to the low proportion of pharmacists able to dispense it. In conclusion, access to EC from community pharmacists in Pennsylvania is severely limited. Interventions to improve timely access to EC involve increased education for pharmacists, as well as increased community request for these products as an incentive for pharmacists to stock them.

To what extent do food purchases reflect shoppers' diet quality and nutrient intake?

PubMed

Appelhans, Bradley M; French, Simone A; Tangney, Christy C; Powell, Lisa M; Wang, Yamin

2017-04-11

Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake. Primary household food shoppers (N = 196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data. HEI-2010 scores derived from food purchases (median = 60.9, interquartile range 49.1-71.7) showed moderate agreement (ρc = .57, p < .0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median = 60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ρc = .10 to .61, with the strongest associations observed for fiber (ρc = .61), whole fruit (ρc = .48), and vegetables (ρc = .39). Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers. ClinicalTrials.gov, NCT02073643 . Retrospectively registered.

Dismissive and deceptive car dealerships create barriers to electric vehicle adoption at the point of sale

NASA Astrophysics Data System (ADS)

Zarazua de Rubens, Gerardo; Noel, Lance; Sovacool, Benjamin K.

2018-06-01

As most consumers do not have pre-existing knowledge of electric vehicles (EVs), and current market conditions favour petrol and diesel vehicles, car dealership experiences may strongly influence EV purchasing decisions. Here, we show that car dealerships pose a significant barrier at the point of sale due to a perceived lack of business case viability in relation to petrol and diesel vehicles. In 126 shopping experiences at 82 car dealerships across Denmark, Finland, Iceland, Norway and Sweden, we find that dealers were dismissive of EVs, misinformed shoppers on vehicle specifications, omitted EVs from the sales conversation and strongly oriented customers towards petrol and diesel vehicle options. Dealers' technological orientation, willingness to sell and displayed knowledge of EVs were the main contributors to likely purchase intentions. These findings combined with expert interviews suggest that government and industry signalling affect sales strategies and purchasing trends. Policy and business strategies that address barriers at the point of sale are needed to accelerate EV adoption.

Sodium and nutrition labelling: a qualitative study exploring New Zealand consumers' food purchasing behaviours.

PubMed

McLean, Rachael; Hoek, Janet

2014-05-01

Dietary sodium reduction is an important public health intervention that would reduce blood pressure and chronic disease. An understanding of how New Zealand consumers' food purchasing behaviour is influenced by perceptions of dietary sodium will inform future sodium-reduction strategies. The present qualitative study used in-depth interviews of adult consumers to explore consumer knowledge, understanding of food labels and food purchasing behaviour with respect to dietary sodium. New Zealand. A convenience sample of sixteen adult grocery shoppers. A thematic analysis of the transcripts showed New Zealand consumers lacked the background knowledge necessary to understand and regulate their own salt intake and were unable to interpret existing food labels with respect to dietary salt. The findings add further weight to calls for food labels that do not require background knowledge or numerical skills and highlight the need for population-based public health interventions. Education of New Zealand consumers on the health benefits of sodium reduction and how this may be achieved would complement this approach.

Are Front of Pack Claims Indicators of Nutrition Quality? Evidence from 2 Product Categories.

PubMed

Schaefer, Debra; Hooker, Neal H; Stanton, John L

2016-01-01

American grocery shoppers face an array of front of pack (FOP) nutrition and health claims when making food selections. Such systems have been categorized as summary or nutrient specific. Either type should help consumers make judgments about the nutrition quality of a product. This research tests if the type or quantity of FOP claims are indeed good indicators of objective nutrition quality. Claim and nutrition information from more than 2200 breakfast cereals and prepared meals launched between 2006 and 2010 were analyzed using binary and multinomial logistic regression models. Results suggest that no type or number of front of pack claims could distinguish "healthy" foods. However, some types and frequencies of FOP claims were significant predictors of higher or lower levels of certain key nutrients. Given the complex and crowded label environment in which these FOP claims reside, one may be concerned that such cues are not closely related to objective measures of nutrition quality. © 2015 Institute of Food Technologists®

Using a Grocery List Is Associated With a Healthier Diet and Lower BMI Among Very High-Risk Adults.

PubMed

Dubowitz, Tamara; Cohen, Deborah A; Huang, Christina Y; Beckman, Robin A; Collins, Rebecca L

2015-01-01

Examine whether use of a grocery list is associated with healthier diet and weight among food desert residents. Cross-sectional analysis of in-person interview data from randomly selected household food shoppers in 2 low-income, primarily African American urban neighborhoods in Pittsburgh, PA with limited access to healthy foods. Multivariate ordinary least-square regressions conducted among 1,372 participants and controlling for sociodemographic factors and other potential confounding variables indicated that although most of the sample (78%) was overweight or obese, consistently using a list was associated with lower body mass index (based on measured height and weight) (adjusted multivariant coefficient = 0.095) and higher dietary quality (based on the Healthy Eating Index-2005) (adjusted multivariant coefficient = 0.103) (P < .05). Shopping with a list may be a useful tool for low-income individuals to improve diet or decrease body mass index. Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

The personal shopper – a pilot randomized trial of grocery store-based dietary advice

PubMed Central

Lewis, K H; Roblin, D W; Leo, M; Block, J P

2015-01-01

The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index – 2005 [0–100 points] ), and nutritional knowledge (0–65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. PMID:25873139

Parent outcome expectancies for purchasing fruit and vegetables: a validation.

PubMed

Baranowski, Tom; Watson, Kathy; Missaghian, Mariam; Broadfoot, Alison; Baranowski, Janice; Cullen, Karen; Nicklas, Theresa; Fisher, Jennifer; O'Donnell, Sharon

2007-03-01

To validate four scales -- outcome expectancies for purchasing fruit and for purchasing vegetables, and comparative outcome expectancies for purchasing fresh fruit and for purchasing fresh vegetables versus other forms of fruit and vegetables (F&V). Survey instruments were administered twice, separated by 6 weeks. Recruited in front of supermarkets and grocery stores; interviews conducted by telephone. One hundred and sixty-one food shoppers with children (18 years or younger). Single dimension scales were specified for fruit and for vegetable purchasing outcome expectancies, and for comparative (fresh vs. other) fruit and vegetable purchasing outcome expectancies. Item Response Theory parameter estimates revealed easily interpreted patterns in the sequence of items by difficulty of response. Fruit and vegetable purchasing and fresh fruit comparative purchasing outcome expectancy scales were significantly correlated with home F&V availability, after controlling for social desirability of response. Comparative fresh vegetable outcome expectancy scale was significantly bivariately correlated with home vegetable availability, but not after controlling for social desirability. These scales are available to help better understand family F&V purchasing decisions.

Abortion misinformation from crisis pregnancy centers in North Carolina.

PubMed

Bryant, Amy G; Levi, Erika E

2012-12-01

This study assessed the accuracy of medical information provided by crisis pregnancy centers in North Carolina. We performed a secondary data analysis of a "secret shopper survey" performed by a nonprofit organization. Reports from phone calls and visits to crisis pregnancy centers were analyzed for quality and content of medical information provided. Web sites of crisis pregnancy centers in the state were also reviewed. Thirty-two crisis pregnancy centers were contacted. Nineteen of these were visited. Fourteen centers (44%) offered that they "provide counseling on abortion and its risks." Inaccurate information provided included a link between abortion and breast cancer (16%), infertility (26%) and mental health problems (26%). Of the 36 Web sites identified, 31 (86%) provided false or misleading information, including 26 sites (72%) linking abortion to "post-abortion stress." Many crisis pregnancy centers give inaccurate medical information regarding the risks of abortion. Overstating risks stigmatizes abortion, seeks to intimidate women and is unethical. Copyright © 2012 Elsevier Inc. All rights reserved.

The personal shopper--a pilot randomized trial of grocery store-based dietary advice.

PubMed

Lewis, K H; Roblin, D W; Leo, M; Block, J P

2015-06-01

The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index--2005 [0-100 points]), and nutritional knowledge (0-65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. © 2015 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity.

Investigating the LED's dark side. Novel LED Model Offers New Insights

DOE PAGES

Chow, Weng Wah

2014-07-01

A revolution in lighting is well on its way. Rewind the clock a year or so and the prices of LED bulbs made many shoppers wince. But now it is possible to get a high-quality 60 W equivalent for well under $10, and that’s allowing sales of LED bulbs incorporating chips from the likes of Cree and Philips Lumileds to take off. Although these solid-state bulbs are much more pricey than incandescents, which have largely disappeared from shelves due to legislation, they more than make up for that additional up-front cost with a substantial trimming of the electricity bill. Itmore » is a more tricky decision, however, whether it makes more sense to buy an LED bulb or a cheaper compact fluorescent (CFL). In terms of durability, adaptability and environmental impact, the solid-state bulb is the clear winner. But both types of light are similar in the efficiency stakes, and thus the running costs.« less

Sentimental analysis of Amazon reviews using naïve bayes on laptop products with MongoDB and R

NASA Astrophysics Data System (ADS)

Kamal Hassan, Mohan; Prasanth Shakthi, Sana; Sasikala, R.

2017-11-01

Start In Today’s era the e-commerce is developing rapidly these years, buying products on-line has become more and more fashionable owing to its variety of options, low cost value (high discounts) and quick supply systems, so abundant folks intend to do online shopping. In the meantime the standard and delivery of merchandise is uneven, fake branded products are delivered. We use product users review comments about product and review about retailers from Amazon as data set and classify review text by subjectivity/objectivity and negative/positive attitude of buyer. Such reviews are helpful to some extent, promising both the shoppers and products makers. This paper presents an empirical study of efficacy of classifying product review by tagging the keyword. In the present study, we tend to analyse the fundamentals of determining, positive and negative approach towards the product. Thus we hereby propose completely different approaches by removing the unstructured data and then classifying comments employing Naive Bayes algorithm.

The Effect of Introducing a Minimum Price on the Distribution of Alcohol Purchase: A Counterfactual Analysis.

PubMed

Sharma, Anurag; Etilé, Fabrice; Sinha, Kompal

2016-09-01

We use counterfactual analysis techniques to evaluate the impact of a $2 minimum unit price (MUP) on the distribution of Australian (Victorian) household off-trade alcohol purchases. Our estimates suggest that a $2 MUP significantly reduces the purchases of at-risk households by up to -0.92 [90% CI: -1.55, -0.28] standard drinks at the highest quantiles and has substantially less effect on households purchasing at light and moderate levels. A $2 MUP may reduce the proportions of male and female shoppers purchasing at the public health threshold of more than two standard drinks per household member per day by -3.03 [90% CI: -4.83, -1.22] percentage points (relative variation: -17%); and -1.85 [90% CI: -2.60, -1.10] percentage points (relative variation:-22%), respectively. Implementing an MUP on alcohol thus promises significant positive impacts on public health. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Selling antimicrobials without prescription - Far beyond an administrative problem.

PubMed

Guinovart, Maria C; Figueras, Albert; Llor, Carles

2018-05-01

Selling antibiotics without prescription is common in many countries; beyond the administrative restrictions, this practice is a risk for patients and society. The aim of the study was to evaluate the information provided by the staff of the pharmacy to a simulated patient requesting an antibiotic. A prospective study was carried out in January 2013 - February 2014 in the Health Region of Tarragona, in which a mystery shopper visited 220 pharmacies requesting an antibiotic to be sold. The actress was not asked about allergies in 73.9% of cases and never was asked about possible pregnancy. Recommendation to see a doctor was observed in 36.1% of cases. When antibiotics were not sold, the explanation provided by the staff was reasoned only in 9.9% of the cases. It is necessary and urgent to improve the training of pharmacists in dispensing antibiotics but also strengthen basic health knowledge among the population. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Food neophobia, nanotechnology and satisfaction with life.

PubMed

Schnettler, Berta; Crisóstomo, Gloria; Sepúlveda, José; Mora, Marcos; Lobos, Germán; Miranda, Horacio; Grunert, Klaus G

2013-10-01

This study investigates the relationship between food neophobia, satisfaction with life and food-related life, and acceptance of the use of nanotechnology in food production. Questionnaire data was collected from a sample of 400 supermarket shoppers in southern Chile. The questionnaire measured knowledge of nanotechnology and willingness to purchase food products involving nanotechnology, and included the SWLS (Satisfaction with Life Scale), SWFL (Satisfaction with Food-related Life) and FNS (Food Neophobia Scale) scales. Using cluster analysis, four consumer types were distinguished with significant differences in their scores on the SWLS, SWFL and FNS. The types differed in their knowledge of nanotechnology, willingness to purchase foods involving nanotechnology, age, socioeconomic level and lifestyle. The least food-neophobic type had the highest levels of satisfaction with life and with food-related life and also had the highest acceptance of packaging and foods produced with nanotechnology. The results suggest that the degree of food neophobia is associated with satisfaction with life and with food-related life, as well as with the acceptance of products with nanotechnological applications. Copyright © 2013 Elsevier Ltd. All rights reserved.

Making choices impairs subsequent self-control: a limited-resource account of decision making, self-regulation, and active initiative.

PubMed

Vohs, Kathleen D; Baumeister, Roy F; Schmeichel, Brandon J; Twenge, Jean M; Nelson, Noelle M; Tice, Dianne M

2008-05-01

The current research tested the hypothesis that making many choices impairs subsequent self-control. Drawing from a limited-resource model of self-regulation and executive function, the authors hypothesized that decision making depletes the same resource used for self-control and active responding. In 4 laboratory studies, some participants made choices among consumer goods or college course options, whereas others thought about the same options without making choices. Making choices led to reduced self-control (i.e., less physical stamina, reduced persistence in the face of failure, more procrastination, and less quality and quantity of arithmetic calculations). A field study then found that reduced self-control was predicted by shoppers' self-reported degree of previous active decision making. Further studies suggested that choosing is more depleting than merely deliberating and forming preferences about options and more depleting than implementing choices made by someone else and that anticipating the choice task as enjoyable can reduce the depleting effect for the first choices but not for many choices. (c) 2008 APA, all rights reserved

Automation and workflow considerations for embedding Digimarc Barcodes at scale

NASA Astrophysics Data System (ADS)

Rodriguez, Tony; Haaga, Don; Calhoon, Sean

2015-03-01

The Digimarc® Barcode is a digital watermark applied to packages and variable data labels that carries GS1 standard GTIN-14 data traditionally carried by a 1-D barcode. The Digimarc Barcode can be read with smartphones and imaging-based barcode readers commonly used in grocery and retail environments. Using smartphones, consumers can engage with products and retailers can materially increase the speed of check-out, increasing store margins and providing a better experience for shoppers. Internal testing has shown an average of 53% increase in scanning throughput, enabling 100's of millions of dollars in cost savings [1] for retailers when deployed at scale. To get to scale, the process of embedding a digital watermark must be automated and integrated within existing workflows. Creating the tools and processes to do so represents a new challenge for the watermarking community. This paper presents a description and an analysis of the workflow implemented by Digimarc to deploy the Digimarc Barcode at scale. An overview of the tools created and lessons learned during the introduction of technology to the market are provided.

An In-Store Experiment on the Effect of Accessibility on Sales of Wholegrain and White Bread in Supermarkets

PubMed Central

de Wijk, René A.; Maaskant, Anna J.; Polet, Ilse A.; Holthuysen, Nancy T. E.; van Kleef, Ellen; Vingerhoeds, Monique H.

2016-01-01

Even though whole grain foods have various health benefits, consumers have been found not to eat enough of them. Nudging interventions are built on the premise that food purchases and consumption are strongly influenced by the environment in which decisions are made. Little research has been conducted to examine the influence of a small and inexpensive nudging intervention on bread choices in a real-life supermarket context. An in-store experiment was conducted in two six-week periods in two supermarkets to investigate the effects of accessibility on consumers’ purchase of healthier whole grain and other types of bread. In the high accessibility condition, healthier bread was placed in a more convenient location for the shopper on the left side of the shelves where it was encountered first. In the low accessibility condition, it was placed on the right side. There were consistent significant differences in sales between supermarkets, types of bread, day of the week, but not between low and high accessibility. Additional research is needed to better understand the effects of convenience and accessibility on bread choices. PMID:27010704

The roles of constraint-based and dedication-based influences on user's continued online shopping behavior.

PubMed

Chang, Su-Chao; Chou, Chi-Min

2012-11-01

The objective of this study was to determine empirically the role of constraint-based and dedication-based influences as drivers of the intention to continue using online shopping websites. Constraint-based influences consist of two variables: trust and perceived switching costs. Dedication-based influences consist of three variables: satisfaction, perceived usefulness, and trust. The current results indicate that both constraint-based and dedication-based influences are important drivers of the intention to continue using online shopping websites. The data also shows that trust has the strongest total effect on online shoppers' intention to continue using online shopping websites. In addition, the results indicate that the antecedents of constraint-based influences, technical bonds (e.g., perceived operational competence and perceived website interactivity) and social bonds (e.g., perceived relationship investment, community building, and intimacy) have indirect positive effects on the intention to continue using online shopping websites. Based on these findings, this research suggests that online shopping websites should build constraint-based and dedication-based influences to enhance user's continued online shopping behaviors simultaneously.

Design and architecture of retailapp: an application to support conventional retailers

NASA Astrophysics Data System (ADS)

Jaya, I.; Tarigan, J. T.; Hardi, S. M.; Nasution, M. K. M.

2018-03-01

Over the last few years, the preference on shopping over internet application, usually called online shopping or e-shopping, has increased significantly. One of the major advantage of online shopping is the capability to use digital content to support the marketing process. Prospective buyers can conveniently browse and look to a certain object and find the information needed with a few clicks. Moreover, the use of multimedia (such as images, sound, and movies) may help prospective buyers to make a decision faster than conventional shopping at retailers. However, shoppers still consider that conventional shopping is the best way to perform shopping due to the ability to make a physical contact to the object. Our objective is to merge these experiences by enabling user to find digital content that relate to nearby retailers. In this research, we built a mobile application that collects data from nearby retailers and shows it to its user. By using this application, it will be easier to users to find the location of the object and to find nearby promotion.

Web 2.0 and health 2.0: are you in?

PubMed

Felkey, Bill G

2008-01-01

With over 6 billion web pages, over $100 billion in online sales every year in the U.S. alone and the average growth rate of online purchasing exceeding 26% over the last 5 years, the Internet is a powerful business tool. Today's shopper sees your actual pharmacy location and your Internet presence as one and the same. One study showed that 82% of the consumers surveyed who had a single frustrating experience online with a retailer would not return to the site for future dealings. A bad experience online made 28% of those surveyed unlikely to return to the retail location of the business, and over 55% said a bad online experience would have a negative impact on their overall opinion of the retailer. Web 2.0 refers to the social networking applications of the internet, Health 2.0 to its special health applications. Taking your Internet presence to the 2.0 level must be balanced with all of the other demands you are facing-but be aware that it's happening all around you.

Shopping center wheelchair accessibility: ongoing advocacy to implement the Americans with Disabilities Act of 1990.

PubMed

McClain, L

2000-01-01

Although the regulations of the Americans with Disabilities Act (ADA) of 1990 were phased in by 1992, monitoring and enforcement continue to be problematic. This study of three large shopping centers in the Southwest included one mall that was opened in the mid-1990s, and two malls that were constructed prior to the law (but have undergone recent renovations). Use of the ADA Accessibility Guidelines Checklist for Buildings and Facilities (Architectural and Transportation Barriers Compliance Board [ATBCB], 1992) generated data which were analyzed descriptively to determine the frequency and percent compliance in: parking lots, entrances, ramps, elevators, telephones, restrooms, food courts, and 12 specific store-types. No mall was fully compliant in any area, other than telephone specifications. In other areas, compliance ranged from 0% (ramp slopes in the newer mall) to many areas of 100% compliance (for example, outdoor curb ramps and food court seating spaces and aisles). The implications are that shoppers who are wheelchair mobile cannot count on complete compliance and cannot predict which physical architectural barriers they will find in shopping centers.

An assessment of public attitudes toward automated external defibrillators.

PubMed

Lubin, Jeffrey; Chung, S Sujin; Williams, Kenneth

2004-07-01

We assessed the familiarity of the general public with automated external defibrillators (AEDs) and their willingness to use them. Shoppers were asked to complete a survey in an AED-equipped suburban shopping mall. 359 surveys were analyzed. Of the participants, 11% were healthcare professionals, 51% had training in CPR or first aid, and 44% had no medical training. Sixty percent were able to define defibrillator adequately. Seventy-one percent stated they would be likely to use an AED to resuscitate a stranger. The most common concerns were fear of using the machine incorrectly (57%) and fear of legal liability (38%). After being told of liability protection from the federal Cardiac Arrest Survival Act, 84% stated they would be likely to use the AED. This increased further to 91% if the participants were given an opportunity to receive training. Although a substantial number of people in this setting were willing to use an AED, education regarding legal liability and proper use of the machines increased the reported likelihood of use. Further public education may be necessary to provide optimally effective public access defibrillation programs.

Store Impulse Marketing Strategies and Body Mass Index.

PubMed

Cohen, Deborah A; Collins, Rebecca; Hunter, Gerald; Ghosh-Dastidar, Bonnie; Dubowitz, Tamara

2015-07-01

We quantified the use of placement and price reduction marketing strategies in different food retail outlets to identify associations between these strategies and the risk of overweight and obesity among customers. In 2011 we collected dietary and health information from 1372 residents in "food deserts" in Pittsburgh, PA. We audited neighborhood restaurants and food stores (n = 40) including 16 distant food venues at which residents reported shopping. We assessed end-aisle displays, special floor displays, cash register displays, and price reductions for sugar-sweetened beverages (SSBs); foods high in saturated oils, fats, and added sugars; and nutritious foods such as fruits, vegetables, and products with at least 51% whole grains. Supermarkets and superstores had the largest numbers of displays and price reductions for low-nutrient foods. Exposure to displays of SSBs and foods high in saturated oils, fats, and added sugars and price reduction of SSBs was associated with increased body mass index. In-store marketing strategies of low-nutrient foods appear to be risk factors for a higher body mass index among regular shoppers. Future research is needed to confirm the causal role of marketing strategies in obesity.

Market environment and Medicaid acceptance: What influences the access gap?

PubMed

Bond, Amelia; Pajerowski, William; Polsky, Daniel; Richards, Michael R

2017-12-01

The U.S. health care system is undergoing significant changes. Two prominent shifts include millions added to Medicaid and greater integration and consolidation among firms. We empirically assess if these two industry trends may have implications for each other. Using experimentally derived ("secret shopper") data on primary care physicians' real-world behavior, we observe their willingness to accept new privately insured and Medicaid patients across 10 states. We combine this measure of patient acceptance with detailed information on physician and commercial insurer market structure and show that insurer and provider concentration are each positively associated with relative improvements in appointment availability for Medicaid patients. The former is consistent with a smaller price discrepancy between commercial and Medicaid patients and suggests a beneficial spillover from greater insurer market power. The findings for physician concentration do not align with a simple price bargaining explanation but do appear driven by physician firms that are not vertically integrated with a health system. These same firms also tend to rely more on nonphysician clinical staff. Copyright © 2017 John Wiley & Sons, Ltd.

Using photovoice methodology to investigate facilitators and barriers to food acquisition and preparation by rural older women.

PubMed

Neill, Carly; Leipert, Beverly D; Garcia, Alicia C; Kloseck, Marita

2011-01-01

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.

Food security and child hunger among recently resettled Liberian refugees and asylum seekers: a pilot study.

PubMed

Hadley, Craig; Sellen, Daniel

2006-10-01

Little is known about the food insecurity situation among families resettled into the United States as part of the refugee resettlement program. This paper reports on a pilot study examining food insecurity among recently arrived refugee families (n=33). Objectives were to evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socio-economic status and measures of acculturation. Results indicated that 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. Results are in broad agreement with those reported in other studies and highlight economic and information barriers to achieving food security. These data suggest that further study of food insecurity is warranted among recently resettled refugee communities resettled in the United States.

Multiple "buy buttons" in the brain: Forecasting chocolate sales at point-of-sale based on functional brain activation using fMRI.

PubMed

Kühn, Simone; Strelow, Enrique; Gallinat, Jürgen

2016-08-01

We set out to forecast consumer behaviour in a supermarket based on functional magnetic resonance imaging (fMRI). Data was collected while participants viewed six chocolate bar communications and product pictures before and after each communication. Then self-reports liking judgement were collected. fMRI data was extracted from a priori selected brain regions: nucleus accumbens, medial orbitofrontal cortex, amygdala, hippocampus, inferior frontal gyrus, dorsomedial prefrontal cortex assumed to contribute positively and dorsolateral prefrontal cortex and insula were hypothesized to contribute negatively to sales. The resulting values were rank ordered. After our fMRI-based forecast an instore test was conducted in a supermarket on n=63.617 shoppers. Changes in sales were best forecasted by fMRI signal during communication viewing, second best by a comparison of brain signal during product viewing before and after communication and least by explicit liking judgements. The results demonstrate the feasibility of applying neuroimaging methods in a relatively small sample to correctly forecast sales changes at point-of-sale. Copyright © 2016. Published by Elsevier Inc.

Where do food desert residents buy most of their junk food? Supermarkets.

PubMed

Vaughan, Christine A; Cohen, Deborah A; Ghosh-Dastidar, Madhumita; Hunter, Gerald P; Dubowitz, Tamara

2017-10-01

To examine where residents in an area with limited access to healthy foods (an urban food desert) purchased healthier and less healthy foods. Food shopping receipts were collected over a one-week period in 2013. These were analysed to describe where residents shopped for food and what types of food they bought. Two low-income, predominantly African-American neighbourhoods with limited access to healthy foods in Pittsburgh, PA, USA. Two hundred and ninety-three households in which the primary food shoppers were predominantly female (77·8 %) and non-Hispanic black (91·1 %) adults. Full-service supermarkets were by far the most common food retail outlet from which food receipts were returned and accounted for a much larger proportion (57·4 %) of food and beverage expenditures, both healthy and unhealthy, than other food retail outlets. Although patronized less frequently, convenience stores were notable purveyors of unhealthy foods. Findings highlight the need to implement policies that can help to decrease unhealthy food purchases in full-service supermarkets and convenience stores and increase healthy food purchases in convenience stores.

An In-Store Experiment on the Effect of Accessibility on Sales of Wholegrain and White Bread in Supermarkets.

PubMed

de Wijk, René A; Maaskant, Anna J; Polet, Ilse A; Holthuysen, Nancy T E; van Kleef, Ellen; Vingerhoeds, Monique H

2016-01-01

Even though whole grain foods have various health benefits, consumers have been found not to eat enough of them. Nudging interventions are built on the premise that food purchases and consumption are strongly influenced by the environment in which decisions are made. Little research has been conducted to examine the influence of a small and inexpensive nudging intervention on bread choices in a real-life supermarket context. An in-store experiment was conducted in two six-week periods in two supermarkets to investigate the effects of accessibility on consumers' purchase of healthier whole grain and other types of bread. In the high accessibility condition, healthier bread was placed in a more convenient location for the shopper on the left side of the shelves where it was encountered first. In the low accessibility condition, it was placed on the right side. There were consistent significant differences in sales between supermarkets, types of bread, day of the week, but not between low and high accessibility. Additional research is needed to better understand the effects of convenience and accessibility on bread choices.

Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia.

PubMed

Ferguson, Megan; Brown, Clare; Georga, Claire; Miles, Edward; Wilson, Alyce; Brimblecombe, Julie

2017-06-01

To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia. Availability was assessed through repeated semi-structured interviews and consumption via a survey. Quantitative data were described and qualitative data classified. Aboriginal and non-Indigenous key informants (n=30 in 2013; n=19 in 2014) from 20 Northern Territory (NT) communities participated in interviews. Aboriginal primary household shoppers (n=73 in 2014) in five of these communities participated in a survey. Traditional foods were reported to be available year-round in all 20 communities. Most participants (89%) reported consuming a variety of traditional foods at least fortnightly and 71% at least weekly. Seventy-six per cent reported being food insecure, with 40% obtaining traditional food during these times. Traditional food is consumed frequently by Aboriginal people living in remote NT. Implications for public health: Quantifying dietary contribution of traditional food would complement estimated population dietary intake. It would contribute evidence of nutrition transition and differences in intakes across age groups and inform dietary, environmental and social interventions and policy. Designing and conducting assessment of traditional food intake in conjunction with Aboriginal leaders warrants consideration. © 2017 The Authors.

Food category purchases vary by household education and race/ethnicity: results from grocery receipts.

PubMed

Cullen, Karen; Baranowski, Tom; Watson, Kathy; Nicklas, Theresa; Fisher, Jennifer; O'Donnell, Sharon; Baranowski, Janice; Islam, Noemi; Missaghian, Mariam

2007-10-01

To characterize food group purchases from grocery receipts. Food shoppers (aged>or=19 years with at least one child aged

Frequent shopping by men and women increases survival in the older Taiwanese population.

PubMed

Chang, Yu-Hung; Chen, Rosalind Chia-Yu; Wahlqvist, Mark L; Lee, Meei-Shyuan

2012-07-01

Active ageing is a key to healthy ageing; shopping behaviour is an economically relevant activity of the elderly. Analysis was based on the NAHSIT 1999-2000 dataset. A total of 1841 representative free-living elderly Taiwanese people were selected and information included demographics, socioeconomic status, health behaviours, shopping frequencies, physical function and cognitive function. These data were linked to official death records. Cox proportional hazard models were used to evaluate shopping frequency on death from 1999-2008 with possible covariate adjustment. Highly frequent shopping compared to never or rarely predicted survival (HR 0.54, 95% CI 0.43 to 0.67) with adjustment for physical function and cognitive function and other covariates HR was 0.73 (95% CI 0.56 to 0.93). Elderly who shopped every day have 27% less risk of death than the least frequent shoppers. Men benefited more from everyday shopping than women with decreased HR 28% versus 23% compared to the least. Shopping behaviour favourably predicts survival. Highly frequent shopping may favour men more than women. Shopping captures several dimensions of personal well-being, health and security as well as contributing to the community's cohesiveness and economy and may represent or actually confer increased longevity.

Nutrition knowledge, and use and understanding of nutrition information on food labels among consumers in the UK.

PubMed

Grunert, Klaus G; Wills, Josephine M; Fernández-Celemín, Laura

2010-10-01

Based on in-store observations in three major UK retailers, in-store interviews (2019) and questionnaires filled out at home and returned (921), use of nutrition information on food labels and its understanding were investigated. Respondents' nutrition knowledge was also measured, using a comprehensive instrument covering knowledge of expert recommendations, nutrient content in different food products, and calorie content in different food products. Across six product categories, 27% of shoppers were found to have looked at nutrition information on the label, with guideline daily amount (GDA) labels and the nutrition grid/table as the main sources consulted. Respondents' understanding of major front-of-pack nutrition labels was measured using a variety of tasks dealing with conceptual understanding, substantial understanding and health inferences. Understanding was high, with up to 87.5% of respondents being able to identify the healthiest product in a set of three. Differences between level of understanding and level of usage are explained by different causal mechanisms. Regression analysis showed that usage is mainly related to interest in healthy eating, whereas understanding of nutrition information on food labels is mainly related to nutrition knowledge. Both are in turn affected by demographic variables, but in different ways.

Outbreak of Salmonella Heidelberg infections linked to a single poultry producer -- 13 states, 2012-2013.

PubMed

2013-07-12

In June 2012, the Oregon Health Authority and the Washington State Department of Health noted an increase in the number of Salmonella enterica serotype Heidelberg clinical isolates sharing an identical pulsed-field gel electrophoresis (PFGE) pattern. In 2004, this pattern had been linked to chicken from Foster Farms by the Washington State Department of Health; preliminary 2012 interviews with infected persons also indicated exposure to Foster Farms chicken. On August 2, 2012, CDC's PulseNet* detected a cluster of 19 Salmonella Heidelberg clinical isolates matching the outbreak pattern. This report summarizes the investigation by CDC, state and local health departments, the U.S. Department of Agriculture's Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA) and reinforces the importance of safe food handling to prevent illness. A total of 134 cases from 13 states were identified, including 33 patients who were hospitalized. This multifaceted investigation used standard epidemiologic and laboratory data along with patient shopper card purchase information, and PFGE data from the retail meat component of the National Antimicrobial Resistance Monitoring System (NARMS)†, a relatively novel tool in outbreak investigation, to link the outbreak strain to chicken from Foster Farms.

Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers.

PubMed

Amaro, Hortensia; Cortés, Dharma E; Garcia, Samantha; Duan, Lei; Black, David S

2017-05-01

To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.

Store Impulse Marketing Strategies and Body Mass Index

PubMed Central

Collins, Rebecca; Hunter, Gerald; Ghosh-Dastidar, Bonnie; Dubowitz, Tamara

2015-01-01

Objectives. We quantified the use of placement and price reduction marketing strategies in different food retail outlets to identify associations between these strategies and the risk of overweight and obesity among customers. Methods. In 2011 we collected dietary and health information from 1372 residents in “food deserts” in Pittsburgh, PA. We audited neighborhood restaurants and food stores (n = 40) including 16 distant food venues at which residents reported shopping. We assessed end-aisle displays, special floor displays, cash register displays, and price reductions for sugar-sweetened beverages (SSBs); foods high in saturated oils, fats, and added sugars; and nutritious foods such as fruits, vegetables, and products with at least 51% whole grains. Results. Supermarkets and superstores had the largest numbers of displays and price reductions for low-nutrient foods. Exposure to displays of SSBs and foods high in saturated oils, fats, and added sugars and price reduction of SSBs was associated with increased body mass index. Conclusions. In-store marketing strategies of low-nutrient foods appear to be risk factors for a higher body mass index among regular shoppers. Future research is needed to confirm the causal role of marketing strategies in obesity. PMID:25521881

Assessing the potential for raw meat to influence human colonization with Staphylococcus aureus.

PubMed

Carrel, Margaret; Zhao, Chang; Thapaliya, Dipendra; Bitterman, Patrick; Kates, Ashley E; Hanson, Blake M; Smith, Tara C

2017-09-07

The role of household meat handling and consumption in the transfer of Staphylococcus aureus (S. aureus) from livestock to consumers is not well understood. Examining the similarity of S. aureus colonizing humans and S. aureus in meat from the stores in which those individuals shop can provide insight into the role of meat in human S. aureus colonization. S. aureus isolates were collected from individuals in rural and urban communities in Iowa (n = 3347) and contemporaneously from meat products in stores where participants report purchasing meat (n = 913). The staphylococcal protein A (spa) gene was sequenced for all isolates to determine a spa type. Morisita indices and Permutational Multivariate Analysis of Variance Using Distance Matrices (PERMANOVA) were used to determine the relationship between spa type composition among human samples and meat samples. spa type composition was significantly different between households and meat sampled from their associated grocery stores. spa types found in meat were not significantly different regardless of the store or county in which they were sampled. spa types in people also exhibit high similarity regardless of residential location in urban or rural counties. Such findings suggest meat is not an important source of S. aureus colonization in shoppers.

Consumer perception and insights on fats and fatty acids: knowledge on the quality of diet fat.

PubMed

Diekman, Connie; Malcolm, Kim

2009-01-01

Research indicates that consumers do not understand dietary fat, either the importance of the quality or the quantity of fats needed for health. Previous consumer surveys suggest the priority placed on fat in various nutrition communications (i.e., low fat or reduction in fats) has contributed to this confusion. This consumer study was carried out in 16 countries in two waves, investigating in total 6,426 subjects. The survey was conducted by phone, internet and face-to-face interviews, depending on the acceptable method for the population. Participants, aged 18-70 years, were the main family shopper. Knowledge about fat is conflicted, including which fats have health benefits; 59% of respondents think fat should be avoided, 65% think a low-fat diet is a healthy diet and 38% claim to avoid foods containing fat. Respondents were aware of different types of fats but did not know which ones were healthier. Omegas have the greatest level of recognition but at the same time many people do not realize they are fats. Around half of consumers do not know whether fats are good or bad, meaning they do not know what to eat. Copyright 2009 S. Karger AG, Basel.

Comparison of methods used for estimating pharmacist counseling behaviors.

PubMed

Schommer, J C; Sullivan, D L; Wiederholt, J B

1994-01-01

To compare the rates reported for provision of types of information conveyed by pharmacists among studies for which different methods of estimation were used and different dispensing situations were studied. Empiric studies conducted in the US, reported from 1982 through 1992, were selected from International Pharmaceutical Abstracts, MEDLINE, and noncomputerized sources. Empiric studies were selected for review if they reported the provision of at least three types of counseling information. Four components of methods used for estimating pharmacist counseling behaviors were extracted and summarized in a table: (1) sample type and area, (2) sampling unit, (3) sample size, and (4) data collection method. In addition, situations that were investigated in each study were compiled. Twelve studies met our inclusion criteria. Patients were interviewed via telephone in four studies and were surveyed via mail in two studies. Pharmacists were interviewed via telephone in one study and surveyed via mail in two studies. For three studies, researchers visited pharmacy sites for data collection using the shopper method or observation method. Studies with similar methods and situations provided similar results. Data collected by using patient surveys, pharmacist surveys, and observation methods can provide useful estimations of pharmacist counseling behaviors if researchers measure counseling for specific, well-defined dispensing situations.

Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers

PubMed Central

Cortés, Dharma E.; Garcia, Samantha; Duan, Lei; Black, David S.

2017-01-01

Objectives. To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. Methods. From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). Results. Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. Conclusions. Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home. PMID:28323473

Healthful grocery shopping. Perceptions and barriers.

PubMed

Hollywood, Lynsey E; Cuskelly, Geraldine J; O'Brien, Michelle; McConnon, Aine; Barnett, Julie; Raats, Monique M; Dean, Moira

2013-11-01

While there is evidence of the factors influencing the healthfulness of consumers' food choice, little is known about how consumers perceive the healthfulness of their shopping. This study aimed to explore consumers' perceptions of, and identify barriers to, conducting a healthful shop. Using a qualitative approach, consisting of an accompanied shop and post-shop telephone interview, 50 grocery shoppers were recruited. Results showed that consumers used three criteria to identify a healthful shop: (1) inclusion of healthful foods; (2) avoidance or restriction of particular foods; and (3) achieving a balance between healthful and unhealthful foods. Those who take a balanced approach employ a more holistic approach to their diet while those who avoid or include specific foods may be setting criteria to purchase only certain types of food. The effectiveness of any of these strategies in improving healthfulness is still unclear and requires further investigation. Two barriers to healthful shopping were: (i) lack of self-efficacy in choosing, preparing and cooking healthful foods and (ii) conflicting needs when satisfying self and others. This highlights the need for interventions targeted at building key food skills and for manufacturers to make healthful choices more appealing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Implementation of mass media community health education: the Forsyth County Cervical Cancer Prevention Project.

PubMed

Dignan, M; Bahnson, J; Sharp, P; Beal, P; Smith, M; Michielutte, R

1991-09-01

The Forsyth County Cervical Cancer Prevention Project (FCP) is a community-based health education project funded by the National Cancer Institute. The target population includes around 25 000 black women age 18 and older who reside in Forsyth County, North Carolina. The overall goal of the program is to prevent mortality from cervical cancer by promoting Pap smears and return for follow-up care when needed. Based on the principles of social marketing, a plan to reach the target population with mass media educational messages through electronic and print channels was developed. Guided by marketing objectives, the target population was divided into relatively discrete segments. The segments included church attenders, patients in waiting rooms of public and selected health providers, female students at local colleges, shoppers, viewers of radio and television, newspaper readers, and business owners and managers. Introduction of the program was based on strategies developed for reaching the target population in each segment with television, radio and print mass media messages. Qualitative assessment of the mass media developed by the program indicated that all forms of communication helped to increase awareness of the program.

Impact of training on pharmacists' counseling of patients starting antidepressant therapy.

PubMed

Liekens, Sophie; Vandael, Eline; Roter, Debra; Larson, Susan; Smits, Tim; Laekeman, Gert; Foulon, Veerle

2014-01-01

To measure the impact of a one-day depression-related training program on pharmacists' counseling of unannounced "mystery shoppers" (MS) starting antidepressant therapy. Clustered RCT pharmacies; intervention group pharmacists received communication skills training related to depression (n=21); control pharmacists did not (n=19). Eight months after training, the 40 community pharmacies were visited by MS with a first prescription for antidepressants. The pharmacy interactions were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Mann-Whitney U tests were used to evaluate the impact of training on pharmacy interactions and MS evaluations of the pharmacists' skills and attitudes. Interactions of intervention group pharmacists were significantly longer and consisted of more education and counseling statements about lifestyle and psychosocial concerns. Intervention group pharmacists asked more questions about medical condition and therapeutic regimen, as well as socioemotional concerns. MS gave more socioemotional information to intervention group pharmacists and were more positive in their assessment of these pharmacists' skills and attitudes (p values<0.05). Pharmacist training in depression care can positively affect the quality of patient care. Postgraduate training in depression related services is a worthwhile approach to improve the quality of pharmaceutical care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Improving shop floor compliance with age restrictions for alcohol sales: effectiveness of a feedback letter intervention.

PubMed

Van Hoof, Joris J; Gosselt, Jordy F; Baas, Niels; De Jong, Menno D T

2012-10-01

In this study, we investigated the effects and handling of an intervention to increase compliance with age limits regarding alcohol sales. The intervention tested in this field experiment was a feedback letter sent to alcohol outlets about their individual compliance results based on a mystery shopping study. We measured compliance in 146 alcohol outlets (cafeterias, supermarkets, bars, liquor stores and youth centres) in one region in the Netherlands with 15-year-old mystery shoppers. About half (n=72) of the outlets received the intervention letter (the experimental group). After this intervention, we measured compliance again (n=138). Then we sent the same letter to the control group and interviewed all the outlets regarding their handling of the intervention (n=106). After the experimental group received the letter, compliance increased significantly (from 18.1% to 32.4%). In the control group, compliance did not change. Of the outlets interviewed, 81% stated that they had received the letter, and the action most commonly taken was to bring the letter to the attention of their staff. Positive feedback letters are more often copied and shared integrally with personnel, compared with negative letters. Compliance with respect to underage alcohol sales can be improved, although compliance levels remain low in the Netherlands.

The interactive effects of affect and shopping goal on information search and product evaluations.

PubMed

Chen, Fangyuan; Wyer, Robert S; Shen, Hao

2015-12-01

Although shoppers often want to evaluate products to make a purchase decision, they can also shop for enjoyment. In each case, the amount of time they spend on shopping and the number of options they consider can depend on the mood they happen to be in. We predicted that mood can signal whether the goal has been attained and when people should stop processing information. When people are primarily motivated to purchase a particular type of product, positive mood signals that they have done enough. Thus, they consider less information if they are happy than if they are unhappy. When people shop for enjoyment, however, positive mood signals that they are still having fun. Thus, they consider more information when they are happy than when they are not. Four experiments among university students (N = 827) examined these possibilities. Experiment 1 provided initial evidence for the interactive effects of mood and goals on search behavior and product evaluation. Other studies examined the implications of this conceptualization for different domains: (a) the relative impact of brand and attribute information on judgments (Experiment 2), (b) gender differences in shopping behavior (Experiment 3), and (c) the number of options that people review in an actual online shopping website (Experiment 4). (c) 2015 APA, all rights reserved).

Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake

PubMed Central

Leone, Lucia A.; Haynes-Maslow, Lindsey; Ammerman, Alice S.

2016-01-01

We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2–3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of −1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P = .01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users. PMID:28529669

Veggie Van Pilot Study: Impact of a Mobile Produce Market for Underserved Communities on Fruit and Vegetable Access and Intake.

PubMed

Leone, Lucia A; Haynes-Maslow, Lindsey; Ammerman, Alice S

2017-01-01

We conducted a pilot evaluation of the Veggie Van, a mobile produce market that brings weekly boxes of reduced-cost locally grown fruits and vegetables (F&V) to lower-income communities and offers cooking and nutrition education to customers. We conducted surveys just prior to starting Veggie Van at each of 3 sites and again at 2-3 months. F&V intake was measured with a 2-question item and a 10-item food frequency questionnaire (FFQ) in a subset of participants. At baseline, average servings/day of F&V was 4.9 (SD = 2.6, n = 60). At follow-up, individuals who reported shopping at Veggie Van frequently (n = 32) increased their F&V consumption by 0.41 servings/day compared with a decrease of -1.19 for those who rarely/never used Veggie Van (n = 27), a total difference of 1.6 servings/day (P = .01). There were no statistically significant differences in F&V consumption between groups based on the FFQ measure. Frequent shoppers reported additional health improvements and increases in their ability to buy enough F&V. We conclude that offering weekly boxes of affordable F&V paired with education in underserved communities may improve F&V consumption for frequent program users.

How satisfied are hospital systems with their ownership of retail clinics?

PubMed

Kaissi, Amer; Charland, Thomas A

2013-01-01

Retail clinics--while innovative--can no longer be considered a new model of healthcare delivery, as an increasing number of hospitals and health systems now own them. The purpose of this article is to explore the extent to which hospital systems are satisfied with their ownership of retail clinics. In terms of operational challenges, respondents to our survey, administered to representatives from 19 health systems, were relatively satisfied with clinic staffing and their relationship with the retailers regarding lease terms, store locations, and shopper demographics. They expressed mostly neutral levels of satisfaction with regulations and laws related to retail clinics and low satisfaction with insurance reimbursement and clinics' seasonal patterns. The two areas that received the lowest respondent satisfaction ratings were patient volume and response to marketing initiatives. When asked to share their perceptions of their organization's satisfaction with various strategic aspects of retail clinic ownership, respondents revealed that the clinics were achieving several important strategic goals, such as improved access, increased referrals, defense against competitors, and increased brand exposure. They indicated overall dissatisfaction with profitability and cost-reduction outcomes. We conclude that serious operational challenges and strategic threats must be overcome if retail clinics are to be a successful service line for hospitals and health systems.

Assessment of Risk Communication about Undercooked Hamburgers by Restaurant Servers.

PubMed

Thomas, Ellen M; Binder, Andrew R; McLAUGHLIN, Anne; Jaykus, Lee-Ann; Hanson, Dana; Powell, Douglas; Chapman, Benjamin

2016-12-01

According to the U.S. Food and Drug Administration 2013 Model Food Code, it is the duty of a food establishment to disclose and remind consumers of risk when ordering undercooked food such as ground beef. The purpose of this study was to explore actual risk communication behaviors of food establishment servers. Secret shoppers visited 265 restaurants in seven geographic locations across the United States, ordered medium rare burgers, and collected and coded risk information from chain and independent restaurant menus and from server responses. The majority of servers reported an unreliable method of doneness (77%) or other incorrect information (66%) related to burger doneness and safety. These results indicate major gaps in server knowledge and risk communication, and the current risk communication language in the Model Food Code does not sufficiently fill these gaps. The question is "should servers even be acting as risk communicators?" There are numerous challenges associated with this practice, including high turnover rates, limited education, and the high stress environment based on pleasing a customer. If servers are designated as risk communicators, food establishment staff should be adequately trained and provided with consumer advisory messages that are accurate, audience appropriate, and delivered in a professional manner so that customers can make informed food safety decisions.

Shopping for fruits and vegetables. Food and retail qualities of importance to low-income households at the grocery store.

PubMed

Webber, Caroline B; Sobal, Jeffery; Dollahite, Jamie S

2010-04-01

Purchasing fruits and vegetables is an integral part of managing food consumption and dietary quality. This study examined how low-income adults who had primary responsibility for household food purchases considered retail produce decisions. We used a qualitative research approach based on grounded theory and an ecological conceptual framework. Twenty-eight low-income rural, village, and inner city heads of households in upstate New York, USA, were selected by purposive and theoretical sampling and interviewed about fruit and vegetable shopping habits, attitudes toward local food stores, and where and how they would prefer to buy produce. Analyses revealed their concerns were organized around five themes: store venue; internal store environment; product quality; product price; relationships with the stores. An unanticipated finding was the differing social relations that appear to exist between participant consumers, store employees and management, and the store itself as a representation of the larger retail food system. Attitudes toward retail food stores in this study are described as passive or fatalistic indifference, supportive, opportunistic, and confrontational (change agents). These attitudes are related to how shoppers considered retail fruit and vegetable choice, access, and availability. These findings suggest ways to individualize nutrition education and consumer education messages. Copyright 2009 Elsevier Ltd. All rights reserved.

Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships.

PubMed

Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A; Clark, Jeanne M; Bleich, Sara N

2014-09-01

To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships. In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m(2) was conducted. Our independent variable was "switching doctors because I felt treated differently because of my weight." Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used. Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p < 0.01] than nonshoppers. No significant differences in reporting high trust in current PCPs were found. A subset of patients with overweight/obesity doctor shop resulting from perceived differential treatment. These prior negative experiences have no association with trust in current relationships, but our results suggest that patients may remain sensitive to provider weight bias. © 2014 The Obesity Society.

Food safety labelling of chicken to prevent campylobacteriosis: consumer expectations and current practices.

PubMed

Allan, Philip D; Palmer, Chloe; Chan, Fiona; Lyons, Rebecca; Nicholson, Olivia; Rose, Mitchell; Hales, Simon; Baker, Michael G

2018-03-27

Campylobacter is the leading cause of bacterial gastroenteritis worldwide, and contaminated chicken is a significant vehicle for spread of the disease. This study aimed to assess consumers' knowledge of safe chicken handling practices and whether their expectations for food safety labelling of chicken are met, as a strategy to prevent campylobacteriosis. We conducted a cross-sectional survey of 401 shoppers at supermarkets and butcheries in Wellington, New Zealand, and a systematic assessment of content and display features of chicken labels. While 89% of participants bought, prepared or cooked chicken, only 15% knew that most (60-90%) fresh chicken in New Zealand is contaminated by Campylobacter. Safety and correct preparation information on chicken labels, was rated 'very necessary' or 'essential' by the majority of respondents. Supermarket chicken labels scored poorly for the quality of their food safety information with an average of 1.7/5 (95% CI, 1.4-2.1) for content and 1.8/5 (95% CI, 1.6-2.0) for display. Most consumers are unaware of the level of Campylobacter contamination on fresh chicken and there is a significant but unmet consumer demand for information on safe chicken preparation on labels. Labels on fresh chicken products are a potentially valuable but underused tool for campylobacteriosis prevention in New Zealand.

Qualitative study of influences on food store choice

PubMed Central

Krukowski, Rebecca A.; McSweeney, Jean; Sparks, Carla; West, Delia Smith

2012-01-01

Previous research indicates food store choice influences dietary intake and may contribute to health disparities. However, there is limited knowledge about the reasons which prompt the choice of a primary food store, particularly among populations vulnerable to obesity and chronic diseases (e.g., individuals living in rural locations and African-Americans). Purposive sampling was used to select rural and urban communities (3 African-American and 2 Caucasian focus groups; n=48) in Arkansas from June to November 2010, allowing examination of potential racial or rurality differences. Primary household food shoppers (n=48) (96% female, 63% African-American, mean age=48.1±13.9 years old, mean BMI=30.5±7.8) discussed reasons for choosing their primary store. Qualitative analysis techniques—content analysis and constant comparison—were used to identify themes. Four themes emerged: proximity to home or work, financial considerations and strategies, availability/quality of fruits, vegetables, and meat, and store characteristics (e.g., safety, cleanliness/smell, customer service, nonfood merchandise availability, and brand availability). While there were persistent rurality differences, the relevant factors were similar between African-American and Caucasian participants. These findings have important implications for future policies and programs promoting environmental changes related to dietary intake and obesity, particularly in rural areas that appear to have significant challenges in food store choice. PMID:22771756

Matriarchal model for cardiovascular prevention.

PubMed

Wild, R A; Taylor, E L; Knehans, A; Cleaver, V

1994-02-01

Family patterns of cardiovascular risk behavior are well documented. Significant correlation exists between spouse-spouse, parent-child, and sibling-sibling for cholesterol, high- and low-density lipoprotein, diet, physical activity, and smoking. Family/environmental influences are important in how/if risk and/or preventive behavior is learned. The family matriarch commonly functions as gatekeeper, controlling eating behavior, access to health care, and other patterns. She often acts as menu planner, shopper, and preparer of meals for all family members. She provides information and verbal reinforcement about food and is a powerful model concerning dietary practices. In fact, the mother, as head of household in most single-parent families, may be the only adult model for many children. Because relevance and credibility are the most important characteristics of a behavioral model, parents (especially mothers) are strong models for observational learning by children. Risk factor information and risk reduction activities adopted by the matriarch can be generalized to the entire family if she learns the skills to act as a change agent. Initiation of this process of education and training the matriarch lies with primary care providers for women (Ob-Gyns see most women). By teaching risk reduction to the matriarch as a component of primary care, physician interaction can have a rippling effect.

A point-of-purchase intervention featuring in-person supermarket education impacts healthy food purchases

PubMed Central

Woolf, Kathleen; Appelhans, Bradley M.

2011-01-01

Objective This study tested the efficacy of a multicomponent supermarket point-of-purchase (POP) intervention featuring in-person nutrition education on the nutrient composition of food purchases. Design The design was a randomized trial comparing the intervention to usual care (no treatment). Setting A supermarket in a socioeconomically diverse region of Phoenix, Arizona. Participants One-hundred fifty-three adult shoppers were recruited on-site. Intervention The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket POP healthy shopping program that included posted shelf signs identifying healthy foods, sample shopping lists, tips, and signage. Main Outcome Measures Outcomes included purchases of total, saturated, and trans fat (g/1000 kcals), and fruits, vegetables, and dark green and bright yellow vegetables (servings/1000 kcals) derived through nutritional analysis of participant shopping baskets. Analysis Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. Results The intervention resulted in greater purchasing of fruit and green and yellow vegetables. No other group differences were observed. Conclusions and Implications Long-term evaluations of supermarket interventions should be conducted to improve the evidence base, and to determine the potential for impact on food choices associated with decreased chronic disease. PMID:22104016

A point-of-purchase intervention featuring in-person supermarket education affects healthful food purchases.

PubMed

Milliron, Brandy-Joe; Woolf, Kathleen; Appelhans, Bradley M

2012-01-01

This study tested the efficacy of a multicomponent supermarket point-of-purchase intervention featuring in-person nutrition education on the nutrient composition of food purchases. The design was a randomized trial comparing the intervention with usual care (no treatment). A supermarket in a socioeconomically diverse region of Phoenix, AZ. One hundred fifty-three adult shoppers were recruited onsite. The intervention consisted of brief shopping education by a nutrition educator and an explanation and promotion of a supermarket point-of-purchase healthful shopping program that included posted shelf signs identifying healthful foods, sample shopping lists, tips, and signage. Outcomes included purchases of total, saturated, and trans fat (grams/1,000 kcal), and fruits, vegetables, and dark-green/yellow vegetables (servings/1,000 kcal) derived through nutritional analysis of participant shopping baskets. Analysis of covariance compared the intervention and control groups on food purchasing patterns while adjusting for household income. The intervention resulted in greater purchasing of fruit and dark-green/yellow vegetables. No other group differences were observed. Long-term evaluations of supermarket interventions should be conducted to improve the evidence base and to determine the potential for influence on food choices associated with decreased chronic disease incidence. Copyright © 2012 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Shopping behaviors of low-income families during a 1-month period of time.

PubMed

Darko, Janice; Eggett, Dennis L; Richards, Rickelle

2013-01-01

To explore food shopping behaviors among low-income families over the course of the month. Two researchers conducted 13 90-minute focus groups. Two community organizations serving low-income populations and a university campus. Low-income adults (n = 72) who were the primary household food shoppers and who had at least 1 child less than 18 years old. Shopping behavior changes during 1 month. Focus groups were recorded, transcribed, and coded independently by 2 researchers. Descriptive statistics were used to evaluate sociodemographic variables such as age, sex, race/ethnicity, and participation in food assistance programs. Economics played a key role in participants' food shopping behaviors and influenced food availability throughout the month. To overcome economic barriers, participants used food and emergency assistance programs and engaged in menu planning, price matching, storing food, using credit cards, and receiving financial assistance from family members and/or neighbors. Low-income families made strategic decisions to maintain a food supply throughout the month. These results suggest limited economics throughout the month may hinder families' ability to consume a varied, nutrient-rich diet, which may have an impact on future health status. Copyright © 2013 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Role of expendable income and price in food choice by low income families.

PubMed

Burns, Cate; Cook, Kay; Mavoa, Helen

2013-12-01

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation. Copyright © 2013 Elsevier Ltd. All rights reserved.

More effective nutrition label formats are not necessarily preferred.

PubMed

Levy, A S; Fein, S B; Schucker, R E

1992-10-01

An experimental design was used to compare performance and preference for five nutrition label formats. Four performance measures--accuracy and false-positives in identifying nutrient differences, time required, and correctness in judging which product was more nutritious--were derived from a product-comparison task. A sample of 1,460 food shoppers over 18 years old was recruited by a shopping mall-intercept method. Results of the study demonstrated that preferences and performance do not necessarily agree. The Control format, which had no nutrition profile information, performed the best but was liked the least. The Adjectival format, which provided nutrition profile information in the form of descriptive adjectives, was the most preferred. Results also showed that listing Daily Reference Values or nutrition profile aids increased preference but either did not affect performance or decreased it, depending on the specific aid and performance measure. Formats that some subjects liked for having adequate information others disliked for being hard to use. Formats that some subjects liked for being easy to use others disliked for having inadequate information. Age, education, and race were related to all of the performance measures except judgment of relative nutrition. Only gender was related to preference. Results of the study are useful as guidance for the development of consumer education materials.

[Compulsive buying disorder: a review and a case vignette].

PubMed

Tavares, Hermano; Lobo, Daniela Sabbatini S; Fuentes, Daniel; Black, Donald W

2008-05-01

Compulsive buying disorder was first described as a psychiatric syndrome in the early twentieth century. Its classification remains elusive, and investigators have debated its potential relationship to mood, substance use, obsessive-compulsive, and impulse control disorders. The objective of this study is to present a review of compulsive buying disorder and present a case vignette. Two databases were reviewed (Medline and PsycINFO) in search for articles published in the last 40 years. Selected terms included oniomania, compulsive buying, and compulsive shopping. Other relevant articles were also identified through reference lists. Compulsive buying disorder is a prevalent and chronic condition that is found worldwide, sharing commonalities with impulse control disorders. In clinical samples, women make up more than 80% of subjects. Its etiology is unknown, but neurobiologic and genetic mechanisms have been proposed. The disorder is highly comorbid with mood, substance use, eating and impulse control disorders. Treatment recommendations derived from the literature and clinical experience suggest that problem shoppers can benefit from psychosocial interventions. Cognitive-behavioral group models appear promising. Medication trials have reported mixed results. The identification and treatment of psychiatric comorbidity is also a key aspect of treatment. In order to determine the validity of compulsive buying disorder, future work should focus on psychopathology and neurobiological findings unique to the syndrome.

Exploring implications of Medicaid participation and wait times for colorectal screening on early detection efforts in Connecticut--a secret-shopper survey.

PubMed

Patel, Vatsal B; Nahar, Richa; Murray, Betty; Salner, Andrew L

2013-04-01

Routine colorectal screening, decreases in incidence, and advances in treatment have lowered colorectal cancer mortality rates over the past three decades. Nevertheless, it remains the second most common cause of cancer death amongst men and women combined in U.S. Most cases of colon cancer are diagnosed at a late stage leading to poor survival outcomes for patients. After extensive research of publically available data, it would appear that the state of Connecticut does not have available state-wide data on patient wait times for routine colonoscopy screening. Furthermore, there are no publicly available, or Connecticut-specific, reports on Medicaid participation rates for colorectal screening amongst gastroenterologists (GI) in Connecticut. In 2012, the American Cancer Society report on Colorectal Cancer Screening Rates confirmed barriers to health-care access and disparities in health outcomes and survival rates for colon cancer patients based on race, ethnicity, and low socioeconomic status. Given this information, one could conjecture that low Medicaid participation rates among GIs could potentially have a more severe impact on health-care access and outcomes for underserved populations. At present, funding and human resources are being employed across the state of Connecticut to address bottlenecks in colorectal cancer screening. More specifically, patient navigation and outreach programs are emerging and expanding to address the gaps in services for hard-to-reach populations and the medically underserved. Low Medicaid participation rates and increased wait times for colonoscopy screening may impair the efficacy of colorectal cancer patient navigation and outreach efforts and potentially funding for future interventions. In this study, we report the results of our secret-shopper telephone survey comprising of 93 group and independent gastroenterologist (GI) practices in different counties of Connecticut. Reviewing online resources and yellow pages, researchers compiled a county-specific list of GI practices throughout Connecticut and conducted a secret-shopper survey by telephone. A standard script and set of questions was formulated and used for each telephone call to GI practices. Data was analyzed in context of statistics available to the public at large from the U.S. Census Bureau. Overall, 46% of all 93 practices and 62% of individual GIs from all 93 practices state-wide reported Medicaid participation. About 35% of surveyed practices were independent practices; 41% of these reported Medicaid participation. About 65% of surveyed practices were group practices; 49% of these reported Medicaid participation. Approximately, 85% of all practices are in Fairfield, Hartford, orNew Haven counties. Of all three counties, New Haven reported the highest Medicaid participation rate by practices; 62% of all practices in New Haven reported participation. Fairfield reported the lowest Medicaid participation rate by practices; 29% of all practices in Fairfield reported participation. When Medicaid participation rates were calculated for total number of gastroenterologists from all practices in a given county (as opposed to participation rates by number of practices), Medicaid participation rates were 80% and 44% for New Haven and Fairfield, respectively. Of all practices in Hartford, only 50% reported Medicaid participation, whereas 67% of the total number of gastroenterologists (as opposed to practices) reported Medicaid participation. According to a recent national survey, 47% of gastroenterologists reported stopping accepting new Medicaid patients. Overall minimum and maximum wait times were reported to be the highest for Hartford, but wait times were long even for smaller counties, reflecting a possible imbalance in supply and demand or inefficiency in allocating the available resources. Only a limited number of gastroenterology practices in Connecticut accept Medicaid patients, notably in selected counties, but in all counties, and this may add to access barriers. It is yet unclear whether these disparities are significant enough to create a supply-demand imbalance and thus, have a significantly negative impact on health outcomes for the underserved. Nevertheless, with the high unemployment rates and impending implementation of mandated state-wide health-care reform as outlined in the Affordable Care Act, the Medicaid population in the state of Connecticut will increase, increasing future demand for services. In addition, based on the survey findings, longer wait times for colonoscopy screening are reported for the many of GI practices in Connecticut for Medicaid-insured as well as non-Medicaid patients. Longer wait times may have an impact on patient compliance, especially for the underserved populations that are hard to reach and ensure follow-up, contributing to potential delayed diagnosis. A Medicaid-associated disparity in this area will serve to exacerbate the problem for the underserved compared to those relatively well served. Those currently not seeking screening are at even higher risk of contributing to the higher mortality rate, and we need to find out how best to ensure that we can more uniformly apply screening and have the capacity to do so.

Mystery shopping and alcohol sales: do supermarkets and liquor stores sell alcohol to underage customers?

PubMed

Gosselt, Jordy F; van Hoof, Joris J; de Jong, Menno D T; Prinsen, Sander

2007-09-01

The Dutch national policy regarding alcohol and youth relies on retailers' willingness to refuse to sell alcohol to underage customers. This study examined unobtrusively whether supermarkets and liquor stores do indeed comply with the legal age restrictions for alcohol sales. A research protocol was developed based on the methodology of mystery shopping. Using the protocol, 150 supermarkets and 75 liquor stores were visited by 15-year-old adolescents who tried to buy soft alcoholic beverages (legal age, 16 years), and 75 liquor stores were visited by 17-year-old adolescents who tried to buy strong alcoholic beverages (legal age, 18). Of all 300 buying attempts, 86% were successful. In supermarkets, 88% of all attempts succeeded. In liquor stores, a difference was found between the purchase of strong alcohol by 17-year-olds (89%) and the purchase of soft alcoholic beverages by 15-year-olds (77%). In only 71 of all visits, mystery shoppers were asked for an ID. In 39% of these cases, they were still able to buy alcohol. Female adolescents were more successful in buying alcohol than male adolescents. The results show that supermarkets and liquor stores generally fail to see the need for extra care when young customers try to buy alcohol. Legal age restrictions without enforcement and facilitation clearly do not suffice to protect adolescents from early exposure to alcohol.

The effectiveness of ID readers and remote age verification in enhancing compliance with the legal age limit for alcohol.

PubMed

Van Hoof, Joris J

2017-04-01

Currently, two different age verification systems (AVS) are implemented to enhance compliance with legal age limits for the sale of alcohol in the Netherlands. In this study, we tested the operational procedures and effectiveness of ID readers and remote age verification technology in supermarkets during the sale of alcohol. Following a trained alcohol purchase protocol, eight mystery shoppers (both underage and in the branch's reference age) conducted 132 alcohol purchase attempts in stores that were equipped with ID readers or remote age verification or were part of a control group. In stores equipped with an ID reader, 34% of the purchases were conducted without any mistakes (full compliance). In stores with remote age verification, full compliance was achieved in 87% of the cases. The control group reached 57% compliance, which is in line with the national average. Stores with ID readers perform worse than stores with remote age verification, and also worse than stores without any AVS. For both systems, in addition to effectiveness, public support and user friendliness need to be investigated. This study shows that remote age verification technology is a promising intervention that increases vendor compliance during the sales of age restricted products. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Women, infants, and children cash value voucher (CVV) use in Arizona: a qualitative exploration of barriers and strategies related to fruit and vegetable purchases.

PubMed

Bertmann, Farryl M W; Barroso, Cristina; Ohri-Vachaspati, Punam; Hampl, Jeffrey S; Sell, Karen; Wharton, Christopher M

2014-01-01

Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them. Eight focus groups were conducted to explore attitudes and behaviors related to CVV use. Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ. Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households. Perceived barriers to CVV use and strategies used to maximize their purchasing value. Transcripts were analyzed using a general inductive approach to identify emergent themes. Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power. Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Healthy Checkout Lines: A Study in Urban Supermarkets.

PubMed

Adjoian, Tamar; Dannefer, Rachel; Willingham, Craig; Brathwaite, Chantelle; Franklin, Sharraine

2017-09-01

To understand the impact of healthy checkouts in Bronx, New York City supermarkets. Consumer purchasing behavior was observed for 2 weeks in 2015. Three supermarkets in the South Bronx. A total of 2,131 adult shoppers (aged ≥18 years) who paid for their groceries at 1 of the selected study checkout lines. Two checkout lines were selected per store; 1 was converted to a healthy checkout and the other remained as it was (standard checkout). Data collectors observed consumer behavior at each line and recorded items purchased from checkout areas. Percentage of customers who purchase items from the checkout area; quantity and price of healthy and unhealthy items purchased from the healthy and standard checkout lines. Measures were analyzed by study condition using chi-square and t tests; significance was determined at α = .05. Only 4.0% of customers bought anything from the checkout area. A higher proportion of customers using the healthy vs standard checkout line bought healthy items (56.5% vs 20.5%; P < .001). When healthier products were available, the proportion of healthy purchases increased. Findings contribute to limited research on effectiveness of healthy checkouts in supermarkets. Similar interventions should expect an increase in healthy purchases from the checkout area, but limited overall impact. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Farmers' Market Use Patterns Among Supplemental Nutrition Assistance Program Recipients With High Access to Farmers' Markets.

PubMed

Freedman, Darcy A; Flocke, Susan; Shon, En-Jung; Matlack, Kristen; Trapl, Erika; Ohri-Vachaspati, Punam; Osborne, Amanda; Borawski, Elaine

2017-05-01

Evaluate farmers' market (FM) use patterns among Supplemental Nutrition Assistance Program (SNAP) recipients. Cross-sectional survey administered June to August, 2015. Cleveland and East Cleveland, OH. A total of 304 SNAP recipients with children. Participants lived within 1 mile of 1 of 17 FMs. Most were African American (82.6%) and female (88.1%), and had received SNAP for ≥5 years (65.8%). Patterns of FM shopping, awareness of FM near home and of healthy food incentive program, use of SNAP to buy fruits and vegetables and to buy other foods at FMs, receipt of healthy food incentive program. Two-stage cluster analysis to identify segments with similar FM use patterns. Bivariate statistics including chi-square and ANOVA to evaluate main outcomes, with significance at P ≤ .05. A total of 42% reported FM use in the past year. Current FM shoppers (n = 129) were segmented into 4 clusters: single market, public market, multiple market, and high frequency. Clusters differed significantly in awareness of FM near home and the incentive program, use of SNAP to buy fruit and vegetables at FMs, and receipt of incentive. Findings highlight distinct types of FM use and had implications for tailoring outreach to maximize first time and repeat use of FMs among SNAP recipients. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

The effect of contact precautions on healthcare worker activity in acute care hospitals.

PubMed

Morgan, Daniel J; Pineles, Lisa; Shardell, Michelle; Graham, Margaret M; Mohammadi, Shahrzad; Forrest, Graeme N; Reisinger, Heather S; Schweizer, Marin L; Perencevich, Eli N

2013-01-01

Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities. Prospective cohort study. Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus. Trained observers performed "secret shopper" monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods. A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; [Formula: see text]) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; [Formula: see text]). Patients on contact precautions tended to have fewer visitors (23.6% fewer; [Formula: see text]). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; [Formula: see text]). Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.

Social ideological influences on reported food consumption and BMI

PubMed Central

Wang, Wei C; Worsley, Anthony; Cunningham, Everarda G

2008-01-01

Background The purpose of this study was to investigate relationships between ideological beliefs, perceptions of the importance of health behaviours, health attitudes, food consumption, and Body Mass Index (BMI). A behavioural model was hypothesized based on the Theory of Reasoned Action (Fishbein & Ajzen, 1975). Methods A survey was conducted among shoppers aged between 40 and 70 years at Eastland Shopping Centre, Melbourne, Australia. The hypothesized model was tested with this empirical data (n = 410) for younger (n = 151) and older (n = 259) age groups using structural equation modelling. Results The findings generally support the study hypotheses. For both groups, egalitarianism had a direct and positive influence on perceptions of the importance of health behaviours. Materialism and masculinity impacted negatively on health attitudes, which positively influenced importance of health behaviours. Perceptions of importance of health behaviours impacted positively on the consumption of healthy foods such as vegetables and fruits, but negatively on consumption of unhealthy foods including sweets and fats. However, BMI was significantly influenced by the consumption of unhealthy foods (e.g., sugar and fats) only for the younger age group. Hence, the associations between beliefs, attitudes, consumption behaviours, and BMI outcomes differed between younger and older age populations. Conclusion Social ideological beliefs appear to influence health attitudes and thereafter, the consumption of healthy and unhealthy foods and BMI via different pathways. PMID:18412977

Discrete Choice Model of Food Store Trips Using National Household Food Acquisition and Purchase Survey (FoodAPS).

PubMed

Hillier, Amy; Smith, Tony E; Whiteman, Eliza D; Chrisinger, Benjamin W

2017-09-27

Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies.

Discrete Choice Model of Food Store Trips Using National Household Food Acquisition and Purchase Survey (FoodAPS)

PubMed Central

Hillier, Amy; Smith, Tony E.; Whiteman, Eliza D.

2017-01-01

Where households across income levels shop for food is of central concern within a growing body of research focused on where people live relative to where they shop, what they purchase and eat, and how those choices influence the risk of obesity and chronic disease. We analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) using a conditional logit model to determine where participants shop for food to be prepared and eaten at home and how individual and household characteristics of food shoppers interact with store characteristics and distance from home in determining store choice. Store size, whether or not it was a full-service supermarket, and the driving distance from home to the store constituted the three significant main effects on store choice. Overall, participants were more likely to choose larger stores, conventional supermarkets rather than super-centers and other types of stores, and stores closer to home. Interaction effects show that participants receiving Supplemental Nutrition Assistance Program (SNAP) were even more likely to choose larger stores. Hispanic participants were more likely than non-Hispanics to choose full-service supermarkets while White participants were more likely to travel further than non-Whites. This study demonstrates the value of explicitly spatial discrete choice models and provides evidence of national trends consistent with previous smaller, local studies. PMID:28953221

Consumer taste tests and milk preference in low-income, urban supermarkets.

PubMed

Weiss, Stephanie; Davis, Erica; Wojtanowski, Alexis C; Foster, Gary D; Glanz, Karen; Karpyn, Allison

2015-06-01

To explore shoppers' responses to the taste of different types of cow's milk in a blind taste test and to examine their willingness to purchase lower-fat milk as part of an in-store marketing intervention. Participants were recruited on-site in the supermarket to participate in a blind taste test of three varieties of cow's milk and asked to guess what type they sampled. The taste testing was conducted as part of the Healthy Retail Solution (HRS) intervention that took place in four large supermarkets in Philadelphia, PA, USA over the course of six months. Adults (n 444) at participating Philadelphia supermarkets. The majority of participants at all stores reported typically purchasing higher-fat milk. Forty per cent of participants reported buying whole milk, 38 % purchased milk with 2 % fat. Very few participants correctly identified all three milk samples during the taste test (6·9 %) and a majority of participants were unable to identify the type of milk they self-reported typically purchased. Most consumers could not accurately distinguish between various types of milk. Taste testing is a promising strategy to introduce lower-fat milks to consumers who have not tried them before. Campaigns to purchase skimmed, 1 % or 2 % milk may result in significant energy reduction over time and can serve as a simple way to combat overweight and obesity.

"I Love Fruit But I Can't Afford It": Using Participatory Action Research to Develop Community-Based Initiatives to Mitigate Challenges to Chronic Disease Management in an African American Community Living in Public Housing.

PubMed

Rogers, Courtney; Johnson, Joy; Nueslein, Brianne; Edmunds, David; Valdez, Rupa S

2018-03-12

As chronic conditions are on the rise in the USA, management initiatives outside of the inpatient setting should be explored to reduce associated cost and access disparities. Chronic conditions disproportionately affect African American public housing residents due to the effects of historical marginalization on the manifestation of economic and social problems exacerbating health disparities and outcomes. Informed by participatory research action tenets, this study focused on identifying the challenges to management of chronic conditions and developing community-envisioned initiatives to address these challenges in a predominantly African American public housing community. Two focus groups were conducted with former and current public housing residents and were analyzed using inductive content analysis. Physical activity, the cost associated with healthy eating, and lack of information were noted as challenges to chronic disease management. Initiatives discussed were the formation of a walking partner's program to promote physical activity, a shopper's club to exchange coupons and learn how to prepare healthy meals, and a natural remedy's book to share information intergenerationally about management tactics. Challenges identified existed predominantly on the individual and the system level, while the initiatives generated target engaging interpersonal and community relationships. These community-envisioned approaches should be explored to facilitate chronic disease management in public housing neighborhoods.

