Who’s cooking? Trends in US home food preparation by gender, education, and race/ethnicity from 2003 to 2016

Abstract Background While US home cooking declined in the late twentieth century, it is unclear whether the trend has continued. This study examines home cooking from 2003 to 2016 by gender, educational attainment, and race/ethnicity. Methods Nationally representative data from the American Time Use Study from 2003 to 2016 and linear regression models were used to examine changes in the percent of adults aged 18–65 years who cook and their time spent cooking, with interactions to test for differential changes by demographic variables of gender, education, and race/ethnicity. Results Cooking increased overall from 2003 to 2016. The percent of college-educated men cooking increased from 37.9% in 2003 to 51.9% in 2016, but men with less than high school education who cook did not change (33.2% in 2016) (p < 0.05). College-educated women who cook increased from 64.7% in 2003 to 68.7% in 2016, while women with less than high school education had no change (72.3% in 2016) (p < 0.05). Women with less education spent more time cooking per day than high-educated women, but the reverse was true for men. Among men, the percent who cook increased for all race/ethnic groups except non-Hispanic blacks. Among women, only non-Hispanic whites increased in percent who cook. Among both men and women, non-Hispanic blacks had the lowest percentage who cooked, and non-Hispanic others spent the greatest amount of time cooking. Conclusions Home cooking in the United States is increasing, especially among men, though women still cook much more than men. Further research is needed to understand whether the heterogeneity in home cooking by educational attainment and race/ethnicity observed here contributes to diet-related disparities in the United States

Added Sugars Intake Across the Distribution of US Children and Adult Consumers: 1977-2012

Public health organizations in the United States (US) have recently increased focus on reducing population consumption of added sugars

Reactions to graphic and text health warnings for cigarettes, sugar-sweetened beverages, and alcohol:An online randomized experiment of US adults.

We aimed to examine reactions to graphic versus text-only warnings for cigarettes, SSBs, and alcohol. A convenience sample of US adults completed an online survey in 2018 (n=1,352 in the analytic sample). We randomly assigned participants to view a: 1) text-only warning without efficacy information (i.e., message intended to increase consumers’ confidence in their ability to stop using the product), 2) text-only warning with efficacy information, 3) graphic warning without efficacy information, or 4) graphic warning with efficacy information. Participants viewed their assigned warning on cigarettes, SSBs, and alcohol, in a random order. Across product types, graphic warnings were perceived as more effective than text-only warnings (p<.001) and led to lower believability, greater reactance (i.e., resistance), more thinking about harms, and lower product appeal (all p<.05); policy support did not differ. Compared to SSB and alcohol warnings, cigarette warnings led to higher perceived message effectiveness, believability, fear, thinking about harms, policy support, and greater reductions in product appeal (all p<.05). The efficacy information did not influence any outcomes. Graphic warnings out-performed text-only warnings on key predictors of behavior despite causing more reactance

Adherence to the Planetary Health Diet Index and Correlation with Nutrients of Public Health Concern: An analysis of NHANES 2003-2018:Planetary Health Diet Index: Trends in the US

Background: The Planetary Health Diet Index (PHDI) is a novel measure adapted to quantify alignment with the dietary evidence presented by the EAT-Lancet Commission on Food, Planet Health.Objectives: To examine how population-level health and sustainability of diet as measured by the PHDI changed from 2003-2018, and to assess how PHDI correlated with inadequacy for nutrients of public health concern (iron, calcium, potassium, and fiber) in the US.Methods: We estimated survey-weighted trends in PHDI scores and median intake of PHDI components in a nationally-representative sample of 33,859 adults aged 20+ years from eight cycles (2003–2018) of the National Health and Nutrition Examination Survey with two days of dietary recall data. We used the NCI method to examine how PHDI correlated with inadequate intake of iron, calcium, potassium, and fiber.Results: Out of a theoretical range of 0 to 140, median PHDI value increased by 4.2 points over the study period, from 62.7 (95% CI: 62.0, 63.4) points in 2003-2004 to 66.9 (66.2, 67.7) points in 2017-2018 (ptrend&lt;0.001), although most of this change occurred before 2011-2012 and plateaued thereafter. For adequacy components that are encouraged for consumption, non starchy vegetable intake significantly decreased over time, while whole grains, nuts and seeds, and unsaturated oils increased. For moderation components with recommended limits for consumption, poultry and egg intake increased, but red and processed meat, added sugars, saturated fats, and starchy vegetables decreased over time. Higher PHDI values were associated with lower probability of iron, fiber, and potassium inadequacy.Conclusions: Although there have been positive changes over the past 20 years, there is substantial room for improving the health and sustainability of the US diet. Shifting diets towards EAT-Lancet recommendations would improve nutrient adequacy for iron, fiber and potassium. Policy action is needed to support healthier, more sustainable diets in the US and globally

