Purpose: The COVID-19 pandemic has rapidly increased online grocery shopping among Canadians; however, little is known about the functionality of e-commerce grocery retail websites and the availability of mandatory labelling information.

Methods: Eight leading grocery retail websites in Canada were independently evaluated by 2 researchers. A random sample of fresh and prepackaged products (n=85) were searched on each website to assess the availability and quality of key labelling information.

Findings: All 8 websites required a member profile, with 2 requiring a membership fee. Five websites offered pick-up (minimum purchases $30-$50 (n=4); fees $2.97-$5.00 (n-3)) and 7 delivery (minimum purchases $35-$50 (n=4); fees $7.97-$11.99).  Seven websites showed order history and 5 saved lists to allow consumers to easily purchase pre-selected foods. Among 17.5±4.9 (mean±SD) food categories, Fruits & Vegetables (5 websites), Prepared Foods (5), and Meat & Seafood (4) were the most commonly used. On all 8 websites, common product information included product images, brand, name, size, price, and delivery/pick-up information. Front-of-pack images were available (99.5%), while back-of-pack and other sides of pack images were not readily available (14.5% and 3.4%, respectively). Nutrition Facts table was available 70.7% of the time (range: 0-93.3%), but needed to scroll-down (36.0%) or click a link (38.9%) or viewed as a product image (25.1%). Ingredient information was available 78.7% (range: 65-100%), without needing to scroll (0.6%), after scrolling down (23.8%), one click (66.3%) or as a product image (10.2%). Allergen information was available 53.3% of the time (range: 0-68.8%), without scrolling (0.9%), after scrolling down (12.4%), one click (67.3%), or as a product image (19.5%). Health and nutrition claims were part of the product description 49.4% of the time (range: 21.0-96.7%) with 3 websites using company-specific symbols to represent other product characteristics (e.g., gluten-free, no artificials) and 3 websites provided a consumer-driven 5-star rating system.  Date markings were not available on any websites.

Conclusions: Although online grocery websites may provide a convenient shopping method, the inconsistencies and low availability of mandatory labelling information can be barriers to consumers making informed purchasing decisions. Policies and guidelines to standardize the e-commerce retail environment are needed.

Purpose: School garden programs are commonly implemented to influence children’s health behaviors, but current research lacks longitudinal and school level data. In this study, we examine the prevalence of school gardens by school level factors in elementary, middle and high schools across 4 New Jersey cities between the school years (SY) 2010-2011 to SY 2017-2018. We use these findings to further examine whether changes in the school food environment through the implementation of the Healthy Hunger Free Kids Act (HHFKA) of 2010 influenced these trends.

Methods: This study uses data from the New Jersey Child Health Study (NJCHS), which was uniquely positioned to collect longitudinal data pertaining to school garden prevalence before and after school food environments changed due to implementation of the HHFKA. The NJCHS 96-item survey provided detailed food and physical activity environment data, which included school garden presence, from SY 2010-2011 to SY 2017-2018 in public schools across 4 New Jersey cities: Camden, Newark, New Brunswick, and Trenton (n=775). Bivariate analyses were conducted through t-tests and chi-squared tests. Multivariate analyses were conducted to determine the unique contribution of various school level characteristics.

Results/Findings: Although the prevalence of school gardens did not show any significant changes from SY 2010-2011 to SY 2017-2018 or pre- and post- HHFKA implementation, a slight increasing trend was observed among all school levels. Bivariate analyses showed significant associations with student demographic data. Schools with gardens were significantly associated with a larger proportion of African-American students (56.5%, p<0.0001) and a smaller proportion of Hispanic students (38.4%, p<0.0001).

Conclusions: School garden prevalence was not influenced by school food policy implementation and associated changes to the school food environment. Despite a lack of significant associations between school garden prevalence and school level, the significant findings of garden presence within schools with larger proportions of African-American students shows potential in addressing health disparities by increasing access to interventions that may affect health behaviors in a historically at-risk population. The significant relationship between school garden prevalence within schools with a smaller proportion of Hispanic students shows opportunity for wider implementation to equitably promote health behaviors.

Purpose Toddler milks are ultraprocessed milk-based drinks marketed for children ages 12-36 months, which contain added sugars and may contribute to unhealthy dietary patterns. Marketing spending on toddler milks has increased in the United States, and toddler milks often have structure/function claims (i.e., statements that describe how an ingredient or nutrient affects the structure or function of the human body) on product packaging that are potentially misleading. This study examined how structure/function claims affect parents’ beliefs and perceptions about a toddler milk product. 

Methods Between May and July 2020, we recruited 2,218 US parents of children ages 1-5 years for an online survey. Participants were randomly assigned to view a toddler milk package for a product sold outside of the United States with either an unrelated claim (“new and improved”, control), a “brain development” claim (i.e., “brain” claim), or an “immunity-related” claim (i.e., “immunity” claim). We examined perceptions, intentions, and beliefs about a toddler milk product between claim conditions using linear regression for continuous outcomes and logistic regression for dichotomous outcomes. 