Pharmacies, communication, and condoms. Research report: Mexico.

PubMed

Pick De Weiss, S

1995-01-01

The Institute Mexicano de Investigacion de Familia y Poblacion, A.C. (IMIFAP) tested the effectiveness of a training course and educational materials that were designed to increase the awareness and knowledge of pharmacy employees concerning acquired immunodeficiency syndrome (AIDS) and its prevention, and to promote condoms. 174 employees participated in workshops that included information on transmission and prevention of sexually transmitted diseases (STDs) and AIDS, and condom usage. Pre- and post-session tests were performed to ascertain the short-term retention of information; the long-term effect was assessed via incognito shopper visits and monitoring of condom sales. Short, intensive training, when reinforced by posters, pamphlets, and video, significantly increased knowledge of AIDS (symptoms, transmission, and prevention) and correct condom usage. Awareness of risk behaviors and groups at risk for AIDS improved. Printed materials alone did not have a substantial impact on knowledge or sales of condoms, and increased knowledge alone did not increase information disseminated. After 6 months there was a significantly higher rise in condom sales (16%) in the course-plus-materials group. This group also took a greater initiative in providing information to clients. In spite of these positive results, knowledge and initiative are still unsatisfactory, especially when the role of pharmacies in general health care and the suspected prevalence of sexually transmitted diseases and human immunodeficiency virus in Mexico are considered.

The association between financial literacy and Problematic Internet Shopping in a multinational sample.

PubMed

Lam, Lawrence T; Lam, Mary K

2017-12-01

To examine the association between financial literacy and Problematic Internet Shopping in adults. This cross-sectional online survey recruited participants, aged between 18 and 60 years, through an online research facility. The sample consisted of multinational participants from mainly three continents including Europe, North America, and Asia. Problematic Internet Shopping was assessed using the Bergen Shopping Addiction Scale (BSAS). Financial Literacy was measured by the Financial Literacy subscale of the Financial Wellbeing Questionnaire. Multiple linear regression analyses were conducted to elucidate the relationship between the study and outcome variables with adjustment for other potential risk factors. Of the total of 997 respondents with an average age of 30.9 (s.d. = 8.8), 135 (13.8%) could be classified as having a high risk of being Problematic Internet Shoppers. Results from the multiple regression analyses suggested a significant and negative relationship between financial literacy and Problematic Internet Shopping with a regression coefficient of - 0.13, after controlling for the effects of potential risk factors such as age, region of birth, employment, income, shopping frequency, self-regulation and anxiety (t = - 6.42, p < 0.001). The clinical management of PIS should include a financial counselling as a component of the treatment regime. Enhancement of financial literacy in the general population, particularly among young people, will likely have a positive effect on the occurrence of PIS.

Data shopping in an open marketplace: Introducing the Ontogrator web application for marking up data using ontologies and browsing using facets.

PubMed

Morrison, Norman; Hancock, David; Hirschman, Lynette; Dawyndt, Peter; Verslyppe, Bert; Kyrpides, Nikos; Kottmann, Renzo; Yilmaz, Pelin; Glöckner, Frank Oliver; Grethe, Jeff; Booth, Tim; Sterk, Peter; Nenadic, Goran; Field, Dawn

2011-04-29

In the future, we hope to see an open and thriving data market in which users can find and select data from a wide range of data providers. In such an open access market, data are products that must be packaged accordingly. Increasingly, eCommerce sellers present heterogeneous product lines to buyers using faceted browsing. Using this approach we have developed the Ontogrator platform, which allows for rapid retrieval of data in a way that would be familiar to any online shopper. Using Knowledge Organization Systems (KOS), especially ontologies, Ontogrator uses text mining to mark up data and faceted browsing to help users navigate, query and retrieve data. Ontogrator offers the potential to impact scientific research in two major ways: 1) by significantly improving the retrieval of relevant information; and 2) by significantly reducing the time required to compose standard database queries and assemble information for further research. Here we present a pilot implementation developed in collaboration with the Genomic Standards Consortium (GSC) that includes content from the StrainInfo, GOLD, CAMERA, Silva and Pubmed databases. This implementation demonstrates the power of ontogration and highlights that the usefulness of this approach is fully dependent on both the quality of data and the KOS (ontologies) used. Ideally, the use and further expansion of this collaborative system will help to surface issues associated with the underlying quality of annotation and could lead to a systematic means for accessing integrated data resources.

Psychosocial Influences on Fruit and Vegetable Intake Following a NYC Supermarket Discount.

PubMed

Bernales-Korins, Maria; Ang, Ian Yi Han; Khan, Shamima; Geliebter, Allan

2017-08-01

To assess the effect of a 50% discount on fruits and vegetables (F&V) on the purchase and intake of F&V and on psychosocial determinants of F&V intake: self-efficacy (SE), stages of change (SOC), and perceived barriers (PB). This randomized controlled trial was conducted in local supermarkets over 16 weeks, including a 4-week baseline, 8-week discount intervention, and 4-week follow-up. Shoppers with overweight or obesity (BMI > 25) were randomized to receive a discount or no discount via their reward scan card after the baseline. Twenty-four-hour recalls and psychosocial measures were obtained for each study period. Purchases (P < 0.0005) and intakes (P = 0.019) of F&V increased significantly during the intervention, while only F&V intake was sustained at follow-up. The discount intervention increased SE (P < 0.01) and SOC (P < 0.05) and did not decrease PB (P = 0.057) during the intervention. SOC mediated the discount intervention effect on F&V intake (P < 0.05) during the intervention, explaining 43% of variance. A supermarket discount intervention led to increases in purchases and intakes of F&V and increases in the psychosocial factors SE and SOC and did not decrease PB. The discount intervention prompted participants to move from the preparation to action stage of SOC, which acted as a mediator for increased F&V intake. © 2017 The Obesity Society.

Use of household supermarket sales data to estimate nutrient intakes: a comparison with repeat 24-hour dietary recalls.

PubMed

Eyles, Helen; Jiang, Yannan; Ni Mhurchu, Cliona

2010-01-01

Electronic supermarket sales data provide a promising, novel way of estimating nutrient intakes. However, little is known about how these data reflect the nutrients consumed by an individual household member. A cross-sectional survey of 49 primary household shoppers (age [mean+/-standard deviation age]=48+/-14 years; 84% female) from Wellington, New Zealand, was undertaken. Three months of baseline electronic supermarket sales data were compared with individual dietary intakes estimated from four random 24-hour dietary recalls collected during the same 3-month period. Spearman rank correlations between household purchases and individual intakes ranged from 0.54 for percentage of energy from saturated fat (P<0.001) to 0.06 for sodium (P=0.68). Other correlation coefficients were: percentage of energy from carbohydrate, 0.48; and protein, 0.44; energy density of nonbeverages, 0.37 (kcal/oz); percentage of energy from total fat, 0.34; sugar, 0.33 (oz/kcal); and energy density of beverages, 0.09 (oz/kcal; all P values <0.05). This research suggests that household electronic supermarket sales data may be a useful surrogate measure of some nutrient intakes of individuals, particularly percentage of energy from saturated and total fat. In the case of a supermarket intervention, an effect on household sales of percentage energy from saturated and total fat is also likely to impact the saturated and total fat intake of individual household members. Copyright 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

Why should I comply? Sellers' accounts for (non-)compliance with legal age limits for alcohol sales.

PubMed

Gosselt, Jordy F; Van Hoof, Joris J; De Jong, Menno D T

2012-01-23

Availability is an important predictor of early and excessive alcohol consumption by adolescents. Many countries have implemented age limits to prevent underage purchases of alcohol. However, shop-floor compliance with these age limits appears to be problematic. This study addresses the issue of non-compliance with age limits. Which measures do vendors take to avoid underage alcohol sales, and what do they report as important reasons to comply or not with age limits for alcohol sales? Open-ended telephone interviews were conducted with store managers selling alcohol (N = 106). Prior to the interviews, all outlets were visited by an underage mystery shopper in order to measure compliance with the legal age limits on alcohol sales. The interview results are compared against actual compliance rates. Several measures have been taken to prevent underage sales, but the compliance level is low. Furthermore, open coding resulted in 19 themes, representing both valid and invalid arguments, that vendors mentioned as relevant to their decisions of whether to comply with the law. Compliance with age limits is dependent on the knowledge of the rules and the ability and motivation to follow the rules. The ability aspect in particular seems to be problematic, but in many cases, the motivation to actively comply with the age limits is lacking. To enhance compliance, it is important to raise the awareness of the importance of age limits and to connect possible violations of the regulations to negative consequences.

There’s more to food store choice than proximity: a questionnaire development study

PubMed Central

2013-01-01

Background Proximity of food stores is associated with dietary intake and obesity; however, individuals frequently shop at stores that are not the most proximal. Little is known about other factors that influence food store choice. The current research describes the development of the Food Store Selection Questionnaire (FSSQ) and describes preliminary results of field testing the questionnaire. Methods Development of the FSSQ involved a multidisciplinary literature review, qualitative analysis of focus group transcripts, and expert and community reviews. Field testing consisted of 100 primary household food shoppers (93% female, 64% African American), in rural and urban Arkansas communities, rating FSSQ items as to their importance in store choice and indicating their top two reasons. After eliminating 14 items due to low mean importance scores and high correlations with other items, the final FSSQ questionnaire consists of 49 items. Results Items rated highest in importance were: meat freshness; store maintenance; store cleanliness; meat varieties; and store safety. Items most commonly rated as top reasons were: low prices; proximity to home; fruit/vegetable freshness; fruit/vegetable variety; and store cleanliness. Conclusions The FSSQ is a comprehensive questionnaire for detailing key reasons in food store choice. Although proximity to home was a consideration for participants, there were clearly other key factors in their choice of a food store. Understanding the relative importance of these different dimensions driving food store choice in specific communities may be beneficial in informing policies and programs designed to support healthy dietary intake and obesity prevention. PMID:23773428

Psychiatric Prescribers' Experiences With Doctor Shoppers.

PubMed

Worley, Julie; Johnson, Mary; Karnik, Niranjan

2015-01-01

Doctor shopping is a primary method of prescription medication diversion. After opioids, benzodiazepines and stimulants are the next most common prescription medications used nonmedically. Studies have shown that patients who engage in doctor shopping find it fun, exciting, and easy to do. There is a lack of research on the prescriber's perspective on the phenomenon of doctor shopping. This study investigates the experiences of prescribers in psychiatry with patients who engage in doctor shopping. Fifteen prescribers including psychiatrists and psychiatric nurse practitioners working in outpatient psychiatry were interviewed to elicit detailed information about their experiences with patients who engage in doctor shopping. Themes found throughout the interview were that psychiatric prescribers' experience with patients who engage in doctor shopping includes (a) detecting red flags, (b) negative emotional responding, (c) addressing the patient and the problem, and (d) inconsistently implementing precautions. When red flags were detected when prescribing controlled drugs, prescribers in psychiatry experienced both their own negative emotional responses such as disappointment and resentment as well as the negative emotions of the patients such as anger and other extreme emotional responses. Psychiatric prescribers responded to patient's doctor shopping in a variety of ways such as changing their practice, discharging the patients or taking steps to not accept certain patients identified as being at risk for doctor shopping, as well as by talking to the patient and trying to offer them help. Despite experiencing doctor shopping, the prescribers inconsistently implemented precautionary measures such as checking prescription drug monitoring programs. © The Author(s) 2015.

Why should i comply? Sellers' accounts for (non-)compliance with legal age limits for alcohol sales

PubMed Central

2012-01-01

Background Availability is an important predictor of early and excessive alcohol consumption by adolescents. Many countries have implemented age limits to prevent underage purchases of alcohol. However, shop-floor compliance with these age limits appears to be problematic. This study addresses the issue of non-compliance with age limits. Which measures do vendors take to avoid underage alcohol sales, and what do they report as important reasons to comply or not with age limits for alcohol sales? Methods Open-ended telephone interviews were conducted with store managers selling alcohol (N = 106). Prior to the interviews, all outlets were visited by an underage mystery shopper in order to measure compliance with the legal age limits on alcohol sales. The interview results are compared against actual compliance rates. Results Several measures have been taken to prevent underage sales, but the compliance level is low. Furthermore, open coding resulted in 19 themes, representing both valid and invalid arguments, that vendors mentioned as relevant to their decisions of whether to comply with the law. Compliance with age limits is dependent on the knowledge of the rules and the ability and motivation to follow the rules. The ability aspect in particular seems to be problematic, but in many cases, the motivation to actively comply with the age limits is lacking. Conclusions To enhance compliance, it is important to raise the awareness of the importance of age limits and to connect possible violations of the regulations to negative consequences. PMID:22269016

Management of dry eye in UK pharmacies.

PubMed

Bilkhu, Paramdeep S; Wolffsohn, James S; Tang, Gou W; Naroo, Shehzad A

2014-10-01

To investigate the ability of pharmacy staff in the United Kingdom (UK) to diagnose and treat dry eye. A mystery shopper technique to simulate a patient with presumed dry eye was used in 50 pharmacy practices in major towns and cities across the UK. Pharmacies were unaware of their involvement in the study. With the exception of a predetermined opening statement to initiate the consultation, no further information was volunteered. Questions asked, diagnoses given, management strategy advised and staff type was recorded immediately after the consultation. The mean number of questions was 4.5 (SD 1.7; range 1-10). The most common question was the duration of symptoms (56%) and the least common was whether the patient had a history of headaches (2%). All pharmacy staff gave a diagnosis, but the majority were incorrect (58%), with only 42% correctly identifying dry eye. Treatment was advised by 92% of pharmacy staff, with the remaining 8% advising referral directly to the patient's GP or optometrist. Dry eye treatments involved topical ocular lubrication via eye drops (90%) and lipid based sprays (10%). However, only 10% gave administration advice, 10% gave dosage advice, 9% asked about contact lens wear, and none offered follow up although 15% also advised GP or optometrist referral. There is a need for improved ophthalmological training amongst pharmacists and pharmacy staff and establishment of cross referral relationships between pharmacies and optometry practices. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Level of awareness regarding some zoonotic diseases, among dog owners of ithaca, new york.

PubMed

Sandhu, Gursimrat Kaur; Singh, Devinder

2014-01-01

Worldwide, dogs and cats are the two most common household companion animals. Because of this, they can be direct or indirect source of many human infections. Fortunately, most of these zoonotic infections can be clinically prevented by appropriate prophylactic interventions. Present kind of cross-sectional study, for the first time, was conducted in city of Ithaca, New York. People visiting local animal hospitals, dog parks, library and shoppers at Walmart supermarket were personally interviewed and a pre-tested questionnaire was got filled from every individual. The collected data were analyzed for percentage proportions using Microsoft Excel(®) and the results had been presented in graphical as well as tabulated forms. Out of 100 participants responding to the request for participation, gender-wise, 45% of the participants were male while 55% of the participants were females. Demographically, 50% participants lived in rural, 35% in urban while 15% participants lived in suburban areas. Educational background of the participants ranged from High school pass-outs to Graduates. Participants were aware about the zoonotic potential of leptospirosis, giardiasis, rabies, hookworms, coccidiosis, lyme disease, roundworms, toxoplasma, leishmaniasis, salmonellosis and ringworm disease. Knowledge gaps in the sampled population, in terms of lack of awareness about zoonotic diseases vectored by mosquitoes, ticks and fleas; practice of not doing regular deworming and prophylactic control of fleas and ticks on pet dogs; and lack of practice among physicians to discuss zoonotic canine diseases with their clients were revealed by this study.

Data shopping in an open marketplace: Introducing the Ontogrator web application for marking up data using ontologies and browsing using facets

PubMed Central

Morrison, Norman; Hancock, David; Hirschman, Lynette; Dawyndt, Peter; Verslyppe, Bert; Kyrpides, Nikos; Kottmann, Renzo; Yilmaz, Pelin; Glöckner, Frank Oliver; Grethe, Jeff; Booth, Tim; Sterk, Peter; Nenadic, Goran; Field, Dawn

2011-01-01

In the future, we hope to see an open and thriving data market in which users can find and select data from a wide range of data providers. In such an open access market, data are products that must be packaged accordingly. Increasingly, eCommerce sellers present heterogeneous product lines to buyers using faceted browsing. Using this approach we have developed the Ontogrator platform, which allows for rapid retrieval of data in a way that would be familiar to any online shopper. Using Knowledge Organization Systems (KOS), especially ontologies, Ontogrator uses text mining to mark up data and faceted browsing to help users navigate, query and retrieve data. Ontogrator offers the potential to impact scientific research in two major ways: 1) by significantly improving the retrieval of relevant information; and 2) by significantly reducing the time required to compose standard database queries and assemble information for further research. Here we present a pilot implementation developed in collaboration with the Genomic Standards Consortium (GSC) that includes content from the StrainInfo, GOLD, CAMERA, Silva and Pubmed databases. This implementation demonstrates the power of ontogration and highlights that the usefulness of this approach is fully dependent on both the quality of data and the KOS (ontologies) used. Ideally, the use and further expansion of this collaborative system will help to surface issues associated with the underlying quality of annotation and could lead to a systematic means for accessing integrated data resources. PMID:21677865

There's more to food store choice than proximity: a questionnaire development study.

PubMed

Krukowski, Rebecca A; Sparks, Carla; DiCarlo, Marisha; McSweeney, Jean; West, Delia Smith

2013-06-17

Proximity of food stores is associated with dietary intake and obesity; however, individuals frequently shop at stores that are not the most proximal. Little is known about other factors that influence food store choice. The current research describes the development of the Food Store Selection Questionnaire (FSSQ) and describes preliminary results of field testing the questionnaire. Development of the FSSQ involved a multidisciplinary literature review, qualitative analysis of focus group transcripts, and expert and community reviews. Field testing consisted of 100 primary household food shoppers (93% female, 64% African American), in rural and urban Arkansas communities, rating FSSQ items as to their importance in store choice and indicating their top two reasons. After eliminating 14 items due to low mean importance scores and high correlations with other items, the final FSSQ questionnaire consists of 49 items. Items rated highest in importance were: meat freshness; store maintenance; store cleanliness; meat varieties; and store safety. Items most commonly rated as top reasons were: low prices; proximity to home; fruit/vegetable freshness; fruit/vegetable variety; and store cleanliness. The FSSQ is a comprehensive questionnaire for detailing key reasons in food store choice. Although proximity to home was a consideration for participants, there were clearly other key factors in their choice of a food store. Understanding the relative importance of these different dimensions driving food store choice in specific communities may be beneficial in informing policies and programs designed to support healthy dietary intake and obesity prevention.

Activity space-based measures of the food environment and their relationships to food purchasing behaviours for young urban adults in Canada.

PubMed

Widener, Michael J; Minaker, Leia M; Reid, Jessica L; Patterson, Zachary; Ahmadi, Tara Kamal; Hammond, David

2018-03-16

To examine the potential links between activity spaces, the food retail environment and food shopping behaviours for the population of young, urban adults. Participants took part in the Canada Food Study, which collected information on demographics, food behaviour, diet and health, as well as an additional smartphone study that included a seven-day period of logging GPS (global positioning system) location and food purchases. Using a time-weighted, continuous representation of participant activity spaces generated from GPS trajectory data, the locations of food purchases and a geocoded food retail data set, negative binomial regression models were used to explore what types of food retailers participants were exposed to and where food purchases were made. Toronto, Montreal, Vancouver, Edmonton and Halifax, Canada. Young adults aged 16-30 years (n 496). These participants were a subset of the larger Canada Food Study. Demographics, household food shopper status and city of residence were significantly associated with different levels of exposure to various types of food retailers. Food shopping behaviours were also statistically significantly associated with demographics, the activity space-based food environment, self-reported health and city of residence. The study confirms that food behaviours are related to activity space-based food environment measures, which provide a more comprehensive accounting of food retail exposure than home-based measures. In addition, exposure to food retail and food purchasing behaviours of an understudied population are described.

Investigation into the animal species contents of popular wet pet foods.

PubMed

Maine, Isabella R; Atterbury, Robert; Chang, Kin-Chow

2015-03-10

The use of the generic term "meat and animal derivatives" in declared ingredient lists of pet foods in the European Union is virtually universal. In the wake of the 2013 "horse meat scandal" in the human food chain, we examined the presence and authenticity of animal sources (cow, chicken, pig and horse) of proteins in a range of popular wet pet foods in the United Kingdom. Seventeen leading dog and cat foods were sampled for the relative presence of DNA from each of the four animal species by quantitative real-time polymerase chain reaction. No horse DNA was detected. However, there was detection at substantial levels of unspecified animal species in most products tested. In 14 out of 17 samples, bovine, porcine and chicken DNA were found in various proportions and combinations but were not explicitly identified on the product labels. Of the 7 products with prominent headline descriptions containing the term "with beef", only 2 were found to contain more bovine DNA (>50%) than pig and chicken DNA combined. There is a need for the pet food industry to show greater transparency to customers in the disclosure of the types of animal proteins (animal species and tissue types) in their products. Full disclosure of animal contents will (a) allow more informed choices to be made on purchases which are particularly important for pets with food allergies, (b) reduce the risk of product misinterpretation by shoppers, and (c) avoid potential religious concerns.

Mystery shopping and coaching as a form of audit and feedback to improve community pharmacy management of non-prescription medicine requests: an intervention study

PubMed Central

Schneider, Carl Richard; Naughtin, Clare Louise; Wilson, Frances; de Almeida Neto, Abilio Cesar; Moles, Rebekah Jane

2017-01-01

Objectives To determine whether repeated mystery shopping visits with feedback improve pharmacy performance over nine visits and to determine what factors predict an appropriate outcome. Design Prospective, parallel, repeated intervention, repeated measures mystery shopping (pseudopatient) design. Setting Thirty-six community pharmacies in metropolitan Sydney, Australia in March–October 2015. Participants Sixty-one University of Sydney pharmacy undergraduates acted as mystery shoppers. Students enrolled in their third year of Bachelor of Pharmacy in 2015 were eligible to participate. Any community pharmacy in the Sydney metropolitan region was eligible to take part and was selected through convenience sampling. Intervention Repeated mystery shopping with immediate feedback and coaching. Outcome measures Outcome for each given scenario (appropriate or not) and questioning scores for each interaction. Results Five hundred and twenty-one visits were analysed, of which 54% resulted in an appropriate outcome. Questioning scores and the proportion of interactions resulting in an appropriate outcome significantly improved over time (P<0.001). Involvement of pharmacists, visit number, increased questioning score and the prescribed scenario were predictors of an appropriate outcome (P=0.008, P=0.022, P<0.001 and P<0.001, respectively). Interactions involving a pharmacist had greater scores than those without (P<0.001). Conclusions Repeated mystery shopping visits with feedback were associated with improved pharmacy performance over time. Future work should focus on the role of non-pharmacist staff and design interventions accordingly. PMID:29247115

Notes from the CKD kitchen: a variety of salt-free seasonings.

PubMed

Sunwold, Duane

2007-05-01

One of the challenges with renal diets is how to make flavorful food while maintaining the low sodium restrictions. I have found three spice companies that have created seasoning mixtures using a mixture of herbs that do not add sodium or potassium chloride in their flavors. The recipe Ginger Roasted Chicken with an Asian Slaw is an example of how you can use three different salt-free seasonings to create a flavorful meal. I know from personal experience that I feel better, have more energy, and sleep better if I restrict my sodium intake. It is easy to stop using the salt shaker and replace the garlic salt and onion salt with garlic powder and onion powder in the kitchen. It takes a dedicated shopper to find the hidden sodium in foods. I find myself reading more and more labels in the aisles of the grocery store before I put any foods in my grocery cart. I also find myself studying the spice selections looking for salt-free seasonings. Mrs. Dash is great and very popular, but there must be more options for us patients with chronic kidney disease. After doing some culinary research, I was pleased to find a much larger section of salt-free seasonings than I expected. I have listed a few of the seasoning combinations below and a table of three major spice companies along with their contact information for purchasing their products.

Personal characteristics, cooking at home and shopping frequency influence consumption.

PubMed

Gustat, Jeanette; Lee, Yu-Sheng; O'Malley, Keelia; Luckett, Brian; Myers, Leann; Terrell, Leonetta; Amoss, Lisa; Fitzgerald, Erin; Stevenson, Peter T; Johnson, Carolyn C

2017-06-01

This study examines how the consumption of fruits and vegetables is affected by home cooking habits and shopping patterns, including distance to patronized stores and frequency of shopping, in two low-income predominantly African American urban neighborhoods in New Orleans, Louisiana. In-person interviews were conducted in 2013 with 901 adult residents who identified themselves as the primary household shopper. Respondents were asked where and how often they shopped and answered a food frequency questionnaire. Addresses were geocoded and distances to the stores where respondents shopped were calculated. Multivariable logistic regression was used to examine the relationship between food consumption and personal factors, neighborhood factors and shopping habits. Consumption of daily servings of fresh produce increased by 3% for each additional trip to a grocery store, by 76% for shopping at a farmer's market, and by 38% for preparing food at home. Each additional trip to a convenience store increased the frequency of consumption of chips, candy and pastries by 3%. The distance from residence to the type of store patronized was not associated with consumption of produce or chips, candy or pastries. Shopping at full-service grocery stores, farmer's markets and cooking at home were positively associated with the consumption of fresh produce while shopping at convenience stores was associated with increased consumption of chips, candy and pastries. These findings are useful for designing programmatic interventions to increase fresh fruit and vegetable consumption among residents in low-income urban communities.

Non-prescription medicines for pain and fever--a comparison of recommendations and counseling from staff in pharmacy and general sales stores.

PubMed

Bardage, Carola; Westerlund, Tommy; Barzi, Sahra; Bernsten, Cecilia

2013-04-01

The purpose of this study is to map and analyze the content and quality of the encounter when customers buy non-prescription medicines for pain and fever. 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A "Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366 units were selected for each scenario. There were in total 625 observers: 208 in the child with fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancy scenario. 21st September to 20th November 2011. In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnant woman. The staff suggested in 9% of the visits a medicine that is inappropriate in late pregnancy. The corresponding percentage in pharmacies was 1%. Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies to a feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the age of the child. General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid product when an acetaminophen preparation was requested. The corresponding percentage in the pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product. The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneity of painkillers, which lead to inappropriate recommendations. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Consumer-reported handling of raw poultry products at home: results from a national survey.

PubMed

Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Chambers, Edgar; Godwin, Sandria

2015-01-01

Salmonella and Campylobacter cause an estimated combined total of 1.8 million foodborne infections each year in the United States. Most cases of salmonellosis and campylobacteriosis are associated with eating raw or undercooked poultry or with cross-contamination. Between 1998 and 2008, 20% of Salmonella and 16% of Campylobacter foodborne disease outbreaks were associated with food prepared inside the home. A nationally representative Web survey of U.S. adult grocery shoppers (n = 1,504) was conducted to estimate the percentage of consumers who follow recommended food safety practices when handling raw poultry at home. The survey results identified areas of low adherence to current recommended food safety practices: not washing raw poultry before cooking, proper refrigerator storage of raw poultry, use of a food thermometer to determine doneness, and proper thawing of raw poultry in cold water. Nearly 70% of consumers reported washing or rinsing raw poultry before cooking it, a potentially unsafe practice because "splashing" of contaminated water may lead to the transfer of pathogens to other foods and other kitchen surfaces. Only 17.5% of consumers reported correctly storing raw poultry in the refrigerator. Sixty-two percent of consumers own a food thermometer, and of these, 26% or fewer reported using one to check the internal temperature of smaller cuts of poultry and ground poultry. Only 11% of consumers who thaw raw poultry in cold water reported doing so correctly. The study results, coupled with other research findings, will inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella and Campylobacter.

Towards an understanding of Internet-based problem shopping behaviour: The concept of online shopping addiction and its proposed predictors

PubMed Central

ROSE, SUSAN; DHANDAYUDHAM, ARUN

2014-01-01

Background: Compulsive and addictive forms of consumption and buying behaviour have been researched in both business and medical literature. Shopping enabled via the Internet now introduces new features to the shopping experience that translate to positive benefits for the shopper. Evidence now suggests that this new shopping experience may lead to problematic online shopping behaviour. This paper provides a theoretical review of the literature relevant to online shopping addiction (OSA). Based on this selective review, a conceptual model of OSA is presented. Method: The selective review of the literature draws on searches within databases relevant to both clinical and consumer behaviour literature including EBSCO, ABI Pro-Quest, Web of Science – Social Citations Index, Medline, PsycINFO and Pubmed. The article reviews current thinking on problematic, and specifically addictive, behaviour in relation to online shopping. Results: The review of the literature enables the extension of existing knowledge into the Internet-context. A conceptual model of OSA is developed with theoretical support provided for the inclusion of 7 predictor variables: low self-esteem, low self-regulation; negative emotional state; enjoyment; female gender; social anonymity and cognitive overload. The construct of OSA is defined and six component criteria of OSA are proposed based on established technological addiction criteria. Conclusions: Current Internet-based shopping experiences may trigger problematic behaviours which can be classified on a spectrum which at the extreme end incorporates OSA. The development of a conceptual model provides a basis for the future measurement and testing of proposed predictor variables and the outcome variable OSA. PMID:25215218

eShopper modeling and simulation

NASA Astrophysics Data System (ADS)

Petrushin, Valery A.

2001-03-01

The advent of e-commerce gives an opportunity to shift the paradigm of customer communication into a highly interactive mode. The new generation of commercial Web servers, such as the Blue Martini's server, combines the collection of data on a customer behavior with real-time processing and dynamic tailoring of a feedback page. The new opportunities for direct product marketing and cross selling are arriving. The key problem is what kind of information do we need to achieve these goals, or in other words, how do we model the customer? The paper is devoted to customer modeling and simulation. The focus is on modeling an individual customer. The model is based on the customer's transaction data, click stream data, and demographics. The model includes the hierarchical profile of a customer's preferences to different types of products and brands; consumption models for the different types of products; the current focus, trends, and stochastic models for time intervals between purchases; product affinity models; and some generalized features, such as purchasing power, sensitivity to advertising, price sensitivity, etc. This type of model is used for predicting the date of the next visit, overall spending, and spending for different types of products and brands. For some type of stores (for example, a supermarket) and stable customers, it is possible to forecast the shopping lists rather accurately. The forecasting techniques are discussed. The forecasting results can be used for on- line direct marketing, customer retention, and inventory management. The customer model can also be used as a generative model for simulating the customer's purchasing behavior in different situations and for estimating customer's features.

Real Decision Support for Health Insurance Policy Selection.

PubMed

Stein, Roger M

2016-03-01

We report on an ongoing project to develop data-driven tools to help individuals make better choices about health insurance and to better understand the range of costs to which they are exposed under different health plans. We describe a simulation tool that we developed to evaluate the likely usage and costs for an individual and family under a wide range of health service usage outcomes, but that can be tailored to specific physicians and the needs of the user and to reflect the demographics and other special attributes of the family. The simulator can accommodate, for example, specific known physician visits or planned procedures, while also generating statistically reasonable "unexpected" events like ER visits or catastrophic diagnoses. On the other hand, if a user provides only a small amount of information (e.g., just information about the family members), the simulator makes a number of generic assumptions regarding physician usage, etc., based on the age, gender, and other features of the family. Data to parameterize all of these events is informed by a combination of the information provided by the user and a series of specialized databases that we have compiled based on publicly available government data and commercial data as well as our own analysis of this initially very coarse and rigid data. To demonstrate both the subtlety of choosing a healthcare plan and the degree to which the simulator can aid in such evaluations, we present sample results using real insurance plans and two example policy shoppers with different demographics and healthcare needs.

Decreased diversion by doctor-shopping for a reformulated extended release oxycodone product (OxyContin).

PubMed

Chilcoat, Howard D; Coplan, Paul M; Harikrishnan, Venkatesh; Alexander, Louis

2016-08-01

Doctor-shopping (obtaining prescriptions from multiple prescribers/pharmacies) for opioid analgesics produces a supply for diversion and abuse, and represents a major public health issue. An open cohort study assessed changes in doctor-shopping in the U.S. for a brand extended release (ER) oxycodone product (OxyContin) and comparator opioids before (July, 2009 to June, 2010) versus after (January, 2011 to June, 2013) introduction of reformulated brand ER oxycodone with abuse-deterrent properties, using IMS LRx longitudinal data covering >150 million patients and 65% of retail U.S. prescriptions. After its reformulation, the rate of doctor-shopping decreased 50% (for 2+ prescribers/3+ pharmacies) for brand ER oxycodone, but not for comparators. The largest decreases in rates occurred among young adults (73%), those paying with cash (61%) and those receiving the highest available dose (62%), with a 90% decrease when stratifying by all three characteristics. The magnitude of doctor-shopping reductions increased with increasing number of prescribers/pharmacies (e.g., 75% reduction for ≥2 prescribers/≥4 pharmacies). The rate of doctor-shopping for brand ER oxycodone decreased substantially after its reformulation, which did not occur for other prescription opioids. The largest reductions in doctor-shopping occurred with characteristics associated with higher abuse risk such as youth, cash payment and high dose, and with more specific thresholds of doctor-shopping. A higher prescriber and/or pharmacy threshold also increased the magnitude of the decrease, suggesting that it better captured the effect of the reformulation on actual doctor-shoppers. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Towards an understanding of Internet-based problem shopping behaviour: The concept of online shopping addiction and its proposed predictors.

PubMed

Rose, Susan; Dhandayudham, Arun

2014-06-01

Compulsive and addictive forms of consumption and buying behaviour have been researched in both business and medical literature. Shopping enabled via the Internet now introduces new features to the shopping experience that translate to positive benefits for the shopper. Evidence now suggests that this new shopping experience may lead to problematic online shopping behaviour. This paper provides a theoretical review of the literature relevant to online shopping addiction (OSA). Based on this selective review, a conceptual model of OSA is presented. The selective review of the literature draws on searches within databases relevant to both clinical and consumer behaviour literature including EBSCO, ABI Pro-Quest, Web of Science - Social Citations Index, Medline, PsycINFO and Pubmed. The article reviews current thinking on problematic, and specifically addictive, behaviour in relation to online shopping. The review of the literature enables the extension of existing knowledge into the Internet-context. A conceptual model of OSA is developed with theoretical support provided for the inclusion of 7 predictor variables: low self-esteem, low self-regulation; negative emotional state; enjoyment; female gender; social anonymity and cognitive overload. The construct of OSA is defined and six component criteria of OSA are proposed based on established technological addiction criteria. Current Internet-based shopping experiences may trigger problematic behaviours which can be classified on a spectrum which at the extreme end incorporates OSA. The development of a conceptual model provides a basis for the future measurement and testing of proposed predictor variables and the outcome variable OSA.

Consumers' various and surprising responses to direct-to-consumer advertisements in magazine print.

PubMed

Arney, Jennifer; Street, Richard L; Naik, Aanand D

2013-01-01

Direct-to-consumer advertising (DTCA) is ubiquitous in media outlets, but little is known about the ways in which consumers' values, needs, beliefs, and biases influence the perceived meaning and value of DTCA. This article aims to identify the taxonomy of readership categories that reflect the complexity of how health care consumers interact with DTCA, with particular focus on individuals' perceptions of print DTCA in popular magazines. Respondent-driven sampling was used to recruit 18 male and female magazine readers and 18 male and female prescription medication users aged 18-71 years. Semi-structured, in-depth interviews with consumers about their attentiveness, motivations, perceived value, and behavioral responses to DTCA were conducted. The analyses were guided by principles of grounded theory analysis; four categories that vary in consumers' attentiveness, motivations, perceived value, and behavioral responses to DTCA were identified. Two categories - the lay physician and the informed shopper - see value in information from DTCA and are likely to seek medical care based on the information. One category - the voyeur - reads DTCA, but is not likely to approach a clinician regarding advertised information. The fourth category - the evader - ignores DTCA and is not likely to approach a clinician with DTCA information. Responses to DTCA vary considerably among consumers, and physicians should view patients' understanding and response to DTCA within the context of their health-related needs. Patients' comments related to DTCA may be used as an opportunity to engage and understand patients' perspectives about illness and medication use. Clinicians may use information about these categories to facilitate shared understanding and improve communication within the doctor-patient relationship.

Cross-sectional analysis of a community-based cooperative grocery store intervention in Saskatoon, Canada.

