Purpose. The main objective of this rapid review was to systematically map the evidence regarding the effects of bicycle infrastructure interventions on physical activity in the general population in high-income countries. Methods. The rapid review followed the Cochrane guidelines. Pubmed was systematically searched using a predetermined search strategy with the following key words: Bicycle infrastructure, multi-strategic intervention and physical activity. Articles in English published between August 1st, 2013 and August 1st, 2023 were included. A previously piloted data extraction spreadsheet was used to extract and summarise key information from the selected studies. Results. A total of 827 articles were screened for eligibility by two reviewers. Thirty-one studies met the inclusion criteria and were included in the still ongoing review. Thus far, mixed effects of bicycle infrastructure interventions on physical activity were found: Several studies demonstrated that multi-component (compared to single-component) bicycle infrastructure interventions, as well as short distances to infrastructure sites, were associated with both, increased infrastructure use and physical activity. Other studies, however, reported no intervention effects when comparing intervention and control areas. Possible explanatory factors are differences in the time points chosen for assessments in the studies, ranging from six month to two-year follow-ups, and differences in the assessment tools chosen (subjective measures: surveys, diaries vs. objective measures: GPS trackers, accelerometers). Conclusions. The preliminary findings of this rapid review suggest that implementation of bicycle infrastructure may positively affect infrastructure use and physical activity at the population level. More detailed results regarding differential intervention effects will be available after the data extraction is completed and will be presented at the conference.
Keywords: public health; bicycle intervention; infrastructure use, physical activity

Presenting & corresponding author: Stähler, L.

Purpose: This study explored current nutrition-related policy, system, and environmental (PSE) changes being implemented in a rural-midwestern state, as well as the supports needed to facilitate successful implementation and maintenance of these efforts. Though PSE changes are known to increase healthy eating, little is currently known about the facilitators and barriers organizations face to implementing these types of changes, specifically in rural contexts—our study uncovered some of these supports and challenges to advance future implementation of PSE efforts.

Methods: This study used a mixed-methods design of an online survey and interviews. The survey was distributed by email to organizations identified by the state public health department as partners working on nutrition programming. The survey assessed organizations’ knowledge, beliefs, resources, and readiness for implementing nutrition PSE changes. Descriptive analyses were conducted for survey responses. Follow-up interviews were conducted with survey respondents. Interviews sought more in-depth responses, including information on the specific PSE changes being implemented and barriers and facilitators. Interviews were recorded, transcribed, coded and a thematic analysis conducted by two coders.

Results/findings: Most survey respondents (n=86) worked on systems (51.4%) or environmental efforts (32.4%), with few reported policy efforts (2.3%). Barriers included not having enough staff (54.6%) and funding (60.5%). Themes emerged from interviews (n=12) which expanded on the survey findings. For example, challenges of staff retention and burnout were highlighted as well as difficulties in using volunteers as program implementers. A lack of long-term and flexible funding was noted. Many survey respondents (86.2%) were involved in partnerships. Themes from interviews highlighted the necessity of longstanding partnerships built on trust, breaking down silos between organizations, and program champions. Survey responses indicated that organizations would benefit from informational supports--such as guidance on the financial impact of nutrition PSE changes (82.1%), toolkits or guides (76.5%), and examples of PSE changes (67.1%).

Conclusions: Findings from this study show the supports and resources that nutrition organizations need from federal, state, and local agencies to ensure PSE interventions can be started, effectively implemented, and sustained; specifically highlighting the need for initiatives that support policy-based approaches for improving nutrition behaviors and outcomes for communities.

Associations between Adolescent Food Environments and Dietary Intake

Saira Sarwar, M.A., Jennie L. Hill, Ph.D., Amy Lazarus Yaroch, Ph.D., Jennifer Mize Nelson, Ph.D., Kimberly Andrews Espy, Ph.D., and Timothy D. Nelson, Ph.D.

Corresponding author: Saira Sarwar
Presenting author: Saira Sarwar

Purpose: Food environments presumably influence adolescent diet. However, there is a lack of studies examining the diet and environment relationship utilizing validated measures, examining multiple food contexts and focusing on adolescents. This study advances understanding of this relationship by examining the home and neighborhood food environment as predictors of adolescent diet using well-validated measures. Less home fruit and vegetable and greater fat and sweet availability was hypothesized to be associated with a more obesogenic adolescent diet. Greater counts of convenience and fast-food retailers was hypothesized to be associated with a more obesogenic diet.

