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Evaluating Interventions for Healthier Food and Beverage Consumption at Institutes of Higher Learning in Singapore.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Evaluating Interventions for Healthier Food and Beverage Consumption at Institutes of Higher Learning in Singapore./
作者:	Ying, Sharna Seah Si.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2020,
面頁冊數:	338 p.
附註:	Source: Dissertations Abstracts International, Volume: 84-04, Section: A.
Contained By:	Dissertations Abstracts International84-04A.
標題:	Cardiovascular disease. -
電子資源:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=29352939
ISBN:	9798352685853

Evaluating Interventions for Healthier Food and Beverage Consumption at Institutes of Higher Learning in Singapore.
Ying, Sharna Seah Si.

Evaluating Interventions for Healthier Food and Beverage Consumption at Institutes of Higher Learning in Singapore. - Ann Arbor : ProQuest Dissertations & Theses, 2020 - 338 p.

Source: Dissertations Abstracts International, Volume: 84-04, Section: A.

Thesis (Ph.D.)--National University of Singapore (Singapore), 2020.

BackgroundReducing unhealthy diet is one of the World Health Organization's recommendations for combatting non-communicable diseases. Frequent out-of-home eating has been identified as a risk factor for poor dietary intakes. However, the effectiveness of interventions aiming to improve the consumption of healthier out-of-home dishes has not been assessed extensively in Asia. Institutions of higher learning (IHL) have been recognised as important platforms which can provide supportive food environments and empower students and staff to make healthier food and beverage choices. This thesis aims to evaluate interventions implemented at an IHL in Singapore to understand their effectiveness in (i) reducing consumption of high-sugar beverages and (ii) improve IHL consumers' intake of healthier out-of-home dishes, dietary fats and fibre. We also seek to understand (iii) the quality and extent of the food environment intervention's implementation, and its effect on food vendors' and consumers' food-related attitudes.MethodsA randomized crossover trial was conducted using 21 beverage vending machines to assess the impact of framing messages which refer to price differences as 'a tax for unhealthier beverages' or 'a subsidy for healthier beverages' on sales of high- and lower-sugar beverages (Study I). A cluster randomized trial to assess the effect of the healthier dining programme (HDP), a nationally implemented programme by the government, on out-of-home dietary quality at an IHL (Study II). We conducted a concurrent mixed-methods process evaluation to assess the reach, fidelity, dose delivered, and the uptake of healthier out-of-home dishes, and changes in food vendors' and consumers' food-related attitudes (Study III). We collected data from 283 consumers (Study II) and 39 cooked food stall vendors (Study III).ResultsIn Study I, we found that there was no difference in the weekly units of high-sugar beverages and lower-sugar beverages sold for the tax message or the subsidy message conditions as compared with the control condition. The percentage of high-sugar beverages sold was 54% in the control, 53% in the tax, and 54% in the subsidy message condition. In Study II, we found that participants in the intervention arm were more likely to have at least one healthier out-ofhome dish per week as compared to those in the control arm (84% vs. 65%, unadjusted RR: 1.29 95% CI: 1.11, 1.50). This was due mainly to the higher consumption of dishes prepared with healthier oil blends (unadjusted RR: 1.47 95% CI: 1.22, 1.78) and lower-sodium salt (unadjusted RR: 3.25 95% CI: 1.73, 6.09) in the intervention arm. Participants in the intervention arm also had lower total fat (-1.27 g/1000 kcal, 95% CI: -2.48, -0.06) and monounsaturated fat intakes (-0.50 g/1000 kcal, 95% CI: -0.94, -0.06) from out-of-home dishes as compared with the control arm.In Study III, reach to food vendors and consumers in the intervention arm were high and moderate, respectively. Three out of five intervention criteria were met. Uptake of the lowercalorie dishes and brown rice dishes were modest. The dose of brown rice delivered during the intervention was low, deviations in lower-calorie dishes serving and poor display of some point-of-purchase posters were observed. The factors which hindered and/or facilitated food vendors' use of healthier ingredients and offering of lower-calorie dishes were related to cost and technical aspects of food preparation, and consumer demand.ConclusionEffects of tax- and subsidy-framed messages on high-sugar beverage purchases in vending machines were modest. However, food environmental interventions at IHL can improve dietary intake from out-of-home foods. Our findings can inform the national-level HDP and the implementation of future food and beverage environment interventions at IHL and workplaces.

