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journal of hunger environmental nutrition issn print online journal homepage https www tandfonline com loi when20 adaptation and validation of the nutrition environment measures survey in stores nems s in ...

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                  Journal of Hunger & Environmental Nutrition
                  ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/when20
              Adaptation and Validation of the Nutrition
              Environment Measures Survey in Stores (NEMS-S)
              in Costa Rica
              Francesca Golfin, Carla Murillo, Melissa L. Jensen & Edward A. Frongillo
              To cite this article: Francesca Golfin, Carla Murillo, Melissa L. Jensen & Edward A.
              Frongillo (2022): Adaptation and Validation of the Nutrition Environment Measures Survey
              in Stores (NEMS-S) in Costa Rica, Journal of Hunger & Environmental Nutrition, DOI:
              10.1080/19320248.2022.2088262
              To link to this article:  https://doi.org/10.1080/19320248.2022.2088262
                  Published online: 16 Jun 2022.
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                        JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 
                        https://doi.org/10.1080/19320248.2022.2088262
                        Adaptation and Validation of the Nutrition Environment 
                        Measures Survey in Stores (NEMS-S) in Costa Rica
                                                a                   a                              a,b                                    c
                        Francesca Golfin , Carla Murillo , Melissa L. Jensen                          , and Edward A. Frongillo
                        a                                                                           b
                         School of Nutrition, University of Costa Rica, San José, Costa Rica;  UConn Rudd Center for Food Policy 
                        and Health, Hartford, Connecticut, USA; cArnold School of Public Health, University of South Carolina 
                        Columbia, South Carolina, USA
                            ABSTRACT                                                                            KEYWORDS 
                            This  study  adapted  and  validated  the  NEMS-S  in  Costa  Rica.                 NEMS-S; IMANEA; nutrition 
                            Twenty-nine food stores were assessed, three times, by two                          environment; food stores; 
                            raters. Inter-rater precision and intra-rater stability were quanti-                food environment
                            fied. Construct validity was determined with the known-groups 
                            method. Relative precision ranged from 0.54 to 0.77 and was 
                            0.87 for total score. Relative stability ranged from 0.58 to 0.96 
                            and was 0.94 for total score. For construct validity, the hypothe-
                            sized  relationship  that  supermarkets  would  have  the  highest 
                            scores was supported. The instrument has moderate to excel-
                            lent precision and stability, has construct validity, and can be 
                            useful to develop policies that encourage healthy environments 
                            in food stores.
                        Introduction
                        Obesity is a main risk factor for the development of chronic diseases, which are 
                                                                                                             1 
                        responsible for up to 60% of the deaths around the world. Furthermore, many 
                        low- and middle-income countries are affected by the burden of malnutrition, 
                        and the coexistence of undernutrition, overweight, and obesity.2 In Costa Rica, 
                        according to the National School Weight and Height Census,3 34% of children 
                        between 6 and 12 years old have overweight or obesity, while the National 
                                                   4 
                        Nutrition Survey, reports that 60% of women between 30 and 44 years old, 
                        and 62% of men between 20 and 64 years old have overweight or obesity.
                            The pandemic of obesity and chronic diseases is due in part to the increased 
                                                                                                                                            5 
                        intake of obesogenic foods and drinks (e.g., high content of sugars and fat).
                        These behaviors are influenced by social, political, and physical environments 
                                                                                       6 
                        that affect availability and access to food. Accessibility, price, and variety in 
                        food stores  influence  consumer’s  food  and  store  selection,  contributing  to 
                        unhealthy  eating  patterns,  less  healthy  food  choices,  and  high  obesity 
                                         7,8 
                        prevalence.           For example, in adults with obesity and metabolic syndrome, 
                        an increase in the consumption of fruits, vegetables, and fiber was associated 
                        with a shorter distance to a food store, which was considered healthy.9 
                        CONTACT Melissa L. Jensen         melissa.jensen@ucr.ac.cr     School of Nutrition, University of Costa Rica, Ciudad de 
                        la Investigación, San José, Costa Rica
                        © 2022 Taylor & Francis Group, LLC 
               2     F. GOLFIN ET AL.
               Populations that are low-income, segregated, and rural are most affected by 
               low access to healthy foods and high exposure to fast and energy-dense 
                     10,11                                                         12,13 
               foods,     which  has  been  positively  associated  with  child  obesity.