PubMed

Lotoski, Larisa C; Engler-Stringer, Rachel; Muhajarine, Nazeem

2015-03-12

The aim of this research is to examine the awareness and use of the Good Food Junction (GFJ), a not-for-profit full service cooperative grocery store in a former food desert in Saskatoon, Canada. Through door-to-door sampling, 365 residents in their neighbourhoods surrounding the GFJ grocery store were recruited. Quantitative surveys examined awareness, use and primary use of GFJ, mode of transportation to and from GFJ and primary grocery stores, other food program use and demographic data. Differences between those who had or had not shopped at GFJ were characterized using descriptive statistics and Pearson's chi-square test. Univariate and multivariate logistic regression models were developed to predict shopping at GFJ and the use of GFJ as a primary grocery store. Of those surveyed, 69% had shopped at GFJ. A significant proportion of shoppers were Aboriginal, had an annual household income per person of less than $20,000, and participated in other food-based programs and initiatives. Aboriginal people (OR = 2.0, p = 0.03) and users of neighbourhood-based fruit and vegetable markets (OR = 2.7, p = 0.04) were significantly more likely, but new immigrants to Canada (OR = 0.3, p = 0.05) were significantly less likely to have ever shopped at GFJ. Aboriginal respondents (OR = 2.6, p = 0.04) were significantly more likely to use GFJ as their primary grocery store. Our results confirm both that GFJ is able to serve households where food insecurity is likely and, based on the prevalence of users, the importance and need for a full-service supermarket in Saskatoon's inner city.

Fruit and vegetable shopping practices and social support scales: A validation.

PubMed

Baranowski, Tom; Missaghian, Mariam; Broadfoot, Alison; Watson, Kathy; Cullen, Karen; Nicklas, Theresa; Fisher, Jennifer; Baranowski, Janice; O'Donnell, Sharon

2006-01-01

To assess the psychometric characteristics of new scales of shopping practices and social support for purchasing fruits and vegetables. Participants were recruited in front of diverse grocery stores. Telephone data collection was done on 2 occasions, separated by 6 weeks. 166 food shoppers with children at home participated. New scales of food shopping practices and social support for purchasing fruits and vegetables were psychometrically analyzed and related to a measure of home fruit or vegetable availability as a test of construct validity. Both classical test and item response theory procedures were used. Correlations related the new measures to home fruit and vegetable availability. Single dimension scales were specified for fruit and vegetable shopping practices (35% of the variance), fruit purchase social support (53% of the variance), and vegetable purchase social support (52% of the variance). Item response theory difficulty estimates varied from -0.64 to 0.73 for fruit and vegetable shopping practices, from -0.55 to 0.33 for fruit purchase social support, and from -0.55 to 0.34 for vegetable social support. Each scale significantly correlated with home fruit and vegetable availability (construct validity), even after controlling for social desirability of response (0.19 for shopping practices, 0.37 for fruit purchasing social support, and 0.28 for vegetable purchasing social support). Person separation reliability was 0.80 for food shopping practices, 0.74 for fruit purchasing social support, and 0.73 for vegetable purchasing social support. The scales performed well. These scales are now available to help better understand fruit and vegetable shopping practices, fruit purchase social support, and vegetable purchase social support.

Indoor air quality at nine shopping malls in Hong Kong.

PubMed

Li, W M; Lee, S C; Chan, L Y

2001-06-12

Hong Kong is one of the most attractive shopping paradises in the world. Many local people and international tourists favor to spend their time in shopping malls in Hong Kong. Good indoor air quality is, therefore, very essential to shoppers. In order to characterize the indoor air quality in shopping malls, nine shopping malls in Hong Kong were selected for this study. The indoor air pollutants included carbon dioxide (CO2), carbon monoxide (CO), total hydrocarbons (THC), formaldehyde (HCHO), respirable particulate matter (PM10) and total bacteria count (TBC). More than 40% of the shopping malls had 1-h average CO2 levels above the 1000 ppm of the ASHRAE standard on both weekdays and weekends. Also, they had average weekday PM10 concentrations that exceeded the Hong Kong Indoor Air Quality Objective (HKIAQO). The highest indoor PM10 level at a mall was 380 microg/m3. Of the malls surveyed, 30% had indoor airborne bacteria levels above 1000 cfu/m3 set by the HKIAQO. The elevated indoor CO2 and bacteria levels could result from high occupancy combined with insufficient ventilation. The increased PM10 levels could be probably attributed to illegal smoking inside these establishments. In comparison, the shopping malls that contained internal public transport drop-off areas, where vehicles were parked with idling engines and had major entry doors close to heavy traffic roads had higher CO and PM10 indoor levels. In addition, the extensive use of cooking stoves without adequate ventilation inside food courts could increase indoor CO2, CO and PM10 levels.

Accessing primary care: a simulated patient study

PubMed Central

Campbell, John L; Carter, Mary; Davey, Antoinette; Roberts, Martin J; Elliott, Marc N; Roland, Martin

2013-01-01

Background Simulated patient, or so-called ‘mystery-shopper’, studies are a controversial, but potentially useful, approach to take when conducting health services research. Aim To investigate the construct validity of survey questions relating to access to primary care included in the English GP Patient Survey. Design and setting Observational study in 41 general practices in rural, urban, and inner-city settings in the UK. Method Between May 2010 and March 2011, researchers telephoned practices at monthly intervals, simulating patients requesting routine, but prompt, appointments. Seven measures of access and appointment availability, measured from the mystery-shopper contacts, were related to seven measures of practice performance from the GP Patient Survey. Results Practices with lower access scores in the GP Patient Survey had poorer access and appointment availability for five out of seven items measured directly, when compared with practices that had higher scores. Scores on items from the national survey that related to appointment availability were significantly associated with direct measures of appointment availability. Patient-satisfaction levels and the likelihood that patients would recommend their practice were related to the availability of appointments. Patients’ reports of ease of telephone access in the national survey were unrelated to three out of four measures of practice call handling, but were related to the time taken to resolve an appointment request, suggesting responders’ possible confusion in answering this question. Conclusion Items relating to the accessibility of care in a the English GP patient survey have construct validity. Patients’ satisfaction with their practice is not related to practice call handling, but is related to appointment availability. PMID:23561783

Level of Awareness Regarding Some Zoonotic Diseases, Among Dog Owners of Ithaca, New York

PubMed Central

Sandhu, Gursimrat Kaur; Singh, Devinder

2014-01-01

Objectives: Worldwide, dogs and cats are the two most common household companion animals. Because of this, they can be direct or indirect source of many human infections. Fortunately, most of these zoonotic infections can be clinically prevented by appropriate prophylactic interventions. Materials and Methods: Present kind of cross-sectional study, for the first time, was conducted in city of Ithaca, New York. People visiting local animal hospitals, dog parks, library and shoppers at Walmart supermarket were personally interviewed and a pre-tested questionnaire was got filled from every individual. The collected data were analyzed for percentage proportions using Microsoft Excel® and the results had been presented in graphical as well as tabulated forms. Results: Out of 100 participants responding to the request for participation, gender-wise, 45% of the participants were male while 55% of the participants were females. Demographically, 50% participants lived in rural, 35% in urban while 15% participants lived in suburban areas. Educational background of the participants ranged from High school pass-outs to Graduates. Conclusions: Participants were aware about the zoonotic potential of leptospirosis, giardiasis, rabies, hookworms, coccidiosis, lyme disease, roundworms, toxoplasma, leishmaniasis, salmonellosis and ringworm disease. Knowledge gaps in the sampled population, in terms of lack of awareness about zoonotic diseases vectored by mosquitoes, ticks and fleas; practice of not doing regular deworming and prophylactic control of fleas and ticks on pet dogs; and lack of practice among physicians to discuss zoonotic canine diseases with their clients were revealed by this study. PMID:25657956

A geo-ethnographic analysis of low-income rural and urban women's food shopping behaviors.

PubMed

MacNell, Lillian

2018-06-06

Many scholars have found evidence that low-income neighborhoods contain fewer supermarkets, but there is a lack of consensus regarding whether and how this matters to residents. A few qualitative studies have asked food desert residents about their experiences of their food environments, while a small number of other studies have utilized spatial analyses to examine actual shopping behaviors. To better understand barriers to food access, this study combines the two in a geo-ethnographic analysis. This study draws on data from a USDA-funded project about families and food to combine quantitative geographic data with qualitative interview data of 100 rural and urban low-income mothers of young children. For each participant, the nearest supermarket, as well most-frequented supermarket, was mapped, and distances to stores were calculated. On average, participants traveled more than twice as far as their nearest supermarket to reach a preferred store. Interviews with participants were conducted to assess the motivations and strategies of shoppers, in particular why they chose to bypass their nearest supermarkets. They shared a variety of reasons for doing so; foremost to find lower prices of food in order to stretch income and SNAP benefits. Access to transportation also played a major role in determining where people shopped for food. This research challenges scholars, policymakers, and health practitioners to look beyond proximate food environments to consider the lived experiences of food desert residents. Efforts to address poor food access should aim to increase household income, in addition to providing targeted food and nutrition assistance. Copyright © 2018. Published by Elsevier Ltd.

Comparing sugary drinks in the food retail environment in six NYC neighborhoods.

PubMed

Adjoian, Tamar; Dannefer, Rachel; Sacks, Rachel; Van Wye, Gretchen

2014-04-01

Obesity is a national public health concern linked to numerous chronic health conditions among Americans of all age groups. Evidence suggests that discretionary calories from sugary drink consumption have been a significant contributor to excess caloric intake among both children and adults. Research has established strong links between retail food environments and purchasing habits of consumers, but little information exists on the sugary drink retail environment in urban neighborhoods. The objective of this assessment was to compare various aspects of the sugary drink retail environment across New York City (NYC) neighborhoods with disparate self-reported sugary drink consumption patterns. In-store retail audits were conducted at 883 corner stores, chain pharmacies, and grocery stores in 12 zip codes throughout NYC. Results showed that among all beverage types assessed, sugary drinks had the most prominent presence in the retail environment overall, which was even more pronounced in higher-consumption neighborhoods. In higher- versus lower-consumption neighborhoods, the mean number of sugary drink varieties available at stores was higher (11.4 vs. 10.4 varieties), stores were more likely to feature sugary drink advertising (97 vs. 89 %) and advertising at multiple places throughout the store (78 vs. 57 %), and several sugary drinks, including 20-oz Coke® or Pepsi®, were less expensive ($1.38 vs. $1.60). These results, all statistically significant, indicate that neighborhoods characterized by higher levels of sugary drink consumption expose shoppers to sugary drinks to a greater extent than lower-consumption neighborhoods. This builds upon evidence documenting the association between the environment and individual behavior.

Use of food label information by urban consumers in India - a study among supermarket shoppers.

PubMed

Vemula, Sudershan R; Gavaravarapu, SubbaRao M; Mendu, Vishnu Vardhana Rao; Mathur, Pulkit; Avula, Laxmaiah

2014-09-01

To study consumer knowledge and use of food labels. A cross-sectional study employing both quantitative and qualitative methods. Intercept interviews were conducted with 1832 consumers at supermarket sites selected using a stratified random sampling procedure. This information was triangulated with twenty-one focus group discussions. New Delhi and Hyderabad, two metro-cities from north and south India. Adolescent (10-19 years), adult (20-59 years) and elderly (≥60 years) consumers. While the national urban literacy rate is 84 %, about 99 % of the study participants were educated. About 45 % reported that they buy pre-packaged foods once weekly and about a fifth buy them every day. Taste, quality, convenience and ease of use are the main reasons for buying pre-packaged foods. Although 90 % of consumers across the age groups read food labels, the majority (81 %) looked only for the manufacturing date or expiry/best before date. Of those who read labels, only a third checked nutrition information and ingredients. Nutrient information on labels was not often read because most consumers either lacked nutrition knowledge or found the information too technical to understand. About 60 % read quality symbols. A positive association was found between education level and checking various aspects of food labels. Women and girls concerned about 'fat' and 'sugar' intake read the nutrition facts panel. The intention of promoting healthy food choices through use of food labels is not being completely met. Since a majority of people found it difficult to comprehend nutrition information, there is a need to take up educational activities and/or introduce new forms of labelling.

Breast Health Services: Accuracy of Benefit Coverage Information in the Individual Insurance Marketplace.

PubMed

Hamid, Mariam S; Kolenic, Giselle E; Dozier, Jessica; Dalton, Vanessa K; Carlos, Ruth C

2017-04-01

The aim of this study was to determine if breast health coverage information provided by customer service representatives employed by insurers offering plans in the 2015 federal and state health insurance marketplaces is consistent with Patient Protection and Affordable Care Act (ACA) and state-specific legislation. One hundred fifty-eight unique customer service numbers were identified for insurers offering plans through the federal marketplace, augmented with four additional numbers representing the Connecticut state-run exchange. Using a standardized patient biography and the mystery-shopper technique, a single investigator posed as a purchaser and contacted each number, requesting information on breast health services coverage. Consistency of information provided by the representative with the ACA mandates (BRCA testing in high-risk women) or state-specific legislation (screening ultrasound in women with dense breasts) was determined. Insurer representatives gave BRCA test coverage information that was not consistent with the ACA mandate in 60.8% of cases, and 22.8% could not provide any information regarding coverage. Nearly half (48.1%) of insurer representatives gave coverage information about ultrasound screening for dense breasts that was not consistent with state-specific legislation, and 18.5% could not provide any information. Insurance customer service representatives in the federal and state marketplaces frequently provide inaccurate coverage information about breast health services that should be covered under the ACA and state-specific legislation. Misinformation can inadvertently lead to the purchase of a plan that does not meet the needs of the insured. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Evaluation of Healthy2Go: A country store transformation project to improve the food environment and consumer choices in Appalachian Kentucky.

PubMed

Rushakoff, Joshua A; Zoughbie, Daniel E; Bui, Nancy; DeVito, Katerina; Makarechi, Leila; Kubo, Hitomi

2017-09-01

Rates of obesity and type 2 diabetes in Kentucky's Cumberland Valley region are among the highest in the United States and limited access to healthy food contributes to these epidemics. The aim of Healthy2Go (H2G), a country store transformation project launched by Spread the Health Appalachia (STHA), was to improve awareness and availability of healthy options in small, rural stores. Ten country stores participated in H2G and received training and technical assistance to increase availability and awareness of healthy foods. Stores made inventory changes; installed point-of-purchase educational and in-store marketing materials directing shoppers to healthier options; provided nutrition education such as healthy recipes; and altered the display and location of healthy items. To measure changes within stores and the potential impact on resident eating and purchasing habits, STHA used four instruments: a modified version of the Nutrition Environs Measures Survey - Corner Stores at baseline and follow-up, a bimonthly store inventory assessment, a final store owner survey, and a Community Nutrition Survey at baseline (n = 287) and follow-up (n = 281). The stores in the H2G program (n = 10) had a 40% increase in stocking fresh produce, a 20% increase in produce variety, and trends towards increasing healthy inventory. During the same period, surveyed residents reported a statistically significant increase in the frequency of healthy food consumption. Small store transformation programs can improve availability of and access to healthy food in rural settings and influence local purchasing patterns.

Linking product design to consumer behavior: the moderating role of consumption experience.

PubMed

Gilal, Naeem Gul; Zhang, Jing; Gilal, Faheem Gul

2018-01-01

Previous investigations of product design broadly link aesthetic, functional, and symbolic designs to sales growth, high turnover, and market share. However, the effect of product design dimensions on consumer willingness-to-buy (WTB) and word-of-mouth (WOM) is virtually ignored by consumer researchers. Similarly, whether the consumption experience can differentiate the effect of the three product design dimensions on WTB and WOM is completely unknown. Using categorization theory as a lens, our study aims to explore the effect of product design dimensions on consumer WTB and WOM directly and indirectly through the moderation of the consumption experience. A convenience sample of (n=357) Chinese and (n=277) Korean shoppers was utilized to test the hypotheses in the fashion apparel industry. Our results showed that the aesthetic design was more prominent in capturing consumer WTB for both Chinese and Koreans. Similarly, the aesthetic design was more salient in enhancing WOM for Chinese, whereas the symbolic design was more promising in terms of improving WOM for Koreans. Further, our moderation results demonstrated that the consumption experience could differentiate the effects of the three product design dimensions on consumer WTB and WOM for Chinese. By contrast, the consumption experience could only interact with the aesthetic design to improve WOM for South Koreans. To the best of authors' knowledge, the present study is one of the initial attempts to link three product design dimensions with consumer WTB and WOM in the fashion apparel context and explored whether consumption experience competes or complement with three product design dimensions to shape consumer WTB and WOM for Chinese and Koreans.

Pediatric access to dermatologists: Medicaid versus private insurance.

PubMed

Chaudhry, Sofia B; Armbrecht, Eric S; Shin, Yoon; Matula, Sarah; Caffrey, Charles; Varade, Reena; Jones, Lisa; Siegfried, Elaine

2013-05-01

There is disparity in access to outpatient care for Medicaid beneficiaries. This inequity disproportionately impacts children. Access for children with skin disease may be especially limited. We sought to compare access to dermatologists for new pediatric patients insured by Medicaid versus a private plan. We surveyed 13 metropolitan markets by conducting secret-shopper scripted telephone calls to dermatology providers listed by Medicaid health plans. Paired calls, differing by insurance type, were made to each office on the same day, portraying a parent requesting a new appointment for a child with eczema. We called the offices of 723 Medicaid-listed providers. Final analysis included 471 dermatologists practicing general dermatology. Of these, an average of 44% refused a new Medicaid-insured pediatric patient. The average wait time for an appointment did not significantly vary between insurance types. Assuming that dermatologists not listed as Medicaid providers do not see Medicaid-insured children, our data indicate that pediatric Medicaid acceptance rates ranged from 6% to 64% by market, with an overall market size-weighted average acceptance rate of 19%. Relative reimbursement levels for Medicaid-insured patients did not correlate with acceptance rates. Although the most current health plan directories were used to create calling lists, these are dynamic. The sample sizes of confirmed appointments were in part limited by a lack of referral letters and/or health plan identification numbers. Only confirmed appointments were used to calculate average wait times. Access to dermatologists is limited for Medicaid-insured children with eczema. Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

The importance of stories in understanding people's relationship to food: narrative inquiry methodology has much to offer the public health nutrition researcher and practitioner.

PubMed

O'Kane, Gabrielle; Pamphilon, Barbara

2016-03-01

Despite the usefulness of quantitative research, qualitative research methodologies are equally needed to allow researchers to better understand the important social and environmental factors affecting food choice and eating habits. The present paper contributes insights from narrative inquiry, a well-established qualitative methodology, to a food-related doctoral research study. The connections between food shoppers and the producer, family, friends and others in the food system, between eaters and the earth, and how these connections affect people's meaning-making of food and pathways to food citizenship, were explored in the research. The research used narrative inquiry methodology and focus groups for data collection. Five different food-ways in the Canberra region of Australia were selected for the present research; that is, community gardens, community-supported agriculture, farmers' markets, fresh food markets and supermarkets. Fifty-two people voluntarily attended eight focus groups with four to nine participants in each. From a practical perspective, the present paper offers a guide to the way in which narrative inquiry has been applied to one research project. The paper describes the application of narrative inquiry methodology, revealing the important place of narratives in generating new knowledge. The paper further outlines how phased narrative analysis can lead to a defensible and rigorous interpretive framework grounded in the data generated from people's stories and meaning-making. We argue that individual, social and system change will not be possible without further rigorous qualitative studies to inform and complement the empirical basis of public health nutrition practice.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria.

PubMed

Burns, Cate; Bentley, Rebecca; Thornton, Lukar; Kavanagh, Anne

2011-06-01

To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping. Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables. Random selection of households from fifty small areas in Melbourne, Australia, in 2003. The main food shoppers in each household (n 2564). A lack of money was significantly more likely among the young and in households with single adults. Difficulty lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficulty lifting and reduced car access. In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Food shopping transition: socio-economic characteristics and motivations associated with use of supermarkets in a North African urban environment.

PubMed

Tessier, Sophie; Traissac, Pierre; Bricas, Nicolas; Maire, Bernard; Eymard-Duvernay, Sabrina; El Ati, Jalila; Delpeuch, Francis

2010-09-01

In the context of the nutrition transition and associated changes in the food retail sector, to examine the socio-economic characteristics and motivations of shoppers using different retail formats (large supermarkets (LSM), medium-sized supermarkets (MSM) or traditional outlets) in Tunisia. Cross-sectional survey (2006). Socio-economic status, type of food retailer and motivations data were collected during house visits. Associations between socio-economic factors and type of retailer were assessed by multinomial regression; correspondence analysis was used to analyse declared motivations. Peri-urban area around Tunis, Tunisia, North Africa. Clustered random sample of 724 households. One-third of the households used LSM, two-thirds used either type of supermarket, but less than 5 % used supermarkets only. Those who shopped for food at supermarkets were of higher socio-economic status; those who used LSM were much wealthier, more often had a steady income or owned a credit card, while MSM users were more urban and had a higher level of education. Most households still frequently used traditional outlets, mostly their neighbourhood grocer. Reasons given for shopping at the different retailers were most markedly leisure for LSM, while for the neighbourhood grocer the reasons were fidelity, proximity and availability of credit (the latter even more for lower-income customers). The results pertain to the transition in food shopping practices in a south Mediterranean country; they should be considered in the context of growing inequalities in health linked to the nutritional transition, as they differentiate use and motivations for the choice of supermarkets v. traditional food retailers according to socio-economic status.

A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR – implications for therapeutic failure and drug resistance

PubMed Central

Sengaloundeth, Sivong; Green, Michael D; Fernández, Facundo M; Manolin, Ot; Phommavong, Khamlieng; Insixiengmay, Vongsavanh; Hampton, Christina Y; Nyadong, Leonard; Mildenhall, Dallas C; Hostetler, Dana; Khounsaknalath, Lamphet; Vongsack, Latsamy; Phompida, Samlane; Vanisaveth, Viengxay; Syhakhang, Lamphone; Newton, Paul N

2009-01-01

Background Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in pharmacies and outlets (shops selling medicines) in the Lao PDR (Laos). Methods In 2003, 'mystery' shoppers were asked to buy artesunate tablets from 180 outlets in 12 of the 18 Lao provinces. Outlets were selected using stratified random sampling by investigators not involved in sampling. Samples were analysed for packaging characteristics, by the Fast Red Dye test, high-performance liquid chromatography (HPLC), mass spectrometry (MS), X-ray diffractometry and pollen analysis. Results Of 180 outlets sampled, 25 (13.9%) sold oral artesunate. Outlets selling artesunate were more commonly found in the more malarious southern Laos. Of the 25 outlets, 22 (88%; 95%CI 68–97%) sold counterfeit artesunate, as defined by packaging and chemistry. No artesunate was detected in the counterfeits by any of the chemical analysis techniques and analysis of the packaging demonstrated seven different counterfeit types. There was complete agreement between the Fast Red dye test, HPLC and MS analysis. A wide variety of wrong active ingredients were found by MS. Of great concern, 4/27 (14.8%) fakes contained detectable amounts of artemisinin (0.26–115.7 mg/tablet). Conclusion This random survey confirms results from previous convenience surveys that counterfeit artesunate is a severe public health problem. The presence of artemisinin in counterfeits may encourage malaria resistance to artemisinin derivatives. With increasing accessibility of artemisinin-derivative combination therapy (ACT) in Laos, the removal of artesunate monotherapy from pharmacies may be an effective intervention. PMID:19638225

Low Prevalence of Substandard and Falsified Antimalarial and Antibiotic Medicines in Public and Faith-Based Health Facilities of Southern Malawi

PubMed Central

Khuluza, Felix; Kigera, Stephen; Heide, Lutz

2017-01-01

Substandard and falsified antimalarial and antibiotic medicines represent a serious problem for public health, especially in low- and middle-income countries. However, information on the prevalence of poor-quality medicines is limited. In the present study, samples of six antimalarial and six antibiotic medicines were collected from 31 health facilities and drug outlets in southern Malawi. Random sampling was used in the selection of health facilities. For sample collection, an overt approach was used in licensed facilities, and a mystery shopper approach in nonlicensed outlets. One hundred and fifty-five samples were analyzed by visual and physical examination and by rapid prescreening tests, that is, disintegration testing and thin-layer chromatography using the GPHF-Minilab. Fifty-six of the samples were analyzed according to pharmacopeial monographs in a World Health Organization-prequalified quality control laboratory. Seven out-of-specification medicines were identified. One sample was classified as falsified, lacking the declared active ingredients, and containing other active ingredients instead. Three samples were classified as substandard with extreme deviations from the pharmacopeial standards, and three further samples as substandard with nonextreme deviations. Of the substandard medicines, three failed in dissolution testing, two in the assay for the content of the active pharmaceutical ingredient, and one failed in both dissolution testing and assay. Six of the seven out-of-specification medicines were from private facilities. Only one out-of-specification medicine was found within the samples from public and faith-based health facilities. Although the observed presence of substandard and falsified medicines in Malawi requires action, their low prevalence in public and faith-based health facilities is encouraging. PMID:28219993

Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

PubMed

Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Godwin, Sandria; Chambers, Delores

2015-07-01

Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

A diagnosis of eosinophilic esophagitis is associated with increased life insurance premiums.

PubMed

Leiman, D A; Kochar, B; Posner, S; Fan, C; Patel, A; Shaheen, O; Keller, C Y; Koutlas, N T; Eluri, S; Dellon, E S

2018-05-24

Eosinophilic esophagitis (EoE) is a chronic disease that can be diagnosed at any age, but is not associated with malignancy and does not shorten lifespan. It remains unknown whether an EoE diagnosis affects insurability or insurance premium costs. We therefore aimed to determine whether a diagnosis of EoE affects the costs of life insurance. Our investigation was a secret shopper audit study whereby we contacted national insurance companies in the United States to evaluate the effect of a diagnosis of EoE on life insurance premiums. We constructed standardized case scenarios for males and females, including a 25-year-old and a 48-year-old without other comorbid conditions, who either had or did not have a diagnosis of EoE. Companies were asked for their best estimate for a $100,000 whole life insurance policy. Comparisons between median premiums were made using the Mann-Whitney U test. There were 20 national life insurance companies contacted and a total of 73 quotes were obtained. The median premium rate was similar for EoE and non-EoE cases at the younger age ($828 [IQR $576-1,020] vs. $756 [IQR $504-$804]; P = 0.10). However, the premium for the older case without EoE was 19% less expensive compared to a case with EoE ($1990 [IQR $1,248-2,350] vs. $2,375 [IQR $2,100-2568; P = 0.02]. This finding was not explained by sex or state of residence. Based on these findings, we conclude that life insurance premiums are significantly more expensive in the older patient case with EoE when compared to the same case without EoE. Patients with EoE and their providers should be aware of the additional cost associated with this diagnosis.

The Impact of New York City’s Health Bucks Program on Electronic Benefit Transfer Spending at Farmers Markets, 2006–2009

PubMed Central

Dunn, Lillian; Nonas, Cathy; Dannefer, Rachel; Sacks, Rachel

2013-01-01

Introduction Increasing the accessibility and affordability of fresh produce is an important strategy for municipalities combatting obesity and related health conditions. Farmers markets offer a promising venue for intervention in urban settings, and in recent years, an increasing number of programs have provided financial incentives to Supplemental Nutrition Assistance Program (SNAP) recipients. However, few studies have explored the impact of these programs on use of SNAP benefits at farmers markets. Methods New York City’s Health Bucks Program provides SNAP recipients with a $2 coupon for every $5 spent using SNAP benefits at participating farmers markets. We analyzed approximately 4 years of electronic benefit transfer (EBT) sales data, from July 2006 through November 2009, to develop a preliminary assessment of the effect of the Health Bucks Program on EBT spending at participating markets. Results Farmers markets that offered Health Bucks coupons to SNAP recipients averaged higher daily EBT sales than markets without the incentive ($383.07, 95% confidence interval [CI], 333.1–433.1, vs $273.97, 95% CI, 243.4–304.5, P < 0.001) following the introduction of a direct point-of-purchase incentive. Multivariate analysis indicated this difference remained after adjusting for the year the market was held and the neighborhood poverty level. Conclusion When a $2 financial incentive was distributed with EBT, use of SNAP benefits increased at participating New York City farmers markets. We encourage other urban jurisdictions to consider adapting the Health Bucks Program to encourage low-income shoppers to purchase fresh produce as one potential strategy in a comprehensive approach to increasing healthful food access and affordability in low-income neighborhoods. PMID:24070035

Pediatric Price Transparency: Still Opaque With Opportunities for Improvement.

PubMed

Faherty, Laura J; Wong, Charlene A; Feingold, Jordyn; Li, Joan; Town, Robert; Fieldston, Evan; Werner, Rachel M

2017-10-01

Price transparency is gaining importance as families' portion of health care costs rise. We describe (1) online price transparency data for pediatric care on children's hospital Web sites and state-based price transparency Web sites, and (2) the consumer experience of obtaining an out-of-pocket estimate from children's hospitals for a common procedure. From 2015 to 2016, we audited 45 children's hospital Web sites and 38 state-based price transparency Web sites, describing availability and characteristics of health care prices and personalized cost estimate tools. Using secret shopper methodology, we called children's hospitals and submitted online estimate requests posing as a self-paying family requesting an out-of-pocket estimate for a tonsillectomy-adenoidectomy. Eight children's hospital Web sites (18%) listed prices. Twelve (27%) provided personalized cost estimate tool (online form n = 5 and/or phone number n = 9). All 9 hospitals with a phone number for estimates provided the estimated patient liability for a tonsillectomy-adenoidectomy (mean $6008, range $2622-$9840). Of the remaining 36 hospitals without a dedicated price estimate phone number, 21 (58%) provided estimates (mean $7144, range $1200-$15 360). Two of 4 hospitals with online forms provided estimates. Fifteen (39%) state-based Web sites distinguished between prices for pediatric and adult care. One had a personalized cost estimate tool. Meaningful prices for pediatric care were not widely available online through children's hospital or state-based price transparency Web sites. A phone line or online form for price estimates were effective strategies for hospitals to provide out-of-pocket price information. Opportunities exist to improve pediatric price transparency. Copyright © 2017 by the American Academy of Pediatrics.

Does transportation mode modify associations between distance to food store, fruit and vegetable consumption, and BMI in low-income neighborhoods?

PubMed

Fuller, Daniel; Cummins, Steven; Matthews, Stephen A

2013-01-01

A consistent body of research has shown that the neighborhood food environment is associated with fruit and vegetable (F&V) consumption and obesity in deprived neighborhoods in the United States. However, these studies have often neglected to consider how transportation can moderate associations between food accessibility and diet-related outcomes. This study examined associations between distance to primary food store, fruit and vegetable consumption, and BMI and whether mode of transportation to the primary food store moderates this relation. Cross-sectional data from the baseline wave of the Philadelphia Neighborhood Food Environment Study were used. A telephone survey of adult (≥18 y of age) household primary food shoppers residing in 2 Philadelphia neighborhoods was conducted (n = 1440). In a bivariate linear regression analysis, distance to primary food store did not predict F&V consumption (β = 0.04; 95% CI: -0.00, 0.09). Linear regression analysis stratified by transportation mode to the main F&V store showed no difference in F&V consumption between car, public, and multimodal transportation users. Compared with respondents using multimodal transportation, those using public transit had a significantly lower BMI (β = -1.31; 95% CI: -2.50, -0.10), whereas those using an automobile did not (β = -0.41; 95% CI: -1.36, 0.54). The assumption that using an automobile to access food stores results in increased F&V consumption was not confirmed. Significant associations were found for the relation between transportation mode and BMI. Theory-based mechanisms explaining relationships between the primary transportation mode used to access food stores and BMI should be further explored.

Linking product design to consumer behavior: the moderating role of consumption experience

PubMed Central

Gilal, Naeem Gul; Zhang, Jing; Gilal, Faheem Gul

2018-01-01

Background Previous investigations of product design broadly link aesthetic, functional, and symbolic designs to sales growth, high turnover, and market share. However, the effect of product design dimensions on consumer willingness-to-buy (WTB) and word-of-mouth (WOM) is virtually ignored by consumer researchers. Similarly, whether the consumption experience can differentiate the effect of the three product design dimensions on WTB and WOM is completely unknown. Using categorization theory as a lens, our study aims to explore the effect of product design dimensions on consumer WTB and WOM directly and indirectly through the moderation of the consumption experience. Methods A convenience sample of (n=357) Chinese and (n=277) Korean shoppers was utilized to test the hypotheses in the fashion apparel industry. Results Our results showed that the aesthetic design was more prominent in capturing consumer WTB for both Chinese and Koreans. Similarly, the aesthetic design was more salient in enhancing WOM for Chinese, whereas the symbolic design was more promising in terms of improving WOM for Koreans. Further, our moderation results demonstrated that the consumption experience could differentiate the effects of the three product design dimensions on consumer WTB and WOM for Chinese. By contrast, the consumption experience could only interact with the aesthetic design to improve WOM for South Koreans. Conclusion To the best of authors’ knowledge, the present study is one of the initial attempts to link three product design dimensions with consumer WTB and WOM in the fashion apparel context and explored whether consumption experience competes or complement with three product design dimensions to shape consumer WTB and WOM for Chinese and Koreans. PMID:29785145

Consumer perception of risk associated with eating genetically engineered soybeans is less in the presence of a perceived consumer benefit.

PubMed

Brown, J Lynne; Ping, Yanchao

2003-02-01

To determine whether perceived benefit alters personal risk perception associated with eating genetically engineered soybeans, consumer desire for labeling, preferred phrase on a label symbol, and desired information in an educational brochure. Comparison of responses of two consumer groups who completed one of two survey versions. One hundred fifty supermarket shoppers, age 21 years and older, for each survey or n=300 total. Focus groups and a pilot test were used to develop the final survey in which consumers read a description of a genetically engineered soybean with either no obvious consumer benefit or an obvious consumer benefit and then completed a set of attitude questions and evaluated a voluntary label design and educational brochure content. Main outcome measures were mean opinion scores of personal risk and desire for labeling and ranking of desired label phrase and brochure topics. Chi;(2) and t Tests were used. Consumers reading about the soybean with obvious consumer benefit were significantly more comfortable eating these than those reading about the soybean with no obvious consumer benefit (2.9+/-1.1 vs 3.4+/-1.0, respectively; P

Consumers’ various and surprising responses to direct-to-consumer advertisements in magazine print

PubMed Central

Arney, Jennifer; Street, Richard L; Naik, Aanand D

2013-01-01

Direct-to-consumer advertising (DTCA) is ubiquitous in media outlets, but little is known about the ways in which consumers’ values, needs, beliefs, and biases influence the perceived meaning and value of DTCA. This article aims to identify the taxonomy of readership categories that reflect the complexity of how health care consumers interact with DTCA, with particular focus on individuals’ perceptions of print DTCA in popular magazines. Respondent-driven sampling was used to recruit 18 male and female magazine readers and 18 male and female prescription medication users aged 18–71 years. Semi-structured, in-depth interviews with consumers about their attentiveness, motivations, perceived value, and behavioral responses to DTCA were conducted. The analyses were guided by principles of grounded theory analysis; four categories that vary in consumers’ attentiveness, motivations, perceived value, and behavioral responses to DTCA were identified. Two categories – the lay physician and the informed shopper – see value in information from DTCA and are likely to seek medical care based on the information. One category – the voyeur – reads DTCA, but is not likely to approach a clinician regarding advertised information. The fourth category – the evader – ignores DTCA and is not likely to approach a clinician with DTCA information. Responses to DTCA vary considerably among consumers, and physicians should view patients’ understanding and response to DTCA within the context of their health-related needs. Patients’ comments related to DTCA may be used as an opportunity to engage and understand patients’ perspectives about illness and medication use. Clinicians may use information about these categories to facilitate shared understanding and improve communication within the doctor–patient relationship. PMID:23378746

A stratified random survey of the proportion of poor quality oral artesunate sold at medicine outlets in the Lao PDR - implications for therapeutic failure and drug resistance.

PubMed

Sengaloundeth, Sivong; Green, Michael D; Fernández, Facundo M; Manolin, Ot; Phommavong, Khamlieng; Insixiengmay, Vongsavanh; Hampton, Christina Y; Nyadong, Leonard; Mildenhall, Dallas C; Hostetler, Dana; Khounsaknalath, Lamphet; Vongsack, Latsamy; Phompida, Samlane; Vanisaveth, Viengxay; Syhakhang, Lamphone; Newton, Paul N

2009-07-28

Counterfeit oral artesunate has been a major public health problem in mainland SE Asia, impeding malaria control. A countrywide stratified random survey was performed to determine the availability and quality of oral artesunate in pharmacies and outlets (shops selling medicines) in the Lao PDR (Laos). In 2003, 'mystery' shoppers were asked to buy artesunate tablets from 180 outlets in 12 of the 18 Lao provinces. Outlets were selected using stratified random sampling by investigators not involved in sampling. Samples were analysed for packaging characteristics, by the Fast Red Dye test, high-performance liquid chromatography (HPLC), mass spectrometry (MS), X-ray diffractometry and pollen analysis. Of 180 outlets sampled, 25 (13.9%) sold oral artesunate. Outlets selling artesunate were more commonly found in the more malarious southern Laos. Of the 25 outlets, 22 (88%; 95%CI 68-97%) sold counterfeit artesunate, as defined by packaging and chemistry. No artesunate was detected in the counterfeits by any of the chemical analysis techniques and analysis of the packaging demonstrated seven different counterfeit types. There was complete agreement between the Fast Red dye test, HPLC and MS analysis. A wide variety of wrong active ingredients were found by MS. Of great concern, 4/27 (14.8%) fakes contained detectable amounts of artemisinin (0.26-115.7 mg/tablet). This random survey confirms results from previous convenience surveys that counterfeit artesunate is a severe public health problem. The presence of artemisinin in counterfeits may encourage malaria resistance to artemisinin derivatives. With increasing accessibility of artemisinin-derivative combination therapy (ACT) in Laos, the removal of artesunate monotherapy from pharmacies may be an effective intervention.