ISBN: 9798352685853Subjects--Topical Terms:

3564561
Cardiovascular disease.

Evaluating Interventions for Healthier Food and Beverage Consumption at Institutes of Higher Learning in Singapore.
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500 $a Source: Dissertations Abstracts International, Volume: 84-04, Section: A.
500 $a Advisor: Van Dam, Rob M. ;Rebello, Salome A. .
502 $a Thesis (Ph.D.)--National University of Singapore (Singapore), 2020.
520 $a BackgroundReducing unhealthy diet is one of the World Health Organization's recommendations for combatting non-communicable diseases. Frequent out-of-home eating has been identified as a risk factor for poor dietary intakes. However, the effectiveness of interventions aiming to improve the consumption of healthier out-of-home dishes has not been assessed extensively in Asia. Institutions of higher learning (IHL) have been recognised as important platforms which can provide supportive food environments and empower students and staff to make healthier food and beverage choices. This thesis aims to evaluate interventions implemented at an IHL in Singapore to understand their effectiveness in (i) reducing consumption of high-sugar beverages and (ii) improve IHL consumers' intake of healthier out-of-home dishes, dietary fats and fibre. We also seek to understand (iii) the quality and extent of the food environment intervention's implementation, and its effect on food vendors' and consumers' food-related attitudes.MethodsA randomized crossover trial was conducted using 21 beverage vending machines to assess the impact of framing messages which refer to price differences as 'a tax for unhealthier beverages' or 'a subsidy for healthier beverages' on sales of high- and lower-sugar beverages (Study I). A cluster randomized trial to assess the effect of the healthier dining programme (HDP), a nationally implemented programme by the government, on out-of-home dietary quality at an IHL (Study II). We conducted a concurrent mixed-methods process evaluation to assess the reach, fidelity, dose delivered, and the uptake of healthier out-of-home dishes, and changes in food vendors' and consumers' food-related attitudes (Study III). We collected data from 283 consumers (Study II) and 39 cooked food stall vendors (Study III).ResultsIn Study I, we found that there was no difference in the weekly units of high-sugar beverages and lower-sugar beverages sold for the tax message or the subsidy message conditions as compared with the control condition. The percentage of high-sugar beverages sold was 54% in the control, 53% in the tax, and 54% in the subsidy message condition. In Study II, we found that participants in the intervention arm were more likely to have at least one healthier out-ofhome dish per week as compared to those in the control arm (84% vs. 65%, unadjusted RR: 1.29 95% CI: 1.11, 1.50). This was due mainly to the higher consumption of dishes prepared with healthier oil blends (unadjusted RR: 1.47 95% CI: 1.22, 1.78) and lower-sodium salt (unadjusted RR: 3.25 95% CI: 1.73, 6.09) in the intervention arm. Participants in the intervention arm also had lower total fat (-1.27 g/1000 kcal, 95% CI: -2.48, -0.06) and monounsaturated fat intakes (-0.50 g/1000 kcal, 95% CI: -0.94, -0.06) from out-of-home dishes as compared with the control arm.In Study III, reach to food vendors and consumers in the intervention arm were high and moderate, respectively. Three out of five intervention criteria were met. Uptake of the lowercalorie dishes and brown rice dishes were modest. The dose of brown rice delivered during the intervention was low, deviations in lower-calorie dishes serving and poor display of some point-of-purchase posters were observed. The factors which hindered and/or facilitated food vendors' use of healthier ingredients and offering of lower-calorie dishes were related to cost and technical aspects of food preparation, and consumer demand.ConclusionEffects of tax- and subsidy-framed messages on high-sugar beverage purchases in vending machines were modest. However, food environmental interventions at IHL can improve dietary intake from out-of-home foods. Our findings can inform the national-level HDP and the implementation of future food and beverage environment interventions at IHL and workplaces.
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