Methods: This cross-sectional study used data from the adolescent phase of a larger longitudinal study. Participants included 204 adolescents (Mage = 15.33) and a participating caregiver. Diet was assessed using the ASA-24 dietary recall and the Family Life, Activity, Sun, Health and Eating (FLASHE) screener. Home environment was assessed using the Comprehensive Home Environment Survey. Neighborhood environment was assessed via Geographic Information System methods and audits of food retailers. Dietary variables were examined in individual multiple regression models.

Results: For the ASA-24 dietary variables, home fruit and vegetable availability predicted greater Healthy Eating Index score (P = .03). There were no other significant associations between ASA-24 variables and environment variables. For the FLASHE dietary variables, home fruit and vegetable availability predicted greater fruit and vegetable intake (P = .003), greater beneficial food consumption (P = .009), and less fast-food intake (P = .02). Home fat and sweet availability positively predicted detrimental food (P = .006), junk food (P < .001), and sugary food intake (P < .001). Convenience store counts positively predicted beneficial food consumption (P = .04). Fast-food counts positively predicted sugary beverage consumption (P = .01).

Conclusions and Implications: The home food environment, particularly fruit and vegetable availability, appears especially important for promoting healthier adolescent diet. Further, limiting home fat and sweet availability and the availability of fast-food establishments around the home may protect against adolescent sugary food intake. Targeting these aspects of the environment may act as a systems-level intervention to promote healthier diet in adolescence, a critical period for health trajectories.

Purpose: Healthy default beverage (HDB) policies for children’s meals (CM) in restaurants hold promise as a population-based approach to encourage healthy choices and address childhood obesity. This research examines restaurant beverages offered to and consumed by children prior to the January 2023 implementation of the first HDB-policy mandated in the Deep South region of the United States [New Orleans, LA (NOLA)], a region disproportionately affected by childhood obesity and health disparities.

Methods: In Fall 2022, our team conducted site visits within NOLA restaurants offering CM (n=138, 12% of NOLA restaurants). Using a modified validated tool, we conducted assessments of restaurant characteristics, food and beverage offerings, facilitators and barriers to healthy eating, and other factors. Beverage consumption data were collected via online surveys among NOLA caregivers of children ages 2-12 who eat restaurant meals at least once a month (n=1,406 child eating occasions). Analysis included the type of beverages offered and consumed by HDB category (water, low/non-fat milk, 100% fruit juice) and non-HDB (sugar-sweetened beverages) and associations between child beverage intake and selected demographics (age, sex, race/ethnicity, household income).

Results/Findings: Of the 138 restaurants, 45 offer beverages with CM. The majority (n=23) offered non-HDB, 18 offered only HDB, and 4 did not list the beverage offerings. Most children consumed CM (57.5%) and non-HDB with their meals (67.5%). The average volume of non-HDB consumed was significantly higher than the amount for HDB (12.9±9.2oz vs. 9.1±9.0oz, respectively, p<0.001). While non-HDB were consumed with 64.4% of CMs, a higher percentage (87.0%) was found for regular meals (p<0.001). HDB intake was associated with younger age (p<0.001), but not with other characteristics examined.

Conclusions: Our study will provide insights on the policy impact and reach. These baseline data allow us to characterize the current beverages offered with CM and consumed by children in NOLA prior to policy implementation. These findings support the need for HDB regulations in restaurants to decrease the frequency of sugar-sweetened beverage consumption among children, but they also suggest the need to push for policies that also address regular combination meals to increase impact.

Purpose: Information and fiscal tools—taxes and/or subsidies—are increasingly used to address diet-related health problems. However, limited attention in complex food retail environments may limit the effectiveness of these policies if individuals restrict their attention to nutritionally similar subsets of available products. Previous research suggests that prompts encountered before individuals limit their attention to a subset of products promotes healthier choices by changing multiple behaviors. In the context of dietary fiber, an under-consumed nutrient of public health concern, we examine the comparative impact of a subsidy to a prompt message, as well as a reminder paired with a subsidy, on attention to products and information, and the dietary fiber content of foods selected.