Results. Parents who were exposed to the “brain” claim or the “immunity” claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow’s milk, compared to those who saw the control claim (89% for “brain” claim, 87% for “immunity” claim, and 79% for control, p <.001 for both comparisons). Parents exposed to either the “brain” or “immunity” claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared to parents exposed to the control (all p’s <.001). 

Conclusions. These findings suggest that structure/function claims on toddler milks packaging may mislead parents and increase the appeal of toddler milks. These findings support calls for public health policies to regulate marketing on toddler milks packaging to prevent misperceptions among parents.   

Purpose:  Low-income populations have disproportionately lower diet quality than their higher income counterparts. Farmers’ market healthy food subsidies are promising interventions to improve dietary patterns among low-income populations. In Canada, the British Columbia Farmers’ Market Nutrition Coupon Program (FMNCP) provides coupons to low-income households to purchase healthy foods from farmers’ markets. Program impacts on dietary outcomes among participants remain to be examined. Thus, the present study aimed to assess the impact of the FMNCP on the diet quality of low-income adults.

Methods: Low-income adults were randomized to a FMNCP intervention group (n= 126) or a no-intervention control group (n= 116). The FMNCP group received 16 coupon sheets valued at $21/sheet over 10–15 weeks to purchase fruits, vegetables, dairy, meat, fish, eggs, and nuts/seeds from farmers’ markets. Both groups completed a questionnaire to report sociodemographic characteristics and health-related variables and two 24-hour dietary recalls (using the Automated Self-Administered 24-hour Dietary Recall) at baseline (0 weeks), post-intervention (10–15 weeks), and 16 weeks post-intervention (26–31 weeks). Diet quality was calculated using the Healthy Eating Index-2015 (HEI-2015). Total HEI-2015 scores can range from 0-100, with a higher score indicating higher diet quality. Repeated measures mixed-effect linear regression assessed differences in total HEI-2015 scores between the FMNCP and control groups at post-intervention and 16 weeks post-intervention, adjusting for baseline values of the outcome.

Results:  There were no significant differences in total HEI-2015 scores (mean ± standard error) between the FMNCP and control groups at post-intervention (61.9 ± 1.13 vs 62.3 ± 1.14; p=0.88) or at 16 weeks post-intervention (59.8 ± 1.13 vs 59.5 ± 1.18; p=0.78).

Conclusion:  To our knowledge, this was the first randomized controlled trial to assess the impact of a farmers’ market healthy food subsidy on diet quality among low-income adults. This study demonstrated that a farmers’ market healthy food subsidy delivered over 10-15 weeks did not significantly impact diet quality among participants. Study findings suggest that a short-term subsidy may not be sufficient to produce meaningful changes in diet quality among low-income adults. Ongoing research is needed to identify effective policy interventions to reduce dietary inequities among low-income populations.

Purpose: This study aimed to examine perceptions of healthfulness and sugar content of different beverage types among youth in various country contexts.

Methods: A cross-sectional online survey was conducted among 11,108 youth ages 10-17 in Australia (n=1,435), Canada (n=3,682), Chile (n=1,252), Mexico (n=1,616), the United Kingdom (UK; n=1,520) and the United States (US; n=1,603) in November/December 2019 as part of the International Food Policy Study. Youth were shown an image of a branded bottle of soda and then randomized to view one additional branded beverage type (diet soda, 100% juice, energy drink, water, sports drink, chocolate milk, iced tea or unflavoured milk). Participants were asked whether the beverage was healthy or unhealthy, and how much sugar it contained. Descriptive analyses examined the proportion of the sample who perceived each beverage as healthy (either ‘healthy’ or ‘very healthy’) and high sugar content (‘quite a bit’ or ‘a lot’ of sugar). Logistic regression examined whether beverage perceptions varied by country, adjusting for sociodemographic factors.

Results/findings: Across all 6 countries, 2% of youth reported the soda was healthy (range 0.3% in Chile to 4% in the US) and 88% reported the soda had high sugar content (range 84% in the US to 91% in Chile). In all 6 countries, water was most commonly rated as healthy (96%), followed by milk (84%), 100% juice (72%), chocolate milk (28%), sports drinks (21%), iced tea (17%), diet soda (7%) and energy drinks (5%). Energy drinks were most commonly perceived as having high sugar content (72%), followed by chocolate milk (40%), iced tea (40%), sports drinks (38%), 100% juice (28%) and diet soda (28%). Milk and water were rarely perceived as high in sugar (4% and 6%, respectively). Perceptions of healthfulness and sugar content differed between countries for soda, 100% juice, sports drinks, chocolate milk, iced tea and unflavoured milk. Socioeconomic differences will be discussed.

Conclusions: Youths’ health-related perceptions of beverages differed across countries, and were often discordant with the objective healthfulness and sugar content of beverages. Policy interventions that effectively communicate the sugar content of beverages may help youth identify more healthful beverage choices.