Single-particle characterization of indoor aerosol particles collected at an underground shopping area in Seoul, Korea.

PubMed

Maskey, Shila; Kang, TaeHee; Jung, Hae-Jin; Ro, Chul-Un

2011-02-01

In this study, single-particle characterization of aerosol particles collected at an underground shopping area was performed for the first time. A quantitative single-particle analytical technique, low-Z particle electron probe X-ray microanalysis, was used to characterize a total of 7900 individual particles for eight sets of aerosol samples collected at an underground shopping area in Seoul, Korea. Based on secondary electron images and X-ray spectral data of individual particles, fourteen particle types were identified, in which primary soil-derived particles were the most abundant, followed by carbonaceous, Fe-containing, secondary soil-derived, and secondary sea-salt particles. Carbonaceous particles exist in three types: organic carbon, carbon-rich, and CNO-rich. A significant number of textile particles with chemical composition C, N, and O were encountered in some of the aerosol samples, which were from the textile shops and/or from clothes of passersby. Primary soil-derived particles showed seasonal variation, with peak values in spring samples, reflecting higher air exchange between indoor and outdoor environments in the spring. Secondary soil-derived, secondary sea-salt, and ammonium sulfate particles were frequently encountered in winter samples. Fe-containing particles, contributed from a nearby subway station, were in the range of about 19% relative abundances for all samples. In underground shopping areas, particulate matters can be a considerable health hazard to the workers, shoppers, passersby, and shop-keepers as they spend their considerable time in this closed microenvironment. However, no study on the characteristics of indoor aerosols in an underground shopping area has been reported to our knowledge. This work provides detailed information on characteristics of underground shopping area aerosols on a single particle level. © 2010 John Wiley & Sons A/S.

Covert checks by standardised patients of general practitioners' delivery of new periodic health examinations: clustered cross-sectional study from a consumer organisation

PubMed Central

Thaler, Kylie; Harris, Mark F

2012-01-01

Objective To assess if data collected by a consumer organisation are valid for a health service research study on physicians' performance in preventive care. To report first results of the analysis of physicians performance like consultation time and guideline adherence in history taking. Design Secondary data analysis of a clustered cross-sectional direct observation survey. Setting General practitioners (GPs) in Vienna, Austria, visited unannounced by mystery shoppers (incognito standardised patients (ISPs)). Participants 21 randomly selected GPs were visited by two different ISPs each. 40 observation protocols were realised. Main outcome measures Robustness of sampling and data collection by the consumer organisation. GPs consultation and waiting times, guideline adherence in history taking. Results The double stratified random sampling method was robust and representative for the private and contracted GPs mix of Vienna. The clinical scenarios presented by the ISPs were valid and believable, and no GP realised the ISPs were not genuine patients. The average consultation time was 46 min (95% CI 37 to 54 min). Waiting times differed more than consultation times between private and contracted GPs. No differences between private and contracted GPs in terms of adherence to the evidence-based guidelines regarding history taking including questions regarding alcohol use were found. According to the analysis, 20% of the GPs took a perfect history (95% CI 9% to 39%). Conclusions The analysis of secondary data collected by a consumer organisation was a valid method for drawing conclusions about GPs preventive practice. Initial results, like consultation times longer than anticipated, and the moderate quality of history taking encourage continuing the analysis on available clinical data. PMID:22872721

The impact of New York City's Health Bucks Program on electronic benefit transfer spending at farmers markets, 2006-2009.

PubMed

Baronberg, Sabrina; Dunn, Lillian; Nonas, Cathy; Dannefer, Rachel; Sacks, Rachel

2013-09-26

Increasing the accessibility and affordability of fresh produce is an important strategy for municipalities combatting obesity and related health conditions. Farmers markets offer a promising venue for intervention in urban settings, and in recent years, an increasing number of programs have provided financial incentives to Supplemental Nutrition Assistance Program (SNAP) recipients. However, few studies have explored the impact of these programs on use of SNAP benefits at farmers markets. New York City's Health Bucks Program provides SNAP recipients with a $2 coupon for every $5 spent using SNAP benefits at participating farmers markets. We analyzed approximately 4 years of electronic benefit transfer (EBT) sales data, from July 2006 through November 2009, to develop a preliminary assessment of the effect of the Health Bucks Program on EBT spending at participating markets. Farmers markets that offered Health Bucks coupons to SNAP recipients averaged higher daily EBT sales than markets without the incentive ($383.07, 95% confidence interval [CI], 333.1-433.1, vs $273.97, 95% CI, 243.4-304.5, P < 0.001) following the introduction of a direct point-of-purchase incentive. Multivariate analysis indicated this difference remained after adjusting for the year the market was held and the neighborhood poverty level. When a $2 financial incentive was distributed with EBT, use of SNAP benefits increased at participating New York City farmers markets. We encourage other urban jurisdictions to consider adapting the Health Bucks Program to encourage low-income shoppers to purchase fresh produce as one potential strategy in a comprehensive approach to increasing healthful food access and affordability in low-income neighborhoods.

How tobacco companies ensure prime placement of their advertising and products in stores: interviews with retailers about tobacco company incentive programmes

PubMed Central

Feighery, E; Ribisl, K; Clark, P; Haladjian, H

2003-01-01

Background: About 81% of cigarette manufacturers' marketing expenditures in the USA is spent to promote cigarette sales in stores. Relatively little is known about how these expenditures help the manufacturers achieve their marketing goals in stores. A better understanding of how tobacco companies influence the retail environment would help researchers and tobacco control activists to monitor industry presence in stores. Objective: To describe the types of tobacco company incentive programmes offered to retailers, how these programmes impact the store environments, and possible visual indicators of retailer participation in incentive programmes. Study design: In-depth qualitative interviews with a convenience sample of 29 tobacco retailers were conducted in 2001. Setting: USA. Main outcome measures: The types and requirements of retailer incentive programmes provided by tobacco companies, and how participation in a programme alters their stores. Results: The retailers provided insights into how tobacco companies convey promotional allowances and special offers to them and how these incentives shape the retail environment. Retailers noted that tobacco companies exert substantial control over their stores by requiring placement of products in the most visible locations, and of specific amounts and types of advertising in prime locations in the store. Retailers also described how tobacco companies reduce prices by offering them volume based discounts, "buy two, get one free" specials, and "buying down" the price of existing product. Conclusions: Tobacco companies are concentrating their marketing dollars at the point-of-sale to the extent that the store is their primary communication channel with customers. As a result, all shoppers regardless of age or smoking status are exposed to pro-smoking messages. Given the financial resources spent by tobacco companies in stores, this venue warrants closer scrutiny by researchers and tobacco control advocates. PMID:12773729

Piloting the global subsidy: the impact of subsidized artemisinin-based combination therapies distributed through private drug shops in rural Tanzania.

PubMed

Sabot, Oliver J; Mwita, Alex; Cohen, Justin M; Ipuge, Yahya; Gordon, Megumi; Bishop, David; Odhiambo, Moses; Ward, Lorrayne; Goodman, Catherine

2009-09-02

WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001). A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. Controlled-Trials.com ISRCTN39125414.

Environmental influences on fruit and vegetable intake: Results from a path analytic model

PubMed Central

Liese, Angela D.; Bell, Bethany A.; Barnes, Timothy L.; Colabianchi, Natalie; Hibbert, James D.; Blake, Christine E.; Freedman, Darcy A.

2014-01-01

Objective Fruit and vegetable intake (F&V) is influenced by behavioral and environmental factors, but these have rarely been assessed simultaneously. We aimed to quantify the relative influence of supermarket availability, perceptions of the food environment, and shopping behavior on F&V intake. Design A cross-sectional study. Setting Eight-counties in South Carolina, USA, with verified locations of all supermarkets. Subjects A telephone survey of 831 household food shoppers ascertained F&V intake with a 17-item screener, primary food store location, shopping frequency, perceptions of healthy food availability, and calculated GIS-based supermarket availability. Path analysis was conducted. We report standardized beta coefficients on paths significant at the 0.05 level. Results Frequency of grocery shopping at primary food store (β=0.11) was the only factor exerting an independent, statistically significant direct effect on F&V intake. Supermarket availability was significantly associated with distance to food store (β=-0.24) and shopping frequency (β=0.10). Increased supermarket availability was significantly and positively related to perceived healthy food availability in the neighborhood (β=0.18) and ease of shopping access (β=0.09). Collectively considering all model paths linked to perceived availability of healthy foods, this measure was the only other factor to have a significant total effect on F&V intake. Conclusions While the majority of literature to date has suggested an independent and important role of supermarket availability for F&V intake, our study found only indirect effects of supermarket availability and suggests that food shopping frequency and perceptions of healthy food availability are two integral components of a network of influences on F&V intake. PMID:24192274

Consultation behaviour of doctor-shopping patients and factors that reduce shopping.

PubMed

Ohira, Yoshiyuki; Ikusaka, Masatomi; Noda, Kazutaka; Tsukamoto, Tomoko; Takada, Toshihiko; Miyahara, Masahito; Funakoshi, Hiraku; Basugi, Ayako; Keira, Katsunori; Uehara, Takanori

2012-04-01

To investigate the subsequent behaviour of doctor-shopping patients (defined as those attending multiple hospitals for the same complaint) who consulted our department and factors related to cessation of doctor shopping. Patients who presented without referral to the Department of General Medicine at Chiba University Hospital in Japan (our department) completed a questionnaire at their first visit. A follow-up questionnaire was also sent to them in order to assess doctor shopping after 3 months. Then items in the questionnaires were investigated for significant differences between patients who continued or stopped doctor shopping. Logistic regression analysis was performed with items showing a significant difference between patients who stopped doctor shopping and those who continued it, in order to identify independent determinants of the cessation of shopping. A total of 978 patients who presented spontaneously to our department consented to this study, and 929 patients (95.0%) completed questionnaires correctly. Among them, 203 patients (21.9%) were identified as doctor shoppers. The follow-up survey was completed correctly by 138 patients (68.0%). Among them, 25 patients (18.1%) were found to have continued doctor shopping, which was a significantly lower rate than before (P < 0.001). Logistic regression analysis selected the following factors as independent determinants of the cessation of doctor shopping: 'confirmation of the diagnosis' (odds ratio: 8.12, 95% confidence interval: 1.46-45.26), and 'satisfaction with consultation' (odds ratio: 2.07, 95% confidence interval: 1.42-3.01). Doctor shopping decreased significantly after patients consulted our department, with 'confirmation of the diagnosis' and 'satisfaction with consultation' being identified as contributing factors. © 2010 Blackwell Publishing Ltd.

Do effects of price discounts and nutrition education on food purchases vary by ethnicity, income and education? Results from a randomised, controlled trial.

PubMed

Blakely, Tony; Ni Mhurchu, Cliona; Jiang, Yannan; Matoe, Leonie; Funaki-Tahifote, Mafi; Eyles, Helen C; Foster, Rachel H; McKenzie, Sarah; Rodgers, Anthony

2011-10-01

Reducing health inequalities requires interventions that work as well, if not better, among disadvantaged populations. The aim of this study was to determine if the effects of price discounts and tailored nutrition education on supermarket food purchases (percentage energy from saturated fat and healthy foods purchased) vary by ethnicity, household income and education. A 2×2 factorial trial of 1104 New Zealand shoppers randomised to receive a 12.5% discount on healthier foods and/or tailored nutrition education (or no intervention) for 6 months. There was no overall association of price discounts or nutrition education with percentage energy from saturated fat, or nutrition education with healthy food purchasing. There was an association of price discounts with healthy food purchasing (0.79 kg/week increase; 95% CI 0.43 to 1.16) that varied by ethnicity (p=0.04): European/other 1.02 kg/week (n=755; 95% CI 0.60 to 1.43); Pacific 1.20 kg/week (n=101; 95% CI 0.06 to 2.34); Māori -0.15 kg/week (n=248; 95% CI -1.10 to 0.80). This association of price discounts with healthy food purchasing did not vary by household income or education. While a statistically significant variation by ethnicity in the effect of price discounts on food purchasing was found, the authors caution against a causal interpretation due to likely biases (eg, attrition) that differentially affected Māori and Pacific people. The study highlights the challenges in generating valid evidence by social groups for public health interventions. The null findings for tailored nutritional education across all social groups suggest that structural interventions (such as price) may be more effective.

Piloting the Global Subsidy: The Impact of Subsidized Artemisinin-Based Combination Therapies Distributed through Private Drug Shops in Rural Tanzania

PubMed Central

Sabot, Oliver J.; Mwita, Alex; Cohen, Justin M.; Ipuge, Yahya; Gordon, Megumi; Bishop, David; Odhiambo, Moses; Ward, Lorrayne; Goodman, Catherine

2009-01-01

Background WHO estimates that only 3% of fever patients use recommended artemisinin-based combination therapies (ACTs), partly reflecting their high prices in the retail sector from where many patients seek treatment. To overcome this challenge, a global ACT subsidy has been proposed. We tested this proposal through a pilot program in rural Tanzania. Methods/Principal Findings Three districts were assigned to serve either as a control or to receive the subsidy plus a package of supporting interventions. From October 2007, ACTs were sold at a 90% subsidy through the normal private supply chain to intervention district drug shops. Data were collected at baseline and during intervention using interviews with drug shop customers, retail audits, mystery shoppers, and audits of public and NGO facilities. The proportion of consumers in the intervention districts purchasing ACTs rose from 1% at baseline to 44.2% one year later (p<0.001), and was significantly higher among consumers purchasing for children under 5 than for adults (p = 0.005). No change in ACT usage was observed in the control district. Consumers paid a mean price of $0.58 for ACTs, which did not differ significantly from the price paid for sulphadoxine-pyrimethamine, the most common alternative. Drug shops in population centers were significantly more likely to stock ACTs than those in more remote areas (p<0.001). Conclusions A subsidy introduced at the top of the private sector supply chain can significantly increase usage of ACTs and reduce their retail price to the level of common monotherapies. Additional interventions may be needed to ensure access to ACTs in remote areas and for poorer individuals who appear to seek treatment at drug shops less frequently. Trial Registration Controlled-Trials.com ISRCTN39125414. PMID:19724644

Alcohol and Tobacco Sales to Underage Buyers in Dutch Supermarkets: Can the Use of Age Verification Systems Increase Seller's Compliance?

PubMed

Roodbeen, Ruud T J; Schelleman-Offermans, Karen; Lemmens, Paul H H M

2016-06-01

Age limits are effective in reducing alcohol- and tobacco-related harm, however, their effectiveness depends on the extent to which they are complied with. This study aimed to investigate the effectiveness of different age verification systems (AVSs) implemented by 400 Dutch supermarkets on requesting a valid age verification (ID) and on sellers' compliance. A mixed method design was used. Compliance was measured by 800 alcohol and tobacco purchase attempts by 17-year-old mystery shoppers. To analyze the effectiveness of AVSs, logistic regression analyses were performed. Insight into facilitating and hindering factors in the purchase process was obtained by 13 interviews with supermarket managers. Only a tendency toward a positive effect of the presence of the keying-on-date-of-birth AVS or ID swiper/checker was found on ID request for both alcohol and tobacco purchase attempts. The use of the keying-on-date-of-birth AVS or ID swiper/checker significantly increased the odds for compliance after an ID was requested, for both alcohol and tobacco purchase attempts. Managers indicated that ID requests and compliance could be facilitated by providing cashiers with sufficient managerial support, technical support, and regular training about the purchase process and use of the AVS. The usage of AVSs calculating and confirming whether the customer reached the legal purchase age for cashiers significantly increases the odds for cashiers to comply with age limits of alcohol and tobacco. Future research should gain insight into how usage of effective AVSs can be improved and explore the feasibility of implementation and effectiveness in other outlets. Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Traditional, modern or mixed? Perspectives on social, economic, and health impacts of evolving food retail in Thailand.

PubMed

Kelly, Matthew; Seubsman, Sam-Ang; Banwell, Cathy; Dixon, Jane; Sleigh, Adrian

Transnational food retailers expanded to middle-income countries over recent decades responding to supply (liberalized foreign investment) and demand (rising incomes, urbanization, female workforce participation, and time poverty). Control in new markets diffuses along three axes: socio-economic (rich to poor), geographic (urban to rural), and product category (processed foods to fresh foods). We used a mixed method approach to study the progression of modern retail in Thailand on these three axes and consumer preferences for food retailing. In Thailand modern retail controls half the food sales but traditional fresh markets remain important. Quantitative questionnaires administered to members of a large national cohort study revealed around half of respondents were primarily traditional shoppers and half either utilized modern and traditional formats equally or primarily shopped at supermarkets. Fresh foods were mainly purchased at traditional retail formats and dry packaged foods at supermarkets. Qualitative interviews found price and quality of produce and availability of culturally important products to be significant reasons for continued support of fresh markets. Our results show socio-economic and geographic diffusion is already advanced with most respondents having access to and utilizing modern retail. Control of the fresh food sector by transnationals faces barriers in Thailand and may remain elusive. The short to mid-term outcome may be a bifurcated food system with modern and traditional retail each retaining market share, but fresh markets longer term survival may require government assistance as supermarkets become more established. Fresh markets supply affordable, healthy foods, and livelihoods for poorer Thais and are repositories of Thai food culture and social networks. If they survive they will confer cultural, social, economic, and health benefits.

Simulated Patient Studies: An Ethical Analysis

PubMed Central

Rhodes, Karin V; Miller, Franklin G

2012-01-01

Context In connection with health care reform, the U.S. Department of Health and Human Services commissioned a “mystery shopper,” or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over “government spying” on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. Methods We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. Findings Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy-relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. Conclusions As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy-relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate socially valuable knowledge. PMID:23216428

Conceptualizing and measuring pharmacist-patient communication: a review of published studies.

PubMed

Shah, Bupendra; Chewning, Betty

2006-06-01

Pharmacist-patient communication in community pharmacies has been studied for over 25 years with little effort to evaluate this research comprehensively. The main objective of this review is to examine and summarize how researchers have conceptualized, defined, and measured pharmacist-patient communication across studies and identify gaps in the literature. Articles were compiled from a search of (1) Medline, IPA, CINAHL, and PubMed databases using the keywords, "counseling", "patient communication", "patient counseling", "patient education", "patient consult( *)", and/or "pharmacists", (2) bibliographies of selected articles. The search generated 56 studies on community pharmacy, of which 39 studies met the inclusion criteria. Most studies (72%) have used the term patient counseling, although pharmacist-patient communication and patient education were also used. The definition of patient counseling varies across studies. Almost half of the studies (49%) conceptualized pharmacist-patient communication solely as a pharmacist information provision activity. A total of 16 studies (41%) also focused on pharmacists' interpersonal behavior in addition to the information provision activity of the pharmacist. In contrast, patient communication behavior and the exchange process between both parties has been understudied. A total of 16 studies (41%) used a retrospective design. All studies used a cross-sectional design, with varying modes of data collection such as mail surveys, telephone interviews, nonparticipant observation, and shopper studies. Taped encounters are rare. SUMMARY/IMPLICATIONS: This review revealed that most studies have focused on a one way communication of pharmacists to patients. A need for examining the patient-pharmacist dyad is apparent. Future research could explore a greater use of taped encounters to analyze the interactive communication process, affective components of communication such as collaborative problem solving, interpersonal relationship development, and the expertise that patients bring into the encounter.

Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries.

PubMed

Fitzpatrick, Anne; Tumlinson, Katherine

2017-03-24

The use of simulated clients or "mystery clients" is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost. © Fitzpatrick and Tumlinson.

How tobacco companies ensure prime placement of their advertising and products in stores: interviews with retailers about tobacco company incentive programmes.

PubMed

Feighery, E C; Ribisl, K M; Clark, P I; Haladjian, H H

2003-06-01

About 81% of cigarette manufacturers' marketing expenditures in the USA is spent to promote cigarette sales in stores. Relatively little is known about how these expenditures help the manufacturers achieve their marketing goals in stores. A better understanding of how tobacco companies influence the retail environment would help researchers and tobacco control activists to monitor industry presence in stores. To describe the types of tobacco company incentive programmes offered to retailers, how these programmes impact the store environments, and possible visual indicators of retailer participation in incentive programmes. In-depth qualitative interviews with a convenience sample of 29 tobacco retailers were conducted in 2001. USA. The types and requirements of retailer incentive programmes provided by tobacco companies, and how participation in a programme alters their stores. The retailers provided insights into how tobacco companies convey promotional allowances and special offers to them and how these incentives shape the retail environment. Retailers noted that tobacco companies exert substantial control over their stores by requiring placement of products in the most visible locations, and of specific amounts and types of advertising in prime locations in the store. Retailers also described how tobacco companies reduce prices by offering them volume based discounts, "buy two, get one free" specials, and "buying down" the price of existing product. Tobacco companies are concentrating their marketing dollars at the point-of-sale to the extent that the store is their primary communication channel with customers. As a result, all shoppers regardless of age or smoking status are exposed to pro-smoking messages. Given the financial resources spent by tobacco companies in stores, this venue warrants closer scrutiny by researchers and tobacco control advocates.

The impact of a supermarket nutrition rating system on purchases of nutritious and less nutritious foods.

PubMed

Cawley, John; Sweeney, Matthew J; Sobal, Jeffery; Just, David R; Kaiser, Harry M; Schulze, William D; Wethington, Elaine; Wansink, Brian

2015-01-01

The current study examines the impact of a nutrition rating system on consumers' food purchases in supermarkets. Aggregate sales data for 102 categories of food (over 60 000 brands) on a weekly basis for 2005-2007 from a supermarket chain of over 150 stores are analysed. Change in weekly sales of nutritious and less nutritious foods, after the introduction of a nutrition rating system on store shelves, is calculated, controlling for seasonality and time trends in sales. One hundred and sixty-eight supermarket stores in the north-east USA, from January 2005 to December 2007. Consumers purchasing goods at the supermarket chain during the study period. After the introduction of the nutrition ratings, overall weekly food sales declined by an average of 3637 units per category (95 % CI -5961, -1313; P<0·01). Sales of less nutritious foods fell by 8·31 % (95 % CI -13·50, -2·80 %; P=0·004), while sales of nutritious foods did not change significantly (P=0·21); as a result, the percentage of food purchases rated as nutritious rose by 1·39 % (95 % CI 0·58, 2·20 %; P<0·01). The decrease in sales of less nutritious foods was greatest in the categories of canned meat and fish, soda pop, bakery and canned vegetables. The introduction of the nutrition ratings led shoppers to buy a more nutritious mix of products. Interestingly, it did so by reducing purchases of less nutritious foods rather than by increasing purchases of nutritious foods. In evaluating nutrition information systems, researchers should focus on the entire market basket, not just sales of nutritious foods.

The impact of parameters of store illumination on food shopper response.

PubMed

Berčík, Jakub; Horská, Elena; Wang, Regina W Y; Chen, Ying-Chun

2016-11-01

Customer behavior in sales areas is strongly influenced by the perception of surroundings and feelings of well-being. By using dynamic retail solutions of basic, accent and dramatic lighting it is possible to attract attention, create a unique in-store environment and give customers a reason to stay and return to the store. The simplest and also the most successful method to reach customer attention in food selection (buying) process is through eye-catchingly illuminated visuals of products. Visual senses has evolved to top ranks in the sensory hierarchy, therefore visual stimuli have a tendency to overcome all other senses. The paper deals with a comprehensive interdisciplinary research of the influence of light and color on the emotional state of consumers (valence) on the food market. It integrates the measurement of light intensity, color temperature or emitted color spectrum in grocery stores, recognition of emotional response and the time of its occurrence among respondents due to different lighting types and color in simulated laboratory conditions. The research is focused on accent lighting in the segment of fresh unpackaged food. Using a mobile 16-channel electroencephalograph (EEG equipment) from EPOC company and a mini camera we observed the response time and the emotional status (valence), in order to reveal true consumer preferences in different lighting conditions (color temperature and color rendering index) and their non-traditional color (yellow, purple, red, blue and green) for the selected food type. The paper suggests possibilities for rational combination of the effective, efficient and energy-saving accent lighting, by which the retailer can achieve not only an eye-catching and attractive presentation of merchandised products, but also significant savings within operating their stores. Copyright © 2016 Elsevier Ltd. All rights reserved.

Strategies for Optimal Implementation of Simulated Clients for Measuring Quality of Care in Low- and Middle-Income Countries

PubMed Central

Fitzpatrick, Anne; Tumlinson, Katherine

2017-01-01

ABSTRACT The use of simulated clients or “mystery clients” is a data collection approach in which a study team member presents at a health care facility or outlet pretending to be a real customer, patient, or client. Following the visit, the shopper records her observations. The use of mystery clients can overcome challenges of obtaining accurate measures of health care quality and improve the validity of quality assessments, particularly in low- and middle-income countries. However, mystery client studies should be carefully designed and monitored to avoid problems inherent to this data collection approach. In this article, we discuss our experiences with the mystery client methodology in studies conducted in public- and private-sector health facilities in Kenya and in private-sector facilities in Uganda. We identify both the benefits and the challenges in using this methodology to guide other researchers interested in using this technique. Recruitment of appropriate mystery clients who accurately represent the facility's clientele, have strong recall of recent events, and are comfortable in their role as undercover data collectors are key to successful implementation of this methodology. Additionally, developing detailed training protocols can help ensure mystery clients behave identically and mimic real patrons accurately while short checklists can help ensure mystery client responses are standardized. Strict confidentiality and protocols to avoid unnecessary exams or procedures should also be stressed during training and monitored carefully throughout the study. Despite these challenges, researchers should consider mystery client designs to measure actual provider behavior and to supplement self-reported provider behavior. Data from mystery client studies can provide critical insight into the quality of service provision unavailable from other data collection methods. The unique information available from the mystery client approach far outweighs the cost. PMID:28126970

Mechanisms of Prescription Drug Diversion Among Drug-Involved Club- and Street-Based Populations

PubMed Central

Inciardi, James A.; Surratt, Hilary L.; Kurtz, Steven P.; Cicero, Theodore J.

2010-01-01

Objective Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician's office, the retail pharmacy, or the patient. However, empirical data on diversion are limited. Method In an attempt to develop a better understanding of how specific drug-using populations are diverting prescription opioids and other medications, or obtaining controlled drugs that have already been diverted, qualitative interviews and focus group data were collected on four separate populations of prescription drug abusers in Miami, Florida—club drug users, street-based illicit drug users, methadone maintenance patients, and HIV positive individuals who abuse and/or divert drugs. Results Sources of abused prescription drugs cited by focus group participants were extremely diverse, including their physicians and pharmacists; parents and relatives; “doctor shopping”; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment flyers advertising telephone numbers to call; and “stealing from grandma's medicine cabinet.” Conclusion While doctor shoppers, physicians and the Internet receive much of the attention regarding diversion, the data reported in this paper suggest that there are numerous active street markets involving patients, Medicaid recipients and pharmacies as well. In addition, there are other data which suggest that the contributions of residential burglaries, pharmacy robberies and thefts, and “sneak thefts” to the diversion problem may be understated. PMID:17305688

Comparative cost evaluation of brand name and generic ophthalmology medications in Ontario.

PubMed

Popovic, Marko; Chan, Clara; Lattanzio, Nisha; El-Defrawy, Sherif; Schlenker, Matthew B

2018-04-01

Medication cost for the same indication can vary considerably and can affect patient compliance. In this comparative cost analysis of commonly prescribed ophthalmology medications, the differences in cost between generic and brand name medications as well as different medications within an individual drug class were evaluated. Eye preparations from the Ontario Drug Benefit Formulary were identified, and further agents commonly prescribed by ophthalmologists were included. The standardized prescription drug cost, which includes the cost of the medication, mark-up, and dispensing cost, was provided by Ontario Shoppers Drug Mart stores in July 2016 for 103 common medications using typical dosages and durations. Based on medication class, the highest and lowest cost medications were antiallergy agents (Zaditor [ketotifen], Vasocon [naphazoline]), antibiotic ophthalmic solutions (Vigamox [moxifloxacin], generic ciprofloxacin), oral antibiotics (Cipro [ciprofloxacin], generic cephalexin), antibiotic ophthalmic ointments (generic erythromycin, Tobrex [tobramycin]), antiviral treatment (Valtrex [oral valacyclovir], Viroptic [topical trifluridine]), blepharitis treatment (Zithromax [oral azithromycin], generic oral tetracycline), beta-adrenergic inhibitors (Timoptic [topical timolol], generic topical timolol), topical prostaglandin analogues (Xalatan [latanoprost], generic travoprost), oral carbonic anhydrase inhibitors (methazolamide, acetazolamide), topical carbonic anhydrase solutions (Trusopt preservative-free [dorzolamide], Azopt [brinzolamide]), topical alpha-adrenergic agonists (Alphagan [brimonidine], generic brimonidine), topical muscarinic agonists (Isopto carpine [pilocarpine], Diocarpine [pilocarpine]), topical combination glaucoma agents (Cosopt [dorzolamide-timolol], generic dorzolamide-timolol), topical lubricants (Lacri-lube, Isopto tears), topical nonsteroidal anti-inflammatory drugs (Acuvail [ketorolac], Ilevro [nepafenac]), and steroids (Durezol [difluprednate], Pred mild [prednisolone]). Substantial cost differences exist between ophthalmology medications of the same class. We encourage ophthalmologists to be aware of the associated costs of the medications they prescribe and to use this information in their decision making. Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Experimental analysis of the effect of taxes and subsides on calories purchased in an on-line supermarket.

PubMed

Epstein, Leonard H; Finkelstein, Eric; Raynor, Hollie; Nederkoorn, Chantal; Fletcher, Kelly D; Jankowiak, Noelle; Paluch, Rocco A

2015-12-01

Taxes and subsidies are a public health approach to improving nutrient quality of food purchases. While taxes or subsidies influence purchasing, it is unclear whether they influence total energy or overall diet quality of foods purchased. Using a within subjects design, selected low nutrient dense foods (e.g. sweetened beverages, candy, salty snacks) were taxed, and fruits and vegetables and bottled water were subsidized by 12.5% or 25% in comparison to a usual price condition for 199 female shoppers in an experimental store. Results showed taxes reduced calories purchased of taxed foods (coefficient = -6.61, CI = -11.94 to -1.28) and subsidies increased calories purchased of subsidized foods (coefficient = 13.74, CI = 8.51 to 18.97). However, no overall effect was observed on total calories purchased. Both taxes and subsidies were associated with a reduction in calories purchased for grains (taxes: coefficient = -6.58, CI = -11.91 to -1.24, subsidies: coefficient = -12.86, CI = -18.08 to -7.63) and subsidies were associated with a reduction in calories purchased for miscellaneous foods (coefficient = -7.40, CI = -12.62 to -2.17) (mostly fats, oils and sugars). Subsidies improved the nutrient quality of foods purchased (coefficient = 0.14, CI = 0.07 to 0.21). These results suggest that taxes and subsidies can influence energy purchased for products taxed or subsidized, but not total energy purchased. However, the improvement in nutrient quality with subsidies indicates that pricing can shift nutritional quality of foods purchased. Research is needed to evaluate if differential pricing strategies based on nutrient quality are associated with reduction in calories and improvement in nutrient quality of foods purchased. Copyright © 2015 Elsevier Ltd. All rights reserved.

Psychological and educational factors: better predictors of work status than FEV1 in adults with cystic fibrosis.

PubMed

Burker, Eileen J; Sedway, Jan; Carone, Stacia

2004-11-01

Now that more individuals with cystic fibrosis (CF) are living into adulthood, vocational attainment is an increasingly important consideration. Work is a key factor in quality of life. The purpose of the present paper was to evaluate the factors that are associated with work status in 183 adults with CF. Approximately half of the participants were working at the time of evaluation, an impressive figure given that the mean forced expired volume in 1 sec (FEV1) was 31.9%. The average number of hours worked was 32.7 hr/week. The majority of individuals were employed in professional, technical, or managerial occupations (accounting, teaching, law, or social work). A third were employed in clerical and sales occupations, and the remaining individuals were employed in a wide range of other occupations (hotel manager, undercover shopper, artist, or dental technician). Interestingly, FEV1 and age did not differentiate between subjects who were working and those who were not. Individuals who were working had significantly lower depression scores and a higher educational level than those who were not working. Future research is needed to determine whether it is the increased socialization and the resulting social support that may come from a work environment, or a reduction in financial stress because of better income and health benefits that helps to explain this difference. Alternatively, work may serve as a distraction from the symptoms of CF. It is likely that those with higher educational levels had more professional jobs that were more easily modified as health declined. Future research needs to assess how career choices are made, and what factors into a patient's decision to keep working. (c) 2004 Wiley-Liss, Inc.

Using a UK Virtual Supermarket to Examine Purchasing Behavior Across Different Income Groups in the United Kingdom: Development and Feasibility Study

PubMed Central

Waterlander, Wilma Elzeline; Rayner, Mike; Scarborough, Peter

2017-01-01

Background The majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food purchases are needed, especially with respect to assessing differential impacts on population subgroups. Objective The aim of this study was to assess the feasibility of using the United Kingdom Virtual Supermarket (UKVS), a three-dimensional (3D) computer simulation of a supermarket, to measure food purchasing behavior across income groups. Methods Participants (primary household shoppers in the United Kingdom with computer access) were asked to conduct two shopping tasks using the UKVS and complete questionnaires on demographics, food purchasing habits, and feedback on the UKVS software. Data on recruitment method and rate, completion of study procedure, purchases, and feedback on usability were collected to inform future trial protocols. Results A total of 98 participants were recruited, and 46 (47%) fully completed the study procedure. Low-income participants were less likely to complete the study (P=.02). Most participants found the UKVS easy to use (38/46, 83%) and reported that UKVS purchases resembled their usual purchases (41/46, 89%). Conclusions The UKVS is likely to be a useful tool to examine the effects of nutrition interventions using randomized controlled designs. Feedback was positive from participants who completed the study and did not differ by income group. However, retention was low and needs to be addressed in future studies. This study provides purchasing data to establish sample size requirements for full trials using the UKVS. PMID:28993301

Built environment affecting visitors' walking choice in commercial areas? - A study with GPS experiments

NASA Astrophysics Data System (ADS)

Hahm, Y.; Yoon, H.

2016-12-01

Retail location is one of the most critical factors explaining the success of store operations. Store owners prefer to choose locations with high visibility and convenient transportation, which might be likely reasons for higher pedestrian volume, hence larger chance to capture impulse shoppers, resulting in more profits. While researches have focused on discerning relationship between pedestrian route choice and physical environments via indirect measures such as survey questionnaire and interviews, recent technologies such as Global Positioning System (GPS) enables collecting direct and precise waking route data. In this study, we investigate the physical environments in which pedestrians prefer to be in commercial district, and further analyze if such locations encompass stores with higher store revenues. The primary method is GPS experiment and travel diary for over hundred visitors of the study site, Hongik University commercial areas in Seoul, South Korea, and statistical analysis, Structural Equation Model (SEM). With SEM, we could assess endogenous latent variables indicating built environments, such as Density, Diversity, Destination Accessibility, Design, and Retail Attraction, and exogenous latent variable, the pedestrian walking choice, based on the observation of pedestrian volume and walking speed. Observed variables include the number of stores, building uses, kind of retail, and pedestrian volume, and walking speed. This research will shed light on planning commercial districts, emphasizing the role of pedestrian walking in the success of retail business, and providing a clue on how to encourage pedestrian visitation by improving physical environment. This work is supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (No. 2015R1C1A2A01055615)

Attitude and Behavior Factors Associated with Front-of-Package Label Use with Label Users Making Accurate Product Nutrition Assessments.

PubMed

Roseman, Mary G; Joung, Hyun-Woo; Littlejohn, Emily I

2018-05-01

Front-of-package (FOP) labels are increasing in popularity on retail products. Reductive FOP labels provide nutrient-specific information, whereas evaluative FOP labels summarize nutrient information through icons. Better understanding of consumer behavior regarding FOP labels is beneficial to increasing consumer use of nutrition labeling when making grocery purchasing decisions. We aimed to determine FOP label format effectiveness in aiding consumers at assessing nutrient density of food products. In addition, we sought to determine relationships between FOP label use and attitude toward healthy eating, diet self-assessment, self-reported health and nutrition knowledge, and label and shopping behaviors. A between-subjects experimental design was employed. Participants were randomly assigned to one of four label conditions: Facts Up Front, Facts Up Front Extended, a binary symbol, and no-label control. One hundred sixty-one US primary grocery shoppers, aged 18 to 69 years. Participants were randomly invited to the online study. Participants in one of four label condition groups viewed three product categories (cereal, dairy, and snacks) with corresponding questions. Adults' nutrition assessment of food products based on different FOP label formats, along with label use and attitude toward healthy eating, diet self-assessment, self-reported health and nutrition knowledge, and label and shopping behaviors. Data analyses included descriptive statistics, χ 2 tests, and logistical regression. Significant outcomes were set to α=.05. Participants selected the more nutrient-dense product in the snack food category when it contained an FOP label. Subjective health and nutrition knowledge and frequency of selecting food for healthful reasons were associated with FOP label use (P<0.01 and P<0.05, respectively). Both Facts Up Front (reductive) and binary (evaluative) FOP labels appear effective for nutrition assessment of snack products compared with no label. Specific attitude and behavior factors were associated with label use. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Intervention research to enhance community pharmacists' cognitive services: a systematic review.