               Furthermore, higher fruit and vegetable prices are associated with lower 
               consumption in young adults; specifically a difference in the price of fruits 
               and  vegetables  of  one  dollar  was  associated  with  32%  lower  weekly 
               consumption.14
                 In recent years, there has been much interest in assessing and monitoring 
               different elements of the food environment,15,16  including that of low- and 
                                       17 
               middle-income countries.  When assessing associations between food envir-
               onment exposure, and diet, nutrition, and health outcomes, aspects, such as 
               availability, accessibility, perceived availability, and food vendor choice have 
               been used.17
                 Although literature on the food environment in Latin America has grown 
               in  size  over  recent  years,  investigations  of  retail  food  environments  using 
               either adapted and validated or locally developed and validated instruments 
               have been mostly in urban areas of Brazil, Mexico, and Paraguay.18 Across 
               diverse  contexts,  results  consistently  showed  lower  availability  of  healthy 
               foods in more disadvantaged neighborhoods, a positive association between 
               the availability of healthy foods and better diet quality (specifically regarding 
               availability  and  consumption  of  fruits  and  vegetables),  and  mostly  null 
               associations  between  healthier  food  environments  and  unfavorable  health 
                                        18 
               outcomes  and  behaviors.  Furthermore,  the  retail  food  environment  in 
               Latin America is similar to North America regarding the strong presence 
               of  large  supermarket  chains  and  convenience  stores,  although  traditional 
               non-chain  channels  represent  a  more  important  source  of  food  in  Latin 
               American countries where there is also a greater heterogeneity within food 
               stores categories.18
                 In 2007, the Nutrition Environment Measures Surveys for Stores (NEMS-S) 
               was developed for use in the United States, to identify the influence of food 
               stores in eating patterns and the increase of obesity.19 The instrument mea-
               sures availability, prices, and quality of 10 food categories, and incorporates an 
               application protocol and scoring system. To validate the instrument, 88 food 
               stores (e.g., convenience stores and supermarkets) from four different com-
                                                                                     19 
               munities were assessed at three different occasions by two pre-trained raters.
               By 2016, more than 15 different projects in the United States and countries in 
                                                   20
               South America had used the NEMS-S.
                 Because the validity of an instrument depends on context,21 we adapted the 
               NEMS-S to the context of Costa Rica and examined its reliability and construct 
               validity, with the intention of establishing the first construct-validated instru-
               ment in the country to assess retail food environments. Specifically, we aimed 
               to examine the inter-rater precision, intra-rater stability, and differences in 
               these by store type, and construct validity.
                                                       JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION       3
                  METHODS
                  Instrument Adaptation
                  The study was carried out in nine stages (Figure. 1), from instrument adapta-
                  tion (stages 1–4) to pilot test (stages 5 and 6) and data collection (stages 7–9). 
                  Both first authors (FG and CM), who were fully bilingual (Spanish/English) 
                  graduate students at the time of the study, participated in the online NEMS-S 
                  training offered by the University of Pennsylvania22 and translated the original 
                  NEMS-S instrument to Spanish. Despite the differences that exist regarding 
                  the type of food stores and dietary patterns between developing countries and 
                  the  United  States,  we  adapted  the  original  NEMS-S  instead  of  an  existing 
                  adapted instrument from Brazil because the latter included major modifica-
                  tions such as assessing the degree of industrial processing of food as reference 
                                            22 
                  for the scoring system,      which would make future comparisons with studies 
                  using the original NEMS-S difficult.
                     The adaptation of the instrument was based on the Dietary Guidelines for 
                  Costa  Rica,23  in  addition  to  several  surveys  assessing  food  and  beverage 
                  purchase and consumption in the Costa Rican population.24–26 The adapted 
                  instrument,  named  IMANEA  after  its  Spanish  acronym  (Instrumento  de 
                  Medición del Ambiente Nutricional en Expendios Adaptado), assessed seven 
                  food categories based on the food culture of Costa Rica: milk, fruits, vege-
                  tables,  whole  grain  products,  meat  and  processed  meats,  soft  drinks  and 
                  prepackaged juices, and cheeses (Table 1). In many Costa Rican households, 
                  cheese might replace other more expensive animal protein sources (such as 
                  beef or chicken) during a main meal. Because of this, and because frozen 
                  meals are not part of the food culture, we included a category for cheese and 
                  omitted frozen dinners. Furthermore, although eggs are an important source 
                  Figure 1. Flow chart diagram of the nine stages through which the study was conducted.
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...Journal of hunger environmental nutrition issn print online homepage https www tandfonline com loi when adaptation and validation the environment measures survey in stores nems s costa rica francesca golfin carla murillo melissa l jensen edward a frongillo to cite this article doi link org published jun submit your view related articles crossmark data full terms conditions access use can be found at action journalinformation journalcode b c school university san jose uconn rudd center for food policy health hartford connecticut usa carnold public south carolina columbia abstract keywords study adapted validated imanea twenty nine were assessed three times by two raters inter rater precision intra stability quanti fied construct validity was determined with known groups method relative ranged from total score hypothe sized relationship that supermarkets would have highest scores supported instrument has moderate excel lent useful develop policies encourage healthy environments introduct...

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