Methods: 1,005 adult US residents completed an online experiment on choices of foods in three categories (breads, ready-to-eat breakfast cereals, crackers), with significant intra-category variation in nutritional quality. Participants were randomized to one four conditions: 1) control, 2) subsidy, 3) reminder, and 4) reminder+subsidy. Each food category had 33 product categories, and participants could choose to view all 33 products in each category or could select a subset of products to view during the choice process. The set of products viewed was documented. After selecting the set of products to view, participants selected a product from the set (or indicated that they would not select any of the products). After choices were made, participants indicated whether they had used nutrition information that was available in the choice environment during the choice process.

Results: Both the prompt (0.36g/serving) and prompt+subsidy (0.61g/serving) conditions significantly increased fiber content of foods chosen. All three interventions affected the set of products that respondents considered, with the subsidy condition increasing attention to medium-healthy foods, while prompt and prompt+subsidy conditions significantly increased attention to healthiest foods. Prompt and prompt+subsidy conditions also led to greater use of fiber information. A multiple mediation analysis illustrates that both direct and indirect pathways lead to the significant overall increase in fiber content of selected foods.

Conclusions: Studying the interaction of limited, self-directed attention to products/information and interventions may provide opportunities to design more effective health promotion strategies.

Corresponding author: edwige.landais@ird.fr

Purpose: French Guiana, is a French oversea territory, with high rates of overweight/obesity and non-communicable diseases among adults where no large-scale survey has been conducted in children to measure their nutritional status and potential associated risk factors. Therefore, the present study aimed to assess the nutritional status, the sedentary behaviour and dietary habits of French Guianese children.
Methods: A cross sectional survey conducted in 2022-2023. The target population was children 5-14 years. A three-stage random sampling design was applied to select the children. Semi-structured questionnaires, investigating screen time (television, video games, smartphones…) and dietary behaviours (meals, snacks and qualitative food frequency questionnaire) were administrated by trained enumerators. Height and weight were measured to computed Body Mass Index (BMI) for age. Means and proportions were computed, and differences according to gender and age (5-9 years vs. 10-14 years) were investigated using either t-tests or chi2 tests. Additional analyses will be conducting to investigate factors associated with obesity.
Results: A total of 509 children (mean age 9.6 ±2.8 years, 50.7% girls) were interviewed. Overall 31.6% were either overweight or obese (17.2% and 14.4%, respectively), with no difference according to gender (p=0.64) or age (p=0.17). The mean daily screen time was 226 min ±144 (122 min for television, 24 min for video games, 80 min for smartphones). There was no difference according to gender (p=0.12) but according to age (206 min/day for 5-9 years, 250 min/day for 10-14 years, p<0.05). Overall, 16.5% of the children skipped breakfast. This behaviour was more common among girls (21.7%, p<0.05) and among the 10-14 years (24.9%, p<0.001). On average, children consumed fruit or vegetables less than once a day (0.52 time/day and 0.33 time/day, respectively), and sugar sweetened beverages (SSB) or confectionery almost once a day (0.86 and 0.87, respectively). The eldest tended to drink significantly more SSB compared to the youngest (0.95 vs 0.78, p<0.05).
Conclusions: The prevalence of overweight/obesity among French Guianese children is worrying. The preliminary results of the Guyaconso project have highlighted sedentary behaviour and eating habits detrimental to health that need to be addressed by relevant public health policies.

Objective
To understand the prevalence and content of corporate social responsibility (CSR) statements in the top selling chain restaurants between 2012 and 2018 to inform the ways restaurants can impact population health.
Methods
We used a web scraping technique to abstract relevant text information (n= 6369 text sections that contained possible CSR statements, or thematically coded portions of the text section) from the archived web pages of the 96 top selling chain restaurants. Content analysis was used to identify key themes in CSR statements across restaurants and over time. All data was abstracted and analyses were completed between November 2019 and November 2023.
Results
The majority of restaurants (68.8%) included a CSR statement on their web pages between 2012-2018, and almost half of the restaurants included a health-related CSR (49.0%). There were increases in CSR statements by chain restaurants over the study period from 186 CSR statements in 2012 to 1218 CSR statements in 2018, with most statements focused on philanthropy (37.1% of coded CSR statements), community activities that were not health-related (18.4% of coded CSR statements), and sustainability initiatives (18.3% of coded CSR statements). Only one quarter (24.4%) of these statements were health-related and many were vague in nature (only 52% of the eligible statements could be coded by theme).
Conclusions
There is a need for more actionable health-focused initiatives in the CSR statements for chain restaurants. Public health initiatives that engage with the restaurant industry should work to promote CSR statements that are in line with other collective positions around improving health and reducing diet-related disease.