Dietary quality and cardiometabolic indicators in the USA: A comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension

Background. The Planetary Health Diet Index (PHDI) measures adherence to the sustainable dietary guidance proposed by the EAT-Lancet Commission on Food, Planet, Health. To justify incorporating sustainable dietary guidance such as the PHDI in the US, the index needs to be compared to health-focused dietary recommendations already in use. The objectives of this study were to compare the how the Planetary Health Diet Index (PHDI), the Healthy Eating Index34 2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to cardiometabolic risk factors.Methods and Findings. Participants from the National Health and Nutrition Examination Survey (2015-2018) were assigned a score for each dietary index. We examined disparities in dietary quality for each index. We used linear and logistic regression to assess the association of standardized dietary index values with waist circumference, blood pressure, HDL-C, fasting plasma glucose (FPG) and triglycerides (TG). We also dichotomized the cardiometabolic indicators using the cutoffs for the Metabolic Syndrome and used logistic regression to assess the relationship of the standardized dietary index values with binary cardiometabolic risk factors. We observed diet quality disparities for populations that were Black, Hispanic, low-income, a low-education. Higher diet quality was associated with improved continuous and binary cardiometabolic risk factors, although higher PHDI was not associated with high FPG and was the only index associated with lower TG. These patterns remained consistent in sensitivity analyses.Conclusions. Sustainability-focused dietary recommendations such as the PHDI have similar cross-sectional associations with cardiometabolic risk as HEI-2015 or DASH. Health-focused dietary guidelines such as the forthcoming 2025-2030 Dietary Guidelines for Americans can consider the environmental impact of diet and still promote cardiometabolic health

Dietary Quality and Dietary Greenhouse Gas Emissions in the USA: A Comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension

BackgroundThe Planetary Health Diet Index (PHDI) measures adherence to the dietary pattern presented by the EAT-Lancet Commission, which aligns health and sustainability targets. There is a need to understand how PHDI scores correlate with dietary greenhouse gas emissions (GHGE) and how this differs from the carbon footprints of scores on established dietary recommendations. The objectives of this study were to compare how the PHDI, Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to (a) dietary GHGE and (b) to examine the influence of PHDI food components on dietary GHGE.MethodsWe used life cycle assessment data from the Database of Food Recall Impacts on the Environment for Nutrition and Dietary Studies to calculate the mean dietary GHGE of 8,128 adult participants in the 2015–2016 and 2017–2018 cycles of the National Health and Nutrition Examination Survey (NHANES). Poisson regression was used to estimate the association of (a) quintiles of diet score and (b) standardized dietary index Z-scores with dietary GHGE for PHDI, HEI-2015, and DASH scores. In secondary analyses, we used Poisson regression to assess the influence of individual PHDI component scores on dietary GHGE.ResultsWe found that higher dietary quality on all three indices was correlated with lower dietary GHGE. The magnitude of the dietary quality-dietary GHGE relationship was larger for PHDI [-0.4, 95% CI (-0.5, -0.3) kg CO2 equivalents per one standard deviation change] and for DASH [-0.5, (-0.4, -0.6) kg CO2-equivalents] than for HEI-2015 [-0.2, (-0.2, -0.3) kg CO2-equivalents]. When examining PHDI component scores, we found that diet-related GHGE were driven largely by red and processed meat intake.ConclusionsImproved dietary quality has the potential to lower the emissions impacts of US diets. Future efforts to promote healthy, sustainable diets could apply the recommendations of the established DASH guidelines as well as the new guidance provided by the PHDI to increase their environmental benefits

Front-of-Package Labels on Unhealthy Packaged Foods in India: Evidence from a Randomized Field Experiment