PubMed

Patwardhan, Pallavi D; Amin, Mohamed E; Chewning, Betty A

2014-01-01

Positive impact of community pharmacists' cognitive pharmaceutical services (CPS) is well documented. However, community pharmacists have been slow to expand CPS roles. This systematic review explores how community pharmacy intervention research can help inform efforts to expand cognitive pharmaceutical service delivery. To: 1) identify community pharmacy CPS intervention studies that report data on pharmacist behaviors, either as a final study outcome itself or as a fidelity measure in patient outcome studies, and 2) describe the state of this research to help frame future research agendas. Empirical articles examining improvement or expansion of community pharmacist cognitive services published through December 2010 were searched using various search engines, bibliography searches and authors' libraries. Studies were included if they: 1) reported findings on pharmacist behaviors during cognitive service delivery, 2) employed a minimum of pre-post design or two study arms for pharmacists/pharmacies, and 3) were in community-based pharmacies. A total of 50 studies evaluated impact of community pharmacy based CPS delivery; however, only 21 included a pharmacist behavior outcome measure as a final outcome or as a fidelity measure. The majority (14 out of 21) of studies used a randomized controlled trial design. Nearly half (10 of 21) addressed asthma or tobacco cessation. Limited details were provided about interventions to prepare pharmacists for CPS delivery. The most frequent measures of pharmacist behavior were patient surveys and observation of pharmacists' behavior by secret shoppers; electronic data sets were rarely used. There is a need for well-designed intervention research that evaluates how interventions impact on pharmacist cognitive service behavior. Positive findings from this review reinforce that planned interventions have the potential to improve and expand pharmacist cognitive service delivery; however, more detail is needed in study publications for this potential to be fully realized. Copyright © 2014 Elsevier Inc. All rights reserved.

Using a UK Virtual Supermarket to Examine Purchasing Behavior Across Different Income Groups in the United Kingdom: Development and Feasibility Study.

PubMed

Mizdrak, Anja; Waterlander, Wilma Elzeline; Rayner, Mike; Scarborough, Peter

2017-10-09

The majority of food in the United Kingdom is purchased in supermarkets, and therefore, supermarket interventions provide an opportunity to improve diets. Randomized controlled trials are costly, time-consuming, and difficult to conduct in real stores. Alternative approaches of assessing the impact of supermarket interventions on food purchases are needed, especially with respect to assessing differential impacts on population subgroups. The aim of this study was to assess the feasibility of using the United Kingdom Virtual Supermarket (UKVS), a three-dimensional (3D) computer simulation of a supermarket, to measure food purchasing behavior across income groups. Participants (primary household shoppers in the United Kingdom with computer access) were asked to conduct two shopping tasks using the UKVS and complete questionnaires on demographics, food purchasing habits, and feedback on the UKVS software. Data on recruitment method and rate, completion of study procedure, purchases, and feedback on usability were collected to inform future trial protocols. A total of 98 participants were recruited, and 46 (47%) fully completed the study procedure. Low-income participants were less likely to complete the study (P=.02). Most participants found the UKVS easy to use (38/46, 83%) and reported that UKVS purchases resembled their usual purchases (41/46, 89%). The UKVS is likely to be a useful tool to examine the effects of nutrition interventions using randomized controlled designs. Feedback was positive from participants who completed the study and did not differ by income group. However, retention was low and needs to be addressed in future studies. This study provides purchasing data to establish sample size requirements for full trials using the UKVS. ©Anja Mizdrak, Wilma Elzeline Waterlander, Mike Rayner, Peter Scarborough. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.10.2017.

Reds are more important than greens: how UK supermarket shoppers use the different information on a traffic light nutrition label in a choice experiment.

PubMed

Scarborough, Peter; Matthews, Anne; Eyles, Helen; Kaur, Asha; Hodgkins, Charo; Raats, Monique M; Rayner, Mike

2015-12-12

Colour coded front-of-pack nutrition labelling ('traffic light labelling') has been recommended for use in the UK since 2006. The voluntary scheme is used by all the major retailers and some manufacturers. It is not clear how consumers use these labels to make a single decision about the relative healthiness of foods. Our research questions were: Which of the four nutrients on UK traffic light labels (total fat, saturated fat, sugar and salt) has the most influence on decisions? Do green lights or red lights have a greater influence? Are there age and gender differences in how people use the colour and nutrient information? We recruited participants from a UK supermarket chain membership list to conduct an online choice experiment in May 2014. We analysed data using multilevel logisitic models with food choices (n = 3321) nested in individuals (n = 187) as the unit of analysis. A food with more reds was 11.4 (95% confidence intervals: 10.3, 12.5) times less likely to be chosen as healthy, whereas a food with more greens was 6.1 (5.6, 6.6) times more likely to be chosen as healthy. Foods with better colours on saturated fat and salt were 7.3 (6.7, 8.0) and 7.1 (6.5, 7.8) times more likely to be chosen as healthy - significantly greater than for total fat (odds ratio 4.8 (4.4, 5.3)) and sugar (5.2 (4.7, 5.6)). Results were broadly similar for different genders and age groups. We found that participants were more concerned with avoiding reds than choosing greens, and that saturated fat and salt had a greater influence on decisions regarding healthiness than total fat and sugar. This could influence decisions about food reformulation and guidance on using nutrition labelling.

Shrinking the food-print: A qualitative study into consumer perceptions, experiences and attitudes towards healthy and environmentally friendly food behaviours.

PubMed

Hoek, A C; Pearson, D; James, S W; Lawrence, M A; Friel, S

2017-01-01

Internationally, there is increasing recognition of the importance of multilevel policies and actions that address healthy and environmentally friendly food behaviours. However it is not yet clear which actions are most suitable to support consumers to adopt both behaviours concurrently. To this end, we undertook a qualitative study to assess consumer perceptions, experiences and attitudes towards healthy and environmentally friendly foods and four target behaviours: reducing overconsumption of food beyond energy needs, reducing consumption of low-nutrient energy dense foods, eating less animal- and more plant-derived foods, and reducing food waste. Online in-depth interviews were held with 29 Australian food shoppers representing different levels of involvement with health and environment in daily food choices. The results indicate that compared to health, the relationship between food and the environment is rarely considered by consumers. The four target food behaviours were primarily associated and motivated by an impact on health, except for not wasting foods. Participants had the most positive attitude and highest motivation for eating less processed and packaged foods, mostly to avoid excessive packaging and 'chemicals' in foods. This was followed by the behaviours reducing food waste and overconsumption. Conversely, there was a predominantly negative attitude towards, and low motivation for, eating less animal-derived products and more plant based foods. Overall, consumers found a joined concept of healthy and environmentally friendly foods an acceptable idea. We recommend that health should remain the overarching principle for policies and actions concerned with shifting consumer behaviours, as this personal benefit appears to have a greater potential to support behaviour change. Future consumer focused work could pay attention to framing behavioural messages, providing intermediate behavioural goals, and a multiple target approach to change habitual behaviours. Copyright © 2016 Elsevier Ltd. All rights reserved.

Increased minimum legal age for the sale of alcohol in the Netherlands as of 2014: The effect on alcohol sellers' compliance after one and two years.

PubMed

Schelleman-Offermans, Karen; Roodbeen, Ruud T J; Lemmens, Paul H H M

2017-11-01

As of January 2014, the Dutch minimum legal age for the sale and purchase of all alcoholic beverages has increased from 16 to 18 years of age. The effectiveness of a minimum legal age policy in controlling the availability of alcohol for adolescents depends on the extent to which this minimum legal age is complied with in the field. The main aim of the current study is to investigate, for a country with a West-European drinking culture, whether raising the minimum legal age for the sale of alcohol has influenced compliance rates among Dutch alcohol vendors. A total of 1770 alcohol purchase attempts by 15-year-old mystery shoppers were conducted in three independent Dutch representative samples of on- and off-premise alcohol outlets in 2013 (T0), 2014 (T1), and 2016 (T2). The effect of the policy change was estimated controlling for gender and age of the vendor. Mean alcohol sellers' compliance rates significantly increased for 15-year-olds from 46.5% before to 55.7% one year and to 73.9% two years after the policy change. Two years after the policy change, alcohol vendors were up to 3 times more likely to comply with the alcohol age limit policy. After the policy change, mean alcohol compliance rates significantly increased when 15-year-olds attempted to purchase alcohol, an effect which seems to increase over time. Nevertheless, a rise in the compliance rate was already present in the years preceding the introduction of the new minimum legal age. This perhaps signifies a process in which a lowering in the general acceptability of juvenile drinking already started before the increased minimum legal age was introduced and alcohol vendors might have been anticipating this formal legal change. Copyright © 2017 Elsevier B.V. All rights reserved.

Simultaneous modelling of multi-purpose/multi-stop activity patterns and quantities consumed

NASA Astrophysics Data System (ADS)

Roy, John R.; Smith, Nariida C.; Xu, Blake

Whereas for commuting travel there is a one-to-one correspondence between commuters and jobs, and for commodity flows a one-to-one correspondence between the size of orders and the shipping cost of the commodities, the situation is much more complex for retail/service travel. A typical shopper may make a single trip or multi-stop tour to buy/consume a quite diverse set of commodities/services at different locations in quite variable quantities. At the same time, the general pattern of the tour is clearly dependent on the activities and goods available at potential stops. These interdependencies have been alluded to in the literature, especially by spatial economists. However, until some preliminary work by the first author, there has been no attempt to formally include these interdependencies in a general model. This paper presents a framework for achieving this goal by developing an evolutionary set of models starting from the simplest forms available. From the above, it is clear that such interdependency models will inevitably have high dimensionality and combinatorial complexity. This rules out a simultaneous treatment of all the events using an individual choice approach. If an individual choice approach is to be applied in a tractable manner, the set of interdependent events needs to be segmented into several subsets, with simultaneity recognised within each subset, but a mere sequential progression occurring between subsets. In this paper, full event interdependencies are retained at the expense of modelling market segments of consumers rather than a sample of representative individuals. We couple the travel and consumption events in the only feasible way, by modelling the tours as discrete entities, in conjunction with the amount of each commodity consumed per stop on each such tour in terms of the continuous quantities of microeconomics. This is performed both under a budget/income constraint from microeconomics and a time budget constraint from time geography. The model considers both physical trips and tele-orders.

Do nutrition labels influence healthier food choices? Analysis of label viewing behaviour and subsequent food purchases in a labelling intervention trial.

PubMed

Ni Mhurchu, Cliona; Eyles, Helen; Jiang, Yannan; Blakely, Tony

2018-02-01

There are few objective data on how nutrition labels are used in real-world shopping situations, or how they affect dietary choices and patterns. The Starlight study was a four-week randomised, controlled trial of the effects of three different types of nutrition labels on consumer food purchases: Traffic Light Labels, Health Star Rating labels, or Nutrition Information Panels (control). Smartphone technology allowed participants to scan barcodes of packaged foods and receive randomly allocated labels on their phone screen, and to record their food purchases. The study app therefore provided objectively recorded data on label viewing behaviour and food purchases over a four-week period. A post-hoc analysis of trial data was undertaken to assess frequency of label use, label use by food group, and association between label use and the healthiness of packaged food products purchased. Over the four-week intervention, study participants (n = 1255) viewed nutrition labels for and/or purchased 66,915 barcoded packaged products. Labels were viewed for 23% of all purchased products, with decreasing frequency over time. Shoppers were most likely to view labels for convenience foods, cereals, snack foods, bread and bakery products, and oils. They were least likely to view labels for sugar and honey products, eggs, fish, fruit and vegetables, and meat. Products for which participants viewed the label and subsequently purchased the product during the same shopping episode were significantly healthier than products where labels were viewed but the product was not subsequently purchased: mean difference in nutrient profile score -0.90 (95% CI -1.54 to -0.26). In a secondary analysis of a nutrition labelling intervention trial, there was a significant association between label use and the healthiness of products purchased. Nutrition label use may therefore lead to healthier food purchases. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The feasibility and utility of grocery receipt analyses for dietary assessment.

PubMed

Martin, Sarah Levin; Howell, Teresa; Duan, Yan; Walters, Michele

2006-03-30

To establish the feasibility and utility of a simple data collection methodology for dietary assessment. Using a cross-sectional design, trained data collectors approached adults (approximately 20 - 40 years of age) at local grocery stores and asked whether they would volunteer their grocery receipts and answer a few questions for a small stipend (dollar 1). The grocery data were divided into 3 categories: "fats, oils, and sweets," "processed foods," and "low-fat/low-calorie substitutions" as a percentage of the total food purchase price. The questions assessed the shopper's general eating habits (eg, fast-food consumption) and a few demographic characteristics and health aspects (eg, perception of body size). Statistical Analyses Performed. Descriptive and analytic analyses using non-parametric tests were conducted in SAS. Forty-eight receipts and questionnaires were collected. Nearly every respondent reported eating fast food at least once per month; 27% ate out once or twice a day. Frequency of fast-food consumption was positively related to perceived body size of the respondent (p = 0.02). Overall, 30% of the food purchase price was for fats, oils, sweets, 10% was for processed foods, and almost 6% was for low-fat/low-calorie substitutions. Households where no one was perceived to be overweight spent a smaller proportion of their food budget on fats, oils, and sweets than did households where at least one person was perceived to be overweight (p = 0.10); household where the spouse was not perceived to be overweight spent less on fats, oils, and sweets (p = 0.02) and more on low-fat/low-calorie substitutions (p = 0.09) than did households where the spouse was perceived to be overweight; and, respondents who perceived themselves to be overweight spent more on processed foods than did respondents who did not perceive themselves to be overweight (p = 0.06). This simple dietary assessment method, although global in nature, may be a useful indicator of dietary practices as evidenced by its association with perceived weight status.

Comparison of Food Choice Motives between Malay Husbands and Wives in an Urban Community.

PubMed

Asma, A; Nawalyah, A G; Rokiah, M Y; Mohd Nasir, M T

2010-04-01

The main objective of this study was to determine the motives underlying the selection of foods between husbands and wives in an urban community. Thiscross-sectional study was carried out in Bandar Baru Bangi, Selangor, Malaysia among 150 married couples aged 20 and above, who voluntarily agreed to participate and were not on any special diet. Data were collected using the Food Choice Questionnaire (FCQ) which measured the health-related and non health related factor that influence people's food choices. It consisted of 36 items designed to assess the reported importance of nine factors: health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern. In this study, the FCQ was adapted and a new factor, religion (religious guidelines), was included. Demographic characteristics including age, occupation, education, household income and household size were also collected. Data were analysed using SPSS version 16. Results showed that 40.7% of husbands (mean age= 43.33 + 11.16 years) and 55.3% of wives (mean age= 41.28 + 10.93 years) perceived themselves as the main food shopper while 12.0% of the husbands and 85.3% of the wives perceived themselves as the main meal planner. Husbands rated religion as the most prominent factor in food choice motives with a mean average rating of 4.56 + 0.59 on a 5-point rating scale, followed by health and convenience factor. Meanwhile, the wives rated health as the most essential factor with mean average rating of 4.49 + 0.58, followed by religion and convenience factor. Sensory appeal, ethical concerns and familiarity were rated as the bottom three factors of food choice motives among these two groups. Price of foods was not considered as an important factor in making food choices for the subjects in this study. In conclusion, the husbands and wives of this urban community rated religion, health and convenience as the three most important food choice motives in food selection.

Use and understanding of nutrition information on food labels in six European countries.

PubMed

Grunert, Klaus G; Fernández-Celemín, Laura; Wills, Josephine M; Storcksdieck Genannt Bonsmann, Stefan; Nureeva, Liliya

2010-06-01

AIM: The goal of the study was to investigate the use of nutrition information on food labels and understanding of guideline daily amount (GDA) front-of-pack nutrition labels in six European countries. SUBJECTS AND METHODS: In-store observations and in-store interviews were conducted in major retailers in the UK (n = 2019), Sweden (n = 1858), France (n = 2337), Germany (n = 1963), Poland (n = 1800) and Hungary (n = 1804), supplemented by questionnaires filled out at home and returned (overall response rate 50.3%). Use of labels was measured by combining in-store observations and in-store interviews on concrete purchases in six product categories. Understanding of GDA front-of-pack nutrition labels was measured by a variety of tasks dealing with conceptual understanding, substantial understanding and health inferences. Demographics, nutrition knowledge and interest in healthy eating were measured as potential determinants. RESULTS: Across six product categories, 16.8% of shoppers were found to have looked for nutrition information on the label, with the nutrition grid (table or list), GDA labels and the ingredients list as the main sources consulted and calories, fat and sugar the information most often looked for. Understanding of GDA labels was high in the UK, Sweden and Germany, and more limited in the other countries. Regression analysis showed that, in addition to country-specific differences, use and understanding are also affected by differences in interest in healthy eating and in nutrition knowledge and by social grade. CONCLUSION: Understanding of nutrition information seems to be more widespread than use, suggesting that lack of use is a question of not only understanding, but also motivation. Considerable national differences exist in both understanding and use, some of which may be attributed to different histories of the role of nutrition in the public debate.

Associations between the purchase of healthy and fast foods and restrictions to food access: a cross-sectional study in Melbourne, Australia.

PubMed

Burns, Cate; Bentley, Rebecca; Thornton, Lukar; Kavanagh, Anne

2015-01-01

To examine the associations between financial, physical and transport conditions that may restrict food access (which we define as food security indicators) and the purchase of fast foods and nutritious staples such as bread and milk. Multilevel logistic and multinomial regression analysis of cross-sectional survey data to assess associations between the three indicators of food insecurity and household food shopping adjusted for sociodemographic and socio-economic variables. Random selection of households (n 3995) from fifty Census Collector Districts in Melbourne, Australia, in 2003. The main food shoppers in each household (n 2564). After adjustment for confounders, analysis showed that a greater likelihood of purchasing chain-brand fast food on a weekly basis compared with never was associated with running out of money to buy food (OR = 1·59; 95 % CI 1·08, 2·34) and reporting difficulties lifting groceries (OR = 1·77; 95 % CI 1·23, 2·54). Respondents without regular access to a car to do food shopping were less likely to purchase bread types considered more nutritious than white bread (OR = 0·75; 95 % CI 0·59, 0·95) and milk types considered more nutritious than full-cream milk (OR = 0·62; 95 % CI 0·47, 0·81). The food insecurity indicators were not associated with the purchasing of fruits, vegetables or non-chain fast food. Householders experiencing financial and physical barriers were more likely to frequently purchase chain fast foods while limited access to a car resulted in a lower likelihood that the nutritious options were purchased for two core food items (bread and milk). Policies and interventions that improve financial access to food and lessen the effect of physical limitations to carrying groceries may reduce the purchasing of fast foods. Further research is required on food sourcing and dietary quality among those with food access restrictions.

The effect of an anti-malarial subsidy programme on the quality of service provision of artemisinin-based combination therapy in Kenya: a cluster-randomized, controlled trial

PubMed Central

2013-01-01

Background Many patients with suspected malaria in sub-Saharan Africa seek treatment from private providers, but this sector suffers from sub-standard medicine dispensing practices. To improve the quality of care received for presumptive malaria from the highly accessed private retail sector in western Kenya, subsidized pre-packaged artemether-lumefantrine (AL) was provided to private retailers, together with a one day training for retail staff on malaria diagnosis and treatment, job aids and community engagement activities. Methods The intervention was assessed using a cluster-randomized, controlled design. Provider and mystery-shopper cross-sectional surveys were conducted at baseline and eight months post-intervention to assess provider practices. Data were analysed based on cluster-level summaries, comparing control and intervention arms. Results On average, 564 retail outlets were interviewed per year. At follow-up, 43% of respondents reported that at least one staff member had attended the training in the intervention arm. The intervention significantly increased the percentage of providers knowing the first line treatment for uncomplicated malaria by 24.2% points (confidence interval (CI): 14.8%, 33.6%; adjusted p=0.0001); the percentage of outlets stocking AL by 31.7% points (CI: 22.0%, 41.3%; adjusted p=0.0001); and the percentage of providers prescribing AL for presumptive malaria by 23.6% points (CI: 18.7%, 28.6%; adjusted p=0.0001). Generally outlets that received training and job aids performed better than those receiving one or none of these intervention components. Conclusion Overall, subsidizing ACT and retailer training can significantly increase the percentage of outlets stocking and selling AL for the presumptive treatment of malaria, but further research is needed on strategies to improve the provision of counselling advice to retail customers. PMID:23452547

Facilitating mental health research for patients, clinicians and researchers: a mixed-method study.

PubMed

Robotham, D; Waterman, S; Oduola, S; Papoulias, C; Craig, T; Wykes, T

2016-08-08

Research registers using Consent for Contact (C4C) can facilitate recruitment into mental health research studies, allowing investigators to contact patients based on clinical records information. We investigated whether such a register was useful for mental health research, seeking the perspectives of patients and research investigators. In 2012, a C4C register was developed in a large secondary mental health provider within the UK; almost 9000 patients have joined. This mixed-method study audited the effectiveness of the register. A 'mystery shopper' exercise was conducted, and patients (n=21) were recruited to ask clinicians about the availability of research opportunities. Structured interviews were conducted with patients (n=52) about their experiences of being on the register. Similar interviews were conducted with 18 investigators from 19 studies, who had attempted to use the register to recruit participants. The impact of C4C on study recruitment, and whether it helped patients learn about research. So far, the register has provided 928 individuals with 1085 research opportunities (in 60% of cases, the individual agreed to participate in the study). Clinicians were willing to link patients to research opportunities, but often lacked information about studies. For patients, the register provided opportunities which they may not otherwise have; 27 of 52 had participated in studies since joining the register (18 participating for the first time). Most investigators used the register to supplement recruitment to their studies, but described problems in prescreening potential participants from a clinical record for complex studies. Although the register helped investigators recruit for studies, and provided patients with research opportunities, clinicians' input is still useful for identifying suitable participants. C4C registers should be adapted to provide clinicians with automatically updated information on local studies allowing them to match patients on their caseload with active studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Household income differences in food sources and food items purchased.

PubMed

French, Simone A; Wall, Melanie; Mitchell, Nathan R

2010-10-26

The present study examined income-related household food purchases among a sample of 90 households from the community. Annotated food purchase receipts were collected for a four-week period by the primary household shopper. Receipt food source and foods items were classified into specific categories, and food quantities in ounces were recorded by research staff. For home sources, a limited number of food/beverage categories were recorded. For eating out sources, all food/beverage items were recorded. Median monthly per person dollars spent and per person ounces purchased were computed. Food sources and food categories were examined by household income tertile. A community-based sample of 90 households. Higher income households spent significantly more dollars per person per month from both home and eating out sources compared with lower income households ($163 versus $100, p < .001). Compared with lower income households, higher income households spent significantly more home source dollars on both fruits/vegetables (21.5 versus 10.2, p < .001) and sweets/snacks (17.3 versus 8.3, p < .001), but did not differ on home dollars spent on sugar sweetened beverages (2.0 versus 1.7, p < .46). The proportion of home beverages that were sugar sweetened beverages was significantly higher among lower income households (45% versus 26%, p < .01). Within eating out sources, lower income households spent a significantly greater percent of dollars per person at carry out places (54% versus 37%, p < .01). No income differences were observed for dollars spent at discount grocery stores, small grocery stores or convenience stores. Higher income households spent more money on both healthy and less healthy foods from a wide range of sources. Lower income households spent a larger proportion of their eating out dollars at carry out places, and a larger proportion of their home beverage purchases were sugar sweetened beverages.

Estimating the Prevalence of Opioid Diversion by “Doctor Shoppers” in the United States

PubMed Central

McDonald, Douglas C.; Carlson, Kenneth E.

2013-01-01

Background Abuse of prescription opioid analgesics is a serious threat to public health, resulting in rising numbers of overdose deaths and admissions to emergency departments and treatment facilities. Absent adequate patient information systems, “doctor shopping” patients can obtain multiple opioid prescriptions for nonmedical use from different unknowing physicians. Our study estimates the prevalence of doctor shopping in the US and the amounts and types of opioids involved. Methods and Findings The sample included records for 146.1 million opioid prescriptions dispensed during 2008 by 76% of US retail pharmacies. Prescriptions were linked to unique patients and weighted to estimate all prescriptions and patients in the nation. Finite mixture models were used to estimate different latent patient populations having different patterns of using prescribers. On average, patients in the extreme outlying population (0.7% of purchasers), presumed to be doctor shoppers, obtained 32 opioid prescriptions from 10 different prescribers. They bought 1.9% of all opioid prescriptions, constituting 4% of weighed amounts dispensed. Conclusions Our data did not provide information to make a clinical diagnosis of individuals. Very few of these patients can be classified with certainty as diverting drugs for nonmedical purposes. However, even patients with legitimate medical need for opioids who use large numbers of prescribers may signal dangerously uncoordinated care. To close the information gap that makes doctor shopping and uncoordinated care possible, states have created prescription drug monitoring programs to collect records of scheduled drugs dispensed, but the majority of physicians do not access this information. To facilitate use by busy practitioners, most monitoring programs should improve access and response time, scan prescription data to flag suspicious purchasing patterns and alert physicians and pharmacists. Physicians could also prevent doctor shopping by adopting procedures to screen new patients for their risk of abuse and to monitor patients' adherence to prescribed treatments. PMID:23874923

Weight resilience and fruit and vegetable intake among African-American women in an obesogenic environment.

PubMed

Parisi, Sara M; Bodnar, Lisa M; Dubowitz, Tamara

2018-02-01

To investigate relationships between weight resilience (maintaining a normal weight in a food desert environment) and fruit and vegetable (F&V) intake, attitudes and barriers. Cross-sectional, in-person surveys collected May-December 2011, including self-reported data on F&V-related psychosocial factors, attitudes and barriers. Two 24 h dietary recalls were completed; weight and height were measured. Multivariable regression models estimated prevalence ratios (95 % CI). Two low-income, predominantly African-American food deserts in Pittsburgh, Pennsylvania, USA. Women aged 18-49 years (n 279) who were the primary food shopper in a household randomly selected for a parent study. Fifteen per cent were weight resilient, 30 % were overweight and 55 % were obese. Overall, 25 % reported eating ≥5 F&V servings/d. After adjustment for age, education, parity, employment, living alone, physical activity, per capita income and mean daily energy intake, women eating ≥5 F&V servings/d were 94 % more likely to be weight resilient compared with those eating <5 servings/d (1·94; 1·10, 3·43). Across BMI groups, self-efficacy regarding F&V consumption was high and few F&V barriers were reported. The most frequently reported barrier was concern about the cost of F&V (36 %). Of the attitudinal F&V-related factors, only concern about wasting food when serving F&V was associated with weight resilience in adjusted models (0·29; 0·09, 0·94). In a model predicting consuming ≥5 F&V servings/d, driving one's own car to the store was the only attitudinal F&V-related factor associated with consumption (1·50; 1·00, 2·24). In this population, weight resilience may be encouraged by improving access to affordable and convenient F&V options and providing education on ways to make them palatable to the entire household, rather than by shifting women's F&V perceptions, which are already positive.

Understanding older adults' medication decision making and behavior: A study on over-the-counter (OTC) anticholinergic medications.

PubMed

Holden, Richard J; Srinivas, Preethi; Campbell, Noll L; Clark, Daniel O; Bodke, Kunal S; Hong, Youngbok; Boustani, Malaz A; Ferguson, Denisha; Callahan, Christopher M

2018-03-06

Older adults purchase and use over-the-counter (OTC) medications with potentially significant adverse effects. Some OTC medications, such as those with anticholinergic effects, are relatively contraindicated for use by older adults due to evidence of impaired cognition and other adverse effects. To inform the design of future OTC medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. The study had a cross-sectional design with multiple methods. A total of 84 adults participated in qualitative research interviews (n = 24), in-store shopper observations (n = 39), and laboratory-based simulated OTC shopping tasks (n = 21). Simulated shopping participants also rank-ordered eight factors on their importance for OTC decision making. Findings revealed that many participants had concerns about medication adverse effects, generally, but were not aware of age-related risk associated with the use of anticholinergic medications. Analyses produced a map of the workflow of OTC-related behavior and decision making as well as related barriers such as difficulty locating medications or comparing them to an alternative. Participants reported effectiveness, adverse effects or health risks, and price as most important to their OTC medication purchase and use decisions. A persona analysis identified two types of consumers: the habit follower, who frequently purchased OTC medications and considered them safe; and the deliberator, who was more likely to weigh their options and consider alternatives to OTC medications. A conceptual model of OTC medication purchase and use is presented. Drawing on study findings and behavioral theories, the model depicts dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making. This model suggests several design directions for consumer-oriented interventions to promote OTC medication safety. Copyright © 2018 Elsevier Inc. All rights reserved.

Health care costs: the other point of view.

PubMed

Beck, D F; Dempsey, J

1990-12-01

Health care delivery in America is not efficient. Hospitals are not efficient and many are still wasteful. Some of the most blatant wastes in hospitals are staffing patterns that developed during the years of cost reports. Spending patterns become the norm, rather than excess, when they continue unabated for years. There are many reasons for cost increases in health care and specifically in hospitals. However, it is difficult to make these reasons add up to the total cost increase. No one has the answers; observation can only be made of what has been occurring and what continues to occur. Whatever the reason for the increase in health care costs, the consumer will bear the burden because of the circular flow of income and expenditures between the business sector and the household sector. Increased health care costs are passed on to the consumer in the form of increased expenditures for household goods and services or taxes. Ford Motor Company President Mr. Peterson says that $1,500 of every new automobile represents employee health care costs. The American consumer created the demand for health care services, and only the consumer can control the demand. One solution would be to let the consumer bear health care costs directly and remove the inefficiencies created by third party insurance carriers. This hypothesizes that the health care consumer is the most efficient shopper for health care services, and that third party insurance carriers are an important source of inefficiency in the health care delivery system. Many other solutions have been proposed by the government and by the insurance and health care industries, but most have only increased the cost of health care. Perhaps some day the health care industry will learn how to control the dynamics of this four-party purchasing decision. Until then, costs will continue to grow dramatically, and the executives of the industries who compete in the two-party purchasing system will wonder why the process is so complicated.

Mobile Virtual Reality : A Solution for Big Data Visualization

NASA Astrophysics Data System (ADS)

Marshall, E.; Seichter, N. D.; D'sa, A.; Werner, L. A.; Yuen, D. A.

2015-12-01

Pursuits in geological sciences and other branches of quantitative sciences often require data visualization frameworks that are in continual need of improvement and new ideas. Virtual reality is a medium of visualization that has large audiences originally designed for gaming purposes; Virtual reality can be captured in Cave-like environment but they are unwieldy and expensive to maintain. Recent efforts by major companies such as Facebook have focussed more on a large market , The Oculus is the first of such kind of mobile devices The operating system Unity makes it possible for us to convert the data files into a mesh of isosurfaces and be rendered into 3D. A user is immersed inside of the virtual reality and is able to move within and around the data using arrow keys and other steering devices, similar to those employed in XBox.. With introductions of products like the Oculus Rift and Holo Lens combined with ever increasing mobile computing strength, mobile virtual reality data visualization can be implemented for better analysis of 3D geological and mineralogical data sets. As more new products like the Surface Pro 4 and other high power yet very mobile computers are introduced to the market, the RAM and graphics card capacity necessary to run these models is more available, opening doors to this new reality. The computing requirements needed to run these models are a mere 8 GB of RAM and 2 GHz of CPU speed, which many mobile computers are starting to exceed. Using Unity 3D software to create a virtual environment containing a visual representation of the data, any data set converted into FBX or OBJ format which can be traversed by wearing the Oculus Rift device. This new method for analysis in conjunction with 3D scanning has potential applications in many fields, including the analysis of precious stones or jewelry. Using hologram technology to capture in high-resolution the 3D shape, color, and imperfections of minerals and stones, detailed review and analysis of the stone can be done remotely without ever seeing the real thing. This strategy can be game-changer for shoppers without having to go to the store.

Biofilm and Diatom Succession on Polyethylene (PE) and Biodegradable Plastic Bags in Two Marine Habitats: Early Signs of Degradation in the Pelagic and Benthic Zone?

PubMed Central

Laforsch, Christian; Weber, Miriam

2015-01-01

The production of biodegradable plastic is increasing. Given the augmented littering of these products an increasing input into the sea is expected. Previous laboratory experiments have shown that degradation of plastic starts within days to weeks. Little is known about the early composition and activity of biofilms found on biodegradable and conventional plastic debris and its correlation to degradation in the marine environment. In this study we investigated the early formation of biofilms on plastic shopper bags and its consequences for the degradation of plastic. Samples of polyethylene and biodegradable plastic were tested in the Mediterranean Sea for 15 and 33 days. The samples were distributed equally to a shallow benthic (sedimentary seafloor at 6 m water depth) and a pelagic habitat (3 m water depth) to compare the impact of these different environments on fouling and degradation. The amount of biofilm increased on both plastic types and in both habitats. The diatom abundance and diversity differed significantly between the habitats and the plastic types. Diatoms were more abundant on samples from the pelagic zone. We anticipate that specific surface properties of the polymer types induced different biofilm communities on both plastic types. Additionally, different environmental conditions between the benthic and pelagic experimental site such as light intensity and shear forces may have influenced unequal colonisation between these habitats. The oxygen production rate was negative for all samples, indicating that the initial biofilm on marine plastic litter consumes oxygen, regardless of the plastic type or if exposed in the pelagic or the benthic zone. Mechanical tests did not reveal degradation within one month of exposure. However, scanning electron microscopy (SEM) analysis displayed potential signs of degradation on the plastic surface, which differed between both plastic types. This study indicates that the early biofilm formation and composition are affected by the plastic type and habitat. Further, it reveals that already within two weeks biodegradable plastic shows signs of degradation in the benthic and pelagic habitat. PMID:26394047

Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey.

PubMed

Foley, Elizabeth; Furegato, Martina; Hughes, Gwenda; Board, Christopher; Hayden, Vanessa; Prescott, Timothy; Shone, Eleanor; Patel, Rajul

2017-11-01

This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards. In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic 'patients' contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression analyses. In March 2015, a convenience sample (one in four) of clinics was visited by researchers with the same clinical symptoms. Ability to achieve a same-day consultation and waiting time were assessed. In 2015, 90.8% of clinics offered symptomatic 'patients' an appointment within 48 hours when contacted by telephone, compared with 95.5% in 2014 (aOR=0.46 (0.26 to 0.83); p<0.01). The decline was greatest in women (96.0% to 90.1%; p<0.05), and clinics in England (96.2% to 90.7%; p<0.01). For asymptomatic patients, the proportion offered an appointment within 48 hours increased from 50.7% in 2014 to 74.5% in 2015 (aOR=3.06 (2.23 to 4.22); p<0.001), and in both men (58.2% to 90.8%; p<0.001) and women (49.0% to 59.6%; p<0.01). In adjusted analysis, asymptomatic women were significantly less likely to be offered an appointment than asymptomatic men (aOR=0.33 (0.23 to 0.45); p value<0.001). 95% of clinics were able to see symptomatic patients attending in person. Access to GUM services has worsened for those with symptoms suggestive of an acute STI and is significantly poorer for asymptomatic women. This evidence may support the reintroduction of process targets. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The role of social networks in the development of overweight and obesity among adults: a scoping review.

PubMed

Powell, Katie; Wilcox, John; Clonan, Angie; Bissell, Paul; Preston, Louise; Peacock, Marian; Holdsworth, Michelle

2015-09-30

Although it is increasingly acknowledged that social networks are important to our understanding ofoverweight and obesity, there is limited understanding about the processes by which such networks shapetheir progression. This paper reports the findings of a scoping review of the literature that sought to identify the key processes through which social networks are understood to influence the development of overweight and obesity. A scoping review was conducted. Forty five papers were included in the final review, the findings of which were synthesised to provide an overview of the main processes through which networks have been understood to influence the development of overweight and obesity. Included papers addressed a wide range of research questions framed around six types of networks: a paired network (one's spouse or intimate partner); friends and family (including work colleagues and people within social clubs); ephemeral networks in shared public spaces (such as fellow shoppers in a supermarket or diners in a restaurant); people living within the same geographical region; peers (including co-workers, fellow students, fellow participants in a weight loss programme); and cultural groups (often related toethnicity). As individuals are embedded in many of these different types of social networks at any one time, the pathways of influence from social networks to the development of patterns of overweight and obesity are likely to be complex and interrelated. Included papers addressed a diverse set of issues: body weight trends over time; body size norms or preferences; weight loss and management; physical activity patterns; and dietary patterns. Three inter-related processes were identified: social contagion (whereby the network in which people are embedded influences their weight or weight influencing behaviours), social capital (whereby sense of belonging and social support influence weight or weight influencing behaviours), and social selection (whereby a person's network might develop according to his or her weight). The findings have important implications for understanding about methods to target the spread of obesity, indicating that much greater attention needs to be paid to the social context in which people make decisions about their weight and weight influencing behaviours.

Knowledge, attitudes and behaviours related to dietary salt among adults in the state of Victoria, Australia 2015.