Purpose: Food banks provide innovative programming but often lack the capacity and funding to assess the impact of their work. The Rooted in Evidence (RIE) grant program, led by the Gretchen Swanson Center for Nutrition (GSCN), provides funding and evaluation support to expand the evidence-base for food bank interventions.

Methods: To date, 16 food banks across three cohorts have or are currently receiving up to $25,000 in funding and participating in a 16-month Learning Collaborative as part of RIE. Grantees receive training in the form of eight interactive group education classes on multiple evaluation topic areas (e.g. evaluation designs, survey development, best practices for qualitative data collection); three peer-to-peer group sharing/learning sessions, including a two-day in-person retreat and two virtual sharing sessions; proactive (planned) technical assistance through four one-on-one sessions between each grantee team and GSCN, and additional reactive (real-time) technical assistance as needed by grantees. With the support of the GSCN scientific evaluation team, grantees identified evaluation questions and corresponding data collection methods (i.e. surveys, interviews), while also identifying validated measures, assessing the timing of data collection, and balancing the scientific rigor of their evaluation with what was feasible for their food bank team and partners. In addition to grantee evaluations, GSCN sought feedback from grantees through interviews and focus groups with grantees representatives at the mid-point or end of their grant period. This allowed GSCN to capture grantees' perceptions of the RIE grant program, and identify lessons learned and best practices for successful completion of RIE projects.

Results/findings: As expected, the evaluation that each grantee designed varied. Grantee evaluations have included implementation (n=8) and outcome measures (n=12); quantitative (n=2), qualitative (n=5), and mixed methods approaches (n=7); pre-post (n=9) and cross-sectional designs (n=7); and data collection from various priority populations including food bank volunteers (n=1); food bank agencies (food pantries, soup kitchens, n=7), and food bank clients (n=13). Grantees identified evaluation planning support, capacity building, peer-networking, and marketing and communication as key benefits of the RIE model.

Conclusions: This work strengthens food banks’ abilities to address nutrition security and builds evidence on how to better service clients/neighbors.

Purpose:
Immigrants in Canada undertake less physical activity (PA) compared to their Canadian-born counterparts. However, studies have yet to examine differences in domain-specific PA between these populations. Despite evidence linking the neighbourhood built environment (BE) with PA, whether these associations differ by residency status remains unknown. Our study aims to: 1) estimate the differences in transportation and leisure PA (i.e., participation and duration) between Canadian-born and immigrant adults, and; 2) determine if neighbourhood BE-PA associations differ between these populations.

Methods:
We used cross-sectional data from the Canadian Community Health Survey (CCHS; 2017/2018), linked with Canadian Active Living Environment data (Can-ALE; 2016). Eligible participants were urban adults (age ≥18 years), either Canada-born or immigrants. We classified immigrants by their residency duration (recent: <10 years or established: ≥10 years). Participants reported their weekly transportation or leisure PA (i.e., participation and duration). A walkability index was calculated using Can-ALE data from GIS, census, and open-source information. Walkability was estimated from intersection, dwelling, and destination counts within a one-kilometer radius of a Dissemination Area's center.

Anticipated Findings:
We selected relevant covariates for our analysis using Direct Acyclic Graphs (i.e., age, sex, marital status, race, education, income, employment, language proficiency, children living at home, and disability status). We have cleaned and checked these data (e.g., missing data, outliers, and statistical assumptions) and begun descriptive and inferential analyses. We will use covariate-adjusted Generalized Linear Models (GLMs) to estimate differences in participation (binomial distribution/log link; odds ratios) and duration (gamma distribution/identity link; beta coefficients) in the PA outcomes by residency status (recent immigrant, established immigrant, and Canadian-born). We will rerun the GLMs with walkability and its interaction with residency status, conducting stratified analyses for specific associations if statistically significant interactions emerge. We will apply sampling and bootstrap weights to the analysis.

Conclusion:
Our findings will garner novel insights into the relationships between the neighbourhood BE and domain-specific PA among recent and established immigrants in Canada. Our findings could highlight whether there is a need for PA interventions that specifically target adults according to residency status and neighbourhood walkability. Our findings could also have implication for urban planning.

Presenter: Hasti Masihay Akbar
Corresponding: Hasti Masihay Akbar, Gavin R. McCormack