Policies to require front-of-package labels (FOPLs) on packaged foods may help Indian consumers to better identify foods high in nutrients of concern, including sugar, saturated fat, and sodium, and discourage their consumption, which are outcomes that are critical for preventing rises in diet-related non-communicable disease. The objective was to test whether FOPLs helped Indian consumers identify “high-in” packaged foods and reduce intentions to purchase them. We conducted an in-person randomized experiment (n = 2869 adults between ages 18 and 60 years old) in six states of India in 2022. Participants were randomized to one of five FOPLs: a control label (barcode), warning label (octagon with “High in [nutrient]”), Health Star Rating (HSR), Guideline Daily Amount (GDA), or traffic light label. Participants then viewed a series of packaged foods high in sugar, saturated fat, or sodium with the assigned FOPL, and rated product perceptions and label reactions. Fewer than half of participants in the control group (39.1%) correctly identified all products high in nutrient(s) of concern. All FOPLs led to an increase in this outcome, with the biggest differences observed for the warning label (60.8%, p < 0.001), followed by the traffic light label (54.8%, p < 0.001), GDA (55.0%, p < 0.001), and HSR (45.0%, p < 0.01). While no FOPLs led to a reduction in intentions to purchase the packaged foods, the overall pattern of results suggested that warning labels are the most effective FOPL to help Indian consumers identify unhealthy foods

Prevalence of health, nutrition, and environment-related claims in the Brazilian packaged food supply

The study examined whether foods with nutritional claims were more likely to be high in critical nutrients. Twenty to thirty percent of caloric intake in Brazil is through ultra-processed foods (UPF). Increased consumption of UPF is associated with weight gain, hypertension, and all causes of mortality. Front-of-package (FoP) nutritional labeling can improve consumers’ ability to assess the healthfulness of products and help them make healthier choices. Nutrition claims were the most prevalent (28.5%), followed by health claims (22.1%), and environment-related claims (5.2%)

Sociodemographic disparities in purchases of fruit drinks with policy relevant front-of-package nutrition claims

Abstract Objective: Our objectives were to describe sociodemographic characteristics associated with the purchase of 1) any fruit drinks and 2) fruit drinks with specific front of package (FOP) nutrition claims. Design: Cross-sectional Setting: United States Subjects: We merged fruit drink purchasing data from 60,712 household-months from 5,233 households with children 0-5y participating in Nielsen Homescan in 2017 with nutrition claims data. We examined differences in predicted probabilities of purchasing any fruit drinks by race/ethnicity, income, and education. We constructed inverse probability (IP) weights based on likelihood of purchasing any fruit drinks. We used IP weighted multivariable logistic regression models to examine predicted probabilities of purchasing fruit drinks with specific FOP claims. Results: One third of households with young children purchased any fruit drinks. Non-Hispanic (NH) Black (51.6%), Hispanic (36.3%), lower-income (39.3%), and lower-educated households (40.9%), were more likely to purchase any fruit drinks than NH White (31.3%), higher-income (25.8%), and higher-educated households (30.3%) (all p<0.001). In IP weighted analyses, NH Black households were more likely to purchase fruit drinks with “Natural” and fruit or fruit flavor claims (6.8% and 3.7%) than NH White households (4.5% and 2.7%) (both p<0.01). Lower- and middle-income (15.0% and 13.8%) and lower- and middle-educated households (15.4% and 14.5%) were more likely to purchase fruit drinks with “100% Vitamin C” claims than higher-income (10.8%) and higher-educated households (12.9%) (all p<0.025). Conclusions: We found a higher likelihood of fruit drink purchases in lower-income, lower-educated, NH Black, and Hispanic households. Experimental studies should determine if nutrition claims may be contributing to disparities in fruit drink consumption

Mexican Households’ Purchases of Foods and Beverages Vary by Store-Type, Taxation Status, and SES

Where people shop for food is often linked to the healthiness of food purchases. In Mexico, no research has examined the connection between where people shop, what they buy, and their socioeconomic status (SES). Mexico’s sugary beverage and junk food taxes have made households decrease purchases of taxed products. However, whether households have changed where they shop is unknown. To address this gap, we use a repeated cross-sectional analysis of household packaged food and beverage purchases from the Nielsen Mexico Consumer Panel Survey from 2012 to 2015 (n &gt; 5500 households). We examine changes in the volume of the purchase of taxed and untaxed products from different store-types (i.e., convenience stores, supermarkets, traditional retailers, wholesalers, home water-delivery, and others) by SES using multivariate linear regression models. Results show that high-SES households purchased more foods and beverages at all store-types except for low-SES who purchased the most foods and taxed beverages at traditional retailers. Purchases of taxed foods and beverages from traditional retailers significantly decreased for low-SES and middle-SES households and from supermarkets for middle-SES and high-SES households. Purchases of untaxed beverages from wholesalers significantly increased for middle-SES households and from convenience stores for high-SES households. Our findings suggest that consumers choose different stores to purchase beverages than to purchase foods and that taxes may have differentially affected each store-type