PubMed

Grimes, Carley A; Kelley, Sarah-Jane; Stanley, Sonya; Bolam, Bruce; Webster, Jacqui; Khokhar, Durreajam; Nowson, Caryl A

2017-05-30

Information on consumer's knowledge, attitudes and behaviours (KABs) related to salt can be used to inform awareness and education campaigns and serve as a baseline measure to monitor changes in KABs over time. The aim of this study was to determine KABs related to salt intake among Victorian adults. Cross-sectional survey conducted in Victorian adults aged 18-65 years. Participants were recruited from shopping centres located in Melbourne and Geelong and via online methods (Facebook and Consumer Research Panel) to complete an online survey assessing KABs related to dietary salt. Descriptive statistics (mean (SD) or n (%)) were used to report survey findings. A total of 2398 participants provided a valid survey (mean age 43 years (SD 13), 57% female). The majority (80%) were born in Australia and 63% were the main household grocery shopper. The majority (89%) were aware of the health risks associated with a high salt intake. Eighty three percent believed that Australians eat too much salt. Three quarters (75%) correctly identified salt from processed foods as being the main source of salt in the diet. Less than a third (29%) of participants believed their own individual salt intake exceeded dietary recommendations and only 28% could correctly identify the maximum recommended daily intake for salt. Just under half (46%) of participants were concerned about the amount of salt in food. Almost two thirds (61%) of participants believed that there should be laws which limit the amount of salt added to manufactured foods and 58% agreed that it was difficult to find lower salt options when eating out. The findings of this study serve as a baseline assessment of KABs related to salt intake in Victorian adults and can be used to assess changes in salt related KABs over time. Public concern about salt is low as many people remain unaware of their own salt intake. An increased awareness of the excessive amount of salt consumed and increased availability of lower salt foods are likely to reduce population salt intake.

ShopSmart 4 Health: results of a randomized controlled trial of a behavioral intervention promoting fruit and vegetable consumption among socioeconomically disadvantaged women.

PubMed

Ball, Kylie; McNaughton, Sarah A; Le, Ha Nd; Abbott, Gavin; Stephens, Lena D; Crawford, David A

2016-08-01

Behavioral interventions show potential for promoting increased fruit and vegetable consumption in the general population. However, little is known about their effectiveness or cost-effectiveness among socioeconomically disadvantaged groups, who are less likely to consume adequate fruit and vegetables. This study investigated the effects and costs of a behavior change intervention for increasing fruit and vegetable purchasing and consumption among socioeconomically disadvantaged women. ShopSmart 4 Health was a randomized controlled trial involving a 3-mo retrospective baseline data collection phase [time (T) 0], a 6-mo intervention (T1-T2), and a 6-mo no-intervention follow-up (T3). Socioeconomically disadvantaged women who were primary household shoppers in Melbourne, Australia, were randomly assigned to either a behavior change intervention arm (n = 124) or a control arm (n = 124). Supermarket transaction (sales) data and surveys measured the main outcomes: fruit and vegetable purchases and self-reported fruit and vegetable consumption. An analysis of supermarket transaction data showed no significant intervention effects on vegetable or fruit purchasing at T2 or T3. Participants in the behavior change intervention arm reported consumption of significantly more vegetables during the intervention (T2) than did controls, with smaller intervention effects sustained at 6 mo postintervention (T3). Relative to controls, vegetable consumption increased by ∼0.5 serving · participant(-1) · d(-1) from baseline to T2 and remained 0.28 servings/d higher than baseline at T3 among those who received the intervention. There was no intervention effect on reported fruit consumption. The behavior change intervention cost A$3.10 (in Australian dollars) · increased serving of vegetables(-1) · d(-1)CONCLUSIONS: This behavioral intervention increased vegetable consumption among socioeconomically disadvantaged women. However, the lack of observed effects on fruit consumption and on both fruit and vegetable purchasing at intervention stores suggests that further investigation of effective nutrition promotion approaches for this key target group is required. The ShopSmart 4 Health trial was registered at www.isrctn.com as ISRCTN48771770. © 2016 American Society for Nutrition.

Biofilm and Diatom Succession on Polyethylene (PE) and Biodegradable Plastic Bags in Two Marine Habitats: Early Signs of Degradation in the Pelagic and Benthic Zone?

PubMed

Eich, Andreas; Mildenberger, Tobias; Laforsch, Christian; Weber, Miriam

2015-01-01

The production of biodegradable plastic is increasing. Given the augmented littering of these products an increasing input into the sea is expected. Previous laboratory experiments have shown that degradation of plastic starts within days to weeks. Little is known about the early composition and activity of biofilms found on biodegradable and conventional plastic debris and its correlation to degradation in the marine environment. In this study we investigated the early formation of biofilms on plastic shopper bags and its consequences for the degradation of plastic. Samples of polyethylene and biodegradable plastic were tested in the Mediterranean Sea for 15 and 33 days. The samples were distributed equally to a shallow benthic (sedimentary seafloor at 6 m water depth) and a pelagic habitat (3 m water depth) to compare the impact of these different environments on fouling and degradation. The amount of biofilm increased on both plastic types and in both habitats. The diatom abundance and diversity differed significantly between the habitats and the plastic types. Diatoms were more abundant on samples from the pelagic zone. We anticipate that specific surface properties of the polymer types induced different biofilm communities on both plastic types. Additionally, different environmental conditions between the benthic and pelagic experimental site such as light intensity and shear forces may have influenced unequal colonisation between these habitats. The oxygen production rate was negative for all samples, indicating that the initial biofilm on marine plastic litter consumes oxygen, regardless of the plastic type or if exposed in the pelagic or the benthic zone. Mechanical tests did not reveal degradation within one month of exposure. However, scanning electron microscopy (SEM) analysis displayed potential signs of degradation on the plastic surface, which differed between both plastic types. This study indicates that the early biofilm formation and composition are affected by the plastic type and habitat. Further, it reveals that already within two weeks biodegradable plastic shows signs of degradation in the benthic and pelagic habitat.

[Using the simulated patient methodology to assess counselling for acute diarrhoea - evidence from Germany].

PubMed

Langer, Bernhard; Bull, Elisa; Burgsthaler, Tina; Glawe, Julia; Schwobeda, Monique; Simon, Karen

2016-01-01

First, to assess the quality of counselling for acute diarrhoea; second, to evaluate the patient's approach and different user groups as a determinant of counselling. The simulated patient methodology was used in all 21 community pharmacies in a north-eastern German city with a population of about 63,000. Four scenarios related to self-medication for acute diarrhoea were developed and used in all pharmacies (total: 84 visits). Two scenarios were direct product-based requests for loperamide (scenario 1: a 74-year old woman with diabetes and hypertension; scenario 3: a 30-year old man with no primary disease). Scenario 2 and 4 were symptom-based requests asking for medicine for acute diarrhoea (scenario 2: a 74-year old woman with diabetes and hypertension; scenario 4: a 30-year old man with no primary disease). The assessment sheet included 9 objective items relating to the pharmacological advice to avoid a subjective evaluation by the mystery shoppers (e. g., the friendliness of the customer contact). Simulated patient visits were conducted covertly by five untrained female master students. After evaluation of the data every pharmacy received an individual performance feedback to encourage behavioural change and improve counselling quality. Overall, the quality of counselling was quite poor (277 out of 756 possible points). The most commonly provided information was dosage (86.9 %); information on adverse effects was least commonly provided (3.6 %). Furthermore, there was a huge difference in the counselling quality between the pharmacies (minimum 4 points, maximum 20 points out of 36 possible points). The symptom-based requests scored significantly better (95 and 85 out of 189 possible points) than the direct product-based requests (42 and 55 out of 189 possible points). The symptom-based requests had a significantly better counselling quality for an older woman with primary disease than for a younger man without any primary disease. This difference was not observed with the direct product-based requests. Copyright © 2016. Published by Elsevier GmbH.

Price discounts significantly enhance fruit and vegetable purchases when combined with nutrition education: a randomized controlled supermarket trial.

PubMed

Waterlander, Wilma E; de Boer, Michiel R; Schuit, Albertine J; Seidell, Jacob C; Steenhuis, Ingrid H M

2013-04-01

Reducing fruit and vegetable (F&V) prices is a frequently considered policy to improve dietary habits in the context of health promotion. However, evidence on the effectiveness of this intervention is limited. The objective was to examine the effects of a 50% price discount on F&Vs or nutrition education or a combination of both on supermarket purchases. A 6-mo randomized controlled trial within Dutch supermarkets was conducted. Regular supermarket shoppers were randomly assigned to 1 of 4 conditions: 50% price discounts on F&Vs, nutrition education, 50% price discounts plus nutrition education, or no intervention. A total of 199 participants provided baseline data; 151 (76%) were included in the final analysis. F&V purchases were measured by using supermarket register receipts at baseline, at 1 mo after the start of the intervention, at 3 mo, at 6 mo (end of the intervention period), and 3 mo after the intervention ended (9 mo). Adjusted multilevel models showed significantly higher F&V purchases (per household/2 wk) as a result of the price discount (+3.9 kg; 95% CI: 1.5, 6.3 kg) and the discount plus education intervention (+5.6 kg; 95% CI: 3.2, 7.9 kg) at 6 mo compared with control. Moreover, the percentage of participants who consumed recommended amounts of F&Vs (≥400 g/d) increased from 42.5% at baseline to 61.3% at 6 mo in both discount groups (P = 0.03). Education alone had no significant effect. Discounting F&Vs is a promising intervention strategy because it resulted in substantially higher F&V purchases, and no adverse effects were observed. Therefore, pricing strategies form an important focus for future interventions or policy. However, the long-term effects and the ultimate health outcomes require further investigation. This trial was registered at the ISRCTN Trial Register as number ISRCTN56596945 and at the Dutch Trial Register (http://www.trialregister.nl/trialreg/index.asp) as number NL22568.029.08.

Influence of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: outcomes of the Supermarket Healthy Eating for Life randomized controlled trial.

PubMed

Ball, Kylie; McNaughton, Sarah A; Le, Ha N D; Gold, Lisa; Ni Mhurchu, Cliona; Abbott, Gavin; Pollard, Christina; Crawford, David

2015-05-01

Fiscal strategies are increasingly considered upstream nutrition promotion measures. However, few trials have investigated the effectiveness or cost effectiveness of pricing manipulations on diet in real-world settings. We assessed the effects on fruit, vegetable, and beverage purchasing and consumption of a 20% price-reduction intervention, a tailored skills-based behavior-change intervention, and a combined intervention compared with a control condition. The Supermarket Healthy Eating for Life trial was a randomized controlled trial conducted over 3 mo [baseline (time 1) to postintervention (time 2) with a 6-mo follow-up (time 3)]. Female primary household shoppers in Melbourne, Australia, were randomly assigned to a 1) skill-building (n = 160), 2) price-reduction (n = 161), 3) combined skill-building and price-reduction (n = 160), or 4) control (n = 161) group. Supermarket transaction data and surveys were used to measure the following study outcomes: fruit, vegetable, and beverage purchases and self-reported fruit and vegetable consumption at each time point. At 3 mo (time 2), price reduction-alone participants purchased more total vegetables and frozen vegetables than did controls. Price reduction-alone and price reduction-plus-skill-building participants purchased more fruit than did controls. Relative to controls, in the price-reduction group, total vegetable consumption increased by 233 g/wk (3.1 servings or 15% more than at baseline), and fruit purchases increased by 364 g/wk (2.4 servings; 35% more than at baseline). Increases were not maintained 6 mo postintervention (time 3). Price reduction-alone participants showed a tendency for a slight increase in fruit consumption at time 2 (P = 0.09) that was maintained at time 3 (P = 0.014). No intervention improved purchases of bottled water or low-calorie beverages. A 20% price reduction in fruit and vegetables resulted in increased purchasing per household of 35% for fruit and 15% for vegetables over the price-reduction period. These findings show that price modifications can directly increase produce purchases. The Supermarket Healthy Eating for Life trial was registered at Current Controlled Trials Registration as ISRCTN39432901. © 2015 American Society for Nutrition.

Study protocol: combining experimental methods, econometrics and simulation modelling to determine price elasticities for studying food taxes and subsidies (The Price ExaM Study).

PubMed

Waterlander, Wilma E; Blakely, Tony; Nghiem, Nhung; Cleghorn, Christine L; Eyles, Helen; Genc, Murat; Wilson, Nick; Jiang, Yannan; Swinburn, Boyd; Jacobi, Liana; Michie, Jo; Ni Mhurchu, Cliona

2016-07-19

There is a need for accurate and precise food price elasticities (PE, change in consumer demand in response to change in price) to better inform policy on health-related food taxes and subsidies. The Price Experiment and Modelling (Price ExaM) study aims to: I) derive accurate and precise food PE values; II) quantify the impact of price changes on quantity and quality of discrete food group purchases and; III) model the potential health and disease impacts of a range of food taxes and subsidies. To achieve this, we will use a novel method that includes a randomised Virtual Supermarket experiment and econometric methods. Findings will be applied in simulation models to estimate population health impact (quality-adjusted life-years [QALYs]) using a multi-state life-table model. The study will consist of four sequential steps: 1. We generate 5000 price sets with random price variation for all 1412 Virtual Supermarket food and beverage products. Then we add systematic price variation for foods to simulate five taxes and subsidies: a fruit and vegetable subsidy and taxes on sugar, saturated fat, salt, and sugar-sweetened beverages. 2. Using an experimental design, 1000 adult New Zealand shoppers complete five household grocery shops in the Virtual Supermarket where they are randomly assigned to one of the 5000 price sets each time. 3. Output data (i.e., multiple observations of price configurations and purchased amounts) are used as inputs to econometric models (using Bayesian methods) to estimate accurate PE values. 4. A disease simulation model will be run with the new PE values as inputs to estimate QALYs gained and health costs saved for the five policy interventions. The Price ExaM study has the potential to enhance public health and economic disciplines by introducing internationally novel scientific methods to estimate accurate and precise food PE values. These values will be used to model the potential health and disease impacts of various food pricing policy options. Findings will inform policy on health-related food taxes and subsidies. Australian New Zealand Clinical Trials Registry ACTRN12616000122459 (registered 3 February 2016).

Effect of a Nutrient Rich Foods consumer education program: results from the nutrition advice study.

PubMed

Glanz, Karen; Hersey, James; Cates, Sheryl; Muth, Mary; Creel, Darryl; Nicholls, Jill; Fulgoni, Victor; Zaripheh, Susan

2012-01-01

The Nutrient Rich Foods (NRF) approach to eating uses the NRF Index, a nutrient profiling metric to help consumers choose foods that contain more vitamins, minerals, and other nutrients per kilocalorie. Research is needed to test the efficacy of dietary guidance using nutrient profiling systems to rank foods. To examine whether nutrition education and supporting materials would increase understanding of the NRF approach and improve food shopping, meal planning, consumption of nutrient-rich foods, and diet quality. Unbalanced randomized controlled trial conducted in February to May 2009 with participants assigned to NRF education group (n=128) or control group receiving standard nutrition education (n=61). Adult primary food shoppers and preparers with at least one child in the household aged 3 to 17 years. Group education session and support tools (pocket guide, shopping list, refrigerator magnet, weekly e-mail messages, and biweekly mailings). Surveys of knowledge, attitudes, and behaviors and two 24-hour telephone dietary recalls at baseline and after an 8-week intervention period. Examined time-by-treatment interactions in outcome measures. Compared to controls, NRF participants increased meal planning (+24.2% vs ?4.9%; P<0.01), ability to identify nutrient-rich foods (+60.2% vs +24.6%; P<0.001), and use of shopping lists (+14.1% vs +3.3%; nonsignificant trend), and consumed more vegetables and fruits (P<0.05). NRF participants improved overall diet quality as shown by their scores on the Healthy Eating Index (P=0.04) and NRF scale scores (nonsignificant trend). Significant improvements were observed in Healthy Eating Index component scores for total fruit; whole fruit; whole grains; saturated fat; and energy from solid fats, alcohol, and added sugars. Findings of this study showed that a consumer education program increased participants' use of the NRF approach and improved diet quality. Larger and longer-term studies are needed to confirm the findings and better understand processes of change. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Energy efficiency in U.K. shopping centres

NASA Astrophysics Data System (ADS)

Mangiarotti, Michela

Energy efficiency in shopping centres means providing comfortable internal environment and services to the occupants with minimum energy use in a cost-effective and environmentally sensitive manner. This research considers the interaction of three factors affecting the energy efficiency of shopping centres: i) performance of the building fabric and services ii) management of the building in terms of operation, control, maintenance and replacement of the building fabric and services, and company's energy policy iii) occupants' expectation for comfort and awareness of energy efficiency. The aim of the investigation is to determine the role of the above factors in the energy consumption and carbon emissions of shopping centres and the scope for reducing this energy usage by changing one or all the three factors. The study also attempts to prioritize the changes in the above factors that are more cost-effective at reducing that energy consumption and identify the benefits and main economic and legal drivers for energy efficiency in shopping centres. To achieve these targets, three case studies have been analysed. Using energy data from bills, the performance of the selected case studies has been assessed to establish trends and current energy consumption and carbon emissions of shopping centres and their related causes. A regression analysis has attempted to break down the energy consumption of the landlords' area by end-use to identify the main sources of energy usage and consequently introduce cost-effective measures for saving energy. A monitoring and occupants' survey in both landlords' and tenants' areas have been carried out at the same time to compare the objective data of the environmental conditions with the subjective impressions of shoppers and shopkeepers. In particular, the monitoring aimed at assessing the internal environment to identify possible causes of discomfort and opportunities for introducing energy saving measures. The survey looked at determining the occupants' expectation for comfort and awareness of energy efficiency in shopping centres. The results show the complexity of prioritizing the three factors affecting energy efficiency in shopping centres, highlighting the relationships between those factors, and the role of different actors, involved in the life of shopping centres, in the energy and environmental performance of these buildings.

Druggists and pharmacists as gatekeepers: sales routines and compliance with sales protocols for over-the-counter naproxen 275 mg medicines in the Netherlands.

PubMed

van Hoof, Joris J; Cents, Michel H G; Megens, Nicole M J; van der Tang, Sijbrand J

2014-09-01

Since for the sales of over-the-counter (OTC) medicines, prescribing physicians are not involved, and written instructions on/in the medicine boxes are inefficient, druggists and pharmacists are important gatekeepers in preventing customers' accidents. In this study we investigated the sales routines, and compliance with sales protocols, in order to evaluate that gatekeeper's function. By means of the mystery shopping method, 228 pharmacies and drugstores in The Netherlands were visited and a naproxen 275mg medium-risk medicine was requested for a (fictitious) patient who was suffering from severe back pains. According to the sales protocols the vendors should never sell the requested medicine, because the mystery shoppers only gave an answer to one of the four mandatory sales protocol questions. Furthermore, the requested medicine is not the right or best choice for back pains. Four different scenarios were used in a 2×2 design (8-year-old patient vs. 25-year-old patient, and 1 box with 12 pills vs. 3 boxes with 12 pills). Of the drugstores and pharmacies only 16.7% complied with the sales protocols and did not sell the specific (or comparable) medicine, after asking all four mandatory questions (or already after one, two or three questions). Most vendors (83.3%) did not comply and sold the requested medicine, a comparable medicine, or even a more risky medicine after no question at all (or after asking some or even all four questions). Although both score low, pharmacists show better compliance (23.9%) than druggists (10.1%). When it comes to OTC medicines, druggists and pharmacists largely commit sloppy sales. The expected gatekeeping function of pharmacists and druggists is very limited, and customers might be in danger of inappropriate medicine selection, quantity and usage. We call for thorough evaluation of the over-the-counter system, improvement of the educational programs for medicine providers, and national campaigns to inform the public. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quality of medicines commonly used in the treatment of soil transmitted helminths and giardia in ethiopia: a nationwide survey.

PubMed

Suleman, Sultan; Zeleke, Gemechu; Deti, Habtewold; Mekonnen, Zeleke; Duchateau, Luc; Levecke, Bruno; Vercruysse, Jozef; D'Hondt, Matthias; Wynendaele, Evelien; De Spiegeleer, Bart

2014-12-01

The presence of poor quality medicines in the market is a global threat on public health, especially in developing countries. Therefore, we assessed the quality of two commonly used anthelminthic drugs [mebendazole (MEB) and albendazole (ALB)] and one antiprotozoal drug [tinidazole (TNZ)] in Ethiopia. A multilevel stratified random sampling, with as strata the different levels of supply chain system in Ethiopia, geographic areas and government/privately owned medicines outlets, was used to collect the drug samples using mystery shoppers. The three drugs (106 samples) were collected from 38 drug outlets (government/privately owned) in 7 major cities in Ethiopia between January and March 2012. All samples underwent visual and physical inspection for labeling and packaging before physico-chemical quality testing and evaluated based on individual monographs in Pharmacopoeias for identification, assay/content, dosage uniformity, dissolution, disintegration and friability. In addition, quality risk was analyzed using failure mode effect analysis (FMEA) and a risk priority number (RPN) was assigned to each quality attribute. A clinically rationalized desirability function was applied in quantification of the overall quality of each medicine. Overall, 45.3% (48/106) of the tested samples were substandard, i.e. not meeting the pharmacopoeial quality specifications claimed by their manufacturers. Assay was the quality attribute most often out-of-specification, with 29.2% (31/106) failure of the total samples. The highest failure was observed for MEB (19/42, 45.2%), followed by TNZ (10/39, 25.6%) and ALB (2/25, 8.0%). The risk analysis showed that assay (RPN = 512) is the most critical quality attribute, followed by dissolution (RPN = 336). Based on Derringer's desirability function, samples were classified into excellent (14/106,13%), good (24/106, 23%), acceptable (38/106, 36%%), low (29/106, 27%) and bad (1/106,1%) quality. This study evidenced that there is a relatively high prevalence of poor quality MEB, ALB and TNZ in Ethiopia: up to 45% if pharmacopoeial acceptance criteria are used in the traditional, dichotomous approach, and 28% if the new risk-based desirability approach was applied. The study identified assay as the most critical quality attributes. The country of origin was the most significant factor determining poor quality status of the investigated medicines in Ethiopia.

Quality of Medicines Commonly Used in the Treatment of Soil Transmitted Helminths and Giardia in Ethiopia: A Nationwide Survey

PubMed Central

Suleman, Sultan; Zeleke, Gemechu; Deti, Habtewold; Mekonnen, Zeleke; Duchateau, Luc; Levecke, Bruno; Vercruysse, Jozef; D'Hondt, Matthias; Wynendaele, Evelien; De Spiegeleer, Bart

2014-01-01

Background The presence of poor quality medicines in the market is a global threat on public health, especially in developing countries. Therefore, we assessed the quality of two commonly used anthelminthic drugs [mebendazole (MEB) and albendazole (ALB)] and one antiprotozoal drug [tinidazole (TNZ)] in Ethiopia. Methods/Principal Findings A multilevel stratified random sampling, with as strata the different levels of supply chain system in Ethiopia, geographic areas and government/privately owned medicines outlets, was used to collect the drug samples using mystery shoppers. The three drugs (106 samples) were collected from 38 drug outlets (government/privately owned) in 7 major cities in Ethiopia between January and March 2012. All samples underwent visual and physical inspection for labeling and packaging before physico-chemical quality testing and evaluated based on individual monographs in Pharmacopoeias for identification, assay/content, dosage uniformity, dissolution, disintegration and friability. In addition, quality risk was analyzed using failure mode effect analysis (FMEA) and a risk priority number (RPN) was assigned to each quality attribute. A clinically rationalized desirability function was applied in quantification of the overall quality of each medicine. Overall, 45.3% (48/106) of the tested samples were substandard, i.e. not meeting the pharmacopoeial quality specifications claimed by their manufacturers. Assay was the quality attribute most often out-of-specification, with 29.2% (31/106) failure of the total samples. The highest failure was observed for MEB (19/42, 45.2%), followed by TNZ (10/39, 25.6%) and ALB (2/25, 8.0%). The risk analysis showed that assay (RPN = 512) is the most critical quality attribute, followed by dissolution (RPN = 336). Based on Derringer's desirability function, samples were classified into excellent (14/106,13%), good (24/106, 23%), acceptable (38/106, 36%%), low (29/106, 27%) and bad (1/106,1%) quality. Conclusions/Significance This study evidenced that there is a relatively high prevalence of poor quality MEB, ALB and TNZ in Ethiopia: up to 45% if pharmacopoeial acceptance criteria are used in the traditional, dichotomous approach, and 28% if the new risk-based desirability approach was applied. The study identified assay as the most critical quality attributes. The country of origin was the most significant factor determining poor quality status of the investigated medicines in Ethiopia. PMID:25473966

Associations between depressive symptomatology, diet, and BMI among participants in the Supplemental Nutrition Assistance Program

PubMed Central

Flórez, Karen R.; Dubowitz, Tamara; Ghosh-Dastidar, Madhumita (Bonnie); Beckman, Robin; Collins, Rebecca

2015-01-01

Background Participation in the Supplemental Nutrition Assistance Program (SNAP) has been shown to increase food security, or access to adequate food; however, SNAP participation has also been associated with obesity among certain demographic groups (e.g., women, but not men and children), possibly due to poorer dietary quality. Depressive symptomatology is an understudied factor, which is associated with obesity across the lifespan. Objective This study examined the relationship between depressive symptomatology, dietary quality, and body weight among a sample of SNAP participants (N= 639). Design The analysis was cross-sectional; survey data was collected in May–December 2011 by trained data collectors. Participants/setting Adults who self-identified as the primary food shopper of the household in two predominantly low-income African-American neighborhoods characterized as “food deserts” in Pittsburgh, PA were recruited to participate in this study. Measures Dietary quality was calculated using the US Department of Agriculture Healthy Eating Index (HEI)-2005. Body Mass Index (BMI) was based on objective measurements taken by the interviewer and derived from the standard formula of weight (kg) divided by height squared (m2). Current depressive symptomatology was assessed by a trained interviewer using the Patient Health Questionnaire-2. Statistical analyses performed Descriptive statistics (means and percentages); two multivariate OLS regression analyses predicting BMI and dietary quality from depressive symptomatology while controlling for sociodemograhic factors and food insecurity were performed. Results Depression was a strong and statistically significant predictor of both dietary quality and BMI: higher score in depressive symptomatology was associated with lower scores in dietary quality (β=−1.26, p<0.0001). A higher score in depressive symptomatology was associated with higher BMI (β=.63, p=0.0031). Conclusions These findings show that depressive symptomatology is significantly associated with weight-related outcomes and suggests that understanding the risk of depression among SNAP participants could be important to understanding the relationship among SNAP participation, diet, and weight. The association between depressive symptomology, elevated BMI and lower dietary quality among low-income, primarily African American residents living in a food desert suggests the potential for mental health interventions to have broader benefits in this population. However, the directionality of this association is unclear and improving diet and reducing weight may also improve mental health symptoms. Further longitudinal studies should assess these possibilities. PMID:25769748

Economic evaluation of price discounts and skill-building strategies on purchase and consumption of healthy food and beverages: The SHELf randomized controlled trial.

PubMed

Le, Ha N D; Gold, Lisa; Abbott, Gavin; Crawford, David; McNaughton, Sarah A; Mhurchu, Cliona Ni; Pollard, Christina; Ball, Kylie

2016-06-01

Pricing strategies are a promising approach for promoting healthier dietary choices. However, robust evidence of the cost-effectiveness of pricing manipulations on dietary behaviour is limited. We aimed to assess the cost-effectiveness of a 20% price reduction on fruits and vegetables and a combined skills-based behaviour change and price reduction intervention. Cost-effectiveness analysis from a societal perspective was undertaken for the randomized controlled trial Supermarket Healthy Eating for Life (SHELf). Female shoppers in Melbourne, Australia were randomized to: (1) skill-building (n = 160); (2) price reductions (n = 161); (3) combined skill-building and price reduction (n = 161); or (4) control group (n = 161). The intervention was implemented for three months followed by a six month follow-up. Costs were measured in 2012 Australian dollars. Fruit and vegetable purchasing and consumption were measured in grams/week. At three months, compared to control participants, price reduction participants increased vegetable purchases by 233 g/week (95% CI 4 to 462, p = 0.046) and fruit purchases by 364 g/week (95% CI 95 to 633, p = 0.008). Participants in the combined group purchased 280 g/week more fruits (95% CI 27 to 533, p = 0.03) than participants in the control group. Increases were not maintained six-month post intervention. No effect was noticed in the skill-building group. Compared to the control group, the price reduction intervention cost an additional A$2.3 per increased serving of vegetables purchased per week or an additional A$3 per increased serving of fruit purchased per week. The combined intervention cost an additional A$12 per increased serving of fruit purchased per week compared to the control group. A 20% discount on fruits and vegetables was effective in promoting overall fruit and vegetable purchases during the period the discount was active and may be cost-effective. The price discount program gave better value for money than the combined price reduction and skill-building intervention. The SHELf trial is registered with Current Controlled Trials Registration ISRCTN39432901. Copyright © 2016 Elsevier Ltd. All rights reserved.

Indoor Lighting Facilities

NASA Astrophysics Data System (ADS)

Matsushima, Koji; Saito, Yoshinori; Ichikawa, Shigenori; Kawauchi, Takao; Tanaka, Tsuneo; Hirano, Rika; Tazuke, Fuyuki

According to the statistics by the Ministry of Land, Infrastructure and Transport, the total floor space of all building construction started was 188.87 million m2 (1.5% increase y/y), marking the fourth straight year of increase. Many large-scale buildings under construction in central Tokyo become fully occupied by tenants before completion. As for office buildings, it is required to develop comfortable and functional office spaces as working styles are becoming more and more diversified, and lighting is also an element of such functionalities. The total floor space of construction started for exhibition pavilions, multipurpose halls, conference halls and religious architectures decreased 11.1% against the previous year. This marked a decline for 10 consecutive years and the downward trend continues. In exhibition pavilions, the light radiation is measured and adjusted throughout the year so as not to damage the artworks by lighting. Hospitals, while providing higher quality medical services and enhancing the dwelling environment of patients, are expected to meet various restrictions and requirements, including the respect for privacy. Meanwhile, lighting designs for school classrooms tend to be homogeneous, yet new ideas are being promoted to strike a balance between the economical and functional aspects. The severe economic environment continues to be hampering the growth of theaters and halls in both the private and public sectors. Contrary to the downsizing trend of such facilities, additional installations of lighting equipment were conspicuous, and the adoption of high efficacy lighting appliances and intelligent function control circuits are becoming popular. In the category of stores/commercial facilities, the construction of complex facilities is a continuing trend. Indirect lighting, high luminance discharge lamps with excellent color rendition and LEDs are being effectively used in these facilities, together with the introduction of lighting designs that take into account the traffic flow of shoppers. For hotels, restaurants and other service industries, lighting equipment that corresponds to the purpose of the facility is being employed. An innovative lighting design was observed for the bath space, while such idea was not so much emphasized in the past. As to residences, illumination positioning plans that cope with diversifying lifestyles in an innovative space expanding in a horizontal or vertical direction using high efficient light sources/appliances are being introduced.

Associations between depressive symptomatology, diet, and body mass index among participants in the supplemental nutrition assistance program.

PubMed

Flórez, Karen R; Dubowitz, Tamara; Ghosh-Dastidar, Madhumita Bonnie; Beckman, Robin; Collins, Rebecca L

2015-07-01

Participation in the Supplemental Nutrition Assistance Program (SNAP) has been shown to increase food security, or access to adequate food; however, SNAP participation has also been associated with obesity among certain demographic groups (eg, women, but not men and children), possibly due to poorer dietary quality. Depressive symptomatology is an understudied factor, which is associated with obesity across the lifespan. This study examined the relationship between depressive symptomatology, dietary quality, and body weight among a sample of SNAP participants (n=639). The analysis was cross-sectional; survey data were collected in May to December 2011 by trained data collectors. Adults who self-identified as the primary food shopper of the household in two predominantly low-income African-American neighborhoods characterized as "food deserts" in Pittsburgh, PA, were recruited to participate in this study. Dietary quality was calculated using the US Department of Agriculture's Healthy Eating Index-2005. Body mass index (BMI; calculated as kg/m(2)) was based on objective measurements taken by the interviewer. Current depressive symptomatology was assessed by a trained interviewer using the Patient Health Questionnaire-2. Descriptive statistics (means and percentages); two multivariate ordinary least-square regression analyses predicting BMI and dietary quality from depressive symptomatology while controlling for sociodemographic factors and food insecurity were performed. Depression was a strong and statistically significant predictor of both dietary quality and BMI; higher score in depressive symptomatology was associated with lower scores in dietary quality (β=-1.26; P<0.0001). A higher score in depressive symptomatology was associated with higher BMI (β=.63; P=0.0031). These findings show that depressive symptomatology is significantly associated with weight-related outcomes and suggests that understanding the risk of depression among SNAP participants could be important to understanding the relationships among SNAP participation, diet, and weight. The association between depressive symptomology, elevated BMI, and lower dietary quality among low-income, primarily African-American residents living in a food desert suggests the potential for mental health interventions to have broader benefits in this population. However, the directionality of this association is unclear and improving diet and reducing weight might also improve mental health symptoms. Additional longitudinal studies should assess these possibilities. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Risk assessment of the entry of canine-rabies into Papua New Guinea via sea and land routes.

PubMed

Brookes, Victoria J; Keponge-Yombo, Andy; Thomson, David; Ward, Michael P

2017-09-15

Canine-rabies is endemic in parts of Indonesia and continues to spread eastwards through the Indonesian archipelago. Papua New Guinea (PNG) has a land border with Papua Province, Indonesia, as well as logging and fishing industry connections throughout Asia. PNG has a Human Development Index of 0.505; therefore, an incursion of canine-rabies could have devastating impacts on human (7.5 million) and animal populations. Given the known difficulties of rabies elimination in resource-scarce environments, an incursion of rabies into PNG would also likely compromise the campaign for global elimination of rabies. A previous qualitative study to determine routes for detailed risk assessment identified logging, fishing and three land-routes (unregulated crossers ["shopper-crossers"], traditional border crossers and illegal hunters) as potential high risk routes for entry of rabies-infected dogs into PNG. The objective of the current study was to quantify and compare the probability of entry of a rabies-infected dog via these routes into PNG and to identify the highest risk provinces and border districts to target rabies prevention and control activities. Online questionnaires were used to elicit expert-opinion about quantitative model parameter values. A quantitative, stochastic model was then used to assess risk, and parameters with the greatest influence on the estimated mean number of rabies-infected dogs introduced/year were identified via global sensitivity analysis (Sobol method). Eight questionnaires - including 7 online - were implemented and >220 empirical distributions were parameterised using >2900 expert-opinions. The highest risk provinces for combined sea routes were West Sepik, Madang and Western Province, driven by the number of vessels and the probability of bringing dogs. The highest risk border districts for combined land routes were Vanimo-Green River and South Fly, driven by the number of people crossing the border and the number of dogs (with hunters). Overall, the risk posed by land routes was much higher than the risk of rabies introduction by sea routes. This study provides a foundation to develop targeted border control measures, surveillance and response strategies for canine-rabies for the highest risk routes and regions in PNG. Sensitivity analysis using the Sobol method played a key role in this study and directed further data collection to refine risk estimates. The ease of expert-elicitation using online methods demonstrates the feasibility of using such methods for animal and human disease surveillance in PNG. Copyright © 2017 Elsevier B.V. All rights reserved.

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search.

PubMed

Cartwright, Alice F; Karunaratne, Mihiri; Barr-Walker, Jill; Johns, Nicole E; Upadhyay, Ushma D

2018-05-14

Abortion is a common medical procedure, yet its availability has become more limited across the United States over the past decade. Women who do not know where to go for abortion care may use the internet to find abortion facility information, and there appears to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used a systematic online search to document the geographic locations and services of abortion facilities. The objective of our study was to describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify US cities where people must travel the farthest to obtain abortion care. In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits. We then summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper method, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all US cities with populations of 50,000 or more. We identified 780 facilities through our online search, with the fewest in the Midwest and South. Over 30% (236/780, 30.3%) of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast (89/233, 38.2%) and West (104/262, 39.7%). The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 US cities must travel over 100 miles (160 km) to reach an abortion facility; the state with the largest number of such cities is Texas (n=10). Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically, and many large US cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited. ©Alice F Cartwright, Mihiri Karunaratne, Jill Barr-Walker, Nicole E Johns, Ushma D Upadhyay. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.05.2018.

A calibration method for the measurement of IR detector spectral responses using a FTIR spectrometer equipped with a DTGS reference cell

NASA Astrophysics Data System (ADS)

Gravrand, Olivier; Wlassow, J.; Bonnefond, L.

