Adaptation and Validation of the Chinese Version of the Nutrition Environment Measurement Tool for Stores

Yang Liu, Shenzhi Song, Joel Gittelsohn, Nan Jiang, Jiajin Hu, Yanan Ma, Deliang Wen

Research output: Contribution to journalArticle

Abstract

Changes in lifestyle and food environment have created a heavy burden of obesity and chronic disease in China. However, measurements of the food environment have been rarely reported in China or other countries with similar food cultures; this measurement shortage is partially due to the lack of valid and reliable measurement tools. The aim of the present study was to adapt and validate a Chinese version of the Nutritional Environment Measurement Survey for Stores (C-NEMS-S). Categories and items of the NEMS-S were culturally adapted to fit the Chinese population and included grains, dry beans, starchy tubers, vegetables, fruits, seafood, meat and poultry, dietary oils, milk, bread, instant noodles, and beverages. A scoring sheet for each food category was created to measure availability, quality, and pricing. Then, the C-NEMS-S was validated in 10 large-sized supermarkets and 10 convenience stores in Shenyang, China. Two trained raters performed their evaluations separately at the same store. The intra-class correlation coefficient (ICC) of the availability composite score was 0.98. All food measures had a moderate or good ICC (0.41 to 1.00). The kappa for each food measure ranged from 0.52 to 1.00. C-NEMS-S was able to show the difference in healthy food availability between large-sized supermarkets and convenience stores, as well as the price differences between healthier options and regular options. Large-sized supermarkets had a significantly higher total score (p < 0.001) and healthier option availability for all food measures (all items were statistically significant (p < 0.05), except sugar-free beverages). Healthier options cost more than regular options for grains, milk, bread, and instant noodles (from 4% to 153%). The adapted C-NEMS-S can be used to measure the consumer food environment in stores in China.

Original languageEnglish (US)
JournalInternational journal of environmental research and public health
Volume16
Issue number5
DOIs
StatePublished - Mar 4 2019

Fingerprint

Food
China
Bread
Beverages
Milk
Unsaturated Dietary Fats
Costs and Cost Analysis
Seafood
Poultry
Vegetables
Meat
Life Style
Fruit
Chronic Disease
Obesity
Surveys and Questionnaires
Population

Keywords

  • China
  • food environment
  • Nutritional Environment Measurement Survey-Stores (NEMS-S)

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health, Toxicology and Mutagenesis

Cite this

Adaptation and Validation of the Chinese Version of the Nutrition Environment Measurement Tool for Stores. / Liu, Yang; Song, Shenzhi; Gittelsohn, Joel; Jiang, Nan; Hu, Jiajin; Ma, Yanan; Wen, Deliang.

In: International journal of environmental research and public health, Vol. 16, No. 5, 04.03.2019.

Research output: Contribution to journalArticle

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abstract = "Changes in lifestyle and food environment have created a heavy burden of obesity and chronic disease in China. However, measurements of the food environment have been rarely reported in China or other countries with similar food cultures; this measurement shortage is partially due to the lack of valid and reliable measurement tools. The aim of the present study was to adapt and validate a Chinese version of the Nutritional Environment Measurement Survey for Stores (C-NEMS-S). Categories and items of the NEMS-S were culturally adapted to fit the Chinese population and included grains, dry beans, starchy tubers, vegetables, fruits, seafood, meat and poultry, dietary oils, milk, bread, instant noodles, and beverages. A scoring sheet for each food category was created to measure availability, quality, and pricing. Then, the C-NEMS-S was validated in 10 large-sized supermarkets and 10 convenience stores in Shenyang, China. Two trained raters performed their evaluations separately at the same store. The intra-class correlation coefficient (ICC) of the availability composite score was 0.98. All food measures had a moderate or good ICC (0.41 to 1.00). The kappa for each food measure ranged from 0.52 to 1.00. C-NEMS-S was able to show the difference in healthy food availability between large-sized supermarkets and convenience stores, as well as the price differences between healthier options and regular options. Large-sized supermarkets had a significantly higher total score (p < 0.001) and healthier option availability for all food measures (all items were statistically significant (p < 0.05), except sugar-free beverages). Healthier options cost more than regular options for grains, milk, bread, and instant noodles (from 4{\%} to 153{\%}). The adapted C-NEMS-S can be used to measure the consumer food environment in stores in China.",
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