2014-07-01

Various high performance IR detectors are today available on the market from QWIPs to narrow gap semiconductor photodiodes, which exhibit various spectral features. In the astrophysics community, the knowledge of the detector spectral shape is of first importance. This quantity (spectral QE or response) is usually measured by means of a monochromator followed by an integrating sphere and compared to a calibrated reference detector. This approach is usually very efficient in the visible range, where all optical elements are very well known, particularly the reference detector. This setup is also widely used in the near IR (up to 3μm) but as the wavelength increases, it becomes less efficient. For instance, the internal emittance of integrating spheres in the IR, and the bad knowledge of reference detectors for longer wavelengths tend to degrade the measurement reliability. Another approach may therefore be considered, using a Fourier transform IR spectrometer (FTIR). In this case, as opposed to the monochromator, the tested detector is not in low flux condition, the incident light containing a mix of different wavelengths. Therefore, the reference detector has to be to be sensitive (and known) in the whole spectral band of interest, because it will sense all those wavelengths at the same time. A popular detector used in this case is a Deuterated Triglycine Sulfate thermal detector (DTGS). Being a pyro detetector, the spectral response of such a detector is very flat, mainly limited by its window. However, the response of such a detector is very slow, highly depending on the temporal frequency of the input signal. Moreover, being a differential detector, it doesn't work in DC. In commercial FTIR spectrometers, the source luminance is usually continuously modulated by the moving interferometer, and the result is that the interferogram mixes optical spectral information (optical path difference) and temporal variations (temporal frequency) so that the temporal transfert function of the DTGS has to be qualified and taken into account. The usual way is to measure it directly by means of an optical shopper and a locking amplifier for different shopping frequencies. We present here an alternative method to estimate this DTGS transfer function, based on the fact that a FTIR continuous scan interfergram contains the different spectral frequencies of interest. Such a calibration method doesn't need a specific setup as it can be performed in standard configuration, playing only with spectrometer parameters. It allows for the precise estimation of detector spectral shapes. However, this measurement is not absolute and the peak response needs therefore to be estimated using a calibrated black body cavity. The method, its results and limits is presented and discussed for a set of different DTGS cells.

Recording brain waves at the supermarket: what can we learn from a shopper's brain?

PubMed

Sands, Stephen F; Sands, J Andrew

2012-01-01

Communication and marketing campaigns have traditionally been divided into two lines: above the line (ATL) and below the line (BTL). ATL campaigns refer to communications such as TV, print, and outdoor displays that are intended to reach large audiences. The effects of ATL are inherently difficult to measure; we do not see the direct consequences of viewing an advertisement (i.e., a talking baby giving financial advice) and actual purchase of the product. ATL is intended to indirectly improve the impression of a brand. BTL campaigns refer to promotions and in-store displays and are designed to affect the point-of-purchase behavior. The effects of BTL are easier to measure; we see direct consequences of viewing a display (i.e., “Today Only, Two for the Price of One”) and eventual purchase of the product. BTL is intended to directly improve the impression of a brand. Neuroscience plays an important role in measuring the effects of marketing campaigns. Traditional methods of measurement (such as surveys and interviews) depend on the verbal ability of the consumer to articulate their motivations for purchasing a product. It is well known that participants are poor at introspective reasoning, leading to an eventual purchase that omits emotional elements. Recently, methods normally employed in cognitive neuroscience have been adapted for use in the evaluation of campaign effectiveness. These methods have increased our understanding of factors leading to economic decisions. The application of neuroscience in ATL campaigns is relatively straightforward. Participants view TV commercials, for example, seated in a comfortable setting with minimal movement while electroencephalogram (EEG) measures are monitored. These brain waves reveal cognitive events related to the media. Participants are exposed to a functional magnetic resonance imaging (fMRI) scanner to monitor changes in blood flow in various regions of the brain. Both of these methods are sensitive to underlying cognitive and emotional activity and are complimentary. EEG is more sensitive to time-locked events (i.e., story lines), whereas fMRI is more sensitive to the brain regions involved. The application of neuroscience in BTL campaigns is significantly more difficult to achieve. Participants move unconstrained in a shopping environment while EEG and eye movements are monitored. In this scenario, fMRI is not possible. fMRI can be used with virtual store mock-ups, but it is expensive and seldom used. We have developed a technology that allows for the measurement of EEG in an unobtrusive manner. The intent is to record the brain waves of participants during their day-to-day shopping experience. A miniaturized video recorder, EEG amplifiers, and eye-tracking systems are used. Digital signal processing is employed to remove the substantial artifact generated by eye movements and motion. Eye fixations identify specific viewings of products and displays, and they are used for synchronizing the behavior with EEG response. The location of EEG sources is determined by the use of a source reconstruction software.

Using a 3D Virtual Supermarket to Measure Food Purchase Behavior: A Validation Study

PubMed Central

Jiang, Yannan; Steenhuis, Ingrid Hendrika Margaretha; Ni Mhurchu, Cliona

2015-01-01

Background There is increasing recognition that supermarkets are an important environment for health-promoting interventions such as fiscal food policies or front-of-pack nutrition labeling. However, due to the complexities of undertaking such research in the real world, well-designed randomized controlled trials on these kinds of interventions are lacking. The Virtual Supermarket is a 3-dimensional computerized research environment designed to enable experimental studies in a supermarket setting without the complexity or costs normally associated with undertaking such research. Objective The primary objective was to validate the Virtual Supermarket by comparing virtual and real-life food purchasing behavior. A secondary objective was to obtain participant feedback on perceived sense of “presence” (the subjective experience of being in one place or environment even if physically located in another) in the Virtual Supermarket. Methods Eligible main household shoppers (New Zealand adults aged ≥18 years) were asked to conduct 3 shopping occasions in the Virtual Supermarket over 3 consecutive weeks, complete the validated Presence Questionnaire Items Stems, and collect their real supermarket grocery till receipts for that same period. Proportional expenditure (NZ$) and the proportion of products purchased over 18 major food groups were compared between the virtual and real supermarkets. Data were analyzed using repeated measures mixed models. Results A total of 123 participants consented to take part in the study. In total, 69.9% (86/123) completed 1 shop in the Virtual Supermarket, 64.2% (79/123) completed 2 shops, 60.2% (74/123) completed 3 shops, and 48.8% (60/123) returned their real supermarket till receipts. The 4 food groups with the highest relative expenditures were the same for the virtual and real supermarkets: fresh fruit and vegetables (virtual estimate: 14.3%; real: 17.4%), bread and bakery (virtual: 10.0%; real: 8.2%), dairy (virtual: 19.1%; real: 12.6%), and meat and fish (virtual: 16.5%; real: 16.8%). Significant differences in proportional expenditures were observed for 6 food groups, with largest differences (virtual – real) for dairy (in expenditure 6.5%, P<.001; in items 2.2%, P=.04) and fresh fruit and vegetables (in expenditure: –3.1%, P=.04; in items: 5.9%, P=.002). There was no trend of overspending in the Virtual Supermarket and participants experienced a medium-to-high presence (88%, 73/83 scored medium; 8%, 7/83 scored high). Conclusions Shopping patterns in the Virtual Supermarket were comparable to those in real life. Overall, the Virtual Supermarket is a valid tool to measure food purchasing behavior. Nevertheless, it is important to improve the functionality of some food categories, in particular fruit and vegetables and dairy. The results of this validation will assist in making further improvements to the software and with optimization of the internal and external validity of this innovative methodology. PMID:25921185

Prescription opioid abuse and diversion in an urban community: the results of an ultrarapid assessment.

PubMed

Inciardi, James A; Surratt, Hilary L; Cicero, Theodore J; Beard, Ronald A

2009-04-01

Prescription-drug diversion is a topic about which comparatively little is known, and systematic information garnered from prescription-drug abusers and dealers on the specific mechanisms of diversion is extremely limited. A pilot ultrarapid assessment was carried out in Wilmington, Delaware, during December 2006 to better understand the scope and dynamics of prescription-drug abuse and diversion. This involved focus groups with prescription-drug abusers and key informant interviews with police, regulatory officials, prescription-drug dealers, and pill brokers. The research team recruited focus group participants from the two residential substance abuse treatment programs in Wilmington reporting the highest proportions of prescription drug abusing clients. A total of six focus groups were conducted with 32 patients in these two programs. Dealers were recruited from the same treatment facilities, and three in-depth interviews were completed. In-depth interviews were also conducted with two prescription pill brokers recruited through the authors' existing contacts in the drug abusing community. Six in-depth interviews were conducted with representatives from a number of Delaware agencies-the Attorney General's Office, the Department of Professional Regulation, the State Police; the Wilmington Police Department, and the Newark Police Department. In-depth interview and focus group guides were developed for each of the target populations. The in-depth interviews with police and regulatory officials focused on the extent of prescription drug abuse and diversion in the community, the types of drugs most commonly diverted, and mechanisms being used to channel the drugs to the illicit market. The focus group areas of inquiry with prescription drug abusers included general perceptions of the prescription drug problem in Delaware, sources and mechanisms of access to prescription drugs, popularity and prices of prescription medications on the street, as well as the initiation and progression of prescription and illicit drug abuse. The primary sources of prescription drugs on the street were the elderly, patients with pain, and doctor shoppers, as well as pill brokers and dealers who work with all of the former. The popularity of prescription drugs in the street market was rooted in the abusers' perceptions of these drugs as 1) less stigmatizing; 2) less dangerous; and, 3) less subject to legal consequences than illicit drugs. For many, the abuse of prescription opioids also appeared to serve as a gateway to heroin use. The diversion of prescription opioids might be reduced through physician education focusing on 1) recognizing that a patient is misusing and/or diverting prescribed medications; 2) considering a patient's risk for opioid misuse before initiating opioid therapy; and 3) understanding the variation in the abuse potential of different opioid medications currently on the market. Patient education also appears appropriate in the areas of safeguarding medications, disposal of unused medications, and understanding the consequences of manipulating physicians and selling their medications.

Deconstructing Cancer Patient Information Seeking in a Consumer Health Library Toward Developing a Virtual Information Consult for Cancer Patients and Their Caregivers: A Qualitative, Instrumental Case Study

PubMed Central

Abdelmutti, Nazek; Giuliani, Meredith E; Snow, Michelle; McCurdie, Tara; Pulandiran, Menaka; Urowitz, Sara; Wiljer, David

2017-01-01

Background Cancer patients and their caregivers want information about their disease and are interested in finding health information online. Despite the abundance of cancer information online, it is often fragmented, its quality is highly variable, and it can be difficult to navigate without expert-level knowledge of the cancer system. The Patient & Family Library at the Princess Margaret Cancer Centre offers a broad collection of high-quality cancer health information and staff are available to help patrons refine their questions and explore information needs that they may not have considered. Objective The purpose of this research study was to deconstruct patrons’ information-seeking behaviors in the library to assess the feasibility of replicating the services provided in the library through a Web app, extending the service beyond the walls of the cancer centre. The specific aims of this research were to understand (1) how patrons approach information seeking in the library (interface design), (2) how patrons communicate their informational needs (information categorization and metadata requirements), and (3) what resources are provided to address the patrons’ information needs (collection development). Methods We employed a qualitative, instrumental case study to deconstruct patrons’ health information-seeking behavior. The study population included patients, the librarian, and library volunteers. Ethnographic observation was conducted at the library over 3 days and key informant interviews with library staff were conducted to address the first aim. A closed card-sorting activity was conducted to address the second aim and the library shift logs and Search Request Forms (SRFs) were reviewed to address the third aim. Results A total of 55 interactions were recorded during the ethnographic observation and nine semistructured interviews were conducted during the key informant interviews. Seven library patron personas were identified: (1) Newbie, (2) Seasoned, (3) Direct, (4) Window Shopper, (5) Collector, (6) Information Seeker, and (7) Distressed. A total of 83 participants completed the closed card-sorting exercise. The participants’ conceptual clusters within the similarity matrix overlapped with the groupings created by the librarian, with a few differences. A total of 161 entries in the library shift log and 65 SRFs were analyzed to determine what resources were given to patrons. Most resources that patrons received were available online (61%), although almost half of these required special access (47%). Conclusions The study findings suggest it is possible to replicate library functions in a Web app with a few exceptions that cannot be replicated online. These elements include access to journal articles or other content behind paywalls and the librarian’s ability to encourage further discussion through empathy and active listening. Discussion with the librarian could serve to refine and predict needs through observing information seekers and to provide immediate connection to spiritual care and psychosocial support for patrons in distress. PMID:28539305

France. Country profile. [France's economy adjusts to a declining birth rate].

PubMed

Inserra, P

1984-09-01

This discussion of France focuses on regions and cities, age distribution, households and families, housing, labor force, consumption, education, and communications. France counted 54,334,871 citizens as of March 4, 1982. There were 250,000 more people than in 1975, yielding a 7-year growth rate of 3.3%. If present trends continue, there will be 56 million French by the end of the 1980s. Since 1975 when the last census was conducted, cities of more than 200,000 lost an average of 5% of their residents. For the 1st time in more than a century, urban areas of 20,000 or more did not gain population but merely held their own. France continues to experience the effects of the large-scale decimation of its male population during the 2 world wars. The World war i loss showed up March 1982 as a relatively smaller 60-74 group. Conversely the population aged 75 and over is growing, both in absolute numbers and as a percent of the population. There were 3.6 million aged 75 and over (6.6% of the population) in 1982 compared with 3 million (5.6%) in 1975. The 19 and under age group declined between 1975-85, from 31% (16.2 million) to 29% (15.6 million). The 20-59 year old group constitutes the largest segment of the population--about double the group aged 19 and under--and its growing. This group was 50% of the population in 1973 and 53% in 1982. The infant mortality rate has declined steadily in France, from 18.2 deaths/1000 births in 1970 to 13.6 in 1975 and 9.5 at present. The total fertility rate has continued to decline: 1.8 children/woman in the 1982 census a rate less than the number needed to replace the present French population. Between 1975-82 households grew 10.4% to a total of 19.6 million. The growth in the number of households is attributed to the increase in divorce and the tendency for French children to leave the parental home at an earlier age. France has nearly 23 million dwelling places. More than half of householders own their own homes. New housing starts declined markedly since 1975. In 1982 France had 23.5 million economically active people, including 2 million unemployed. Both figures are higher today with at least 10% of the population seeking work. Most French earn less than 8000 francs/month. The average weekly household expenditure in 1981 was 2076 francs, about $460 at 1981 exchange rates. Food took the biggest share at 439 francs. In 1983 France had 13.9 million students enrolled in primary and secondary schools and more than 905,000 in universities. France has an estimated 18.5 million television households and has 104 dailies and 850 weekly and shopper newspapers.

Using a 3D virtual supermarket to measure food purchase behavior: a validation study.

PubMed

Waterlander, Wilma Elzeline; Jiang, Yannan; Steenhuis, Ingrid Hendrika Margaretha; Ni Mhurchu, Cliona

2015-04-28

There is increasing recognition that supermarkets are an important environment for health-promoting interventions such as fiscal food policies or front-of-pack nutrition labeling. However, due to the complexities of undertaking such research in the real world, well-designed randomized controlled trials on these kinds of interventions are lacking. The Virtual Supermarket is a 3-dimensional computerized research environment designed to enable experimental studies in a supermarket setting without the complexity or costs normally associated with undertaking such research. The primary objective was to validate the Virtual Supermarket by comparing virtual and real-life food purchasing behavior. A secondary objective was to obtain participant feedback on perceived sense of "presence" (the subjective experience of being in one place or environment even if physically located in another) in the Virtual Supermarket. Eligible main household shoppers (New Zealand adults aged ≥18 years) were asked to conduct 3 shopping occasions in the Virtual Supermarket over 3 consecutive weeks, complete the validated Presence Questionnaire Items Stems, and collect their real supermarket grocery till receipts for that same period. Proportional expenditure (NZ$) and the proportion of products purchased over 18 major food groups were compared between the virtual and real supermarkets. Data were analyzed using repeated measures mixed models. A total of 123 participants consented to take part in the study. In total, 69.9% (86/123) completed 1 shop in the Virtual Supermarket, 64.2% (79/123) completed 2 shops, 60.2% (74/123) completed 3 shops, and 48.8% (60/123) returned their real supermarket till receipts. The 4 food groups with the highest relative expenditures were the same for the virtual and real supermarkets: fresh fruit and vegetables (virtual estimate: 14.3%; real: 17.4%), bread and bakery (virtual: 10.0%; real: 8.2%), dairy (virtual: 19.1%; real: 12.6%), and meat and fish (virtual: 16.5%; real: 16.8%). Significant differences in proportional expenditures were observed for 6 food groups, with largest differences (virtual - real) for dairy (in expenditure 6.5%, P<.001; in items 2.2%, P=.04) and fresh fruit and vegetables (in expenditure: -3.1%, P=.04; in items: 5.9%, P=.002). There was no trend of overspending in the Virtual Supermarket and participants experienced a medium-to-high presence (88%, 73/83 scored medium; 8%, 7/83 scored high). Shopping patterns in the Virtual Supermarket were comparable to those in real life. Overall, the Virtual Supermarket is a valid tool to measure food purchasing behavior. Nevertheless, it is important to improve the functionality of some food categories, in particular fruit and vegetables and dairy. The results of this validation will assist in making further improvements to the software and with optimization of the internal and external validity of this innovative methodology.

Deconstructing Cancer Patient Information Seeking in a Consumer Health Library Toward Developing a Virtual Information Consult for Cancer Patients and Their Caregivers: A Qualitative, Instrumental Case Study.

PubMed

Papadakos, Janet; Trang, Aileen; Cyr, Alaina B; Abdelmutti, Nazek; Giuliani, Meredith E; Snow, Michelle; McCurdie, Tara; Pulandiran, Menaka; Urowitz, Sara; Wiljer, David

2017-05-24

Cancer patients and their caregivers want information about their disease and are interested in finding health information online. Despite the abundance of cancer information online, it is often fragmented, its quality is highly variable, and it can be difficult to navigate without expert-level knowledge of the cancer system. The Patient & Family Library at the Princess Margaret Cancer Centre offers a broad collection of high-quality cancer health information and staff are available to help patrons refine their questions and explore information needs that they may not have considered. The purpose of this research study was to deconstruct patrons' information-seeking behaviors in the library to assess the feasibility of replicating the services provided in the library through a Web app, extending the service beyond the walls of the cancer centre. The specific aims of this research were to understand (1) how patrons approach information seeking in the library (interface design), (2) how patrons communicate their informational needs (information categorization and metadata requirements), and (3) what resources are provided to address the patrons' information needs (collection development). We employed a qualitative, instrumental case study to deconstruct patrons' health information-seeking behavior. The study population included patients, the librarian, and library volunteers. Ethnographic observation was conducted at the library over 3 days and key informant interviews with library staff were conducted to address the first aim. A closed card-sorting activity was conducted to address the second aim and the library shift logs and Search Request Forms (SRFs) were reviewed to address the third aim. A total of 55 interactions were recorded during the ethnographic observation and nine semistructured interviews were conducted during the key informant interviews. Seven library patron personas were identified: (1) Newbie, (2) Seasoned, (3) Direct, (4) Window Shopper, (5) Collector, (6) Information Seeker, and (7) Distressed. A total of 83 participants completed the closed card-sorting exercise. The participants' conceptual clusters within the similarity matrix overlapped with the groupings created by the librarian, with a few differences. A total of 161 entries in the library shift log and 65 SRFs were analyzed to determine what resources were given to patrons. Most resources that patrons received were available online (61%), although almost half of these required special access (47%). The study findings suggest it is possible to replicate library functions in a Web app with a few exceptions that cannot be replicated online. These elements include access to journal articles or other content behind paywalls and the librarian's ability to encourage further discussion through empathy and active listening. Discussion with the librarian could serve to refine and predict needs through observing information seekers and to provide immediate connection to spiritual care and psychosocial support for patrons in distress. ©Janet Papadakos, Aileen Trang, Alaina B Cyr, Nazek Abdelmutti, Meredith E Giuliani, Michelle Snow, Tara McCurdie, Menaka Pulandiran, Sara Urowitz, David Wiljer. Originally published in JMIR Cancer (http://cancer.jmir.org), 24.05.2017.

American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment.

PubMed

Manchikanti, Laxmaiah; Abdi, Salahadin; Atluri, Sairam; Balog, Carl C; Benyamin, Ramsin M; Boswell, Mark V; Brown, Keith R; Bruel, Brian M; Bryce, David A; Burks, Patricia A; Burton, Allen W; Calodney, Aaron K; Caraway, David L; Cash, Kimberly A; Christo, Paul J; Damron, Kim S; Datta, Sukdeb; Deer, Timothy R; Diwan, Sudhir; Eriator, Ike; Falco, Frank J E; Fellows, Bert; Geffert, Stephanie; Gharibo, Christopher G; Glaser, Scott E; Grider, Jay S; Hameed, Haroon; Hameed, Mariam; Hansen, Hans; Harned, Michael E; Hayek, Salim M; Helm, Standiford; Hirsch, Joshua A; Janata, Jeffrey W; Kaye, Alan D; Kaye, Adam M; Kloth, David S; Koyyalagunta, Dhanalakshmi; Lee, Marion; Malla, Yogesh; Manchikanti, Kavita N; McManus, Carla D; Pampati, Vidyasagar; Parr, Allan T; Pasupuleti, Ramarao; Patel, Vikram B; Sehgal, Nalini; Silverman, Sanford M; Singh, Vijay; Smith, Howard S; Snook, Lee T; Solanki, Daneshvari R; Tracy, Deborah H; Vallejo, Ricardo; Wargo, Bradley W

2012-07-01

Opioid abuse has continued to increase at an alarming rate since the 1990 s. As documented by different medical specialties, medical boards, advocacy groups, and the Drug Enforcement Administration, available evidence suggests a wide variance in chronic opioid therapy of 90 days or longer in chronic non-cancer pain. Part 1 describes evidence assessment. The objectives of opioid guidelines as issued by the American Society of Interventional Pain Physicians (ASIPP) are to provide guidance for the use of opioids for the treatment of chronic non-cancer pain, to produce consistency in the application of an opioid philosophy among the many diverse groups involved, to improve the treatment of chronic non-cancer pain, and to reduce the incidence of abuse and drug diversion. The focus of these guidelines is to curtail the abuse of opioids without jeopardizing non-cancer pain management with opioids. 1) There is good evidence that non-medical use of opioids is extensive; one-third of chronic pain patients may not use prescribed opioids as prescribed or may abuse them, and illicit drug use is significantly higher in these patients. 2) There is good evidence that opioid prescriptions are increasing rapidly, as the majority of prescriptions are from non-pain physicians, many patients are on long-acting opioids, and many patients are provided with combinations of long-acting and short-acting opioids. 3) There is good evidence that the increased supply of opioids, use of high dose opioids, doctor shoppers, and patients with multiple comorbid factors contribute to the majority of the fatalities. 4) There is fair evidence that long-acting opioids and a combination of long-acting and short-acting opioids contribute to increasing fatalities and that even low-doses of 40 mg or 50 mg of daily morphine equivalent doses may be responsible for emergency room admissions with overdoses and deaths. 5) There is good evidence that approximately 60% of fatalities originate from opioids prescribed within the guidelines, with approximately 40% of fatalities occurring in 10% of drug abusers. 6) The short-term effectiveness of opioids is fair, whereas the long-term effectiveness of opioids is limited due to a lack of long-term (> 3 months) high quality studies, with fair evidence with no significant difference between long-acting and short-acting opioids. 7) Among the individual drugs, most opioids have fair evidence for short-term and limited evidence for long-term due to a lack of quality studies. 8) The evidence for the effectiveness and safety of chronic opioid therapy in the elderly for chronic non-cancer pain is fair for short-term and limited for long-term due to lack of high quality studies; limited in children and adolescents and patients with comorbid psychological disorders due to lack of quality studies; and the evidence is poor in pregnant women. 9) There is limited evidence for reliability and accuracy of screening tests for opioid abuse due to lack of high quality studies. 10) There is fair evidence to support the identification of patients who are non-compliant or abusing prescription drugs or illicit drugs through urine drug testing and prescription drug monitoring programs, both of which can reduce prescription drug abuse or doctor shopping. The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended to be a "standard of care."

Lessons from the evolution of 401(k) retirement plans for increased consumerism in health care: an application of behavioral research.

PubMed

DiCenzo, Jodi; Fronstin, Paul

2008-08-01

Employment-based health and retirement benefit programs have followed a similar path of evolution. The relative decision-making roles of the employer and the worker have shifted from the employer to the worker, and workers are more responsible than perhaps they ever have been for their well being--both in terms of their health in general and their financial security during retirement. This shift has been supported, in part, by legislation--namely ERISA, the HMO Act of 1973, the Revenue Act of 1978, and most recently, the Pension Protection Act. This Issue Brief does not pass judgment on this development or address who should bear the responsibilities of preparing workers for retirement or of rationing health care services. The current trend in health care design is toward increased "consumerism." Consumer-driven health is based on the assumption that the combination of greater cost sharing (by workers) and better information about the cost and quality of health care will engage workers to become better health care decision makers. It is hoped that workers will seek important, necessary, high-quality, cost-effective care and services, and become less likely to engage providers and services that are unnecessary and ineffective from either a quality or cost perspective. As employers look ahead toward continually improved plan design, there may be benefits in considering the lessons learned from studying worker behaviors. Specifically, there is evidence about the effects of choice, financial incentives, and information on worker decision making. As a result of research in this area, many retirement plan sponsors have moved toward plan designs and programs that recognize the benefits of well-designed defaults, simplified choices, required active decision making, framing, and commitment to future improvements. With respect to choice, it is now known that more is not always better and may even be worse in some cases. Just as fewer shoppers actually bought a jar of jelly when it was one of 24 as opposed to one of six, evidence has shown that people tend to be less likely to join a company-sponsored retirement plan when more investment options are offered. More choice can also lead to lower satisfaction. It is also known that workers may not be able to appropriately sort through many complex alternatives and that education is not always as effective as employers would hope. Decision complexity often forces people to find a way to simplify, and one of the easiest rules of thumb is to pick the option with the lowest short-term cost, even when that alternative is more costly in the longer run. It is also known that, for good or for bad, choices are constructed on the fly; preferences are dynamic, and logic does not always apply. Financial incentives are helpful in motivating behavior, but they do not affect everyone's decisions. Despite significant financial incentives to participate in 401(k) plans, many workers choose not to. Similarly, despite many of the financial incentives embedded in health care plan design, it can be expected that these incentives will not effectively motivate and engage all workers. One seemingly rational approach to improve workers' decision making is to provide education and guidance to help them sort through complex alternatives and to demonstrate the value of financial incentives. Certainly, providing education and guidance in the form of decision support tools may be an employer's responsibility. However, some studies have shown that, even when "educated" workers have the intent to make improved decisions, they often lack follow-through and fail to take action. In short, education and guidance may not be enough to foster improved health care consumerism. Some employers have begun to design benefit programs with a view toward overcoming behavioral tendencies that negatively affect workers' well-being. Newer retirement plan designs involve careful consideration of default choices. These defaults apply unless workers actively choose a different alternative. Typically, the default attempts to "nudge" workers toward optimal behavior. In the case of 401(k) retirement plan design, more employers are moving toward a default of automatic enrollment in the plan, with automatic investment in a diversified portfolio. Still, additional empirical research and experimentation may be needed to further understand the effects of new retirement plan design features. Future work may also precisely illuminate how the lessons discussed in this Issue Brief may apply to health care plan design that results in improved health-related behaviors. Given the impressive preliminary results in improving retirement planning behaviors, such research and experimentation are likely to be worthwhile.

Physics Computing '92: Proceedings of the 4th International Conference

NASA Astrophysics Data System (ADS)

de Groot, Robert A.; Nadrchal, Jaroslav

1993-04-01

The Table of Contents for the book is as follows: * Preface * INVITED PAPERS * Ab Initio Theoretical Approaches to the Structural, Electronic and Vibrational Properties of Small Clusters and Fullerenes: The State of the Art * Neural Multigrid Methods for Gauge Theories and Other Disordered Systems * Multicanonical Monte Carlo Simulations * On the Use of the Symbolic Language Maple in Physics and Chemistry: Several Examples * Nonequilibrium Phase Transitions in Catalysis and Population Models * Computer Algebra, Symmetry Analysis and Integrability of Nonlinear Evolution Equations * The Path-Integral Quantum Simulation of Hydrogen in Metals * Digital Optical Computing: A New Approach of Systolic Arrays Based on Coherence Modulation of Light and Integrated Optics Technology * Molecular Dynamics Simulations of Granular Materials * Numerical Implementation of a K.A.M. Algorithm * Quasi-Monte Carlo, Quasi-Random Numbers and Quasi-Error Estimates * What Can We Learn from QMC Simulations * Physics of Fluctuating Membranes * Plato, Apollonius, and Klein: Playing with Spheres * Steady States in Nonequilibrium Lattice Systems * CONVODE: A REDUCE Package for Differential Equations * Chaos in Coupled Rotators * Symplectic Numerical Methods for Hamiltonian Problems * Computer Simulations of Surfactant Self Assembly * High-dimensional and Very Large Cellular Automata for Immunological Shape Space * A Review of the Lattice Boltzmann Method * Electronic Structure of Solids in the Self-interaction Corrected Local-spin-density Approximation * Dedicated Computers for Lattice Gauge Theory Simulations * Physics Education: A Survey of Problems and Possible Solutions * Parallel Computing and Electronic-Structure Theory * High Precision Simulation Techniques for Lattice Field Theory * CONTRIBUTED PAPERS * Case Study of Microscale Hydrodynamics Using Molecular Dynamics and Lattice Gas Methods * Computer Modelling of the Structural and Electronic Properties of the Supported Metal Catalysis * Ordered Particle Simulations for Serial and MIMD Parallel Computers * "NOLP" -- Program Package for Laser Plasma Nonlinear Optics * Algorithms to Solve Nonlinear Least Square Problems * Distribution of Hydrogen Atoms in Pd-H Computed by Molecular Dynamics * A Ray Tracing of Optical System for Protein Crystallography Beamline at Storage Ring-SIBERIA-2 * Vibrational Properties of a Pseudobinary Linear Chain with Correlated Substitutional Disorder * Application of the Software Package Mathematica in Generalized Master Equation Method * Linelist: An Interactive Program for Analysing Beam-foil Spectra * GROMACS: A Parallel Computer for Molecular Dynamics Simulations * GROMACS Method of Virial Calculation Using a Single Sum * The Interactive Program for the Solution of the Laplace Equation with the Elimination of Singularities for Boundary Functions * Random-Number Generators: Testing Procedures and Comparison of RNG Algorithms * Micro-TOPIC: A Tokamak Plasma Impurities Code * Rotational Molecular Scattering Calculations * Orthonormal Polynomial Method for Calibrating of Cryogenic Temperature Sensors * Frame-based System Representing Basis of Physics * The Role of Massively Data-parallel Computers in Large Scale Molecular Dynamics Simulations * Short-range Molecular Dynamics on a Network of Processors and Workstations * An Algorithm for Higher-order Perturbation Theory in Radiative Transfer Computations * Hydrostochastics: The Master Equation Formulation of Fluid Dynamics * HPP Lattice Gas on Transputers and Networked Workstations * Study on the Hysteresis Cycle Simulation Using Modeling with Different Functions on Intervals * Refined Pruning Techniques for Feed-forward Neural Networks * Random Walk Simulation of the Motion of Transient Charges in Photoconductors * The Optical Hysteresis in Hydrogenated Amorphous Silicon * Diffusion Monte Carlo Analysis of Modern Interatomic Potentials for He * A Parallel Strategy for Molecular Dynamics Simulations of Polar Liquids on Transputer Arrays * Distribution of Ions Reflected on Rough Surfaces * The Study of Step Density Distribution During Molecular Beam Epitaxy Growth: Monte Carlo Computer Simulation * Towards a Formal Approach to the Construction of Large-scale Scientific Applications Software * Correlated Random Walk and Discrete Modelling of Propagation through Inhomogeneous Media * Teaching Plasma Physics Simulation * A Theoretical Determination of the Au-Ni Phase Diagram * Boson and Fermion Kinetics in One-dimensional Lattices * Computational Physics Course on the Technical University * Symbolic Computations in Simulation Code Development and Femtosecond-pulse Laser-plasma Interaction Studies * Computer Algebra and Integrated Computing Systems in Education of Physical Sciences * Coordinated System of Programs for Undergraduate Physics Instruction * Program Package MIRIAM and Atomic Physics of Extreme Systems * High Energy Physics Simulation on the T_Node * The Chapman-Kolmogorov Equation as Representation of Huygens' Principle and the Monolithic Self-consistent Numerical Modelling of Lasers * Authoring System for Simulation Developments * Molecular Dynamics Study of Ion Charge Effects in the Structure of Ionic Crystals * A Computational Physics Introductory Course * Computer Calculation of Substrate Temperature Field in MBE System * Multimagnetical Simulation of the Ising Model in Two and Three Dimensions * Failure of the CTRW Treatment of the Quasicoherent Excitation Transfer * Implementation of a Parallel Conjugate Gradient Method for Simulation of Elastic Light Scattering * Algorithms for Study of Thin Film Growth * Algorithms and Programs for Physics Teaching in Romanian Technical Universities * Multicanonical Simulation of 1st order Transitions: Interface Tension of the 2D 7-State Potts Model * Two Numerical Methods for the Calculation of Periodic Orbits in Hamiltonian Systems * Chaotic Behavior in a Probabilistic Cellular Automata? * Wave Optics Computing by a Networked-based Vector Wave Automaton * Tensor Manipulation Package in REDUCE * Propagation of Electromagnetic Pulses in Stratified Media * The Simple Molecular Dynamics Model for the Study of Thermalization of the Hot Nucleon Gas * Electron Spin Polarization in PdCo Alloys Calculated by KKR-CPA-LSD Method * Simulation Studies of Microscopic Droplet Spreading * A Vectorizable Algorithm for the Multicolor Successive Overrelaxation Method * Tetragonality of the CuAu I Lattice and Its Relation to Electronic Specific Heat and Spin Susceptibility * Computer Simulation of the Formation of Metallic Aggregates Produced by Chemical Reactions in Aqueous Solution * Scaling in Growth Models with Diffusion: A Monte Carlo Study * The Nucleus as the Mesoscopic System * Neural Network Computation as Dynamic System Simulation * First-principles Theory of Surface Segregation in Binary Alloys * Data Smooth Approximation Algorithm for Estimating the Temperature Dependence of the Ice Nucleation Rate * Genetic Algorithms in Optical Design * Application of 2D-FFT in the Study of Molecular Exchange Processes by NMR * Advanced Mobility Model for Electron Transport in P-Si Inversion Layers * Computer Simulation for Film Surfaces and its Fractal Dimension * Parallel Computation Techniques and the Structure of Catalyst Surfaces * Educational SW to Teach Digital Electronics and the Corresponding Text Book * Primitive Trinomials (Mod 2) Whose Degree is a Mersenne Exponent * Stochastic Modelisation and Parallel Computing * Remarks on the Hybrid Monte Carlo Algorithm for the ∫4 Model * An Experimental Computer Assisted Workbench for Physics Teaching * A Fully Implicit Code to Model Tokamak Plasma Edge Transport * EXPFIT: An Interactive Program for Automatic Beam-foil Decay Curve Analysis * Mapping Technique for Solving General, 1-D Hamiltonian Systems * Freeway Traffic, Cellular Automata, and Some (Self-Organizing) Criticality * Photonuclear Yield Analysis by Dynamic Programming * Incremental Representation of the Simply Connected Planar Curves * Self-convergence in Monte Carlo Methods * Adaptive Mesh Technique for Shock Wave Propagation * Simulation of Supersonic Coronal Streams and Their Interaction with the Solar Wind * The Nature of Chaos in Two Systems of Ordinary Nonlinear Differential Equations * Considerations of a Window-shopper * Interpretation of Data Obtained by RTP 4-Channel Pulsed Radar Reflectometer Using a Multi Layer Perceptron * Statistics of Lattice Bosons for Finite Systems * Fractal Based Image Compression with Affine Transformations * Algorithmic Studies on Simulation Codes for Heavy-ion Reactions * An Energy-Wise Computer Simulation of DNA-Ion-Water Interactions Explains the Abnormal Structure of Poly[d(A)]:Poly[d(T)] * Computer Simulation Study of Kosterlitz-Thouless-Like Transitions * Problem-oriented Software Package GUN-EBT for Computer Simulation of Beam Formation and Transport in Technological Electron-Optical Systems * Parallelization of a Boundary Value Solver and its Application in Nonlinear Dynamics * The Symbolic Classification of Real Four-dimensional Lie Algebras * Short, Singular Pulses Generation by a Dye Laser at Two Wavelengths Simultaneously * Quantum Monte Carlo Simulations of the Apex-Oxygen-Model * Approximation Procedures for the Axial Symmetric Static Einstein-Maxwell-Higgs Theory * Crystallization on a Sphere: Parallel Simulation on a Transputer Network * FAMULUS: A Software Product (also) for Physics Education * MathCAD vs. FAMULUS -- A Brief Comparison * First-principles Dynamics Used to Study Dissociative Chemisorption * A Computer Controlled System for Crystal Growth from Melt * A Time Resolved Spectroscopic Method for Short Pulsed Particle Emission * Green's Function Computation in Radiative Transfer Theory * Random Search Optimization Technique for One-criteria and Multi-criteria Problems * Hartley Transform Applications to Thermal Drift Elimination in Scanning Tunneling Microscopy * Algorithms of Measuring, Processing and Interpretation of Experimental Data Obtained with Scanning Tunneling Microscope * Time-dependent Atom-surface Interactions * Local and Global Minima on Molecular Potential Energy Surfaces: An Example of N3 Radical * Computation of Bifurcation Surfaces * Symbolic Computations in Quantum Mechanics: Energies in Next-to-solvable Systems * A Tool for RTP Reactor and Lamp Field Design * Modelling of Particle Spectra for the Analysis of Solid State Surface * List of Participants